JCPSLP Vol 21 No 1 2019

how to support or communicate with hearing impaired prisoners. Prisons rely on sound in order to run smoothly: loudspeaker systems, verbal directions from staff, bells and alarms are key in daily routines (Kelly, 2017). A study of English and Welsh prisons show that they are ill- equipped to meet the needs of hearing impaired prisoners: reasonable adjustments that would help make sound accessible to prisoners with hearing loss, including hearing aids, are often not provided (Kelly, 2017). Globally, prisoners with hearing loss report that difficulties communicating with guards is an additional detrimental and stressful element of prison life (Dahl, 1994; McCulloch, 2012; Quinn & Rance, 2009; Vanderpoll & Howard, 2011). Knowing that courtrooms can be difficult listening environments for people with hearing loss, I asked Christine how she managed in this environment. Unfamiliar, technical legal language is common, multiple speaking locations make it difficult to make use of visual cues, distances between the defendant and the person questioning them can be further than optimal, and long periods of listening concentration may be required, fatiguing defendants with hearing loss. Howard, Quinn, Blokland, and Flynn (1993) speculate on the extent to which the apparently withdrawn courtroom demeanour of a noticeable number of Aboriginal defendants relates to hearing loss: remaining silent, gazing out the window or looking down. Christine confirmed that courtrooms were not easy listening environments for her, and when she could not hear, she guessed what was being asked and answered accordingly. Hearing loss is certainly prevalent among the cohort of people who pass through courtrooms and then into prisons. The final report of the Royal Commission into Aboriginal Deaths in Custody first commented on the relationship for Aboriginal people between childhood ear disease and hearing loss, poor school performance and incarceration (Johnstone, 1991). Murray et al. (2004) examined the hearing of 640 people in New South Wales prisons. The hearing of all inmates was poorer than for the normative Australian population, and the hearing of Aboriginal people was poorer than non-Aboriginal inmates. At Bandyup Women’s Prison in Western Australia, 45% of Aboriginal women assessed did not pass hearing screening, compared with 12% of non-Indigenous women (Siewert, 2010). In the Northern Territory, 94% of Aboriginal men in Alice Springs and Darwin prisons had hearing outside the normal range (Vanderpoll & Howard, 2011). So what are the mechanisms that appear to lead to the apparent overrepresentation of people with hearing loss in prison? Hearing loss of any degree, unless identified and remediated early, causes language and communication problems. Australia’s Longitudinal Outcomes of Children with Hearing Impairment isolates the factors that are supportive of global language development in children with hearing loss requiring amplification: early device fitting, higher maternal education level, absence of additional disabilities and higher cognitive ability (Ching, Dillon, Leigh, & Cupples, 2018). Since the implementation of newborn hearing screening in Australia, hearing loss present at birth is often identified and remediated within the first few months of life. Prior to this, particularly for less severe loss, identification and remediation often occurred significantly later. Unremediated hearing loss is one cause of delay in listening and talking skills, a pre-requisite for transition to literacy in the early years of schooling and for academic success across the whole school curriculum (Snow & Powell, 2012).

had been in and out of prison annually since the age of 18 years. She had passed through police, court, prison and parole systems 18 times without attention being brought to her ear health or hearing problems. Was this because Christine had not been screened for it, had not reported it, no one had noticed the signs, or the signs had been misinterpreted? Multiple studies from Australia, the United Kingdom and North America evaluate prevalence of hearing loss among prisoners (Dahl, 1994; Holmes et al., 1996; McCulloch, 2012; Murray, Butler, & LePage, 2004; Quinn & Rance, 2009; Vanderpoll & Howard, 2011). All studies note higher prevalence among prisoners than in the general population and the particular risks associated with not hearing well in the prison environment. Most comment on the absence of objective hearing screening as part of routine health assessment processes, and make recommendations for audiometric hearing screening to be implemented. Currently, self-report is often relied upon, either through prisoners volunteering the information or prison staff soliciting the information: problematic for populations where hearing loss is normalised. As part of an unpublished 2015–16 trial carried out in the Northern Territory by Australian Hearing, Anyinginyi Aboriginal Health Service and the NT Corrections Barkly Work Camp, the response to “Do you have hearing trouble?” was compared with the results of hearing screening for 60 male Aboriginal volunteers. Twenty-two per cent of the men had moderate or greater hearing loss. Relative to the hearing screening results, self-report was found to be poor at correctly identifying people with hearing loss, confirming that asking about hearing status, the most common approach to detecting hearing loss in prisons, is unreliable. It is quite plausible that Christine had not commented on her ear and hearing trouble. Many members of the Aboriginal community perceive ear and hearing trouble to be inevitable and normal for Aboriginal people. Evidence suggests, however, that prior to colonisation, it was not (Bhutta, 2015; Stuart, 2007). An Elder interviewed as part of social research commissioned by the Australian government Department of Health and Ageing (2010) commented “I always associate ear problems with Aboriginal people ... it’s a blackfella thing … you can’t do much ... it’s just one of nature’s things that happens”. In addition, treatments for ear disease are often perceived as ineffective (Jeffries-Stokes et al., 2004) and ear specialist services as expensive and inaccessible (Department of Health and Ageing, 2010). When viewed in this way, hearing loss and ear trouble can easily become something not worth raising. When Aboriginal men in Darwin and Alice Springs prisons who indicated they experience hearing problems were asked whether they had notified the prison health service, 72% had not (Vanderpoll & Howard, 2011). It is also quite likely that most prison staff did not recognise any communication difficulties Christine had as hearing related. The guard who escorted me to the prison clinic to see Christine memorably commented “Christine, is she deaf? I just thought she was stupid”. This is not uncommon: a Canadian study showed that many prison staff are unable to recognise behavioural signs of hearing loss, and when those behaviours were described, staff were five times more likely to ascribe them to personality or behaviour disorders, resulting in adverse consequences for the prisoner (Dahl, 1994). Staff who do recognise the behaviour as an indicator of hearing loss often do not know

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JCPSLP Volume 21, Number 1 2019

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