Guidance on Providing Patient-Centered Care.

This article explores the clinical applications of Audiology Practice Standards Organization (APSO) Standards 2 and 13, both of which keep us fully focused on the patient-as-person. The topics within Standard 2 include audiologists' interpersonal communication skills, specifically clarity (ensuring patient comprehension) and empathy (understanding the patient's experiences). Standard 2 also addresses the topic of health literacy, which has been recently expanded to consider not only the degree to which individuals are able to find, understand, and use information and services to inform health-related decisions but also how organizations equitably support those necessary skills. The characteristics and benefits of services provided in patient- and family-centered care contexts are also described. Standard 13 addresses audiologists' support toward overall successful adjustment as defined by the patient, including both technical and personal adjustment to amplification, nontechnical communication issues, and rehabilitation support using readily available technologies. A new assessment protocol that includes goal setting and intervention is described, as well as a patient-centered intervention strategy involving discussion of personally meaningful photographs. Both standards provide a necessary balance to our technology-reliant profession.

Adolescents with Hearing Loss and the International Classification of Functioning, Health, and Disability: Children & Youth Version.

In 2007, the World Health Organization published a set of International Classification of Functioning, Disability and Health (ICF) codes designed for children and youth (ICF-CY version). The ICF-CY considers typical developmental changes associated with childhood while describing health status and the effects of intervention. In this article we will describe how a specific intervention (transition planning for adolescents) can be documented with the ICF-CY. Transition planning in health care prepares adolescents and their families for the transfer from pediatric to adult health services and has been demonstrated to be an effective practice for adolescents with many types of chronic health conditions (e.g., cystic fibrosis, epilepsy, diabetes). Audiology has not yet addressed transition planning for adolescents with hearing loss; therefore, we propose using the ICF-CY to design a pathway of care. The ICF-CY can standardize transition planning to the benefit of both teen patients and audiologists: teens and their families would gradually acquire necessary knowledge and skills, and audiologists would develop a meaningful data set to help further inform our pediatric practices, as well as give more structure, depth, and accountability to our role in rehabilitation.

Measuring the effectiveness of an audiological counseling program.

OBJECTIVE: Audiologists routinely observe patients struggle with psycho-emotional difficulties associated with hearing loss, yet are often underprepared to manage this vital aspect of patient care. For this reason, a workshop was developed for audiologists interested in expanding their counselling skills. Since one-time workshops typically do not result in changes in practice, this program adopted a distributed-over-time learning model, consisting of 20 hours of participation across six weeks. The extended nature of the program provided multiple opportunities to learn several counselling strategies, and apply and evaluate the effectiveness of these strategies in clinical settings. DESIGN: Learning objectives were assessed throughout the six-week program. However, at the conclusion of each program, it was unknown whether new knowledge carried over into sustained new skills. Therefore, we surveyed attendees six months after their program, to determine if the program had affected changes in their practice. STUDY SAMPLE: Twenty clinicians (response rate = 91%) participated in the survey. RESULTS: All respondents made some, and often many, changes in patient communication. They applied several counseling concepts to their work settings and reported positive changes in patient-clinician dynamics. CONCLUSION: Results suggest that a six-week program is effective in helping clinicians change their counseling skills within their practice.

Development of an instrument to evaluate audiologic counseling skills.

This study describes the development of an instrument designed to evaluate audiologic counseling skills. In simulated counseling sessions, a trained actor portrayed a parent, and ten graduate audiology students role-played counseling sessions as audiologists informing the "parent" that her infant has a hearing loss. The ten sessions were videotaped, and three raters viewed the taped sessions while evaluating counseling skills with a new evaluation tool, the Audiologic Counseling Evaluation (ACE). The ACE was found to have excellent internal reliability (alpha = .91) and moderate-to-good inter-rater reliability. Raters' subjective evaluations of the tool were generally positive, and students' evaluations of the simulated counseling experience were overwhelmingly so. This instrument can be used by audiology faculty and clinical instructors to help students improve their counseling skills before interacting with parents. It can also be used in clinical settings for professional development by way of self- and peer-evaluation.

Counseling adolescents with hearing loss with the use of self-assessment/significant other questionnaires.

After adapting a pair of adult Self-Assessment/Significant Other questionnaires, the first author explored the value of the modified questionnaires in providing counseling to adolescents with hearing loss. Twenty adolescents with hearing loss served as subjects; peers with normal hearing were selected as their Significant Other to capitalize on the importance of peer relationships and opinions during adolescence. Each dyad completed a 12-item questionnaire designed to explore the communicative, emotional, and social impact of hearing loss. Responses to each pair of questionnaires were reviewed by the adolescent and the audiologist and served as a basis for counseling. Subsequent dialogues revealed recurring themes as the teens attempted to face age-appropriate developmental challenges as individuals with hearing loss. Based on their responses to a follow-up questionnaire, most of the adolescents found the counseling process beneficial.

Unilateral Hearing Loss in Children: An Update for the 1990s.

In the 1980s, two studies found that children with unilateral hearing impairment were 10 times more likely to repeat a grade compared to the general school-age population. Since the publication of those reports, grade retention has been found to be an ineffective strategy for achieving long-term academic success, and is no longer widely recommended. This survey describeshow children with unilateral hearing loss are presently supported given this change in educational practices. Reports on 406 children indicated that 54% received individualized special education services, in addition to some level of audiologic support, and that 24% were functioning below average relative to their peers. Other information regarding demographics, use of amplification, and additional educational concerns are also reported.