#ASHA14 Audiologist in the House

blogI have been attending the national ASHA convention since 2008 in Chicago, but this year is a special first for me–MY FIRST ASHA CONVENTION AS A CERTIFIED DOCTOR OF AUDIOLOGY!!! I started attending ASHA as undergraduate while still trying to determine if I wanted to study audiology or speech-language pathology. As an undergrad, ASHA was a little overwhelming. The graduate school fair and exhibit halls, as well as the many networking events, were greatly beneficial, but as I still didn’t have a concrete plan or field, my choice in sessions was eclectic and I don’t know how much I got out of them.

The next several years I served on the NSSLHA Executive Council as a delegate for Region 8 and then as a representative for Region 3, and even though I was “at convention” I was very busy with meetings and helping run NSSLHA Day and as such, didn’t get to many sessions. The networking has always continued to be phenomenal and I loved being emcee of the NSSLHA Battle of the Regions Knowledge Bowl, but I was missing out on sessions.

Last year, as a fourth year extern who was free of meeting and other responsibilities, I was finally able to attend as a regular attendee and found some great sessions (which after three-and-a-half years of grad school, I could understand), but this year will even top that as I now have a job as an educational audiologist and can search out sessions related to what I do on a daily basis.

I always look forward to continued networking and social events as well as the exhibit hall. I’ll be sure to check out Audiology Row, the opening plenary session and closing party (Where’s my owl with a letter inviting me to Hogwarts?). As I’ve been researching audiology sessions, I selected so many sessions and posters that were of potential interest that I’ve only got two slots that don’t have conflicting sessions. I’m working on whittling the list down, but there are some sessions I feel I need to catch. Management of School‐Age Children With Hearing Loss: From the Clinic to the Classroom (#1019) is one I feel will be particulary relevant. As I’m learning the ropes at my new job (I’m the only educational audiologist in a rural four-county area of Maryland), I’m rapidly discovering that regular follow-up with dispensing/managing audiologists is not something that always happens with my students due to geographic and socio-economic issues. As such, I’m starting to develop relationships with some of the audiologists at the Children’s Hospital a couple hours away where many students were initially fit.

I’m also looking forward to some sessions and posters on APD as working in the school, it is a “hot topic.” Disentangling Central Auditory Processing (CAP) Test Findings: A Road to Greater Clarity (#1110) , Differential Diagnosis & Intervention of Central Auditory Processing Disorders (#1405), and Treatment Efficacy of the Fast ForWord-Reading Program on Language in a Child With SLI/APD (6036 poster #136).

One final session I’m also very excited about is Noise Exposure & Noise-Induced Hearing Loss Among Rural Adolescents (#1492). The area in which I live and work has agriculture and aquaculture as two significant components of the local economy in addition to many recreational opportunities for noise exposure (hunting, shooting, ATVs, boating, etc) and I feel there will be opportunities to work on implementing some hearing conservation education at the high school level for many of the students I serve.

What are some of the sessions you’re looking forward to? See you in Orlando!

Caleb McNiece, AuD, CCC-A, is a new grad and educational audiologist for the Mid-Shore Special Education Consortium which serves four county school systems on Maryland’s eastern shore. Caleb is a former NSSLHA Executive Council member and is passionate about audiology students, audiology advocacy, pediatric audiology, and private practice.

Is There a Heffalump in the Room? Learning to Be a Leader, Part 1

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In Pooh’s “Huffalump” movie, Roo asks, “’Scuse me, what’s a heffalump?” Pooh, Tigger, Rabbit, Piglet, and Eeyore sing a song about the horrible qualities that they believe heffalumps possess (three heads, fiery eyes, spiked tails, etc.).

When presented with a difficult task or situation, we often find ourselves in conflict about how to deal with it. The Chinese word for conflict or crisis consists of two symbols: danger and opportunity. When we are faced with difficult moments, we must remember we have a choice. How we manage that choice often determines the outcome of the situation. In audiology, we are often faced with conflict ranging from difficult hearing aid fitting and counseling sessions to negotiating with vendors. Sometimes we have conflicts internally in our office or conflicts regarding professional issues in our membership organizations.

Conflict often makes us think of a negative experience that did not go well. We must remember, however, that conflict is not a bad thing but an opportunity for both personal and professional growth. Think about how boring meetings and conversations would be if people did not speak up and share their thoughts and ideas. If conflict is handled right, then there are benefits that you might not expect such as:
Better understanding of the issues and the opportunity to expand your awareness to the situation.
Increased trust among your team members and colleagues. People feel safe to express themselves, allowing an opportunity for growth.
Enhanced self-awareness due to being more aware of your goals and thoughts on how to be an effective leader and team member.

Handling conflict, however, does not necessarily come easily for most. Here are some key strategies that leaders use every day to help prevent and/or defuse conflict to allow for productive opportunities or engaged conversations.

When dealing with difficult moments:
Focus on the process. It is not about the people, it is about the system or process.
Go “below the line” for a collaborative approach for conflict resolution. Imagine an iceberg. You can only see the top, which is usually only 10 percent of it. To navigate the waters, you need to know what is below the sea line, the other 90 percent, to be safe.
Listen first and then ask questions for understanding. Remember restate, rephrase, and summarize when trying to gain understanding and trust.
• Create options collaboratively. Be open to ideas.
• Negotiate what options would solve the conflict.

When dealing with conflict, it is important to consider when do you take action and who should have the conversation. To answer when—the sooner the better. Addressing unprofessional behaviors, engaging with the dissatisfied patients, and/or intervening before people forget are essential to maintaining accountability, employee satisfaction and retention, and minimizing potential liabilities. To answer who—anyone in most cases. Regardless of the title, anyone should be able to talk to us and share ideas without feeling minimized or degraded. If the leaders blink or if the culture is of the mindset “it doesn’t matter, can’t change it…,” then it is important for the leadership to step in and be a role model on how to resolve conflict or better yet create a culture where conflict is considered to be an opportunity not a negative event.

To learn more about your conflict style, the Thomas-Kilmann Conflict Mode Instrument is a widely used instrument that provides helpful information on your conflict style. The conflict styles are Competitive, Collaborative, Compromising, Accommodating, and Avoiding. Different situations call for different conflict styles, so knowing what domains you typically prefer will be helpful.

I encourage you to take Roo’s direction and instead of being scared of conflict, look for the heffalump yourself and discover that often the many traits outlined are things that are not true or can be negotiated.

So, you ask, how do I negotiate these uncharted waters? Next, Leadership Realities Part II will provide you with your compass.

Tamala Selke Bradham, PhD, CCC-A, is a quality consultant in the Department of Quality, Safety, and Risk Prevention at Vanderbilt University Medical Center. She is an affiliate of ASHA Special Interest Group 9, Hearing and Hearing Disorders in Childhood.

Changing the Clinical Question from ‘Can I?’ to ‘How Can I?’

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It’s always easy to discuss how things should be. We start sentences with:

“It’d be great if…”

“Ideally…”

“In a perfect world…”

But typically, when we discuss ideals, we quickly follow up with:

“But that’s not realistic.”

“Too bad that can’t actually happen.”

“Wish it could really be that way.”

When it comes to clinical practice, I think we default to the latter group of statements far too often. We significantly limit what we believe is actually possible, because the things we know are good in theory are just too hard to apply in the “real world.” It’s easy to sit through a graduate class or a continuing education session, but it’s another thing entirely to apply that information day-to-day in the therapy room. Think about some examples:

We learn about the importance of evidence-based practice, but “realistically,” there is not a vast amount of high-quality evidence for many of our practices in this relatively young field.

We discuss the necessity of being sensitive to culturally and linguistically diverse populations, but “realistically,” we can never learn to speak every language or understand every culture.

We understand that the Code of Ethics exists for the purpose of maintaining best practices, but “realistically,” ethical dilemmas are not always so black-and-white.

So what’s the point then? Why do we have standards that we can’t live up to in practice? Why are we taught things that we are doubtful we can ever actually apply?

That, right there, is the problem. It’s the question we’re asking. We look at a client or a situation, and we ask, “Can I do this?”

“Can I find any evidence to guide my clinical decisions with this unique and difficult case?”

“Can I effectively treat this client whose language I do not speak?

“Can I maintain my personal and professional ethical codes when a ‘sticky situation’ arises?”

The problem with these questions is that from the moment we decide to become speech-language pathologists, we have already answered all of them. In accepting the responsibilities that come with being a part of this field, we have already said a huge, resounding “Yes” to every ‘Can I?’ question. No matter how challenging the situation may be, yes, we can do it, because we must.

One of my professors recently challenged our class to change the question. When faced with difficult situations that make us uneasy, or cause us to doubt what we can handle, we have to start thinking of it differently. Instead of asking, “Can I do this?” we should ask, How will I do this?”

 How will I follow the levels-of-evidence hierarchy in order to implement EBP, even when the current existing evidence base is not extremely strong in this particular area?”

How will I be creative and use resources to effectively treat this client whose language I do not speak?”

How will I ensure that I maintain my personal and professional ethical codes and engage in best practices, even when a ‘sticky situation’ arises?”

 How will I do this?”

 Many people are familiar with the famous quote from Spider Man, “With great power comes great responsibility.” While a few ‘Cs’ behind your name may not seem like power to most of the world, as members of this field, we know differently. SLPs have the power to help others, facilitate communication, and cause change, and I would say that is great power. We have been given the power, and therefore we have accepted the responsibility. We have said, “Yes,” to every tricky situation and every obstacle, whatever it may be, no matter how challenging. We have said “Yes,” because it is our responsibility to do so, based on the power we have been given. We can, because we must.

The next time you are faced with a tough case and are tempted to ask, “Can I do this?,” remember that you have already answered yourself. Can you do this? Yes, you can, because you must.

So, start asking yourself and others something different. Start changing the question. Start asking, “How?”
Kelsey Roberts is a student in the master’s speech-language pathology program at Abilene Christian University in Abilene, Texas.

Audiologists, You Know the Science of Hearing but Do You Know the Art of Listening? 

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As audiologists, we learn about anatomy, physiology, psychoacoustics, pathologies, technologies, and interventions. We are experts in assessing hearing sensitivity, diagnosing hearing loss, and providing audiological (re)habilitation with technologies and counseling.

Here’s a question, though: Are we experts in listening? To be an effective listener, you need to focus on the meaning of what you hear and take in to gain understanding. Have you ever taking a listening test? Have you ever given your patient a listening test?

There are many types of listening styles, and there’s also depth of listening. In reviewing the literature, I identified 27 different styles of listening and six depths of listening. I believe we use different listening styles and depths of listening based on what is happening in the moment. So, I am a client, I may, during a hearing test, be a discriminative, deep listener. Or if I am the patient learning about the new hearing aids you just fitted for me, I may be a content, full listener.

These are the four most common types of listeners.

People-oriented (empathic) listeners, who:

  • Build relationships and interpersonal connections
  • Search for common areas of interest
  • Tune into the speaker’s emotions, body language and prosody of speech
  • Ask, “Tell me all about it – what happened?”

Action-oriented (evaluative) listeners, who:

  • Prefer information that is well organized, brief and error-free.
  • Will digress when a speaker goes off on a tangent.
  • Evaluate information heard and do not take things at face value.
  • Ask, “What am I supposed to do with all this information?”

Content-oriented listeners, who:

  • Enjoy listening to complex, detailed information.
  • Ask questions to test speakers (are they credible?).
  • Focus on issues and if information is credible.
  • Ask, “Is that so?”

Time-oriented listeners, who:

  • Love “to do” lists.
  • Are overbooked, so they want messages delivered quickly and briefly.
  • Enjoy the role of keeping people on task during the meetings (the time keeper).
  • Ask, “And, what’s your point?”

If you are a people-oriented listener and your patient is a time-oriented listener, then your patient may feel that you are intrusive and not respecting their time. If you are a content-oriented listener, then be careful not to “throw the baby out with the bathwater”: When taking a patient’s history, you don’t want to ignore what could be key information because you believe there’s a lack of sufficient evidence.

And those audiologists who are action-oriented listeners may need to watch that they aren’t perceived as inpatient and not caring. Knowing your listening style can help you better understand how to adapt to various listening situations. Knowing your patient’s listening style will help you with how to deliver quality care!

There are multiple tests available to assess your dominant listening style.  Here are a few that I have used:

In establishing relationships with your patients, the importance is not so much in what you say as how you listen. Knowing hearing thresholds is only part of the evaluation. Listening to what your patient shares with you will drive your overall outcomes in patient care.

Tamala Selke Bradham, PhD, CCC-A, is associate director of quality, protocols, and risk management in the Department of Hearing and Speech Sciences at Vanderbilt University. She is an affiliate of ASHA Special Interest Group 9, Hearing and Hearing Disorders in Childhood.

Ensuring a Warm Send-Off for Your Clients

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Those of us working in hospital settings hear about discharges all day long. And we track everything about them: monthly rates, handovers, discharge summaries, patient’s perceptions of them.

In the outpatient world, discharges are just as important. When the patient leaves your office, do they know what they need to do next?

No matter the setting, we health care providers have a responsibility to ensure safety and efficiency when discharging a patient from care.

What happens when discharge isn’t done well? Patients experience adverse events due to delayed or absent communication, inaccuracies in information exchange, or ineffective planning or coordination of care between providers, as found recently in a study by Gijs Hesselink and his colleagues. In fact, at least 20 percent of patients report adverse events following discharge, and least half of these adverse events could have been prevented.

So what is your discharge or “thank you, goodbye” practice?  Here are five take-aways to consider:

  • Write it down!  Discharge instructions should be written down for patient understanding, not for compliance and insurance companies.  Don’t worry about saving the trees, give the patient the recommendations/plan of care in writing.  And, if you have it available, the patient should be able to review them at any time on your secure, web-based patient portal that you have available.
  • Share your instructions/plan of care with the patient’s medical home, therapists, and those that need to know!  Handoffs are one of the biggest problems in patient care that leads to adverse events.
  • Check for comprehension!  Having the patient repeat back what they heard is essential.  Using techniques like “Teach Back” or motivational interviewing are great ways to check for comprehension.
  • Make the discharge follow-up phone callMultiple studies show that if a simple phone call is made within 48 hours of the patient being seen or discharged from the hospital, it is a win-win for everyone involved. For outpatients, not only will you keep that person as a patient, but you will get more referrals due to having a happy customer. For hospitals, research shows reduced readmission rates and significant cost savings.
  • Own the discharge process.  When the patient leaves your practice/hospital, everyone who directly and indirectly touched that patient needs to own the process.  Does the patient know when to return?  Does the patient know who to contact if they have problems?  Will the patient tell a friend about the great experience they had?

Are you already doing these five simple things to keep patients safe?  If not, consider one of these for your next Plan-Do-Study-Act (PDSA).

For additional information about discharge planning, visit leancare.wordpress.com.

Tamala Selke Bradham, PhD, CCC-A, is associate director of quality, protocols, and risk management in the Department of Hearing and Speech Sciences at Vanderbilt University. She is an affiliate of ASHA Special Interest Group 9, Hearing and Hearing Disorders in Childhood. This post was adapted from her blog leanhcare.

 

Audiologists: Are Your e-Records Putting You At Risk for an Audit?

EHR imageMedicare is encouraging the implementation and use of electronic health records, but the way some practitioners fill out these records is under scrutiny. The U.S. Department of Health and Human Services Office of Inspector General has made cloning (inappropriate use of the copy-paste feature) and over-documentation areas of high priority for 2014.

OIG has recommended that the Centers for Medicare and Medicaid Services  evaluate EHRs for fraud vulnerabilities. If fraud is suspected, practices will be subject to fines and penalties. It is essential that audiologists use EHRs effectively and not take too many shortcuts. As we transition from paper charts to EHRs, here are a few things to know.

1.) Review all entries in your note. Avoid repeating past information.
According to CMS 1995 and 1997 documentation guidelines, “A review of systems and/or a past medical, family, and social history obtained during an earlier encounter does not need to be re-recorded if there is evidence that the physician [audiologist] reviewed and updated the previous information.” In other words, in your note, refer to a previous note that has the comprehensive history. For example, you could write, “See note dated 1/1/2014 for a comprehensive history of patient X,” and update the present concerns/reason for the visit.

2.) Make sure all your diagnoses listed are relevant for that patient’s visit.
Many EHR systems allow the copying of all diagnoses listed in the problem list, even those that have been resolved or aren’t the reason for that day’s patient visit. Be sure to only list the diagnoses that are relevant for the reason the patient is seeing you. For audiologists, the first diagnoses code should be your treating diagnosis followed by the relevant medical diagnoses. Sometimes the treating and the medical diagnoses are the same and there is only one listed.

3.) Make sure your note is individualized for that patient’s encounter.
Many EHR systems also allow you to clone a previous note. Use extreme caution with this feature. Auditors are looking for patterns in documentation. If all your notes look essentially the same across time and across the patients you serve, then they will cite you for not providing individualized care. Review every item in your note to make sure they are relevant for that patient’s visit that day.

4.) All notes should be signed by the licensed professional, correctly dated for when the services were rendered, and the time associated with the visit.
Lawyers, auditors and accreditation organizations look when the notes are completed. All notes should be started on the day services were rendered and finished within 24 hours. The note should have not only the signature of the provider but the time and date on the note. If your notes are not completed in a timely manner, then be prepared to answer, “What are you trying to hide?” or, “How many patients did you see that day? How could you remember what to write if you did your note a week later?” Any notes that are placed in the medical chart greater than 24 hours after the patient was seen is subject to concern.

5.) Avoid saving the note on the wrong date—a common mistake when a professional does not complete documentation on the day of service.
Two things to know:

  • If the note is not there on the day of service, then the patient was not seen.
  • If you dropped charges on a day of services that the patient did not have an appointment and was not seen, then this is considered fraudulent billing and you could be subject to not only losing your license to practice but also significant fines. If this happens, amend the note immediately to the correct day of service! To prevent this from happening, try to incorporate your documentation during the day or at “bedside” when you are with the patient.

6.) Develop a policy on the use of cloning, the copy-paste feature, and over-documentation in EHR technology. CMS has been charged with reviewing your policy if your site is selected for audit. OIG reported that only a third of practices audited had a policy. Be prepared!

Documentation should not be considered additional work but an extension to your patient care activities. Finally, remember our ultimate goal is to provide the best possible care that is timely and based on evidence-based practices. Having timely and accurate information in your note, and nothing else, will help provide the best possible care to your patients. The consequences are too serious to do anything less.

For additional information about documentation, visit leancare.wordpress.com.

Tamala Selke Bradham, PhD, CCC-A, is associate director of quality, protocols, and risk management in the Department of Hearing and Speech Sciences at Vanderbilt University. She is an affiliate of ASHA Special Interest Group 9, Hearing and Hearing Disorders in Childhood.

 

 

Learning to Hear: Finally, the Technology

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Hearing aids have improved by leaps and bounds over the past decade. The advanced signal processing and wireless connectivity options absolutely boggle the mind. As an audiologist, I’m constantly amazed at what today’s hearing aids are capable of doing for patients. I’m equally amazed at what my patients expect the hearing aids to be capable of doing for them; yet can we blame them? They are bombarded by newspaper advertisements and mailers boasting the incredible benefits of modern hearing aids. They don’t understand what all is (or should be) included in bundled pricing, so they figure that a $X,000 pair of hearing aids should fix their hearing problems and more. I believe these inflated expectations, coupled with a lack of comprehensive patient education during the rehabilitative process, explain why patient satisfaction and market penetration are not increasing at the same rate as the technological advancements in amplification.

So how do we address these issues? The answer always goes back to the root of our profession. As audiologic rehabilitation specialists, our job is to equip our patients with tools and strategies necessary to function successfully in the world, despite their hearing loss. Patients must understand that hearing aids are only one piece of the puzzle when it comes to successful communication. In fact, there are five essential keys to communication success:

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In previous blogs we’ve discussed listener strategies, speaker strategies, and environmental modifications as critical parts of the communication puzzle. During the aural rehabilitation process, I deliberately present those pieces before I discuss technology options. Listener strategies empower the patient to take responsibility for their hearing loss. Speaker strategies engage the communication partners to be involved. Environmental modifications make the patient and their communication partners aware of their surroundings and empower them to actively create the best possible listening situations.

When we’re finally ready to present technology options, there are two important points to keep in mind. First, we need to be sure we are presenting options. I don’t mean options in terms of different hearing aid manufacturers. I mean options in terms of ALL the technology options appropriate for the patient, based on his or her specific listening challenges. I present the options as a continuum, with inexpensive assistive listening devices and personal sound amplifiers on one end, and high end hearing aids with wireless accessories on the other end. Obviously there are many technological options in between. Second, it is critical that the technology options are presented in conjunction with the other strategies discussed. Patients must understand that technology must be combined with speaker and listener strategies and environmental modifications. The speaker, listener, environment, and technology keys are equally important when it comes to ensuring a successful communication exchange.

The fifth key to communication success is practice. Patients can learn all the communication strategies in the world, but they won’t help a bit if they don’t actually use them. The same goes for technology. Patients can buy the most advanced digital hearing aids available, but they are just a waste of money if they refuse to wear them in all of their challenging listening situations. As rehabilitation specialists, we are responsible for motivating our patients to practice and use all that they’ve learned. We must find ways to hold them accountable and create a follow-up plan that ensures long-term success.

Patients with hearing loss have many options when it comes to pursuing technology. As audiologists, it is our responsibility to make them see the “big picture” and implement a comprehensive plan that addresses all pieces of the communication puzzle. I truly believe that patient satisfaction and market penetration rates will only increase when we return to our roots and make patient education the focus of our rehabilitation efforts.

 

Dr. Dusty Ann Jessen, AuDis a practicing audiologist in a busy ENT clinic in Littleton, Colo. She is the founder of Cut to the Chase Communication, LLC, a company dedicated to providing “fun, easy, and effective” counseling tools for busy hearing care professionals. She is also the author of Frustrated by Hearing Loss? 5 Keys to Communication Success. Dr. Jessen can be contacted at info@CutToTheChaseCommunication.com.

 

Become a (Hearing) Environmentalist

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Communication is a complex puzzle that requires all pieces to be properly placed. It is critical for audiologists to address all pieces of that puzzle during the aural rehabilitation process to ensure a successful outcome for the patient. A comprehensive counseling protocol should thoroughly address the following five keys to communication success:

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My previous blogs focused on the roles of the speaker and the listener in a communication exchange. Today we’ll address the third key to communication success: environment. No, I’m not talking about the trees and the birds! When it comes to communication, environmental modifications often have the biggest impact, yet they are often overlooked. Let’s take a look at one of the most difficult listening situations for people with hearing loss, and how environmental modifications can reduce potential communication challenges.

The hastily-educated patient:

Mr. Jones and his wife are looking forward to dinner at their favorite restaurant to celebrate their anniversary. After a busy day, they rush out of the house at 5:30 p.m., hoping they won’t have to wait too long for a table. They are both starving, so they accept the first-available table, which happens to be in the middle of the restaurant and close to the kitchen. Mr. Jones is still adapting to his new hearing aids and feels overwhelmed by all of the noise. They are surrounded by families with loud children, clanking dishes, and noises from the kitchen. He and his wife can hardly hear each other above all the noise and feel frustrated that they weren’t able to fully enjoy their anniversary dinner. They are both disappointed that his new hearing aids did not perform better in this situation.

The well-educated patient:

Mr. Jones and his wife are looking forward to dinner at their favorite restaurant to celebrate their anniversary. They make a 4:00pm reservation and request a corner booth with good lighting. When they arrive for dinner, they are pleased to find that they nearly have the restaurant to themselves. They are seated immediately, served quickly, and enjoy reminiscing about the past year over a pleasant early dinner. Mr. Jones is pleased that his new hearing aids made it easier to hear his wife’s voice.

It doesn’t take a rocket scientist to figure out which scenario will result in a more satisfied patient outcome. Determine which situations are most challenging for your patients, and help them to develop an “environmental modification” plan for those specific situations. These plans typically incorporate some version of the following two elements:

1. Reducing background noise
2. Improving visibility (ex. lighting, proximity, orientation)

It is our professional responsibility to make sure that every patient is educated and equipped with tools and strategies that address all pieces of the communication puzzle. They must understand that environmental modifications are just as important as the hearing aids. While thorough patient education may take a bit longer in the beginning, it almost always saves valuable clinic time in the end. The resulting patient success and satisfaction certainly make it time well-spent.

 

Dr. Dusty Ann Jessen, AuDis a practicing audiologist in a busy ENT clinic in Littleton, Colo. She is the founder of Cut to the Chase Communication, LLC, a company dedicated to providing “fun, easy, and effective” counseling tools for busy hearing care professionals. She is also the author of Frustrated by Hearing Loss? 5 Keys to Communication Success. Dr. Jessen can be contacted at info@CutToTheChaseCommunication.com.

 

 

 

Why Growing a Healthy Green School is Golden

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Remember dioramas from first and second grade? Last fall I was invited to attend the opening of the U.S. Environmental Protection Agency’s “Lessons for a Green and Healthy School” exhibit, a giant, life-sized, walk through diorama on how to create a green environment in schools. Located at the Public Information Center of US EPA’s Region 3 offices in Philadelphia, what I learned there about sustaining a healthy school for students, teachers, and community was exciting…and I heard it from the students themselves. [How to Build A Healthy School]

The Green Ribbon Schools Program is a joint endeavor between the U.S. EPA and U.S. Department of Education. The program honors schools and districts across the nation that are exemplary in reducing environmental impact and costs; improves the health and wellness of students and staff; and provides effective environmental and sustainability education, which incorporates STEM (science, technology, engineering, mathematics), civic skills and green career pathways.

A healthy green school is toxic free, uses sustainable resources, creates green healthy spaces for students and faculty, and engages students through a “teach-learn-engage” model. Examples of greening techniques include the using building materials for improved acoustics; installing utility meters inside the classroom as a concrete aid for teaching abstract concepts in math; and incorporating storm water drainage systems within a school’s landscape design to teach and practice water conservation. What are some environmental concerns to address when you are growing a healthy school?

  • Asthma and asthma triggers (indoor air quality)
  • Asbestos and lead (especially in older buildings)
  • Carbon monoxide (from old furnaces, auto exhaust)
  • Water fountains
  • Chemicals in the science lab (think mercury)
  • Art and educational supplies
  • Managing extreme heat
  • Upkeep of athletic grounds
  • Mold, lighting fixtures
  • Waste and recycling

Now more than ever, we must educate new generations of citizens with the skills to solve the global environmental problems we face. How can we have a green future or a green economy without green schools?

Benefits of green schools

1. Cost/Energy Savings:Daylighting” or daylit schools achieve energy cost reductions from 22 percent to 64 percent over typical schools. For example in North Carolina, a 125,000 square foot middle school that incorporates a well-integrated daylighting scheme is likely to save $40,000 per year compared to other schools not using daylighting. Studies on daylighting conclude that even excluding all of the productivity and health benefits, this makes sense from a financial investment standpoint. Daylighting also has a positive impact on student performance. One study of 2000 school buildings demonstrated a 20 percent faster learning rate in math and 25 percent faster learning rate in reading for students who attended school with increased daylight in the classroom.

2. Effects on Students: Students who attended the diorama presentation in Philadelphia expressed a number of ways how their green school changed personal behavior and attitudes. One young lady spoke of how a green classroom helped her focus and stay awake. Another student said being in a green school made them happier. There was more interest in keeping their school environment cleaner by monitoring trash disposal, saving water by not allowing faucets to run unnecessarily, picking up street trash outside the school, sorting paper for recycling, and turning off lights when room were no longer in use. Some students went so far as to carry out their green behaviors at home. Small changes in behavior and attitude such as these are the foundation for a future citizenry who will be better stewards of the environment.

3. Faculty Retention: Who wouldn’t want to be a speech-language pathologist in a green school? Besides, there would be so many opportunities for a therapist to embed environmental concepts in to their session activities. Think how a quieter environment would foster increased student attention. How about having the choice of conducting a small group session in the pest-free landscape of the school yard? Research supports improved quality of a school environment as an important predictor of the decision of staff to leave their current position, even after controlling for other contributing factors.

How to make your school green

  • Have a vision for your school environment. You can start small at the classroom level or go district wide. Focus on one area or many (healthier cafeteria choices, integrated pest management, purchase ordering options, safer chemistry lab) Maybe you already know what environmental hazards affect your school – if you do then start there.
  • Get a committee going. It helps to have friends. Is there someone you can partner with? School nurse, building facilities manager, classroom teacher, PTA, students?
  • Conduct a school environmental survey. This doesn’t have to be complicated, you can poll your colleagues, or discuss at the next department meeting, or over lunch. If you like, check out EPA’s “Healthy SEAT – Healthy School Environments Assessment Tool” for ideas.
  • Have a plan. Select a time frame, short term first and use it as a pilot to evaluate whether a green school is possible. Pick something small to work on.
  • Monitor and evaluation your progress. It’s always a good idea to collect data but it doesn’t have to be too sophisticated. Use “before and after “ photos or video student testimonials.
  • Embed the green environment into the student curriculum and activities. Create speech lesson plans with green materials or photos of your green school project. Growing Up Wild is an excellent curriculum for early childhood educators.

Anastasia Antoniadis is with the Tuscarora (PA) Intermediate Unit and works as a state consultant for Early Intervention Technical Assistance through the Pennsylvania Training and Technical Assistance Network. She earned a Master of Arts degree in speech pathology from City College of the City University of New York and a Master’s degree in public health from Temple University. She was a practicing pediatric SLP for 14 years before becoming an early childhood consultant for Pennsylvania’s early intervention system. Her public health studies have been in the area of environmental health and data mapping using geographic information system technology.  You can follow her on Twitter @SLPS4HlthySchools. 

 

 

 

Aural Rehab: Getting an “A” in Listening

listening

There is no denying that aural rehab is critical for patient success with amplification. Unfortunately, most hearing care professionals do not implement a structured, patient-focused aural rehab program. They report lack of time, lack of patient compliance, and lack of reimbursement as the common challenges. As a practicing audiologist, I face these challenges on a daily basis, which prompted me to develop the 5 Keys to Communication Success and the Cut to the Chase Counseling program. The 5 Keys to Communication Success are:

dusty graphic

Educating our patients about these five simple keys to successful communication will help them to understand a few important points:

  • Communication is like a puzzle that requires several pieces to work properly.
  • Hearing aids are only one piece of this communication puzzle.
  • Involvement of family members, friends, and caregivers is essential.

When patients fully grasp the complexity of communication, and understand that each piece of the puzzle is critical for communication success, they are much more likely to be satisfied with their hearing aids and to comply with our recommendations.
My previous blog went into detail about the first key, The Speaker.
Today I’ll dive deeper into the second Key to Communication Success: The Listener. Most of the listener strategies we attempt to teach our patients are critical for all listeners, including those with perfect hearing. However, the importance increases exponentially when the listener is challenged by hearing loss. We must impress upon our patients that implementing these strategies is just as important as wearing their hearing aids.
Listener strategies revolve around the concept of active listening. The listener is no longer allowed to sit back and passively expect communication to happen effortlessly. Even with new hearing aids, this is an unrealistic expectation. I encourage my patients to earn an “A” in listening. To accomplish this, they must:

  • Be aware of their surroundings.
  • Anticipate what might be said.
  • Take action to make sure they can clearly see the speaker’s face.

As with all of the communication keys, I find it works best to classify the listener strategies by environment. For example, in a restaurant environment I instruct the listeners to read and discuss the menu ahead of time, to focus on the facial expressions and lip movements of the speaker, and to actively “tune out” the noises that aren’t helpful for communication. We also discuss listener strategies for the following environments: around the house, in the car, dining out, on the phone, and public events. While repetition of strategies is common between environments, I find that patients are more likely to retain and implement the information when it is applied to a specific situation where they experience listening challenges. It is also easier for patients to grasp the importance of these strategies when they see them repeated across environments.
The ultimate goal is to equip and empower our patients with a multitude of tools that will facilitate successful communication. The simple structure of the 5 Keys to Communication Success makes this easier and more efficient for both clinicians and patients alike. Next month I’ll discuss the third key: Environment.

 

Dr. Dusty Ann Jessen, AuDis a practicing audiologist in a busy ENT clinic in Littleton, Colo. She is the founder of Cut to the Chase Communication, LLC, a company dedicated to providing “fun, easy, and effective” counseling tools for busy hearing care professionals. She is also the author of Frustrated by Hearing Loss? 5 Keys to Communication Success. Dr. Jessen can be contacted at info@CutToTheChaseCommunication.com.