Annotated Bibliography

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The Annotated Bibliography includes articles, books, presentations, and videos related to atypical language and relevant to CALI’s curriculum development. Each resource is summarized in ASL and English and includes direct links whenever possible. We’d like to thank Dr. Neil Glickman, Dr. Lori Whynot, Rosa Lee Timm, and Damon Timm for their involvement.

The Annotated Bibliography consists of the following categories: Sign Language Development, Adult Communication Skills and Assessments, Forensic Psychology, Interpreting for Persons with Atypical Language, Language Deprivation Syndrome, Language Dysfluency in Hearing Persons, Mental Health Assessment and Treatment, Neurology of Language, Traditionally Underserved Deaf People, and Wellbeing and Health Literacy.

To suggest a resource for the Annotated Bibliography, email us here.

Sign Language Development

Osborne, L. (1999, October 24). A linguistic big bang. New York Times.

This newspaper article presents an account of the development of Nicaraguan Sign Language, explaining why this is so important to linguists and others interested in cognitive development. The article includes a review of the research by linguist Judy Kegl and Ann Senghas. Dr. Kegl has developed a theory on how home signs are enhanced into pidgin languages, which in turn are enhanced to become languages. Kegl and Senghas have observed the children using increasingly more complex grammatical constructions. For instance, they have seen verbs add inflection and agreement and other parts of speech, like prepositions, taking different forms than they do in spoken languages. For the people studying the development of Nicaraguan Sign Language, the most amazing feature may be that this is a language developed entirely by children.

Senghas, A. (1994). The development of Nicaraguan Sign Language via the language acquisition process. In D. MacLaughlin & S. McEwen (Eds.), Proceedings of the Boston University Conference on Language Development, 19 (pp. 543-552).

This is a study of language development among deaf children in Nicaragua as the Nicaraguan Sign Language developed. It discusses how the grammatical structure of these deaf signers grew in complexity. Key variables influencing the development of more complex language structures were the age of acquisition of Nicaraguan Sign Language and the year in which the child was first exposed to sign language. The latter is important because Nicaraguan Sign Language is a new language, and those exposed to it more recently have been exposed to a more rich and complex language. The language structures studied include the development of verb inflection and agreement. Deaf children who began signing at younger ages and those who began signing when the Nicaraguan Sign Language was more well established showed greater ability to use verb inflection and agreement.

Adult Communication Skills and Assessments

Long, G. (1996). Assessing workplace communication skills with traditionally underserved persons who are deaf. DeKalb, IL: Northern Illinois University Research and Training Center on Traditionally Underserved Persons who are Deaf.

The article presents a description of the population of traditionally underserved deaf persons and one of the earliest formal communication assessment tools. The tool is designed to assess the communication skills of these deaf workers in relation to the key communication skills needed in their work sites. The report contains four sections plus a summary. Part 1 is a consumer communication profile; it addresses consumer communication skills as well as consumer interpreting and assistive technology needs. Part 2 presents an assessment of the communication environment in the workplace, including the critical communication skills needed there. Part 3 addresses the consumer-environment communication match. Part 4 addresses interventions and natural supports.

Williams, R. C. & Crump, C. J. (2013). Communication skills assessment.

This tool is a current state-of-the-art-assessment of language and communication skills in deaf persons seen in mental health settings. It presents an organized format for assessing lip-reading, speech, reading, writing, fingerspelling, and manual communication skills. The tool is very sensitive to known forms of language dysfluency (drawing heavily upon the “Do you hear voices?” article and book chapter). It includes a grid for differentiating language errors associated with mental illness from those associated with language deprivation.

Forensic Psychology

Language Services Section, Special Programs Unit, Programs and Procedures Division, Office of Trial Court Services, Administrative Office of the Courts, Trenton, NJ. (2004). Guidelines for proceedings that involve deaf persons who do not communicate competently in American Sign Language.

The New Jersey Judiciary developed guidelines to assist judges, lawyers, and others involved in the legal system to (1) understand the unique communication needs of Deaf people who use a sign language other than ASL, and (2) provide guidance for improving successful accommodations for such persons.

LaVigne, M. & Vernon, M. (2003). An interpreter isn’t enough: Deafness, language and due process. Wisconsin Law Review, 5, 844-936. 

This report presents an overview of the challenges of providing due process in legal proceedings to deaf individuals who have language limitations. Using case examples of deaf people with varying levels of language deprivation, the report describes the challenges of interpreting highly abstract legal concepts like pleading “no contest,” clarifying how to optimize the interpreter’s ability to work, as well as explaining the limitations of even the most skilled interpreting. Differences between English and ASL, especially when ASL lacks technical vocabulary for abstract legal concepts, are discussed. The relationship between language deprivation, cognitive impairments, fund-of-knowledge gaps, and being incompetent to stand trial are explored. Incompetency is normally understood in relation to either neurological impairment or mental illness, but here the idea of legal incompetence due to language impairment is discussed. Recommendations are offered for compliance with federal laws to the extent possible.

Miller, K. R. (2004). Linguistic diversity in a Deaf prison population: Implications for due process. Journal of Deaf Studies and Deaf Education, 9(1).

The entire deaf prison population in the state of Texas formed the basis for this research. The linguistic skills of prison inmates were assessed using the following measures: (1) Kannapell’s categories of bilingualism, (2) adaptation of the diagnostic criteria for Primitive Personality Disorder, (3) reading scores on the Test of Adult Basic Education, and (4) an evaluation of sign language use and skills by a certified sign language interpreter who had worked with deaf inmates for the past 17 years. Deaf inmates with reading scores below the federal standard for literacy (grade level 2.9) were the group most likely to demonstrate linguistic incompetence to stand trial, meaning that they probably lacked the ability to understand the charges against them and/or were unable to participate in their own defenses. Based on the language abilities and reading scores of this population, up to 50% of deaf state prison inmates may not have received due process throughout their arrest and adjudication. Despite their adjudicative and/or linguistic incompetence, these individuals were convicted in many cases, possibly violating their constitutional rights and their rights under the Americans with Disabilities Act.

Miller, K. R. & Vernon, M. (2002). Assessing linguistic diversity in deaf criminal suspects. Sign Language Studies, 2(4), 380-390.

This is a study of how interpreters in forensic settings identify and respond to indicators that a person they are working with has minimal language skills and doesn’t understand the questions being asked of him. Interpreters look for inappropriate responses. Interpreting difficulties from poorly developed language skills are compounded by social and legal knowledge. Communication difficulties may reflect non-comprehension of syntax, impoverished socialization, emotional reactivity, inadequate vocabulary, and attempts to respond to the apparent situation or those portions of the communication that they understand. Attention is also devoted to the frequently encountered difficulty with understanding time, especially with sentences where time is imbedded within time, as in, “how many days out of the past month have you used alcohol?” Strategies for interpreters within criminal justice settings to field test language comprehension, legal knowledge, and literacy are offered.

Tuck, B. M. (2010). Preserving facts, form, and function when a deaf witness with minimal language skills testifies in court. University of Pennsylvania Law Review, 158(3), 905-956.

Many courts lack the ability to fully accommodate deaf witnesses who are semi-lingual, non-lingual, or otherwise possess minimal language skills. Courtroom participants use language in precise ways to exert control and power. The use of language monitor interpreters, deaf interpreters, and other best practice approaches do not always protect against inadvertent adjustments in facts, form, or function. The contemporaneous objection requirement bars parties from fully analyzing complex linguistic interactions before they enter the court’s official record. As an alternative, parties can borrow procedural tools from the document translation evidentiary model. Parties can apply additional resources to certain contested portions of the interpretation, and the court and jury can have additional information to help them settle the dispute.

Vernon, M., & Miller, K. (2001). Linguistic incompetence to stand trial: A unique condition in some deaf defendants. Journal of Interpretation, Millennial Edition, 99-120.

Deaf individuals in the United States who have a severely constricted understanding of English, little knowledge of the court system, a basic lack of information, and limited ASL skills are often unable to understand the charges they face in court, nor can they participate in their own defense. Consequently, they are legally incompetent on linguistic grounds. Thus, as in the case of a person who is legally insane or severely developmentally delayed, they cannot stand trial unless and until the condition can be successfully treated. This concept of linguistic incompetence is relatively new to the courts and poses a major problem. In this paper, this concept is explained and documented, and its prevalence in the deaf population is discussed. The paper discusses common difficulties with written English that deaf people have. It discusses reasons why the vocabularies of sign languages are severely constricted. It discusses pressures on interpreters and how they often respond in ways that do not provide linguistic equivalence for deaf defendants. Solutions for the dilemma it creates for the courts and interpreters are discussed.

Interpreting for Persons with Atypical Language

Glickman, N. & Crump. C. (2013). Sign language dysfluency in some Deaf persons: Implications for interpreters and clinicians working in mental health settings. In N. Glickman, Deaf mental health care (pp. 107-137). New York: Routledge.

Many deaf persons served in mental health settings show significant language dysfluency in the “best” language, usually ASL. Sign language dysfluency in deaf people has four major causes: neurological problems associated with the etiology of deafness, language deprivation, aphasias, and psychotic disorders. Each cause can affect language development and usage in a particular way. In this article, numerous examples of sign language dysfluency are offered along with a discussion of their implications for interpreting, especially in mental health settings. The authors draw upon the Demand-Control interpreting approach of Dean and Pollard to illustrate interpreter decision-making when faced with the challenge of dysfluent language. The advantages and disadvantages of collaboration with deaf interpreters are reviewed. Finally, suggestions for best practice in interpreting for language dysfluent deaf persons in mental health settings are offered. Clinical discussion pertains to what the language problems may mean; specifically, how clinicians can begin to differentiate between language problems related to mental illness and those related to language deprivation. Another issue is how language problems can contribute to psychiatric problems such as with a patient whose inability to communicate his feelings to his team of helpers lead to behavioral problems, the inference he was suicidal, and psychiatric hospitalization. Understanding language problems is of particular importance in mental status exams and diagnostic interviewing. Some guidelines for clinician/interpreter collaboration are included.

Pollard, R. (1998). Mental health interpreting: A mentored curriculum. Rochester: University of Rochester School of Medicine.

The target audience for the curriculum includes foreign language and sign language interpreters who occasionally or frequently work in mental health service settings. There is an open-captioned version of the video for deaf or hard-of-hearing viewers (the regular version of the video shows subtitles when characters speak in a foreign language and their comments are not immediately translated into English). The curriculum was designed and written by a multi-cultural team of bilingual clinicians and mental health interpreters. The text and video are designed to be used together in a learning relationship between the interpreter-trainee and an experienced teacher or mentor. The curriculum format allows for study at the interpreter and mentor’s own pace, although it has been used in traditional classroom settings as well. Chapters 1 through 9 begin with a set of learning objectives and end with a learning check or brief examination so that educational progress can be documented. At the end of most of the chapters, there are instructions about which videotape vignettes to watch, followed by discussion questions for the interpreter and mentor to talk about together to facilitate deeper appreciation of the material and issues raised.

Smith, C. & Dicus, D. (2015). A preliminary study on interpreting for emergent signers. Sign Language Studies, 15(2), 202-224.

Sign language interpreters work with a variety of consumer populations throughout their careers. One such population, referred to as “emergent signers,” consists of consumers who are in the process of learning American Sign Language and who rely on interpreters during their language acquisition period. A gap in the research is revealed when considering the interaction between this growing population and the interpreting field. The present study thus attempts to provide a preliminary examination of the topic by reporting on the findings of a survey conducted with interpreters affiliated with Gallaudet Interpreting Service at Gallaudet University. Results show that interpreters are working on a regular basis with this population, that the work is different from traditional interpreting work with fluent signers, and that interpreters have differing opinions on how the work should be approached. Implications for future areas of study and the overwhelming need for research on this subject are also discussed.

Solow, S. N. (1988). Interpreting for minimally linguistically competent individuals. The Court Manager, 3(2), 18-21.

This article provides an overview of working with consumers who have limited ASL skills due to a variety of reasons, particularly when working in legal settings. When working with such consumers, it is often beneficial to employ the services of a Deaf interpreter to work as a team with the hearing interpreter. Discussed, as well, is how the use of a Deaf interpreter in legal settings can be beneficial to all participants.

Language Deprivation Syndrome

Gulati, S. (2014). Language deprivation syndrome. ASL Lecture Series.

In this ASL lecture, Dr. Gulati talks about the reality of language deprivation in many deaf persons and the impact of language deprivation on development. He also summarizes research from 98 persons with language deprivation seen in his clinic. Language deprivation, as measured by age of exposure to sign language and current sign language skills, was very highly correlated with dangerousness to others. He then addresses limitations in cochlear implant research, principally that outcome studies measure acquisition of vocabulary but not language. Large numbers of deaf children with cochlear implants are not acquiring anything approaching language fluency. His lecture is followed by interesting dialogue with members of his audience. Dr. Gulati describes the kinds of cognitive and language problems he has seen in persons with severe language deprivation. Examples include difficulties with abstract thinking, inability to arrange narratives in a linear sequence, and difficulties with constructs like cause and effect.

Hall, W. C. (2017, February 9). What you don’t know can hurt you: The risk of language deprivation by impairing sign language development in deaf children. Journal of Maternal Child Health.

This article presents a commentary on the dangers to deaf children that come with denying them access to sign language in their critical language learning years. The commentary synthesizes research outcomes with signing and non-signing children and highlights fully accessible language as a protective factor for healthy development. Brain changes associated with language deprivation may be misrepresented as sign language interfering with spoken language outcomes of cochlear implants. Language deprivation puts deaf children at risk for cognitive delays, mental health difficulties, lower quality of life, a higher level of trauma, and limited health literacy.

Hall, W. C., Leven, L. L., & Anderson, M. L. (2017). Language deprivation syndrome: A possible neurodevelopmental disorder with sociocultural origins. Social Psychiatry and Psychiatric Epidemiology, 1-16.

There is a need to better understand the epidemiological relationship between language development and psychiatric symptomatology. Language development can be particularly impacted by social factors—as seen in the developmental choices made for deaf children, which can create language deprivation. A possible mental health syndrome may be present in deaf patients with severe language deprivation. The researchers conducted an extensive review of existing databases to identify publications focusing on language development and mental health in the deaf population. They review the literature supporting the existence of a condition they propose be called “language deprivation syndrome” and recommend research to formalize the diagnostic criteria.

Language Dysfluency in Hearing Persons

Andreasen, N. (1986). Scale for the assessment of thought, language and communication. Schizophrenia Bulletin, 12(3), 473-482. 

This resource presents a description of the kinds of language dysfluency associated with what used to be called “formal thought disorders.” Andreasen breaks these items down into those she considers “communication disorders” and those she considers “thought and language disorders.” She recommends that, collectively, these problems be characterized as “disorders of thought, language and communication.” Some of these problems are strongly associated with forms of severe mental illness such as schizophrenia, mania, and depression. She provides examples of each, relevant interviewer questions, and a scale for measuring their presence and severity.

Mental Health Assessment and Treatment

Crump, C. J., & Hamerdinger, S. H. (2017). Understanding etiology of hearing loss as a contributor to language dysfluency and its impact on assessment and treatment of people who are deaf in mental health settings. Community Mental Health Journal.

Working with individuals who are deaf in mental health settings can be complex work, necessitating consideration for the difference in language abilities. These differences include not only variations in ASL and spoken language skills but various forms of language dysfluencies. This article discusses the many possible causes of language dysfluencies, highlighting not just language deprivation but medical etiologies which impact language development. Language dysfluency is discussed in terms of how it may impact psychiatric diagnosis. The authors refer to the detailed communication assessment done in the Alabama Office of Deaf Services and how it may guide clinicians and interpreters. This article contributes to the emerging discussion of language dysfluency patterns commonly seen in many deaf persons.

Fellinger, D., Holzinger, D., & Pollard, R. (2012). Mental health of deaf people. The Lancet, 379, 1037-1044.

Deafness is a heterogeneous condition with far-reaching effects on social, emotional, and cognitive development. Onset before language has been established happens in about seven per 10,000 people. Increased rates of mental health problems are reported in deaf people. Many regard themselves as members of a cultural minority who use sign language. In this review, the authors describe discrepancies between a high burden of common mental health disorders and barriers to health care. About a quarter of deaf individuals have additional disabilities and a high probability of complex mental health needs. Research into factors affecting mental health of deaf children shows that early access to effective communication with family members and peers is desirable. Improved access to health and mental health care can be achieved by provision of specialist services with professionals trained to directly communicate with deaf people and with sign language interpreters.

Glickman, N. (2009). Do you hear voices? Problems in assessment of mental status in Deaf persons with severe language deprivation. In N. Glickman, Cognitive behavioral therapy for Deaf and hearing persons with language and learning challenges (pp. 47-78). New York: Routledge.

When mental health clinicians perform mental status examinations, they examine the language patterns of patients because abnormal language patterns, sometimes referred to as “language dysfluency,” may indicate a thought disorder—a symptom of severe mental illness. Performing such examinations with deaf patients is a far more complex task, especially with traditionally underserved deaf people who have language deficits in their best language or communication modality. Many deaf patients suffer language deprivation due to late and inadequate exposure to ASL. They are also language dysfluent, but the language dysfluency is usually not due to mental illness. Others are language dysfluent due to brain disorders such as aphasia. This paper examines difficulties in performing a mental status examination with deaf patients. Issues involved in evaluating for hallucinations, delusions, and disorganized thinking are reviewed. Guidelines are drawn for differential diagnosis of language dysfluency related to thought disorder vs. language dysfluency related to language deprivation. This book chapter also includes a discussion of work with certified Deaf interpreters, the difficulty of interpreting abstract concepts, and examples of hearing psychologists drawing wrong conclusions because they weren’t aware of differences between ASL and English. Reference is also made to strategies for interpreting dysfluent language developed at the Deaf Wellness Center in Rochester, New York.

Gulati, S. (2003). Psychiatric care of culturally Deaf people. In N. Glickman & S. Gulati, Mental health care of Deaf people: A culturally affirmative approach (33-108). New York: Lawrence Earlbaum Associates.

This book chapter presents one of the first discussions of the relationship between language deprivation and psychiatric disorders. It presents a lot of general information designed to orient mental health professionals unfamiliar with deaf people to the special considerations involved in their psychiatric care. Dr. Gulati then describes the syndrome of language deprivation with clinical presentations and case examples. He describes common characteristics and behaviors of persons with varying degrees of language deprivation. Dr. Gulati also presents guidelines for clinical responses to persons with this syndrome.

Morgan, G., Herman, R., & Woll, B. (2007). Language impairments in sign language: Breakthroughs and puzzles. International Journal of Language and Communication Science, 42(1), 97-105.

Specific language impairment has previously solely been documented for children acquiring spoken languages, despite informal reports of deaf children with possible sign language disorder. The paper reports the case of a deaf child exposed to British Sign Language (BSL) from birth who has significant developmental deficits in the comprehension and production of BSL grammar based on formal assessment and linguistic analyses of his sign communication in comparison with age-matched unimpaired signers. It is shown that linguistic difficulties with BSL verb morphology underlie the child’s poor performance compared with same-age native signers. The appearance of linguistic impairments in sign and spoken languages in comparable domains supports cross-linguistic and modality free theories of specific language impairment. Cited examples of expressive language dysfluency in this article: child uses small sentences made up of one or two signs with very limited grammar, overuses sign repetition and pointing, and uses exaggerated facial expression and gestures.

Pollard, R. (1998). Psychopathology. In M. Marschark and M. D. Clark, Psychological perspectives on deafness, 2 (pp. 171-197).

In this book chapter, Pollard discusses special considerations in the clinical interview of deaf persons. Of most relevance is the section on language, communication, and translation. He discusses the variability in language skills in deaf people and the danger of misinterpreting communication dysfluency. He notes that while mental illness can affect language and thought patterns, most deaf persons who show dysfluency do so for reasons other than neuro- or psychopathology. He also describes how interpreters unprepared for the challenges of mental health interpreting and work with dysfluent persons can inadvertently contribute to clinicians making significant clinical misjudgments.

Pollard, R. Mental health and Deaf individuals: On-line training for clinicians. Missouri Department of Mental Health.

This online training provides an excellent overview of Deaf mental health issues. Unit 5 is devoted to language dysfluency, literacy, and fund-of-information issues. The goals of this unit are: 1) to understand the much greater range of language fluency found in deaf individuals, 2) to recognize the significance of language fluency deficits in relation to differential diagnosis in mental health service settings, 3) to be prepared to encounter and deal with language dysfluency in deaf patients, 4) to understand how interpreters may work in light of language dysfluency, 5) to understand why English literacy is compromised among many deaf persons, and 6) to learn about the meaning and significance of fund-of-information.

Thacker, A. (1994). Formal communication disorder: Sign language in deaf people with schizophrenia. British Journal of Psychiatry, 165, 818-823.

This study is a summary of research which demonstrated how formal communication disorders often found in persons diagnosed with schizophrenia can manifest in deaf persons with schizophrenia in their dysfluent sign communication. Sign language samples were elicited from 30 prelingually deaf adults diagnosed with schizophrenia, seven diagnosed with mania, and from a matched group of deaf controls. Preliminary analysis found multiple kinds of sign language errors. These include reversing the order of fingerspelling or movement of signs, producing signs in the wrong location, clanging (making association between signs based on formal properties like handshapes and not on meaning), switching or dropping topics abruptly, and repeating signs and themes unnecessarily.

Trumbetta, S. L., Bonvillian, J. D., Siedecki Jr., T., & Haskins, B. G. (2001). Language-related symptoms in persons with schizophrenia and how Deaf persons may manifest these symptoms. Sign Language Studies, 1(3), 228-253.

This article reviews core features of the disorganized speech seen in schizophrenia and illustrates how deaf persons with schizophrenia may display such language anomalies. It discusses the difficulties involved in studying language in persons with schizophrenia in general and specifically in deaf persons with schizophrenia. Some examples are given of sign language dysfluency related to thought disorder: decline in sign skills from previous level, stereotyped (repetitive) manner of signing, neologisms (invented signs unknown to other people), derailment (gradually losing focus), clanging by associating signs based on handshape and not meaning, incomplete references (which also occur in persons with language deprivation), prosody (intonation, stress, and rhythm), and facial affect not in agreement with sign communication. The authors also review the presence of other psychotic symptoms in deaf persons such as auditory, visual, and tactile hallucinations.

Neurology of Language

Poizner, H., Klima, E., & Bellugi, U. (1987). What the hands reveal about the brain. Cambridge, Massachusetts: MIT Press. 

This book provided ground-breaking research demonstrating that languages are processed in the left hemisphere of the brain, regardless of language modality. The researchers also describe parallels between the different forms of aphasic impairment in sign and spoken language users. They provide examples in spoken and sign languages of the two main kinds of aphasias, one located in the anterior areas of the left hemisphere and referred to as non-fluent aphasia, and the other found in the posterior regions, referred to as fluent aphasia.

Traditionally Underserved Deaf People

Dew, D. (Ed.). (1999). Serving individuals who are low-functioning deaf. Report from the study group:  25th Institute on Rehabilitation Issues. Washington, D.C.: The George Washington University Regional Rehabilitation Continuing Education Program.

The report describes the population of people who used to be referred to as “low functioning deaf” (LFD) and provides population estimates. The five main characteristics are inadequate communication skills; vocational deficiencies; deficiencies in behavioral, emotional, and social adjustment; independent living skills deficiencies; and educational and transitional deficiencies. Population estimates are provided along with estimates of prevalence rates for additional disabilities. The authors write that “the defining characteristic of individuals who are LFD is that they have inadequate communication skills because of a secondary disability (mental illness, brain injury) or of deprivation in social development or education. Persons who are born deaf with no other disability and who have not been given the opportunity to develop language become low functioning. The lack of formal language results in developmental deficits that cannot be fully resolved by education or training. Poor to no language skills creates a barrier to the acquisition of other critical academic and social skills required for employment and independent living,” (p. 11). Most of the report focuses on challenges providing vocational rehabilitation services to these persons.

Wellbeing and Health Literacy

Pollard, R. Q. & Barnett, S. (2009). Health-related vocabulary knowledge among deaf adults. Rehabilitation Psychology, 54(2), 182-185. 

Many deaf individuals are at increased risk for fund-of-information deficits, including deficits in health-related information. Research on health information knowledge, an aspect of health literacy, demonstrates an association between low health literacy and health disparities in many populations. Deaf individuals are at risk for low health literacy, but no research has been conducted on this topic. This study investigated the health-related knowledge in a sample of 57 deaf adults. Results found that even this highly educated deaf participant sample demonstrated risk for low health literacy. The general deaf population is likely at even higher risk for health problems associated with low health literacy.

Pollard, R., Dean, R., O’Hearn, A. & Hayes, S. (2009). Adapting health education materials for deaf audiences. Rehabilitation Psychology, 54(2), 232-238.

This resource discusses the approach of the Deaf Wellness Center at the University of Rochester Medical Center to adapt health education materials, including mental health information materials, for Deaf audiences. The approach seeks to bridge the literacy and fund-of-information gaps, as well as cultural differences, to make healthcare information more accessible and relevant for Deaf audiences. The methodology presented here has wide applicability to attempt to make public and mental health information accessible for Deaf signing audiences, including those with language deprivation.