Many of us enter communication sciences and disorders because, nerdiness aside, we want to positively affect others’ lives. Clinicians are, at some level, driven by a desire to help. We believe that, by completing a thorough evaluation, giving a solid diagnosis, and creating a plan for treatment, we empower a patient. It is, after all, our collective goal to make “effective communication, a human right, accessible and achievable for all.”
Things seemingly out of our control can dampen our optimism, however. A patient misses their appointment because they didn’t have a way to get there. Or a patient is turned away because of insurance or financial reasons. Or a patient can afford an evaluation, but, frustratingly, can’t afford treatment (for patients seeking audiology services, the most obvious access problem can be the prohibitive cost of hearing aids).
In other words, we quickly learn that communication disorders are not immune to health disparities.
Check out the data
According to the U.S. government’s Healthy People initiative (which provides 10-year, science-based objectives for improving Americans’ health) a health disparity occurs when a health outcome differs between populations as grouped by age, race or ethnicity, sex, socioeconomic status, disability, sexual identity, health insurance status, religion, educational attainment, mental health and so on. The initiative aims to eliminate those disparities, but it also provides many searchable data about the disparities.
For example, one of the initiative’s objectives includes increasing the proportion of adults aged 20 to 69 years with hearing loss who have ever used a hearing aid. In 2007, data showed that 139 out of 1,000 adults with hearing loss who have a high school degree or equivalent use hearing aids, whereas for for those with higher education, the number of users increased to 181 out of 1,000.
The objectives—and perhaps even more interesting, the disparities within the objectives according to sex, educational attainment and disability status—are tracked by the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics. We can search the CDC’s database by topic area for additional data on health care disparities.
While the government works toward the Healthy People initiative, we can help improve health care access for those with communication disorders in our communities. I started by considering people’s social determinants of health in my community and surrounding areas.
Improve access in your community
Whether you plan to change your own model of care or simply provide more resources for your patients or anyone who calls your office, here are some ways ways we (me, an audiologist, and my partner, a speech-language pathologist) work to make the disparity gap a bit smaller:
- Educate yourself more on the social determinants of health. Here in California, we use the Let’s Get Healthy California initiative as a guide.
- Something I want to revisit is a topic I tackled in graduate school—the effect of lead exposure on the auditory system. I already know the population most at-risk of lead poisoning—low-income children living in old housing—lacks resources for the central auditory assessment needed to pinpoint any related deficits. I plan to contact my local Childhood Lead Prevention Program and offer my knowledge and time as my first step.
- If you don’t have a specific starting point in mind, find the nearest community speech and hearing center. Connect with staff to learn what services they provide, how to refer and if they’re interested in collaboration. The National Association of Speech and Hearing Centers is a consortium of nonprofits across the United States and they can help to point you in the right direction.
- Find the nearest graduate school clinic. Again, connect with the staff and find out how to refer. Like nonprofit speech and hearing centers, these clinics sometimes offer free or sliding-scale services. See ASHA’s CAA list of accredited programs for schools in your state.
- If you work with a patient with a communication disorder who is a student or unemployed, refer them to your state’s Department of Rehabilitation/Vocational Rehabilitation Services. These agencies contract with local providers—consider becoming one!—and will often step in when insurance doesn’t cover testing services, hearing aids, assistive technologies, speech-language treatment and more. The Employer Assistance and Resource Network on Disability Inclusion (EARN) keeps a list of all US state vocational rehab agencies.
- Consider telepractice to expand your reach to patients in rural areas, those with limited transportation, or those who—for whatever reason—can’t visit a clinic.
- Celebrate Better Hearing and Speech Month this May to raise awareness about communication disorders. The 2019 theme is “Communication Across the Lifespan,” and ASHA provides numerous resources for activities all month long.
- Provide consults or screenings at a community health fair. This is also listed as a National Day of Service idea and could be promoted as such.
- Become involved with ASHA advocacy and the public policy agenda.
The daily grind makes it easy to forget what once motivated you to enter our professions. “Helping people” is exhausting enough without thinking of the thousands of others who aren’t getting the help they, too, need. Yet, recognition of disparity and action to lessen it can remind us why we chose these communication sciences and disorders professions and work so hard to make communication a truly accessible right for all.