Learning to Hear: Finally, the Technology

tech

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:

dusty graphic

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

green school

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.

 

Mission Impossible: Collaboration (Are We Succeeding?)

collaboration

 

Ellie’s parents were optimistic about her transition from her private preschool for children with hearing loss to her neighborhood public school kindergarten.  After all, Ellie’s speech and language skills had improved greatly since enrolling her in the preschool. Ellie’s previous school had an audiologist who came to the school daily to check all the children’s equipment and interacted easily with Ellie’s speech-language pathologist and teachers of the deaf.  However, only a few weeks into kindergarten, Ellie’s mother was already concerned that the new speech-language pathologist was not checking Ellie’s cochlear implant on a regular basis.  The audiologist for the school district was responsible for 250 children at multiple schools throughout the county so how attentive could she be to Ellie’s needs?  Would Ellie tell her teacher if her implant wasn’t working, or if her battery was dead?  Would Ellie’s implant audiologist at the hospital share her test results with the speech-language pathologist, as Ellie’s mother had requested?

Scenarios such as this one are familiar to those of us who work with children with hearing loss.  Children are being identified and treated for hearing loss earlier than ever thanks to universal newborn hearing screenings and enhanced technologies.  The same children who 30 years ago would have been in specialized educational settings are now entering mainstream classrooms across the nation.  Clearly this was our goal, and we are excited to see the progress that has been made on this front.  However, when a child is in a general education classroom, sees her audiologist twice a year for programming at a hospital 50 miles from home, gets private speech therapy one hour a week at ABC Therapy, and sees the school SLP for 30 minutes twice a week, coordination of care can fall through the cracks.  It was this disconnect between the professions of speech-language pathology and audiology that first drove me to pursue both my Au.D. and SLP degrees and become dually certified.  I wanted to be able to treat the whole patient, from diagnosing the hearing loss to helping them achieve listening and spoken language outcomes.

In 2011-2012, I conducted a survey under the direction of Anne Marie Tharpe, Ph.D. examining this issue.  We wanted to know whether or not audiologists and speech-language pathologists believed they were collaborating effectively, and we wanted to see if the parents of children with significant (moderate-profound) hearing loss agreed.  We surveyed 189 individuals, essentially evenly divided between parents, audiologists, and speech-language pathologists.  Almost all respondents to the survey felt that collaboration between the two professions was important.  “Collaboration” meant everything from sharing test results to attending IEP meetings.  The take-home message from the survey results was that about 1/3 of the parents and audiologists, and 1/4 of SLPs surveyed did not agree that professionals were working collaboratively.  So one out of every three parents with whom you interact may feel there is something more we could be doing to work better as a team.

The most often-cited barriers by clinicians to collaboration included time constraints and large caseloads.  One of the most rewarding findings in the survey was that 100 percent of parents of children ages birth-3 years felt that professionals were working collaboratively.  This tells us that we have indeed done a good job in improving our service delivery to this population with a focus on family-centered care.  However, we are still challenged by how to provide collaborative hearing care to children and their families when they reach school.

So what are your thoughts? Do you feel you work well as part of the parent-audiologist-speech-language pathologist team?  What are your biggest frustrations? How might we improve our collaborations with other professionals – perhaps by embracing new technology that allows us to communicate and collaborate in a more timely manner? As we think about Better Speech and Hearing Month this May, let’s focus on working toward better collaboration with one another so that children such as Ellie have the best chance to succeed.

 

Adrian Taylor, Au.D., M.S., CCC-A/SLP is an audiologist and speech-language pathologist at the Vanderbilt Bill Wilkerson Center in Nashville, Tenn.  She works primarily in the area of cochlear implants and aural (re)habilitation in both the pediatric and adult populations. Adrian may be contacted at Adrian.l.taylor@Vanderbilt.edu.  

Are You Ready for Better Speech and Hearing Month?

bhsm

Better Hearing and Speech Month is a mere week away, and ASHA is gearing up for an exciting month! By now, we hope you’ve seen some of the resources we developed specifically for members—press release and media advisory templates, our 2014 poster, a Facebook cover photo, a letter to parents, our 2014 product line, and much more. We also encourage members to utilize the Identify the Signs member toolkit during May, as the campaign will be front and center for this year’s BHSM. The campaign’s message of early detection is a great tie-in to the 2014 BHSM theme of “Communication disorders are treatable.”

If you’re still looking for ideas on ways to celebrate, it’s not too late to plan something. We’ve got a list of suggestions here, and you can check out our new interactive map featuring stories of how your fellow ASHA members have recognized the month.

If you do have a fabulous event or activity in store, we want to see it! Take a photo and post to Instagram with the hashtag #BHSM. One winner will be randomly selected to receive a package of 2014 BHSM products. More details can be found on the BHSM member resource page. The contest will run from May 1st – 12th.

In addition to member resources and contests, ASHA will be conducting a lot of public outreach during the month to raise the profile of communication disorders and the role of ASHA members in treating them. Some highlights this May include:

  • Google Hangout—A live, online Google Hangout to mark BHSM will be held on May 6th from 1:30 – 2:30 p.m. ET. Moderated by ASHA CEO Arlene Pietranton, the event will convene experts from a wide range of backgrounds to discuss the critical role that communication plays in daily life—and the importance of early detection of any speech, language, or hearing difficulties in children to allow them to reach their full potential academically and socially. Guests will include Elizabeth McCrea, ASHA’s 2014 President; Libby Doggett, deputy assistant secretary for policy and early learning at the U.S. Department of Education; Sara Weinkauf, an autism expert from Easter Seals North Texas; Patti Martin, an ASHA-certified audiologist from Arkansas Children Hospital; and Perry Flynn, an ASHA-certified speech-language pathologist at the University of North Carolina – Greensboro. The panel will take questions from the public, and members are encouraged to participate. Questions can be posted to ASHA’s Google+ page, or use the hashtag #BHSM on Twitter. You can RSVP for the event here.
  • Twitter Party—A Twitter party hosted by lifestyle technology and parenting blogger Michele McGraw (@scrappinmichele), and co-hosted by five other leading parenting bloggers, will be held on May 20th from 12 – 1 p.m. ET. During the party, parents and other interested parties will have the opportunity to learn, and ask and answer questions, about speech, language, and hearing disorders. No RSVP is required; members who are interested in joining in should just follow the hashtag #BHSMChat at that time.
  • New Infographic—A new infographic illustrating the prevalence and cost of communication disorders, as well as the benefits of early intervention, will be posted online at www.asha.org/bhsm and http://IdentifytheSigns.org, and distributed widely to traditional and new media.
  • Podcast Series—Four new topical podcasts featuring ASHA members will be rolled out weekly during the month. These are: Newborn Hearing Screening—In the Hospital and Beyond (May 1); Noise-Induced Hearing Loss in Children: A Preventable Problem (May 12); Autism Diagnosis and Treatment of Today and Tomorrow (May 19); and Building Language and Literacy Skills During the Lazy Days of Summer (May 27). These will be available at http://IdentifytheSigns.org.
  • International Communication Project 2014—During May, ASHA is going to be disseminating digital messaging that relates to the International Communication Project 2014 that was launched earlier this year—and promoting signatories to the Universal Declaration of Communication Rights. Members are encouraged to sign the Declaration and invite others to do so to show their support for people with communication disorders. Watch the February Google Hangout to learn more and hear from the participating countries.

 

Many of these resources won’t be available until May 1 or later, when they are debuted to the public. We encourage you to visit our member resource page www.asha.org/bhsm frequently to see the latest, and hope you can share the information with your networks. These resources will also be posted to http://ldentifytheSigns.org, the home of the Identify the Signs campaign and a site designed for consumers to easily find information tailored to them.

We hope this year’s BHSM will be one of the best yet, and look forward to hearing how you’re celebrating the month. Send us any stories, questions, or comments to bhsm@asha.org.

 

Francine Pierson is the public relations manager at ASHA. She can be reached at fpierson@asha.org.

Beyond Skype for Online Therapy: Protecting Student Privacy

Privacy

 

The trend for kids online is sharing more, not less. Today’s kids consciously and unconsciously share so many aspects of their life using Facebook, Skype or even newer tech tools like Snapchat. But, as educators, we hold ourselves to a much higher legal and professional standard for protecting the information of these very same students. We’ve all heard about the laws—FERPA, HIPAA, COPPA— that set the standards for privacy of student records and personally identifiable information, but what do the laws mean in the context of delivering speech-language therapy online?

HIPAA: Protecting Individually Identifiable Health Information

Created by the Department of Health and Human Services in 1996, The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that protects patient medical records. HIPAA specifically protects “individually identifiable health information,” which includes:

  • the individual’s name, address, birth date and Social Security number.
  • the individual’s past, present or future physical or mental health or condition.
  • the provision of health care to the individual.
  • the past, present or future payment for the provision of health care to the individual.

HIPAA gives patients a variety of rights regarding individually identifiable health information. With consent, HIPAA permits the disclosure of health information needed for patient care, such as speech therapy.

FERPA: Protecting Education Records

The Family Educational Rights and Privacy Act (FERPA) is a federal law that protects student education records. FERPA gives parents certain rights with respect to their children’s education records until they turn 18 or transfer to a school higher than the high school level, thus making them “eligible students.” The law applies to all schools that receive funds under an applicable program of the U.S. Department of Education. Under FERPA, parents or eligible students have the right to:

  • Inspect and review the student’s education records.
  • Request a school to correct records they believe to be inaccurate or misleading.
  • Prevent a school from releasing information from the student’s education record without written permission (with some exceptions).

COPPA: Protecting Children’s Personal Information

The Federal Trade Commission instituted COPPA (Children’s Online Privacy Protection Act) in April, 2000 to protect children’s personal information on websites and applications that target children under the age of 13. Under the legislation, websites and apps that collect this information must notify parents directly and get their approval prior to the collection, use or disclosure of a child’s personal information. The FTC describes personal information as:

  • A child’s name, contact information (address, phone number or email address.
  • A child’s physical whereabouts.
  • Photos, videos and audio recordings of the child.
  • A child’s “persistent identifiers,” like IP addresses, that can be used to track a child’s activities over time and across different websites and online services.

Recommendations for Online Therapy

Clinicians and educators often focus on the capabilities of individual pieces of technology, and, indeed, a secure therapy platform is highly recommended both to ensure the privacy of sessions as well as student data. However, it is the information, and the sharing of that information by the adults responsible for the care of each child, that these laws focus on. So educators need to focus on a systems approach that considers the end-to-end process of handling and securing student data.

While clinicians are trained in student identity protection, non-disclosure methods and the maintenance of student record confidentiality, it is ultimately the school’s responsibility to ensure agreements they have in place with online therapy service providers support them in protecting student privacy. So what are the practical considerations in this end-to-end approach to protecting the privacy of students receiving online therapy?

  1. Ask what type of security is in place. Solutions with bank-level security offer the strongest protection of data. This includes 256-bit encryption using TLS 1.0, restricted physical access to the servers on which data is stored, and 24/7 on-site security personnel.
  2. Use a secure platform for therapy. Secure platforms use an invite-only, encrypted, secure connection. In this model, only the online clinician and the student assigned to that particular appointment time are permitted to enter the password-protected “therapy room.” Parents may also view a session with a prior written request.
  3. Use a secure server to store data. Make sure all student files containing individually identifiable health information and education records are stored on a secure server using industry-leading security.
  4. Restrict access. Only online clinicians, authorized school administrators and parents should have access to this password-protected information, thus further protecting student privacy.

This “big picture” thinking will let educators take advantage of new online delivery models for therapy services AND stay compliant with privacy laws. And leave Snapchat to the students.

Melissa Jakubowitz, MA, CCC-SLP, is the Vice President of SLP Clinical Services at PresenceLearning. She is a Board Recognized Specialist in Child Language with more than with more than 20 years of clinical and managerial experience. She is the past-president of the California Speech-Language-Hearing Association and is active in ASHA, serving as a Legislative Counselor for 12 years.

Aural Rehab: The Role of the Speaker

speaker
In my last blog post, Aural Rehab: Are we getting the job done?, I discussed the challenges faced by audiologists when it comes to the education and counseling aspects of the aural rehab process. I gave a brief overview of our Cut to the Chase counseling program, and introduced the “5 Keys to Communication Success.” 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.
Let’s take a closer look at the first key to communication success: The Speaker. Obviously the speaker and the listener are the two most important keys, as there would not be a communication exchange without them. But the speaker is arguably the most important key as they are responsible for creating a clear message that will be understood by their listener. This is why it is so important to involve family members in the aural rehab process. I’m sure I’m not the only audiologist who has experienced the following scenario:
I just fit Mr. Jones with new hearing aids, verified his fitting, and asked him what he thinks. He smiles and reports that they sound kind of strange, but that my voice seems nice and clear. He then turns to his wife and asks her to say something. Rather than looking at her husband and speaking to him in a normal tone, Mrs. Jones stands, walks to the far side of the office, and (with her back toward him) whispers to her husband, “Can you hear me now?”
Of course, Mr. Jones cannot hear her and, although I may have slightly unpleasant words going through my head for Mrs. Jones, I find this is the perfect time to educate her about her essential role as the speaker. I teach my patients to use their senses as a reminder about their critical role in the communication process.

The first sense is vision. The listener must be able to see the speaker’s face. This means that the speaker will often have to go to the listener before they begin speaking. Other times, the speaker will need to call to the listener, and wait for the listener to come to them before they begin speaking. This eliminates the difficulties associated with speaking from another room, or with their back toward the listener. Sometimes, however, this is not enough. That’s when we turn to the sense of touch.

When the speaker moves close enough to the listener that they can actually reach out and touch them, the speaker and the listener are perfectly situated for a perfect communication exchange. Sometimes the listener is so intent on a television program that they simply don’t hear the speaker calling to them. Rather than getting angry and yelling, I teach my patients to gently touch the listener on the arm to get their attention, and their message will then be received successfully.
Of course, we also teach the family members and caregivers to speak clearly and not to over-exaggerate their words. We encourage them to alert the listener to changes in topic, and to check-in frequently to make sure they are being understood. Most importantly, we try to impress upon the speakers that they are half of the equation when it comes to communication. We let them know that they can either be half of the problem, or half of the solution. This may seem harsh, but the importance should not be understated if we are to provide our patients with complete communication solutions! Next month we’ll focus on the other half of that equation: The Listener.

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.

Kid Confidential: The Latest on Treatment of Ear Infections

ear infection

For those of us speech-language pathologists who serve the birth-5 year old population (or have young children of our own), it is always important for us to know the most recent health and safety regulations that can affect our clients/students. Here are the newest regulations regarding the medical treatment of ear infections.

As otitis media affects three out of four children by the age of three, and there is a correlation between chornic otits media and communication delay, it is likely that we as SLPs will treat students with acute or chronic otitis media.  As a result we must understand the American Academy of Pediatrics (AAP) guidelines regarding the medical treatment of this condition.

Although, these regulations were initially released in 2004, it appears there is still much confusion among the medical community and, as a result, a second publication of the same AAP medical regulations for treating otitis media was released in 2013.

The regulations were written in response to antibiotic overuse and resistance in children.  Traditionally children are treated with antibiotics as the first line of defense for acute otitis media.  As there are a number of causes for ear pain, it is crucial that pediatricians firstly make an accurate diagnosis of otitis media prior to administration of antibiotics.  Doctors are urged to diagnose otitis media only when a moderate to severe bulging of the tympanic membrane (i.e. ear drum) is present.  Mild bulging and recent ear pain (i.e. meaning within 48 hours) exhibited along with other signs of ear infection (e.g. fever) also may be diagnosed appropriately.  Therefore, if the pediatrician is unsure of the diagnosis of otitis media he/she is discouraged t to prescribe antiobiotics.

Although pain is present, antibiotics are not necessarily to be considered the first course of action. In fact, in response to ear pain and/or low grade fevers, pain relievers are to be recommended initially as “about 70 percent of kids get better on their own within two or three days, and giving antibiotics when they aren’t necessary can lead to the development of superbugs over time” reports Dr. Richard M. Rosenfield, professor and chairman of otolaryngology at SUNY Downstate Medical Center, Brooklyn.

Antibiotics are only to be prescribed when the child is exhibiting several signs or symptoms of otitis media (e.g. pain, swelling for at least 48 hours, fever above 102.2 degrees Fahrenheit, etc.).  Immediate prescription of antibiotics should be recommended in the event a child’s tympanic membrane ruptures.

Although it is important to understand the medical treatment of otitis media, perhaps it is more important for us to understand the simple preventive measures a parent can take to help avoid the development of ear infections in the first place.  In addition to this medical treatment plan, the guidelines also stress avoidance of tobacco exposure, receiving the influenza vaccination, and breast feeding exclusively for the first 6 months (if possible) as additional ways to prevent infant ear infections.

Medial guidelines for “silent ear infections” (i.e. middle ear fluid without presence of other symptoms typically following acute otitis media or colds) consist of “watchful waiting.”  If a child is diagnosed with “silent ear infections” also known as otitis media with effusion the pediatrician should initially provide no medical treatment.  A follow up reexamination should take place three to six months later.  If fluid persists for more than three months, the pediatrician should recommend a speech/language and hearing assessment.  If middle ear fluid persists more than four months and signs of hearing loss are evident, a pediatrician may recommend placement of PE tubes or refer their patient to an ENT for further assessment.

I very much appreciate the AAP for adding in the guideline of further assessment in the areas of speech/language and hearing if fluid persists longer than three months.  This demonstrates the AAP’s understanding of the important of communication development and the need for a quick resolution to such delays rather than the typical “wait and see” attitude that parents often report to encounter particularly in instances of “late talkers.”  Now we, as SLPs, have guidance and support from the AAP for our clients/students with long-term persistent middle ear fluid.

Please refer to the resources below for further information.

Resources:

Jaslow, R. (2013, February 25). Antibiotics for ear infections: Pediatrician release new guidelinesCBS News.

New guidelines for treating ear infections. (2004). The Harvard Medical School Family Health Guide.

 

Maria Del Duca, M.S. CCC-SLP, is a pediatric speech-language pathologist in southern, Arizona.  She owns a private practice, Communication Station: Speech Therapy, PLLC, and has a speech and language blog under the same name.  Maria received her master’s degree from Bloomsburg University of Pennsylvania.  She has been practicing as an ASHA certified member since 2003 and is an affiliate of Special Interest Group 16, School-Based Issues.  She has experience in various settings such as private practice, hospital and school environments and has practiced speech pathology in NJ, MD, KS and now AZ.  Maria has a passion for early childhood, autism spectrum disorders, rare syndromes, and childhood Apraxia of speech.  For more information, visit her blog or find her on Facebook.

On Becoming an Interprofessional

teamwork

According the authors of “The Interprofessional Healthcare Team: Leadership and Development,” interprofessionalism refers to the active participation of different professionals, which may include persons with professional licensure or certification in nursing, occupational therapy, physical therapy, speech-language pathology, social work, and other health-related professions who are collaborating to provide quality services to the patients they serve. Through a steadfast commitment to collaboration, interprofessional practice among healthcare professionals seeks to enhance the quality of health and medical services, which lead to improved patient outcomes. Developing synergy between through shared knowledge and decision-making promotes positive change in work settings and builds meaningful relationships with patients and their families. But, say the authors, shaping efficacious teams depends upon fundamental knowledge of the represented field, the use of evidence-based practice, interprofessional leadership, and members who are prepared to collaborate effectively in a team, which we believe can be accomplished through interprofessional education (IPE).

 
The Institute of Medicine Committee on Health Professions Education provides recommendations for developing a strong team: “health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics.” Because of ongoing changes to the U.S. healthcare system, including insurance policy initiatives, technological advances, and innovative service delivery models, it is imperative for all professionals, including speech-language pathologists and audiologists, to embrace a new spirit of interprofessional collaboration and cooperation. Leading health organizations, such as the Pew Health Professions Commission, the Institutes of Medicine, and the World Health Organization, support the concept that health professionals have received adequate education to work in healthcare settings only if it includes experience participating in interdisciplinary teams to collaboratively solve complex problems.

 
Due to changes in service delivery models that have resulted in an increase of members within healthcare teams, interprofessional practice is rapidly becoming an expectation in most healthcare settings. Universities and training programs in speech-language pathology and audiology are only recently beginning to embrace models of IPE. In some universities, students from several disciplines are enrolled in the same courses, teamed for practicum experiences, participate in field-based experiences, and ultimately learn to work as effective, interprofessional teams. A unique way for IPE to be learned has recently occurred though simulation-based education in the College of Health Professions at The University of Akron.

 
Simulation-based education is an innovative process for creating authentic situations in which groups of IPE students learn to collaborate. Specifically, this technique can assist in overcoming some of the challenges that exist in healthcare: inadequate communication among professionals, focusing on specific needs rather than the whole patient, lack of knowledge of other professionals’ roles, the inability to work as an effective team member, and a lack of conflict-resolution skills. IPE conducted as a simulation activity may supplement traditional classroom strategies to enhance the performance of healthcare providers, ultimately resulting in reduction of errors in the workplace and an increase in the quality of care provided to patients. Although this strategy has been recognized by various international professional societies, including the World Health Organization and Institute of Medicine, as foundational to achieving safe, high-quality, accessible patient-centered care, not many healthcare training programs are on board.

Fortunately, as graduate students in speech-language pathology at The University of Akron, we were given the opportunity to participate in an IPE simulation activity. It included more than 90 students studying in the fields of nursing, nutrition/dietetics, social work, medicine, and pharmacy. Groups of five or six students from each discipline worked together to treat a specific, simulated patient. This particular simulation portrayed a young female combat veteran primarily diagnosed with a traumatic brain injury, with secondary diagnoses of depression, binge eating, insomnia, post-traumatic stress-syndrome, and cognitive deficits. Working as a team, our goal was to assess, diagnose and create a treatment plan for this patient to help alleviate her daily struggles, such as her inability to maintain a healthy diet, pay attention during class, and communicate effectively with loved ones. To develop an effective treatment plan, these challenges needed the knowledge and skills of each of the disciplines that participated in the simulation activity.

As the simulation began, we quickly recognized the need for strong interpersonal skills. It was a challenge figuring out when to speak, when to listen, and how to deliver opinions appropriately. Common observations of group dynamics included students promptly stating their opinions on how the patient should be treated before discussing a rationale or their role; students aggressively prioritizing needs of the patient without consultation; and many students reported they were unaware or had misconceived ideas about the roles of other professionals, especially speech-language pathologists. From these experiences, the need for this type of training was even more apparent. We learned that professional roles, especially speech-language pathologists, may be unclear to others, and we found ourselves advocating for our field and its importance in making treatment decisions. We also found that many students were very knowledgeable about their discipline but lacked good communication skills. This challenge resulted in a struggle to connect constructively with other students in other courses of study. We now recognize how vital  interpersonal skills are to delivering optimum patient-centered care.

 
From this exercise we now believe an IPE approach to teaching and training can have a tremendous impact on the preparation of speech-language pathologists and audiologists. With this training, students will enter the workforce with experience collaborating with other professionals and will understand the power of teamwork to accomplish a task. When students practice interprofessionalism and see the power in collaborating with other professionals, greater progress can be achieved in the workplace. Participating in the IPE simulation has boosted our confidence by showing us how to apply our clinical knowledge and skills in a safe but functional learning environment, but most importantly, it has given us a sense of how to work as a team to improve the life of our patient, which is the essence of patient-centered care. We have definitely taken our first critical steps toward becoming truly interprofessional!

Crystal Sirl, BA, is a graduate student in the School of Speech-Language Pathology and Audiology at The University of Akron.
Grace Bosze, BA, is a graduate student in the School of Speech-Language Pathology and Audiology at The University of Akron.