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Care Act transitions assessment with deaf young people

This page is for social workers or other professionals who are carrying out a Care Act transitions assessment with a deaf young person. Although intended for professionals in England, it may be useful to other professionals across the UK.

Deaf young people have specific needs and face challenges such as accessing information or experiencing isolation. These challenges can occur within their families and communities, and at school or work. They may experience these challenges many times a day, which can negatively impact their health and wellbeing, social maturity, self-esteem and self-efficacy.

This guidance is meant to help you consider the daily barriers and challenges deaf young people experience or have experienced. In particular, it will help you relate deaf young people’s experiences to the Care Act’s eligibility outcomes.

We use the term ‘deaf’ to refer to all levels of hearing loss. Even mild hearing loss can have a significant impact on a deaf young person’s daily life.

On this page

What to consider before the conducting the assessment

Before undertaking an assessment, you should consider the following:

  • Is information on services accessible?
    Information and advice on all care and support matters must be accessible to everyone. For example, is web-based information on services accessible for deaf people whose first language is British Sign Language (BSL)?
  • Does the deaf young person need an independent advocate?
    If the deaf young person would experience substantial difficulty in understanding the necessary information or communicating their views, wishes or feelings, they will need someone to act on their behalf (Care Act guidance 16.39). While this is often a parent or carer, they may not be the right person to undertake the role if they have different views from the deaf young person. If there is no one else appropriate, local authorities must provide an independent advocate. Local deaf organisations may be able to provide formal advocacy services.
  • Will a sign language interpreter be needed?
    Interpreters must be registered and qualified (in England, the registration bodies are NRCPD and RBSLI). You may need a deaf relay interpreter if the deaf young person has limited language abilities, uses other sign languages from abroad, or has mental difficulties. It is not appropriate to use a family member, carer or friend as an interpreter, particularly where they are supporting the deaf young person in an advocacy role.
  • Who should carry out the assessment?
    If the assessor does not have the necessary knowledge of a particular condition or circumstance, they must consult someone who has relevant expertise. For example, this could be colleagues in adult sensory teams or a Teacher of the Deaf who has worked with the deaf young person in school or college.

See Care Act guidance from GOV.UK for detailed information about local authority responsibilities.

Eligibility outcomes

As part of the Care Act, there are 10 eligibility outcomes that are used to determine if an adult requires care. Six of these outcomes may be particularly significant for deaf young people.

For each of these six outcomes, we have provided key information to consider about how deafness may affect these areas of the young person’s life. We have also provided questions to explore in your discussions with the deaf young person.

Developing and maintaining family or other personal relationships

Key things to consider:

  • Over 90% of deaf children are born into hearing families with parents or carers who have had no experience of deafness.
  • Many deaf children grow up in families where they are the only child.
  • Most deaf children attend mainstream schools where there may be few or no other deaf children.
  • Some deaf young people may have attended a residential deaf school far from their homes.

Deaf young people have fewer opportunities to communicate freely and fluently in their families, schools and communities. It is therefore more difficult for deaf young people to establish and maintain friendships. This can cause delays in their social and emotional skills, and they may experience isolation and bullying as a result.

Deaf young people are twice as likely to experience mental health difficulties than hearing young people (NHS 2020).

Questions to explore:

  • What is the deaf young person’s experience of family life?
  • What is their experience of education?
  • Did they attend a residential school with significant time away from their family?
  • Are there communication difficulties with key family members which present challenges?
  • Does the deaf young person have a supportive friendship network?
  • Does the deaf young person attend their nearest deaf club? If not, explore the reasons why.

Accessing and engaging in work, training, education or volunteering

Key things to consider:

Given the above, some deaf young people may have lower expectations of what they might be able to achieve.

Questions to explore:

  • What outcomes does the deaf young person wish to achieve in their education, training, working or volunteering?
  • What are the barriers to those outcomes and possible solutions?
  • Are there job clubs or programmes available at the local deaf club?
  • Does the deaf young person have an existing Education Health and Care Plan?
  • What are the barriers to those outcomes and possible solutions?
  • Has the deaf young person had any specialist or tailored careers advice?

Making use of necessary facilities or services in the local community, including public transport and recreational facilities or services

Key things to consider:

  • Deaf people can struggle to participate in community and recreational activities. This is because these are often run and attended by hearing people who communicate using speech and the ability to hear. Even for deaf people who use speech and/or hearing aids, it can still be challenge in noisy environments where people speak over each other. In addition, induction loop facilities don’t always work.
  • Community and recreational settings often lack deaf awareness and cannot meet Deaf cultural needs. Therefore, they often cannot provide the social benefits that individuals would otherwise get from accessing these activities.
  • Accessing public transport can be difficult where information is given through speech or relies on sound. Some deaf young people may also have never developed the skills to travel independently due to ‘over parenting’.

Questions to explore:

  • What social and recreational activities would the deaf person wish to access? What are the barriers to accessing these?
  • Does the deaf young person use any apps to support communication for basic interactions? (For example, voice-to-text apps such as Otter or Google Translate)

Managing and maintaining nutrition

Key things to consider:

  • Deaf people do not have equal access to health services due to a lack of access to interpreters and accessible information (SignHealth 2014). This became worse during the Covid-19 pandemic when access to face-to-face interpreters largely stopped and there were no alternative arrangements in place.
  • Many deaf people have lower literacy levels compared to their hearing peers. Therefore, they may not understand (or misunderstand) written information around diet, on food labels, or on medication.
  • Health settings have a duty to provide communication support to deaf people, but in practice they are often not in place when needed. Due to this, many deaf people avoid seeking health advice when they need it.
  • Deaf people’s health is poorer, with underdiagnosis and undertreatment of chronic conditions putting them at risk of preventable ill health (BMJ 2014).

Questions to explore:

  • Is the deaf young person registered with a local practice?
  • Are they able to book a GP appointment and get access to communication support?
  • Are they relying on a family member to interpret? If they are, what are the reasons for this?
  • Does the deaf young person have any on-going health issues? Are these being monitored by the GP or health services?
  • Do they fully understand their health needs and how they can manage these?

Being able to make use of the adult’s home safely

Key things to consider:

  • Deaf young people may not be able to hear fire alarms.
  • Deaf people may not be able to directly contact emergency services. Even text-based emergency systems can be challenging because many deaf young people have lower literacy levels or do not have English as their first language.
  • Assistive technology can help deaf people live safely. This technology can be provided by local authorities through the prevention duty in the Care Act. It will likely fall within ‘aids and minor adaptations’ and should be provide free up to the value of £1,000. For deaf students in university accommodation, assistive technology is often provided by the university itself. For students in private rented accommodation, the duty lies on the local authority where they have come from.

Questions to explore:

  • Does the deaf young person need assistive technology or adaptations, for example, to know when there is a person at the door or when there is a fire?
  • Do they know whom to contact in an emergency?

Maintaining a habitable home environment

Key things to consider:

  • Deaf people often miss out on everyday conversations and have reduced opportunities to communicate freely. As a result, they may lack world knowledge and have delays in social maturing.

Questions to explore:

  • Does the deaf young person know what they need to do to manage and maintain their home environment and live independently? For example, budgeting, meal planning, health and safety, living in shared environments, etc.
  • Do they control their own finances? If other family members are involved, explore why this is necessary.

Other issues to consider

Safeguarding

The barriers and challenges to accessing language and communication can result in increased vulnerabilities for deaf children, young people and adults to experience abuse.

See Community Care’s safeguarding guide for social workers.

Deafblind young people

There are additional challenges when considering the needs of deafblind young people.

See the statutory guidance for assessments with deafblind children or adults.