Of Language Barriers, Culture Gaps and e-Bridges

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It certainly isn’t news that our country is becoming increasingly diverse. What may surprise us is that some of the biggest growth is happening in non-border, less-urbanized states. California, Texas and Florida continue to have the most residents who were born in another country. However, Alabama, Arkansas, Delaware, North Carolina and Tennessee all saw more than a 70% increase in foreign-born residents between 2000 and 2012.

This means that ASHA members probably find themselves with more and more English-language learners on their caseloads. These audiologists and SLPs likely also live in areas where there may not be many resources for serving ELL students. Our Code of Ethics states that we should provide culturally and linguistically appropriate services. ASHA also acknowledges that the ideal situation for ELL clients is to work with a bilingual service provider with specific language and clinical skills.

Telepractice offers an elegant solution for connecting colleagues with these competencies to our clients that need them.

The versatility of telepractice makes it useful in different settings. A school district might use several Spanish-speaking telepractitioners to manage its entire ELL caseload. A rural health clinic may create a limited agreement with a bilingual audiologist for follow-up care of a patient who communicates in a less-commonly spoken language.

Telepractice can be used for more than intervention. We can assess patients—even formally—through telepractice. Formal assessment via telepractice is getting easier because many well-known tests are now digitized. Even when a certified professional is not available through telepractice, an onsite team can use technology to connect with interpreters and cultural brokers to help provide appropriate services.

Telepractice licensing, however, remains a hurdle for taking advantage of remote services or becoming a telepractitioner. Most states don’t currently have regulations on telepractice for our professions. ASHA and local associations, however, advocate for states to formulate and adapt guidelines permitting telepractice.

In the meantime, associations advise telepractitioners to verify requirements and policies, as well as hold all appropriate credentials, both in the state where we reside and where the client receives services. This applies also to special credentialing for bilingual telepractitioners.

ASHA doesn’t certify bilingual service providers, but it provides guidelines for those who represent themselves as such. For example, we are ethically-bound to ensure that we speak or sign another language with native or near-native proficiency, and possess various clinical competencies.

To my knowledge, only Illinois and New York have a type of credential for bilingual practitioners, and these are specific to professionals working in schools. However, because policy changes frequently (and is difficult to track), SLPs and audiologists should verify any bilingual-specific requirements in states where they might practice before providing services.

Telepractice holds a lot of promise for serving clients with diverse needs. Even when there is some red tape to figure out, using technology to build bridges to communities that may not have many resources is one of my most rewarding professional experiences!

 

Nate Cornish, M.S., CCC-SLP is a bilingual (English/Spanish) SLP and clinical director for VocoVision and Bilingual Therapies.  He is the professional development manager for SIG 18: Telepractice, a member of ASHA’s Multicultural Issues Board, and a past president and vice-president of the Hispanic Caucus.  Cornish provides clinical support to monolingual and bilingual telepractitioners around the country.  He also organizes and presents at various continuing education events, including an annual symposium on bilingualism.  Contact him at nate.cornish@vocovision.com.

An Audiologist’s Experiences at Convention

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I have been an audiologist since December 1982 and joined ASHA in January 1983 obtaining my CCC-A in October 1983. During those 31 plus years I’ve attended 11 ASHA national conventions and with the exception of the 2014 event my typical reason for going was to either see a city that I never saw before or to go to a city with a warm November climate.

Yes, in truth, the warmth was also why I went to Orlando! I prepared to spend many a grueling hour at Disney World and other tourist attractions. However, when I registered, I observed that every day of the convention held multiple interesting courses either directly on audiology or concerning issues related to the changing medical environment. What a blast!! Even at 60, I still believe that to learn is to live!

Keep this up ASHA and you will start to see far more audiologists attending your conferences. I truly believe that if the conventions in the past were like the 2014 convention there would never have been the American Academy of Audiology, Academy of Doctors of Audiology or Audiology Foundation of America organizations. These organizations were created because we audiologists felt disenfranchised.

At this year’s convention I didn’t feel left out and believe in giving the “devil his due.” Good job ASHA, keep it up!

 

James M. O’Day, Au.D., CCC-A, is an audiologist managing the audiology department at Androscoggin Valley Hospital in Berlin, NH. where he has worked for ten years. O’Day works directly with ENTs in both private practice and in hospital settings. He’s owned a private practice for more than 20 years. You can contact him at james.oday@avhnh.org.

#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.