AR Delivery Methods Flashcards
Does incorporating comprehensive AR into clinical practice take time?
Yes
The challenge is to get information, complete clinical tasks, and move on to negotiating outcomes
Don’t forget to take time to develop a relationship with the patient
What are the different AR delivery methods?
Individual counseling
Refer to another professional for services: Speech perception training, Visual perception training, Auditory-Verbal Therapy, Communication Strategy training, etc.
Group Counseling
Community workshops
Telehealth services
What does the patient learn from the 5 keys to communication success book?
Technology alone will not resolve their activity limitations
Both the PHL and CP are responsible for improved conversational fluency
They’ve learned facilitative strategies for the listener, the speaker, the environment, and specific listening environments
What is the next step in identifying residual activity limitations?
Patient completes a needs assessment questionnaire at the beginning of each follow up visit
This step tracks improvement while identifying situations that remain problematic despite hearing aid use.
5 Keys to Success Needs Assessment or COSI goal validation procedure
Follow up visit counseling focuses on addressing communication strategies for the residual activity limitations first
Reprogramming is not ignored, but minimized b/c the auditory processing system is STILL ADAPTING to the amplified signal
What step is after the needs assessment?
Create a communication plan for the visit
For residual activity limitations, identify source of communication breakdown, suggest facilitative strategies (which they learned in the book), don’t ignore the need to reprogram the device (ask about sound quality when you reach the technology section)
Plan program modifications to reduce complaints at this time
Recommend Hearing Assistive Technology (HAT) to support environmental breakdown
At the end of the appointment offer handouts with practical exercises to try IRL
Let the pt. know you’ll discuss how this plan and exercises worked during the next appointment
Can you refer to a local AR program?
Yes, such as HLAA
What are some benefits of group AR?
Atmosphere of peer support
Participants learn with and from one another
The group itself becomes a venue for practicing communication skills
Group sessions provide a space for people to share and learn from one another’s psychosocial experiences of hearing loss (such as embarrassment and loneliness)
This delivery model is time and financially efficient
Meets ASHA 2022 recommendations to include informational and personal adjustment counseling in rehab plans
What did research find about the ACE group AR program?
Reduced activity limitations and participation restrictions
Tracked these improvements through Reduced Hearing Handicap Index, Improvement on the Quantified Denver Scale of Communicative Function, Improvements on the Self Assessment of Communication (SAC), Improvements on the Ryff Psychological Wellbeing Scale, and COSI improvements
Benefits remained present 6 months later
What is the I-ACE program?
Done on participant who were not fit with hearing aids
Completed on their own at home
Reported positive outcomes and goal attainment, but no change in hearing disability
The effects remained present 3months later
Increased recognition and awareness of hearing difficulties
Increased ability to develop potential solutions to these difficulties
Participants also enjoyed the opportunity to involve communication partners
Were there speechreading benefits present at a home based program?
Yes, delivered to PHL and CP
Participants completing the program report increased awareness of benefits of speechreading, improved interaction with the CP, and favorable attitudes towards the program
Follow-up measures showed improved quality of life and satisfaction
Did those who participated in Group AR sessions employed communication strategies better than individuals who did not participate?
Yes
These results remained present when reassessed 1 year later
Did those with CIs experience improvements with group AR?
Yes
Experienced cochlear implant users who participated in Group AR programs experienced improvements on measures of assertiveness, emotional well-being, and coping behaviors
Did AR group reduce 3rd party disability?
Yes
PHLs & CPs judged their communication problems as being significantly less severe after their participation in the session
Group interviews showed:
Although they were more conscious of their hearing difficulties, they agreed on being much more confident in dealing with them
Different steps were taken towards improving their situation, including disclosure of their hearing impairment to others, making requests to conversational partners to facilitate communication, and acquiring instrumental aids
Do AR programs improve quality of life for CPs?
Yes
Reported improved understanding of PHL experiences with hearing loss.
Improved quality of life (QOL)
Congruence (as defined by similar scores) between CP and PHL assessments of Hearing Loss-QOL
Does underutilized amplification waste personal finances?
Yes, when treatment plans only recommended hearing aids
Only 69.1% new and experienced hearing aid users report wearing hearing aids > 4 hr/day
23.4% use them < 2 hr/day
3.5% do not use them at all
Is the unemployment rate higher for PHL with untreated HL?
Yes
Unemployment rates are twice as high for people with severe untreated hearing loss (2010)
Unemployment rate for a normal hearing population- 7.8%
Unemployment rate for those with severe hearing loss- 15.6%
Unemployment results for aided severe hearing loss- 8.3%
What is the societal cost of untreated hearing loss?
Reduces in the amount of federal taxes collected
The Hearing Health Foundation estimates that untreated hearing loss leads to an income loss of $176 billion annually due to underemployment
Estimates that the cost to society from unrealized federal taxes is as high as $26 billion
Can untreated hearing loss decrease a person’s annual income?
Yes, by as much as $30,000
Individuals with hearing loss make about 25% less
Audiologic rehabilitation reduces the risk of income loss by 90 to 100% for those with milder hearing loss, and from 65 to 77% for those with moderate to severe hearing loss
Does untreated hearing loss result in higher healthcare costs?
Yes
Untreated hearing loss is associated with 46% higher total health care costs over a 10-year period
When healthcare utilization of the hard of hearing is compared to those without hearing loss:
Health care utilization increases
More inpatient stays
Longer hospital stays
Increased risk of hospital readmissions
More outpatient visits
Is there a code for AR services?
Yes, but it’s not reimbursable for audiologists
However, many PHLs will opt to self-pay for service after learning associated benefits
Do AR sessions result in fewer returned hearing aids?
Yes
You are still being paid for those services by keeping that revenue
Does AR and amplification result in greater adherence to the plan of care?
Yes
Which means less office visits resulting in more cost-effective treatment
Did new hearing aid users who participated in group AR get benefits?
Yes
Showed improved daily ratings of hearing aid satisfaction, as compared to those who did not
What are the evidence based patient benefits from group AR?
Fosters self-advocacy
Improves socialization
Recognition that you’re not alone with your hearing loss
Increased self-sufficiency
Promotes relationships with the audiologist
What are the evidence based practice benefits from group AR?
Fewer hearing aid returns
Increase in the number of satisfied patients
Increase in word-of-mouth referrals from loyal clients
Distinguishes your practice from others
Decreased drop-in appointments due to increased self-sufficiency
Mastery of troubleshooting techniques
Better understanding of controls & use of programs
Increase in sales of hearing assistive technology systems
Are there pre-designed group AR programs?
Yes, such as ACE (can be downloaded)
Can download Ida Institute resources too
Is there an effect on the congruence regarding hearing loss related to quality of life if the PHL goes to an AR group but the CP doesn’t?
No
However, in the experimental group, where spouses completed a special rehabilitation program, congruence improved
Pre-treatment only 44% of couples were congruent; post treatment this improved to 72%
Future research will determine if an increase in congruence among couples improves hearing loss related quality of life outcomes
How is the C2 Hear model different than the ACE model?
Created based off of the ACE model
Found that the objectives of the ACE models didn’t really apply to an American population, so they revised it into the C2 Hear model
Not group AR – more of a do-it-yourself AR
What is adult learning theory?
Andragogy
Different than sitting and listening to a lecture for hours
Are adult learners internally motivated and naturally self-directed?
Yes
Adults want to be partners in developing an educational plan
They are intellectually curious
They are motivated to learn driving them to work harder to achieve a goal
Motivation improves retention
Adults will resist learning if they feel you are imposing information, ideas, or actions on them
If you impose something on people, you use your authority to force them to accept it
Do adult learners bring life experiences and knowledge to learning experiences?
Yes
Adults want an opportunity to use their existing knowledge but will need guidance applying those experiences in new ways
Personal life experiences serve as a resource during problem solving activities
Are adult learners goal oriented?
Yes
Learning activities must be designed to efficiently direct adult learner on ways to achieve their goals
Need to give them suggestions on the first meeting to satisfy them
Are adult learners concerned with how relevant the information that is being taught to what they want to achieve?
Yes
Adults are concerned with learning topics that have immediate benefit
If content isn’t directly applicable, it’s viewed as a waste of time
Are adult learners practical?
Yes
Adults commit to learning when concepts are realistic and have practical applications
Adults have a desire to know the purpose of learning something (why?)
Clearly explain why a strategy will improve communication
Create activities that allow participants to try skills rather than observe them
Do adult learners want to feel respected?
Yes
Truly listen to the participants so you can show interest in what they find important
Include activities that acknowledge the wealth of experiences that they bring
Encourage expression of ideas, and reasoning at every opportunity
Provide positive feedback showing how their thoughts supported the discussion
What is a facilitator?
One who plans, guides, and manages a group to ensure a group’s objective is met effectively
Facilitators do not change the behavior of others
Rather, they provide information that enables the people to decide whether (or not) to change their behavior
What are some signs that you’re listening?
Lean toward the speaker
Maintain good eye contact and an interested facial expression
Facial gestures and small movements can show interest or support
Avoid unconscious signs of impatience (i.e., looking at an agenda/phone/watch)
Should you make sure to allow mental space available for listening?
Yes
Focus on what speaker is saying rather than what you want to say
Should you use verbal cues to draw out your speaker’s thoughts?
Yes
Example: How did you feel about that? Tell me more
Can AR groups be run by more than one facilitator?
Yes
Each facilitators role is planned in advance of a session
Take turns supporting each other
Co-facilitators are useful to check understanding of what is being said
Each person should know exactly what job they’re doing
2nd facilitator monitors participation, keeps track of who might speak next, senses and addresses underlying feelings by listening carefully and watching body language, acts as timekeeper, takes notes for tracking group ideas, and acts as a doorkeeper- greets,and summarizes what’s been covered for latecomers
Is it the job of the facilitator to monitor and address underlying emotions, concerns, and tensions a speaker has about a subject?
Yes
They guide the group to help them deal with conflicts
Maintain a safe, and respectful, group environment
Plan strategies to create supportive environment encouraging everyone to shares their ideas and feelings
Is it important to set group expectations and boundaries?
Yes
One speaker talks at a time
The person speaking uses a microphone
Make sure everyone can see your face
If you cannot understand practice politely explaining the difficulty
Don’t feel embarrassed about asking for repetition or clarification
Everyone in the group may miss something said now and then
*Could have the group come up with their own rules
What are expectations for group engagement?
Everyone should contribute to group discussions; much can be learned from one another
Open up
This will add to the richness of the group
Freely shareyour thoughts, feelings and experiences
Listen carefully to other group members
Should there be expectations of engagement boundaries?
Yes
The group benefits when we commit to acting as a team
Try to go to all the group meetings and do your assigned homework activities
Speak concisely and to the point so everyone has an opportunity to speak
Facilitator can help regulate the flow of discussions:
Vary the timing of who answers first
The last person often winds up with limited responses
Tools, such as talking sticks or small group discussion may help equalize participation
Should you have an overall take home message?
Yes
All of the activities are leading to this
What are modeling activities?
Modeling requires the facilitator to explicitly describe and demonstrate a behavior without assuming the participants know it Examples:
Facilitator pretends to misunderstand
Describes the problem and may poses good or bad solutions to the group
Let group discuss the pros/cons of that behavior
Facilitator models the best behavior
What is role-playing?
Facilitator, or group members role play inappropriate and appropriate management techniques
The group discusses sources of communication breakdown and facilitative strategies for improvement
What is ideastorming?
Whenever possible, have the group drive the ideas for improvement
Ideastorming gathers many ideas quickly
Start by stating the issue
Ask people to say whatever comes into their heads
Encourages creativity
Write down all ideas for later discussion
What is the 15 things ideastorming?
You have a problem and you need to come up with 15 ideas to solve it
Should you always include a wrap up discussion is each session?
Yes
Summarize the ideas of the group & explain how they relate to the lesson’s learning objective
Helps the group connect with critical information
This assures the participants heard what was said
Allow the facilitator to repeat common concerns or suggestions
Should you have exercises that participants can do in the real-life?
Yes
The combination of practice exercises and real-world practice increases likelihood of skill use
“Homework” to practice new skills outside of the group setting
The activities should relate to skills performed successfully during the group session
Recommended activities support different levels of difficulty.
Begin with known CP then to less familiar
Begin with quiet environments then to complex/noisy
Ask participants to keep daily logs and/or checklists.
Plan to discuss experiences at the next session
What is an example of a real-world activity?
Hide and seek
CP hides an object in home and verbally directs PHL to location
PHL listens to directions
Uses newly learned repair strategies when clarification is needed
PHL writes reflection after the activity:
Did you understand the directions?
How did your CP respond?
Did you have any problems finding the object?
If yes, could you have asked for clarification in a different way?
Did you or your CP learn something new?
What is another real world example?
Keep a log of positive communications
What is was and who it was with
