Carrie: [00:00:14] Welcome to the empowEAR Audiology podcast, a production of the 3C Digital Media Network. I am your host, Doctor Carrie Spangler, a passionate, deaf and hard of hearing audiologist. Each episode will bring an empowering message surrounding audiology and beyond. Thank you for spending time with me today, and let's get started with today's episode.

Carrie: [00:00:40] All right. Today I am really excited to introduce to all of you an award winning social impact entrepreneur, disability advocate, and content creator. Today I have Tiffany Yu with me and she is the founder and CEO of Diversability, Diversabilty  social enterprise to elevate disability pride and build disability power. Having started her career at Goldman Sachs, Bloomberg and Revolt, Yu is now an in-demand corporate speaker, creating an approachable bridge in corporate diversity, equity and inclusion spaces spaces. Tiffany is the co-founder of the Awesome Foundation Disability chapter, serves on the LA 28 Olympic and Paralympic Games Working Group, and was the co-chair of the World Economic Forum Sustainable Development Impact Summit. Her TEDx talk, How to Help Employees with Disabilities Thrive has over 1 million views. Her work and story have been featured in The Wall Street Journal, The New York Times, Business Insider, Forbes, USA today, The Guardian, and more. And she lives in Los Angeles. And we are going to talk a lot today about her new release of her book, The Anti-Ableist Manifesto. So, Tiffany, welcome to the EmpowEAR Audiology podcast.

Tiffany: [00:02:12] Thank you so much for having me.

Carrie: [00:02:13] I'm excited to have this conversation today. I bought your book and I reached out to you on LinkedIn, and I wanted to be able to share your message with another audience who may not know you. And so just to get started today, I would love if you could just share a little bit about your background so that the audience knows a little bit more about you.

Tiffany: [00:02:38] Sure. So again, my name is Tiffany Yu and I am the author of this book that just came out called The Anti-Ableist Manifesto. And the purpose of the book is really around trying to close the gap around attitudes and perspectives around disability so that we can realize the full potential of whether it's the Americans with Disabilities Act or whatever the local legislation is in, in your part of the world to really combat and dismantle disability discrimination and ableism in all of its forms. I also run a large community called Diversability. The best way to think of us is we're kind of like a disability employee resource group that exists outside of a company. And my entrance into this space is through my own personal lived experience. At the age of nine, I was involved in a car accident where my dad, who was driving, unfortunately passed away and I acquired a handful of injuries and disabilities, including permanently paralyzing one of my arms and much later being diagnosed with post-traumatic stress disorder, which is a mental health disability.

Carrie: [00:03:46] Yeah. So all of those your background and and experiences really, I think shaped where you are today. And so did that drive you into writing the Anti-Ableist manifesto?

Tiffany: [00:04:03] Yeah. I feel like the whole process around the book kind of came accidentally. I, I remember and I wrote about this in the intro of the book when I was in high school. I remember having this dream that one day I wanted to write a book. And high school for me was 20 years ago. And, um, but, uh, I think that dream kind of sat on the proverbial shelf for a really long period of time until a couple of years ago, in 2021, I had, as I was starting to speak out more online and start to build a platform online, a literary agent actually caught wind of it and ended up reaching out asking if I had ever thought about writing a book. Interestingly enough, I started drafting up a book proposal for a different type of book that maybe one day will see the light of day. But a couple of months after I started working on that first book proposal, which was really centered on community stories around disability pride, I ended up getting another email from someone who worked in the publishing industry asking if I had thought about writing a book geared toward geared toward disability inclusion. Um, in a more in a, in a more formal way, or on a professional or in corporate spaces. And in order to fund a lot of our work at Diversability, because a lot of disability advocacy work pays $0, we're trying to change a lot of that. I know you were talking before we started recording about some of the advocacy that you're doing.

Tiffany: [00:05:37] Um, impactful, but sometimes does not, uh, does not impact your livelihood. Uh, but, um, so I had started doing some corporate speaking engagements as a way to help fund our work, our are my disability advocacy work, and I saw my experience working at places like Goldman Sachs and Bloomberg as an exception, as someone who is disabled, who has both apparent and non-apparent disabilities, and I no longer wanted to be the exception. So I saw myself kind of as this bridge between these corporate spaces, these advocacy spaces to figure out how we could move the needle forward on disability advocacy and disability inclusion, no matter where you were, if you were in a corporate world, if you were in nonprofits, if you were just grassroots and advocate doing your own thing, if you're an entrepreneur or a small business owner. And so I started drafting up a second proposal, now a new proposal about what ultimately ended up becoming the Anti Ableist Manifesto. And it's been super exciting to see the reception of the book so far, now that it's been out for a little bit over a month. About how excited people are and how digestible and approachable they feel like this information is, and how they feel energized and hopeful that creating a disability inclusive society is possible. And that's what I wanted, is that no matter who you were, you could pick up this book and there was something that you could learn and implement right away.

Tiffany: [00:07:13] And maybe it's not sitting on a hearing or changing laws right away, but maybe it's changing your everyday language, or calling in, or calling out microaggressions that you see. So I wanted to take people along that journey of just realizing that not not only is ableism all around and has been upheld by other systems of oppression for a really long time, is that how can we? You know, it's one thing to show up to a hearing or have a policy in place, but if you really do not fundamentally believe that disabled people are whole, valuable, worthy human beings simply by existing. And that were your peers and your colleagues, your coworkers, your teachers, your, uh, I don't know, podcast hosts, your hiring managers. We're literally everywhere. But if you do not believe that we deserve to be in those spaces, or that we exist or belong in those spaces, it's a lot harder to show up in a meaningful, non-performative way to a hearing or implement a policy which then may not, that may not get executed because you don't believe the you don't believe it. So the hope is let's get the hearts and minds and perspectives and attitudes to catch up to the fact that here in the US, we do have a policy in place. It's just not implemented or it's not enforced. Um, and in a lot of ways, we talk about how the ADA is a floor, not the ceiling, but we're not even meeting the floor at this particular point in time.

Carrie: [00:08:43] Yeah. No, you bring up so many good points in my mind. Just keeps going and going. For our listeners, what how would you define ableism, maybe as a large, um, for our society at large, for our listeners at large?

Tiffany: [00:09:01] Yes. So ableism is a system of oppression that devalues someone based on the way their body and or mind works.

Carrie: [00:09:09] Um.

Tiffany: [00:09:10] So I'm going to repeat that again. It's when we devalue someone based on the way their body and or mind works. And we can see this in everyday ways by saying things like, oh, if you're deaf or hard of hearing, you wouldn't be a podcast. How could you be a podcast host? You know, it's kind of asking those those questions that have embedded assumptions in them. And as a result of some of these societal ableist assumptions that people place on us, like if you're disabled, how could anyone want to be in a relationship with you? Or, um, how could you even have a job, you know? And, uh, Where we actually, as disabled people, start to internalize some of those assumptions ourselves. So one of the ableist assumptions that I had, again, when you're devaluing someone is because I can only type with one hand. I assumed I couldn't write a book, right. I think that there's probably more to it than the fact that this dream sat on, sat as a dream for 20 years. I didn't take any meaningful action toward it. But I wonder if part of my own internalized ableism was devaluing my voice as an author, because I couldn't write a book in the same way as other people could. Uh, fun fact I actually wrote the entire first draft of the book using speech to text technology. I find it much easier to talk than it is for me to write large amounts of text. Um, and and that.

Carrie: [00:10:36] Now you have a book, right? Yeah.

Carrie: [00:10:40] And probably the speech to text. Right. Came from the life hackers of individuals with disabilities.

Tiffany: [00:10:50] Yes. And and and in in some ways, you know, I talk about the ways that we life hack. But it also makes me think about what if we didn't have to. Uh, and I do, and I'm curious if you see it too, but I'm starting to notice a cultural shift around disability where I'm seeing more disabled content creators. I'm seeing, uh, younger people be able to find their voice as disability advocates a lot quicker. I just did a podcast recording yesterday with someone who is 22 and has a really incredible, uh, creates content, um, has a podcast, like, really building out their voice. And I think about nine year old Tiffany, who I not only did I dedicate this book to her, but I think about the younger version of myself and all of the things I wish I had access to, or I wish I could have seen, or the communities that I that I could have been a part of that maybe would have helped accelerate me finding my voice a lot quicker. No regrets, of course, but I do think about that a lot. About how now we have access, thanks to technology, to a lot more tools to not be so disempowered and isolated and excluded as we were before. That's still existing in a lot of parts of the world and even here within the US. But I think with the introduction of social media and hashtags, I can go online and search the hashtag brachial plexus injury, which is the name of my disability, and be able to find a lot of people quicker than how it was 25 years ago.

Carrie: [00:12:24] And in your book, I believe you write something that said disability is not a bad word. And I love just that phrase because I think it's so empowering. And I have been saying more and more, I have a disability and this is what I need. But it takes a lot of courage and I think strength from an internal perspective, a personal perspective to to put myself out there sometimes. And I'm not sure if it's just me or like you were saying, like our world needs to kind of catch up with the ground floor of ADA. And, you know, making more, more things accessible. I don't know if you've ever felt that way.

Tiffany: [00:13:11] Yeah. You know, one thing I think about is I think about the weight that the word disability weighed on many of us and probably society with, with this negative value judgment. Mhm. But I have said the word disability so many times and I talk about this in the book. It's called semantic satiation where if you say a word a lot of times it actually loses its meaning, like whatever emotional weight you put on it. And I feel like for a long time, not only many of us within the disability community, we and a lot of us still, uh, both within the disability community and not in our community, carry this negative weight around this word disability. But I have noticed and and the other thing that comes to mind is I wonder if it comes with time, because I am almost three decades into living with a disability. I am 15 years into my career. You read my bio. I have a lot of. things on there that would make any parent proud.

Carrie: [00:14:18] Yes. Um, but.

Tiffany: [00:14:20] I wonder if I would still, I wonder if I would feel confident enough in myself and in my experience to be doing this, be delivering this message in a similar way 20 years ago. Um, but I feel like a huge part of it. Step number one for me was finding a disability community. And I have a new theory. This didn't make it into the book. That part of the way that the system that ableism has been upheld is through us being isolated, because us being isolated puts us in a disempowered state. It makes us think we don't have a voice and that our stories don't matter and that we can't make change. But when we start to meet other people who are out there doing the thing, who are out there making waves, then we realize, oh, how can I use my voice? Because when I came into so there's, you know, I've been disabled for 27 years. I call my Add. I call myself an advocate for 15 years. So for only about half of that time have I considered myself an advocate. And I do think that there's a difference between those of us who are living with our with our disabilities and those of us who are out there advocating. I do think there's a certain level of privilege that it takes to have the safety to be able to talk about these things.

Tiffany: [00:15:50] But I also think that the visibility of us talking about it helps other people find us quicker so that we can create community, create those coalitions, and build that solidarity so that we can make change together. So 15 years ago I went out looking to build a disability community. I did not go out thinking I was going to become an advocate. And once that community started to build, I started to find my own self-confidence and build my own self-esteem in a way that I actually started to realize that my story matters. And I would be remiss if I didn't acknowledge there was a period of ten plus years where I really I thought disability was a bad word. I was sitting in my internalized ableism. I'm still working to unlearn a lot of those. Uh, it's an ongoing journey, and I feel grateful for not only the people. It takes a certain type of person to decide to opt in to read this book. Right. And I'm just so grateful that there are people who want to care and want to show up better, and want to join me on this learning and unlearning journey together.

Carrie: [00:17:01] That your point about finding your community and finding people like you, I think is so strong. And when I was younger, I lived with my disability my entire life, and I remember the first time that I met someone else who wore hearing aids, who was my age, around my age, and it shifted me in a whole different direction that I didn't know it would. And by connecting people together that way, who can share their story, I think empowers you in such a different way because you don't feel alone. And I think I felt so alone going through the public schools with, you know, a disability. And you talk about not apparent and non-apparent disability. I wanted to hide it. I never wanted anyone to see my hearing aids. I didn't talk about it. And then to be able to meet someone, I just felt like I could come out of my shell.

Carrie: [00:18:01] Yeah.

Tiffany: [00:18:01] And I think about I think about liberation. You know, we talk about liberation and social justice movements and for minoritized communities. But I also think about the liberation of my own voice, of my own power, you know, and you you sharing that story and meeting those other people, you see the possibility of what it can be like and the potential of what it's like to be in your fully liberated state, where you don't feel shame or a burden for advocating for the things that you need.

Carrie: [00:18:37] Yes.

Carrie: [00:18:38] So I think this is a good way to really get into your book, because in your book, you talk so much about how we can do some of these things, whether you have a disability or you're an ally or an advocate in your book. So how did you decide on the title? I love the title. So let's start there.

Tiffany: [00:19:04] Yeah. Actually, it goes back to your love of that phrase. Disability is not a bad word. And I thought about, you know, when something is called a manifesto, it's kind of like an instructional guide. It's saying here's here's the pathway forward. The title was actually inspired by a social media series that I have called the Anti-ableism series. And maybe by the time this goes live right now, it has almost 300 parts to it with a couple in the queue, so we'll probably be above 300. But part of why there are 300 parts is that there's no one way to show up to the to show up better for the disability community. Um, there's a reason why the book is 250 pages. Uh, there's and probably could have been even longer if I had had more time, but I wanted I thought about some of these statements. Disability is not a bad word. Disability is not a bad thing. Representation matters nothing about us without us, which I've now heard edited to nothing without us. Um, and, uh, not all disabilities are apparent. And I wanted to, you know, when I created this book, I didn't have a clear idea of what the chapters were going to look like just yet.

Tiffany: [00:20:23] But I knew that I wanted every chapter to inspire a manifesto. And a manifesto are directive statements, right? So, uh, the chapters of the title very loosely resemble, um, resemble statement, and some of them don't. Uh, so, for example, there's a chapter called What is ableism? And the way it shows up in, um, in the manifesto is anti ableism, and you can actually find the ultimate manifesto in the conclusion of the book. But but I will have to give credit to my literary agent who came up with that title. Um, but I'd like to think I planted the seeds around it. And, and you know what's interesting about the publishing process and I went through a traditional publisher is that the title can change. Uh, the subtitle can change. Um, they have. And this is part of why I went with traditional publishing as well. And part of the frustrations with traditional publishing as well is sometimes they, you know, will determine that a title may not sell as well and they'll change it. And I've been hearing that from some of my friends who are writing their books right now that they're currently with a working title. That may change over time, but it was kind of cool to see that even from the inception of the proposal of a book called The Anti-ableism Manifesto, it stuck.

Tiffany: [00:21:44] And something I love about it is that even in the way it shows up on the cover, which is this bright orange gradient, it is in big block, bold letters, and orange also makes you feel something. It reminds me of a sunrise. It could be Phoenix rising from the ashes. It could be fire or it could be friendly. Orange can also be friendly. You know, people will will attach whatever meaning they have with it. But the first draft of the cover was black. Um, and I like where I do appreciate where we ultimately ended up. Uh, but I do think about all these little things that end up going into determining how a book will will come to be. So all of that to say the title of the book came in community, if we'll if we'll do it like that. Um, but we but yeah, I it was very much inspired by a social media series that I have and so many conversations that I've had over the last couple of years around digging into disability and ableism and anti-ableism.

Carrie: [00:22:58] And in your book, you.

Tiffany: [00:23:01] Oh, can I say one other thing?

Carrie: [00:23:02] Yeah. Go for it.

Tiffany: [00:23:04] Uh, so if you make it to the end of the book, uh, you will get introduced to something called the Anti Ableist Manifesto art, which actually. Yes. And you have it. Oh, you got your did you get your book from Yu and me books.

Carrie: [00:23:19] Yes I did.

Carrie: [00:23:21] Okay.

Tiffany: [00:23:22] Um so the that manifesto art. So, uh, so Carrie has it on a poster and I have it have it on a postcard. This is meant to be. No matter who you are, your entryway into this work. It's a piece of art. It hangs on your wall, it hangs up in the background, and it becomes a conversation starter because it's art, and art creates conversation. And so that to me, I almost went backwards in a way where I said, okay, if the title is the Anti Ableist Manifesto, let me think of a lot of different statements that I would want to appear on a manifesto that we're going to turn into a piece of art, because while I like the book cover, a piece of art stays with you. Um, a piece of art gets hung up, like, I mean, I have a book stand for my book, but you're not going to, you know, put my book on display hanging on your wall. Um, and.

Carrie: [00:24:15] So that's.

Carrie: [00:24:16] An orange wall over here that you cannot see. So orange is my favorite color.

Carrie: [00:24:21] Okay.

Tiffany: [00:24:21] So orange orange is your favorite color. But but yeah, it was this idea of if it's a manifesto, let's think of the statements. How are the statements going to appear on a piece of art? And whether or not you read the book, you now have access to this piece of art that can be your introduction into anti-ableism or into better supporting the disability community.

Carrie: [00:24:46] And I just have to say, I love it because it's easy to like just short phrases from the book that trigger what you read and you. It's almost like a summary of everything that you have wrapped up in the book, and that's probably what your intent was. But it was really good.

Tiffany: [00:25:08] Well, it makes me think, because, you know, I've been doing a lot of podcast interviews and I always get asked, you know, what's one thing someone can do today to show up better for the disability community? And that's hard to answer because depending on who you are, that answer is going to be going to be different. So now I can just hand them this manifesto art. And I say which statement on here resonates with you and let's start there.

Carrie: [00:25:34] I love that that is such a great way because like you said, everybody is entering this community from a different angle and from a different point in the journey. And whether they're an ally or someone living with a disability, you can be part of this anti ableist manifesto. In your book, you also have it sectioned out into three parts. Can you talk a little bit more about that?

Tiffany: [00:26:09] Yes. So the book is structured into three parts through a framework called me we, Us and Me. We us is a framework that I it's a social impact framework that I learned about years ago about how we can create transformative change. So while I would love for everyone to be in the US, um, in the US part, which in the book is called anti-ableism and societal change that can feel overwhelming to people if you don't even know, if you don't even know that, if you still think that disability is a bad word. Um, so even if I look at chapter one, which is in the Anti-ableism and use section, uh, we renamed them for the sense for, for the, for clarity because originally it was called Anti-ableism and me Anti-ableism and we and Anti-ableism and us. And then as we were going through editing, most people who saw a section of the book called Anti-ableism and me thought it was going to be more a biographical memoir about me and not you. Uh, so then we were like, okay, if we're going to rename this first one, we should probably rename them all. But let's make sure in the intro that we know. We people understand that it's inspired by me. We, us. But, uh, chapter one is called disability is not a Bad Word. And chapter 34 is called Get civically engaged. Uh, getting civically engaged for some people can feel extremely overwhelming. And, um, maybe your privilege enables you to decide not to opt in. Uh, it takes a lot of work costs. It pays $0. Right. Um, and so, uh, so, yeah, that's how I decided to structure the book, because, again, I want to take you along this transformative journey that by the end, again, no matter who you are, you feel like this work can be accessible for you.

Carrie: [00:28:10] Yeah. And it is. I feel like you're the way you section it off is very digestible and applicable for the reader. So I want all of my listeners to go and, um, get this book and we'll definitely link it in the show notes, too. But I, I don't want to give too much away, but I want to like, highlight the the points in the book. So would it be a good way to highlight maybe like in part one for Anti-ableism and you like what would be a main takeaway point for that like section?

Tiffany: [00:28:50] Um, I guess I would come back to maybe disability is not a bad thing. Um, I mean, it's hard. It's hard because section one, section one, I think has 10 or 11 chapters, uh, and it talks about privilege and turning guilt into action. And, and I'm fine giving away everything. Right? I've actually been thinking about not only why I wrote this book, but what my goals are for the book. And really, why I wrote this book is I wanted to figure out a way that we could scale, impact. You know, I feel very grateful that I can go do an hour presentation or come on an hour long podcast. But how do in some ways, having a book out I'm or creating a piece of social media content, but having a book, I'm reaching people who will never meet me. They are having discussions about this book that I'm just observing. I actually haven't chimed in on them. Um, and uh, one of the discussions was about the way that I have defined ableism. Uh, and I thought and I thought that was interesting. And I was like, you know what? Let me have them discuss it. I don't need to come in. And I've tried to make it very accessible. How people can reach out to me if they have something they they need to say to me. Um, but I've also ended every single chapter with reflection questions. So, for example, in chapter one, which talks about different, uh, definitions of disability, thinking about the origins of the word and how we we may have attributed negative value judgment to it. At the end of the chapter it says, how do you define disability? Or go ask a couple of your friends how they define it and see where there might be some similarities and differences. So no matter who you are, again, you can come together and learn. But yeah, but that part one section, I mean essentially you can go into part one and read every and read out loud every chapter title. And that will be the takeaway from the book.

Carrie: [00:31:02] Right?

Tiffany: [00:31:03] It was fascinating because, for example, um, every chapter averages about 7 to 8 pages, but I think the chapter on Anti-ableism is like three pages. Uh, and, and in some ways, uh, and actually someone said this. So the, uh, the chapter titles are the takeaway from the chapter.

Carrie: [00:31:27] Yeah.

Tiffany: [00:31:28] And if you want to go deeper. So, for example, uh, one of the things I learned as I was writing this book was that the first use of the word ableism was 1981. Um, and depending on who you are, I was born in the 80s. Having a word first used in the 80s means that that word is not that old.

Carrie: [00:31:52] Right.

Tiffany: [00:31:53] And so if you if you have never heard the term ableism before, that's okay. Because while disability discrimination and devaluing disabled bodies and minds has existed forever, we haven't had language for it until the 80s, right? So we could say, hey, I'm being treated differently or differently or I'm never picked for for the team in the gym class. Did I know that that was ableism? No, because we didn't have language for it. Right. So part of it is just the beauty of of language. But yeah, the takeaways are the chapter titles. So disability is not a bad word. It's not a bad thing. Turn guilt into action. Learn about what ableism and anti-ableism are. Um, just think about the ways that representation really matters. I think that's in chapter one. And then, uh, and then talking about your privilege.

Carrie: [00:32:47] Yes. Yeah. All of those were kind of, you know, in that chapter one too. But, uh, yeah, I think one thing that really, you know, from the community like that second part, uh, that really resonated with me too, was, um, because I have a non apparent disability and I like that language because I know a lot of people have said like invisible or I used it in other ways, but I like that the way that you describe non-apparent disability, and a lot of the people that will be listening are kind of part of that community, whether they're supporting them professionally or as a parent or someone that might be deaf or hard of hearing. Do you have anything else to kind of share on how you treat people that way or support people that way?

Tiffany: [00:33:48] Yeah, I mean, I feel like the biggest microaggression that people who have non-apparent disabilities face is not being believed.

Carrie: [00:33:55] Mhm.

Tiffany: [00:33:55] Uh, and you know, we talk a lot about empathy in this work. And I kind of say like empathy with an asterix in the sense that you may never understand what it's like to live in my body. And that's okay. It's okay to validate that my experience is wildly different from my own. And maybe it's hard to relate, but can you just make space for the validity of that? And I also want to share that my shift to describing non-apparent disabilities as non-apparent was part of my own learning too, as I was doing research. You know, most of the time you'll see other people describe them as hidden disabilities or invisible disabilities. And I realized that while yes, they are those things too, there may be an underlying subtext that a hidden disability might mean someone's trying to hide it when they're not, uh, or having an invisible disability may mean that someone feels more or more invisible than they already do within the context of the disability movement and non-apparent disabilities just means that for now, they're not apparent, but they can become apparent at any point in time, and apparent or not apparent. It just means that you are not able to, uh, there's no look. There's no look for it. So so yeah, I think it was just really around like believing experiences, but then also understanding that support may look different for, for every person, uh, whether they have apparent or non-apparent disabilities as well. Uh, and, and offering that support and listening to how you can best support someone is is also another way. But I'm sure you have other ideas as well. I don't want to come in here and say I'm the expert because I'm someone who lives with both apparent and non-apparent disabilities. And I think that because I do have those comorbidities, meaning I have multiple disabilities, I don't know, I don't know what it's like to decide to opt in to not have an apparent disability.

Carrie: [00:36:16] Mhm.

Carrie: [00:36:18] Yeah. I think you touch on some really good points about uh the non-apparent disabilities because and not, you know, people not believing you. And I've heard from a lot of people sometimes who are like well you seem to hear me great like you seem to you speak well and you're following a conversation. And sometimes that I think plays into my internal ableism, where I feel like, well, maybe I'm not deaf enough because I am able to have a conversation with you and have a podcast. But if I'm in another situation, such as a larger group, I might fall apart, and then I'll be hesitant at times to ask for an accommodation or support because I feel like I'm putting a burden on someone else. And I think the you know what you said about me, we, us, and from a me perspective, I need to be okay with asking and and saying, hey, I need to have captioning or I need you to use a microphone in this situation. But in another situation I might not need that. So asking the person how you want to be identified and what do you need is a really powerful way to support someone.

Tiffany: [00:37:56] Yeah. And and one of the things I, I actually had a friend her name is Kayla or I follow her on Instagram and she, um, she has a limb difference on one of her arms. And she shared two videos recently around her trying to film some content. And someone walks by and they go, what happened to your hand or what happened to your arm? And she responds in the video saying, hey, I'm just trying to film my content. You know, that's not really an appropriate question to ask versus in a different video, a different scenario. She is showcasing that she's like working out and someone comes by and they ask what happened to her arm. And she explains that she was born with her disability and, and things like that. And so the context also matters as well. Like, we are not out here to educate you on your curiosity, on your intrusive curiosity at any one point in time. But we may choose dedicated times to engage, or we may choose not to engage and just to have other people respect those boundaries as well. I thought that was a good display where, like, I'm not always like I remember in 2019 I decided I was going to start rewearing a wrist splint on my injured arm. And I remember going back, going home from that appointment with the occupational therapist, and I was on the bus and someone next to me was like, oh, like what happened to your hand? And oh, it looks so different. Does it hurt? Blah, blah blah. And I was not in that particular point in time. I did not want to answer those questions. Right. And so, um, I feel like sometimes it's put on us, so much weight is put on us to have to educate or have to show up in a different way. And part of what I feel excited not only about this book, but having more disability narratives out there, is that it's not on all of us, on one person, all the time. To have to go out and educate. You can get your information from so many different areas, uh, areas as well.

Carrie: [00:40:02] Yeah. And I even think go ahead.

Tiffany: [00:40:04] I was going to say even what you were talking about, about not feeling disabled enough. Like, I think I experienced a lot of that as well. And that's why when I think about the definition I use of disability, it's a condition of your body and or mind that impacts your daily life in a certain way. Uh, so it may not impact your daily life in terms of you moderating a podcast, but it could impact how you engage in social large group interactions the same way that. I don't know, uh, and that's the beautiful thing about the disability community too, is we're so diverse. And I want to I want to make space for all of us to share our disability, our stories and our narratives and how different they are, and that there's no one size fits all for our experience.

Carrie: [00:41:03] Right. There's no right way to, I guess, be disabled. Right? Or so there's. Yeah, we're all different, and we all bring a different story to it. Thinking about you made me think about our allies. And that the weight doesn't always need to be on us to share. How can those who are non-disabled be an ally for us, too?

Tiffany: [00:41:32] I think it's chapter 33 of the book, which is called Advocate with Disabled People. And the original title of the chapter, or the way it shows up in the manifesto is advocate with us, not for us. Or maybe it doesn't show up in the manifesto. Um, but the reason why. Oh, or it says nothing. I decided I ended up with nothing about us without us. But maybe if I could do it again, it would have been advocate with us. Not for us. Or it could have been nothing without us. But the reason why I referenced chapter 33 is I came up with an acronym called PAPUSD, which now, thanks to ChatGPT, I probably would have asked ChatGPT to make it a more a better acronym than that. Probably that ends with an S, actually. Maybe after this I'll do that. Um, but essentially PAPUSD stands for Platform Amplify Partner. Use your privilege, share your story, and decenter yourself. Um, and hopefully we can use that as the carrot to dangle you to want to learn more about those. But essentially it's just saying, hey, you have nondisabled privilege. You may have access to spaces that we as disabled people don't. If you have an opportunity to bring us into that space, or to help ensure that you can help advocate and remember that there is a community that wants to access this experience or wants to access this product. Um, but then also remember that yes, your story is.

Carrie: [00:43:08] Important.

Tiffany: [00:43:09] But it's not ours. It's not our story. So make sure that you understand that you're sharing parts of your story in relation or in connection with us. But they're they're both important and they're different.

Carrie: [00:43:25] Um, and I love how you have those, like you said, that manifesto or that kind of plan for those who want to be an ally and advocate with us, uh, in that, in that community, too. What I, I guess moving forward and I know we're kind of coming up on the end of our time. You talked a little bit at the beginning that I kind of stuck in my head. You talked about when you were employed at a couple of couple of different places that your. It was an exception for and for your support and your your services there. Can you share why or how that was an exception at your place of work?

Tiffany: [00:44:19] Uh, I yeah, I want to clarify that. I feel like it's an exception in our community because if we look at our employment numbers, uh, we are twice, uh, our unemployment numbers are twice that of our non-disabled peers. And as I think about how we can meaningfully create change in the disability community, I do feel like having pathways to entrepreneurship and being able to support our livelihoods and getting hired and finding gainful employment are things that should not be so difficult for our community. Yes. Yet we continue to encounter barriers. So, um, yeah, I wanted to clarify. I did not feel like I was an exception while I was there, but I felt like I felt like those experiences and the fact that I do have these work experiences feel like they are an exception and not the norm in the disability community, as many of us struggle to still find employment opportunities.

Carrie: [00:45:19] Yeah, I think in your book, your research said, what was it only like 21% of the individuals with disabilities had employment?

Carrie: [00:45:30] And I think it increased.

Tiffany: [00:45:31] I think it was 22.3%, which ended up being like a record high. But I'll, I'll, I'll double check that. But still, that's really low.

Carrie: [00:45:40] That is.

Carrie: [00:45:41] Really low.

Carrie: [00:45:43] Uh, and I did some.

Tiffany: [00:45:44] Research as to why why it reached a record high a couple, the employment rate reached a record high. And there were a couple of reasons for it was the first was a tightening of the labor market in and retail and hospitality, which is where a lot of disabled people are hired. The second was the introduction or having access to remote or hybrid work, which means that disabled people would not experience transportation barriers to get to work, or it could work at hours that they worked best. And then finally, the new numbers of millions of now disabled people who have long haul Covid, who already had jobs, were now included in those numbers. So, uh, all of this to say, I know there's a much broader conversation around return to office mandates. And as someone who now works for myself, but, uh, works flexible hours, uh, at work stations that work best for me, I, I actually I reserve my like social media content editing time to like as I'm winding down during the day and I'm in my bed with my phone because I edit most of my video content on my phone, and that's how I how I work best.

Tiffany: [00:46:57] And again, I think about this didn't make it into the book, but this is one of my new ideas when I was looking at the definition of inclusive design. It is creating multiple design variations for the same desired outcome. And the desired outcome in this case is social media content. Uh, multiple design variations means I can do it. Sitting here at my desk. I can do it from my bed. I can do it at some random hour. And desired outcome is you still get the content right. Um, and I translate that back to work and how we think about accommodations as well. Uh, in some ways, I actually feel like accommodations are a form of inclusive design. It's thinking the desired outcome is you do your job. Multiple design variations. We have different ways of doing it, and the final product is what matters. You get a book, you can get it in print, audio or e-book. You know multiple formats of how you engage. That's even an example too.

Carrie: [00:48:03] Yeah. Now, having all of those different, um, options really opens up the door for so many people. You talk about a little bit about being kind of a fly on the wall with some of your book studies. And so what do you what what is the future? What do you feel like you would like to see as an outcome of putting yourself out there, writing this book and and getting it into the hands of of people?

Tiffany: [00:48:32] Um, there's a reason why I dedicated this book to nine year old Tiffany. And so much of what I have dedicated my life and my work to is ensuring that the world is a little bit kinder and more compassionate and better for.

Carrie: [00:48:52] Her.

Tiffany: [00:48:53] Because I think about how hard things were for her, and I don't want other people and these future generations to experience that. And I really do believe that our greatest gift is by being ourselves. And we, um, these systems of oppression have made us mistakenly believe that these aspects of who we are are things that we should feel shame about or hide away, when really, I think they unlock a lot of different things to create this whole picture of who we are. So my hope is that this book contributes to the conversation around ableism, calling it what it is, taking meaningful action to dismantle it. And. Ideal. Ideal. The idealistic part of me sees it as a way. Would love to see us end ableism in my lifetime. Uh, but there's also a quote I'm really inspired by from Doctor Robert Bullard. And he says the fight for justice is a marathon relay. Uh, and I love that quote, because for this particular point in time that I have the baton, I am putting this work out to hand the baton off to the next generation, and hopefully things look a little bit different, but we won't ever stop fighting.

Carrie: [00:50:33] Mm.

Carrie: [00:50:34] That is a great like wrap up of like your book and what your why and your passion. And for nine year old Tiffany and how nine year old Tiffany has made a huge impact um moving forward. Is there anything else that I didn't ask you that you think I should have, that you want to share with our listeners today?

Carrie: [00:51:00] Ooh.

Tiffany: [00:51:01] You know, I've been really reflecting on rest and how important it is. And I think capitalism made us believe that we always needed to produce. We always needed to have something new. We always needed to be doing something. And rest is doing something. And I think I've had to learn that my sustainability relies on my ability to recharge and nourish myself, and trust that I'm in a community that will take this work on when I can't. Uh, so so that's something I've been just reflecting on. You know, it's been fascinating having a book out. And people ask, you know, what's next? And I'm like, the book literally came out a month ago. Uh, can I celebrate this moment? And, um, but yeah, I've been I've been so grateful with how excited people are that this book is out and that in a lot of ways, I also didn't mention I also dedicated this book to my late dad. Um, that he can. That he and nine year old Tiffany can both live on in these pages, even though this book is not a memoir. Uh, maybe that one's coming next. But, uh. But yeah, just remembering to find moments of rest and joy.

Carrie: [00:52:35] Life.

Tiffany: [00:52:36] Life is lifing a lot of times, and sometimes has hard edges. For those of us who are disabled trying to exist in ableism, it's consistent cognitive dissonance, um, and can get really exhausting. And in those times I lean back on community and rest. So I think I wanted to make sure I shared that, because I think if you hear about all the things I'm doing, you're like, when do you sleep? And I'm like, actually a lot, uh, because it's so important.

Carrie: [00:53:08] Well, I think you deserve rest right now. And you also deserve a huge kudos because I haven't read a book like From Cover to Cover in a really long time. And I was just taking notes. And I appreciate all of the reflection questions. And I can see how this book can be so valuable for so many different audiences. And I really hope that a lot of people will, um, purchase this book, start a club, um, really digest it and talk about it and own it. And also use your art as like guiding words to reflect on as well. Tiffany, if people want to get a hold of you or buy your book, how can they do that?

Tiffany: [00:53:59] Yeah. So the best place to go is Tiffanyyu.Com and while you're there, you'll see more information on the book. You can get it at your favorite retailer. Carrie got her book at this amazing independent bookstore called Yu and Me books. No relation to me, but it's based in New York. And actually they just told me, depending on when this goes live, that they still have a couple copies that can come with the signed book plate and the manifesto art print for free. So if you want a copy of that to hang up to continue the conversation. Definitely check that out. But you can get the book at your favorite retailer, and then you'll find social media links. If you want to follow me across any places there, and even a place to get in contact with me as well.

Carrie: [00:54:41] Perfect. Well, I want to hold my book up and I will, like take a screenshot of us because I cannot wait to, um, get this. And I don't even know how to do that, but, um, I'll do it, um, through the through the video too. I'll take a screenshot. And, Tiffany, I hope someday we will be able to meet in person because and I just want to say thank you for writing this book, for putting your story out there, because I know that takes a lot of courage to. But it also impacts a lot of people and and many different ways, no matter where they are and their journey. And thank you for for being a guest today. I really appreciate you.

Tiffany: [00:55:27] Thank you.

Announcer: [00:55:28] Thank you for listening. This has been a production of the 3C Digital Media Network.

Carrie: [00:00:14] Welcome to the empowEAR Audiology podcast, a production of the 3C Digital Media Network. I am your host, Dr Carrie Spangler, a passionate, deaf and hard of hearing audiologist. Each episode will bring an empowering message surrounding audiology and beyond. Thank you for spending time with me today, and let's get started with today's episode.

Carrie: [00:00:41] All right. I am excited to have two guests with me today on the empowEAR Audiology podcast. I have Dr Julie Honaker. She is currently the director of the Vestibular and Balance Disorders Program within the Head and Neck Institute at the Cleveland Clinic Foundation. Dr Honaker is an audiologist specializing in state of the art assessment and management planning for all patients with dizziness, imbalance, and falling risk concerns. In addition to patient care, she engages in clinical research pertaining to patients across the lifespan with vestibular disorders, with an emphasis on risk of falling assessment and prevention. Dr Honaker completed her PhD at the University of Cincinnati and her post-doctoral fellowship fellowship at the Mayo Clinic in Rochester. I also have today with me, Dr Violette Lavender, and she is a pediatric audiologist with Cincinnati Children's Hospital. She attended Purdue University, where she earned both her bachelor's of communication Disorders and Masters of Audiology. She graduated from the University of Florida with her AuD. She specializes in both hearing and balance disorders and has published and presented in the areas of pediatric balance assessment. Violette is interested in translational research and strives to make the vestibular test battery accessible for young children. So Dr Lavender and Dr Honaker, thank you for joining me on the audiology podcast.

Violette: [00:02:23] Thank you for having us.

Carrie: [00:02:25] Thank you. Well, um, one of the things that I always like to ask first, when I have professionals and audiologists on the podcast, is how did you find your way to audiology and then your niche in vestibular disorders. So, um, Julie, do you want to go first?

Julie: [00:02:43] Sure, I'll go first. Well, I think my story is probably like many others. In college, I started off in one direction. I actually was interested in special education and my minor was Communication sciences and disorders. And from there I took an intro to audiology course at Ohio State, and I just fell in love with it. And I just was fascinated with the ear. And I made a transfer to University of Cincinnati and just switched everything over to speech and hearing sciences for my undergrad. And I can remember in undergrad, I did a project where we made a life size traveling wave, and that was just the the most exciting thing for me to to do that. And from there, I went into grad school and it was really my first class in vestibular, where I fell in love with it. And I had a lot of friends at the University of Cincinnati who were in med school. And I would talk about physiology, and they were seeing the other end of the spectrum of pathophysiology, and it just really broadened my horizon. And ever since then, I've been hooked. That's my story and decided to go on to my PhD because I had more questions than answers in my program.

Carrie: [00:03:56] Well, good.

Violette: [00:03:56] My story is not that dissimilar. No it's not. It's not very dissimilar at all. It's, um. I was interested in speech therapy and teaching, and I went into those classes, but I really craved the science portion. And so when audiology was introduced, it was it was definitely more heavily science based. So I really loved that. And I knew that I wasn't cut out to be a speech therapist, to plan sessions. I wanted to go in there and do some evaluations and some testing, and that's where audiology kind of fell into my lap. Um, my uncle was an audiologist, and in our little town he had a rotary chair. And that was a very big deal because it was a rotary chair in this small town that was the only one in a big area. So it was really fun for me to see that, that how different it was from regular audiology and grad school at the time. And so I started really developing this interest in vestibular sciences. And then I sought out a fellowship at the University of Michigan because I knew they had a strong vestibular program. So I trained with them, and I was fortunate enough when I came to Cincinnati to meet Julie, and Julie partnered with us at Cincinnati Children's. She was so kind to let us partner with her so that we could really develop a pediatric vestibular program. It was something that wasn't really heard of. There may have been only one other program in the country, 1 or 2 other programs in the country, and she was kind enough to let us, you know, use equipment for a couple of months, for a few months and really get our feet wet learning how to do a vestibular program for kids. So thank you, Julie. It's good to it's good to work with you on this capacity again.

Julie: [00:05:45] We're all friends in audiology.

Violette: [00:05:47] Yes, exactly.

Julie: [00:05:48] That's the beauty of it.

Carrie: [00:05:49] I love how the circles kind of connect. And that is so, um, interesting too. And I am excited because I have not done a podcast for our listeners about vestibular disorders and function and balance and orientation. So this would be a great way to really have our listeners get a taste of some of the this other aspect of audiology and why it is so important to to look at. But before we get started, would one of you want to just give the audience more of like a 360 degree view of like, what vestibular, um, function looks like and disorders and how that really can impact.

Violette: [00:06:35] I can start and I can start and give it to you from the pediatric approach and how we look at the development of the vestibular system. And maybe, Julie, you want to pick up and talk about how we carry over into the lifetime. Um, but when we look at vestibular disorders in children, the number one thing families tell us is that their child might have a motor delay. They might also have some hypotonia. And I think for years when children had delays and they had hearing loss, particularly, um, the thought was that children who have hearing loss also have concurrent comorbidities. So they have these other, um, delays going on. And I don't think the vestibular system was really looked at in the past as a cause for some of these delays, per se. And now we know that, you know, through research, um, you know, Kristen Janke did a great paper in 2018 on predictive factors showing that, you know, if your child with hearing loss that is greater than 66dB and for your pure tone average. So really a moderately severe hearing loss that really puts you at greater risk for having a vestibular delay. And what that might show up as is that you're sitting is delayed. You're walking is delayed. Um, a lot of parents tell me that they notice from birth that their moro reflex may be delayed.

Violette: [00:07:54] And that's the reflex that you notice with your baby at home, where if you're holding them and you tip them back, they naturally put their hands out quickly. It's almost like a primitive reflex to almost catch yourself. Or some doctors call it the parachute reflex. And so parents will tell us that they don't even see it in some of their children with severe or profound hearing loss. And that continues, like I said, we'll see. Delayed sitting, delayed walking. And what we also know from literature now is that children with vestibular loss left untreated often never catch up to the levels of their peers. They never completely make that switch over to look exactly like their. Their typical hearing peers, um, functionally. So maybe they're the kiddos who are not the most graceful on the soccer field or the most athletic. Or they might have a difficult time learning how to ride a bike or roller skate, or do some of those activities that kids love to do. So those are things we look out for when children have hearing loss particularly, and what things to look out for when we suspect they may have a vestibular loss too.

Carrie: [00:09:00] Okay, so Julie, what happens as they get older. And it's something that is a later onset.

Julie: [00:09:09] Well, I'll just kind of I'll give everybody like the the 360 view of the vestibular system. It's part of our balance system which is a sensory motor system. So we utilize our vision. We have touch sensors throughout our body, in particular important sensors within our ankles that help us understand externally where we are in space. Our vestibular system is that internal gyroscope that lets us know where we are internally, where we're moving with respect to the world around us. The vestibular system helps us with gaze stability when we're in motion or performing activities of daily living. It helps us orient where we are in space. So our perception of true north vertical as well as the horizon. And then it also helps us with postural control. And as Violette was saying, many of those reflexive, um, pathways that happen to keep us upright when everything's working well, we don't even think about our vestibular system. And our vestibular system doesn't have really primary pathways to a cortex. So it is all behind the scenes work that's being done and reflexive work that's happening just to keep us moving and grooving throughout the day. And it's not until things break down that we really have an appreciation for this sense, which is, in essence, kind of our sixth sense that helps us where we are.

Julie: [00:10:29] Um, as we mature in age, we have declined to all of our sensory systems. And that, um, includes what we know with our hearing apparatus as well as our vestibular system, where we can have a breakdown in, um, the neural pathways, the functionality of the sensory systems, even hair cells within these organs that help to transfer electrical signals to help us with these reflexive movements that can all start to break down and that can lead to debilitating symptoms of dizziness, vertigo, unsteadiness a feeling that your world, what you're seeing visually, is bobbing when you're in motion. And then it also increases falls. And that's really what we see on the other end when we have a decline of our sensory structures, how those sensory structures interact with each other, and then also a decline in the motor output that helps with those quick reflexive responses. So we can see clearly, keep us upright, know where we are in space and prevent falls that can all start to decline with age.

Carrie: [00:11:34] Yeah. Well thank you both for that big, big view. And like what you said, Julie, this is probably something that you don't think about until it impacts you. And then what are some of those common reasons, some from an adult perspective, that may contribute to vestibular? I know you said aging in general, just because our senses start to kind of break down, but what else?

Julie: [00:12:03] Well, I'll say dizziness and imbalance is a very common reason that adults will present to their primary care providers with concerns. And we so often think of dizziness as having the caveat of, oh, it's an inner ear, it's a vestibular thing. But there are so a multitude of reasons why somebody may be presenting with dizziness. And dizziness itself is a descriptor, but it can have very many different characteristics. So we have to get creative and we have to help our patients articulate what they're feeling so that we can best pinpoint what could be the cause for this. I think it's estimated and prevalence for dizziness of anywhere from 11 to like 16% of the population, but that increases as we advance in our age. For individuals, as they mature in age, if we're thinking just inner ear disorders, there's very common disorders. The most common one is called benign paroxysmal positional vertigo. And that's where part of our sensory vestibular system that is gravity sensitive and has little crystals within it. These crystals can branch off with age, and they can free float into parts of the inner ear that's fluid filled where they don't belong. And that can cause transient episodes of vertigo, even imbalance. In particular, when patients or individuals are rolling in bed, tipping their head back to put eye drops in, pulling something off the grocery shelf, or even getting their hair done and being reclined back, that can trigger these very short lived but debilitating symptoms of vertigo. That's probably the most common reason. But for symptoms of dizziness, it can span from medication interaction or side effects. It could be something that's more visual, where maybe they're getting acclimated to new progressive lenses that can throw off somebody's balance and their perception of the world. We have cardiovascular causes, heart related causes, neurologic causes, even psychosomatic causes, anxiety, depression, panic that all can have secondary effects of, um, symptoms of imbalance, swaying, dizziness, vertigo, what have you. And it's really our job as vestibular audiologists and part of the interprofessional team that works with patients with these symptoms to try to decipher what's going on.

Carrie: [00:14:26] Yeah, that sounds like, um, a very thorough case history and assessment to determine what that actual cause is, because, as you said earlier, it's dizziness can mean a lot of things. And getting to the core of what that looks like is important. So Violette, from a more pediatric perspective, can you just share maybe some of those common symptoms or causes for vestibular loss?

Carrie: [00:14:53] Sure.

Violette: [00:14:54] So in the pediatric world, what we notice most is that they don't necessarily present with complaints of dizziness. So especially in the kids under ten, a lot of times if they've been experiencing vertigo, they may not share that with their parents because they may think it's normal, because they've been experiencing it for a long enough time, that it may have become normal to them. And often they don't even have the vocabulary to describe that something is different. So when parents present to us with their child who is having vertigo attacks, it's usually because they're experiencing episodes of vomiting. They may be experiencing times where they feel like they can't go to school and their child feels off. Um, some of the kids tell us they feel like they're floating or they're flying or, um, they may not be able to describe it the way an adult can describe it. Um, and especially true with our kiddos who have hearing loss. So in the chances that they might have a bilateral vestibular loss from birth, those kids don't know anything is different or off about their vestibular system, because that's how they've always functioned. And they wouldn't feel dizziness. Instead, they may have, like I said, that motor delay and again, that could feel very normal to them. Um, and that's where we come in as audiologists, because we're going to offer some help or some opportunities for them to improve their balance when they may have not noticed anything was was different. Um, back to the Vertigo piece. For our kids who experience vertigo. The most common cause is often variations of migraine.

Violette: [00:16:29] Um, sometimes we have kids who have something called recurrent vertigo of childhood. Um, that's the latest terminology that I think most of the neurologists. Neurologists are using recurrent vertigo of childhood, that is, spells of vertigo where they are having clear and cut spells, where it turns on and it turns off and they feel dizzy and they really don't. They might not have any other symptoms, so there may be vomiting. There may not be. They may have a headache like actual head pain, but they may not. But it's just clear. Clear cut spells of vertigo attributed to no other cause. Um, and sometimes they outgrow it. Sometimes as they get older, the children can outgrow that, and they may have a period where they have nothing for a while. So a lot of times we'll see kids come in, um, at age three, four, five, and then they kind of drop off for a while. So they're almost cured. And the parents get very excited. So they have nothing from ages eight, nine, ten. But then as the hormones shift in their body and they start to enter puberty, all of a sudden that kind of kicks back up. And it doesn't happen to all the kiddos, but sometimes they may go into a more traditional Migraine as a teenager. Um, so those are the things we typically watch for in our kids who have migraine. Migraine is vertigo. Um, we also see psychosomatic, just like Julie does. We also will see, um, kiddos who have hypermobility spectrum disorder. So this is very interesting for us. I think for years we saw kids who had symptoms that looked like Pots, postural orthostatic tachycardia syndrome, where they stood up and had blackening of their vision or feeling of vertigo or feeling lightheaded.

Violette: [00:18:11] A lot of times that hit in the teenage years. Um, and for years we were seeing these kids. They might also have dysautonomia where they were getting dizzy from working too hard or being active or normal things that you and I would do, which would be like, get up, move around, go pack your lunch, go get your backpack. But that would fatigue them or make them feel more dizzy. Um, and what we started noticing is that there was a connection with their, um, their joints. And so we now know that with hypermobility, even if it's not full blown. Ehlers-Danlos syndrome, even if they're on the spectrum of hypermobility, they often experience dysautonomia. So we are we are getting children, um, with that diagnosis now. And we're starting to ask about it more often. And a lot of times that does run in families. And it's very easy to ask a parent and they'll say, oh, I've been dealing with that for years. And so even the parents who have dealt with it their whole life might not think it's different. Um, yeah. So those are our usual causes. We don't have a lot of bppv in the little kids that are ten or under. We don't get a lot of neuritis. We often don't have even Meniere's disease in this population, so very different than adults. Um, but yes, we are still getting children who come in with vertigo.

Carrie: [00:19:25] Yeah. So either other disorders that give you kind of red flags, I mean, you mentioned hearing loss as one, but are there other things that you're like, okay, if they have this disorder or syndrome or whatever, like a red flag? Like we need to make sure that they have a vestibular assessment too.

Violette: [00:19:49] Yes. That's a great question. Let me circle back to hearing loss first. So amongst kids with hearing loss, I know I already have shared that Kristen Janke predictive factor was having a moderately severe or worse hearing loss predisposed you more often to have a vestibular disorder. But amongst kids who had hearing loss, we know that there are certain genetic factors that can cause them to more likely have a vestibular loss. So things like enlarged vestibular aqueduct syndrome, they can have fluctuating vestibular input. Kids with cytomegalovirus. We're starting to learn a lot more about these children just because of advances in newborn screenings for cytomegalovirus. And we now know that kids can have no hearing loss sometimes and still have a vestibular disorder, or they can have a vestibular loss on one side and a hearing loss on the other side. So it doesn't always match up perfectly just because they have hearing loss with CMV. Um, but sometimes that does affect their vestibular system. We know kids who have Usher syndrome are often born, especially type one are born without a vestibular system, and children who have charge association. Those children are often born without any type of vestibular apparatus, so they don't even have oftentimes any semicircular canals. Um, those are our our big heavy hitters. Kids with Waardenburg syndrome often have vestibular loss as well. But those are our our main ones. But certainly there are plenty of other syndromes and inner ear malformations that can cause vestibular loss as well. Um, in terms of other disorders that may cause vestibular loss, I had already shared, you know, our hypermobile kids can be at risk. Um, and then Julie also shared cardiology. So if there's any cardiac concerns, we can have that as well. Um, we often look at children who have mental health disorders because they are more often likely to have vestibular loss. And those are our main ones, I would say.

Carrie: [00:21:42] Okay.

Carrie: [00:21:43] Julie, are there any more? For adults, I know you had mentioned BPV as one thing, but is there anything else that's kind of a red flag for adults to be seen for vestibular workout?

Julie: [00:21:57] I'll just piggyback on Violette's comment about migraines. We see that commonly in our adult population, and oftentimes when they make their way to myself or one of my team members at the Cleveland Clinic, our goal is to rule in or rule out a peripheral cause as a source. And sometimes patients will present with vertigo secondary to their migraine events. And we'll be looking at function, whether or not this is causing any dysfunction or whether or not we can pinpoint that. It's maybe another condition that's causing these Vertigo episodes.

Carrie: [00:22:32] Um.

Julie: [00:22:33] Kind of other vestibular disorders that impact adults. Um, many have heard of Meniere's disease. So this has a triad of symptoms of vertigo episodes with fluctuations in hearing, typically one ear, uh, unilateral tinnitus and that involved ear as well as a fullness feeling in that ear that is very brief in duration for these episodes on the order of minutes to hours, not more than a day. Um, but they're very debilitating, and they can progress over time, and eventually it can cause dysfunction of the other ear. Sometimes there's an overlap between migraines and Meniere's disease. So individuals can have both conditions. One condition. And we have to really decipher what is the most appropriate management option for these individuals. Um, there's involvement of tumors. You can have schwannomas. So small benign tumors that arise on the, eighth cranial nerve, which is involves both hearing and balance. Um individuals can have vascular issues. Strokes can be common in older adults. There's many spinocerebellar dysfunctions and disorders that can impact the balance system as a whole. Ms. can be as a secondary symptom. Individuals can have dizziness. They can have vertigo. They can even have subsequent um bppv because of that condition. And then there's just other things that can go across any age, any stage. Head injury can cause dizziness and vestibular problems. Um, neck injuries can cause issues of dizziness and imbalance. So there's there's lots of lots of different disorders to think about.

Carrie: [00:24:17] Yeah. So with all of that, I mean, like you said, there's lots of different disorders to kind of think about. And it goes beyond hearing as well. How do people get to you? I mean, what is that referral process? Are family physician saying, hey, you need to go for a vestibular workup. What is kind of that mechanism if they have these symptoms of vestibular disorders?

Julie: [00:24:48] From an adult perspective, I think patients can come many different ways. And I'll just speak to how it is at the Cleveland Clinic. So we have some patients who again, knowing that their primary care provider is there, their home base, they will be referred to perhaps an ear, nose and throat specialist to evaluate if there's common hearing and, um, vertigo or maybe balance dysfunction, um, from ENT. They'll make a referral for us for evaluation. Um, we have dizzy clinics at the Cleveland Clinic and that involves, um, audiology working alongside um, providers and otology. So ear specialists and non-medical audiology providers evaluating hearing and balance function and patients come for these visits all in one day. They have a multitude of visits and then they're able to get their evaluation and management in one stop shop. Um, other patients, it kind of depends. Sometimes they'll make a route and go to neurology, and perhaps from there they'll be sent to physical therapy for management of their symptoms. And when they're not progressing in physical therapy, they'll then see us to make some determinations of what what is the true cause for their symptoms, and how do they need to make some changes in their management pathways. So I would say there's lots of resources and there are a multitude of interdisciplinary clinics, not only at Cleveland Clinic, I assume also at Children's Hospital in Cincinnati. Um, but there's lots of pathways for patients to get in. It's getting the word out of how we can all work together. And when patients are meeting targets with with therapy or other management to then have other resources for evaluation and to know that we're here to help really make that determination of whether or not it is truly an inner ear problem, and to what extent.

Carrie: [00:26:41] All right. Yeah. Similar to.

Violette: [00:26:45] Yes. So similar. Um, usually I would feel like the primary care doctors are the the usual referral sources. Ear, nose and throat. That's our second. That's ENT is probably our largest referral source than primary care doctors. Um, like Julie said, just getting the word out and letting people know there are probably only 20 or less dedicated pediatric vestibular centers across the United States, and we're scattered amongst the United States. So there's not a lot of places for people to go to get tested or comprehensively tested for their child. It's getting the word out, letting other audiologists know that they can do this work as well. Um, actually, I'm speaking ahead of AAA. They're going to be publishing a, um, I think in the next couple of months, there will be a guideline published on how to test children. And there's a nice graphic in that document showing that if you have a child that is 0 to 2 years old, for example, um, how would you test them as an audiologist or, um, you know, the different age groups showing that there are different tests you could do in your clinic even if you don't have pediatric adapted, um, goggles or you don't have, um, all the fancy equipment to be able to test children. There's lots of bedside tests that you can do for children. So just getting that word out, letting other audiologists know in their communities that they can also do this test, um, I would say a referral source for us that's kind of come about in the last few years might be hematology oncology. So, um, children who are undergoing cancer treatments, sometimes it affects their vestibular system as well. So sometimes we're getting children come through that process. Um, Those are our main referral sources in general. Carrie.

Carrie: [00:28:28] Okay.

Carrie: [00:28:29] Yeah. And like you said, Violette, like only having 20 dedicated centers in the US and knowing the prevalence is high, I would assume. And, you know, making sure that kids and adults get the care that they need. Is that pretty common, too? Julie. For adult populations, as far as vestibular centers, I would think it would be a little more. But is it still kind of we need more?

Julie: [00:29:00] I would say we need more. Number one, I don't I don't know, off the top of my head the number of centers we have. And I think it can be broken down into major medical centers that may have access to more equipment versus, um, ent outpatient centers or, you know, facilities where they have maybe one provider who's able to perform the testing and maybe more limited equipment. It just depends. But I would say there's probably more opportunity in adults, but probably there's still a real need in audiology to have more providers. Just knowing, um, with our aging population, there's going to be more more patients who need our services and more answers that we have to give the managing providers to better understand what could be the cause.

Carrie: [00:29:48] Which is, I think, a good segue into diagnosing vestibular disorders. Can you just give maybe Julie, from an adult perspective, what does that look like as far as maybe the testing and and the sequence? I know you can't get into details, but just from a bigger view. If they're coming to see you for a whole day, like what are the different pinpoints along the way? Sure.

Julie: [00:30:17] Carrie, we Violette and I feel that I can talk your ear off for hours on end about this. It's our passion. But I'll give you a synopsis of it. So I think I alluded to it a little bit earlier that, um, we are well, we're we're clinician scientists, and as scientists, we have to put on our, our clinical questioning hat to develop hypotheses of what could be going on. And first and foremost, we have to have an appreciation for the patient symptoms and the signs that they've been dealing with. And I would say the bulk of our work for any provider dealing with patients with dizziness and balance or vertigo is to have a thorough case history to let the patient talk, because they have the answers that can help us pinpoint what could be the cause. Um, where we come in and I don't know how you feel about this, but sometimes testing is not necessary for some conditions and disorders. Um, we help to clarify function of the vestibular system. We help to clarify the status of a person recovering from vestibular onset. Um, we can help to appreciate what structures or site of lesion are involved. But we're not necessarily a key in many aspects of the diagnosis. But we're vital. We're a vital part of this.

Julie: [00:31:31] But I would say case history is is the number one thing from there, from case history, we can get a good appreciation for both physiology. So the function of the system with many of our tests and we can look like a hearing test. We can look across the vestibular spectrum like a frequency spectrum, where we have some testing that will pinpoint very low frequency responses, such as, um, what happens maybe when you're standing very still, just as the vestibular system is, is sending information to help keep us upright and keep our vision stable so we can see the world clearly to very much, um, when the vestibular system is activated, when we're performing more activities of daily living, which is more of a high frequency response, so we can look across the spectrum with our testing and we can add tests into the mix that can help us answer particular questions that are stemming from our detective work and looking at case history, maybe even some bedside investigations at the beginning, or office examination and even functional examination of a person's posture, their gait, their their head orientation. That can give us good clues into whether or not this is a vestibular problem or not. I'll turn it over to you.

Carrie: [00:32:47] Yes. What about these kids that are.

Carrie: [00:32:50] Probably a little more challenging to to test.

Carrie: [00:32:55] Sometimes?

Violette: [00:32:56] Yes, but so much fun and so rewarding. Truly. Um, like Julie said, some some kids just really don't necessarily need testing. And especially when they are presenting with concerns. And in our world, um, a 14 year old girl who, when she stands up, gets a little lightheaded. Originally when people thought we had a vestibular clinic, they wanted to send all of those kiddos over to us, and we felt like they would do better with the cardiology referral, um, and, and whatnot. And sometimes, like the hypermobility clinic whatnot, those were those were the better places to send those kiddos. But like Julie also said, we are a, um, answer the question type of test, type of test battery. So we're looking to see what is the question the family has and how we can answer it for them. I think when I first started out as a clinician, I was very test based, and so I knew I had all these tests in my toolbox, and I wanted to go in and perform all those tests and get all of the answers. And as I have grown as a clinician, I have realized you don't need every test necessarily. We need to answer the question. And so if I have a child, for example, who comes in with hearing loss or cochlear implants, and I already know that they're delayed in walking, I need to tell the physical therapist, number one, how much vestibular loss they have.

Violette: [00:34:18] Is it both sides? Is it one side only? Is it a total wipeout that they don't have any vestibular function? Or do they have partial vestibular function that they can really utilize in vestibular rehab to uptrain to help this kiddo? So those are the questions I'm answering when I have a child coming in with hearing loss. When I have a child coming in who has normal hearing and has vertigo complaints, I really need to let the doctors know. Is there any chance this could be attributed to an inner ear disorder? And so I have a collection of tests that I would run specifically to look at inner ear function, and then that way I can really give them a clean bill of health so they can move on with their process of finding out the diagnosis. And sometimes I'm surprised. Sometimes they might have a little inner ear, something going on, and we can feed that back to the physicians as well. What's always interesting to me is whenever we have a child who will come in with cochlear implants on, and I feel very strongly that their vertigo is going to show me that they have an asymmetric, asymmetrical vestibular system or some sort of active process going on. And in what we find out is that they have totally normal inner ear function on both sides.

Violette: [00:35:27] And really, when I've obtained the case history further and listening to their complaints, we realize that they are also having a migrainous disorder going on as well. So it's such a it's always a rewarding day because in vestibular, because you never know what you're going to get. Every every time we see a patient, it's impossible often to predict what we're going to be looking at. And I think one of the diagnoses that we're getting a lot more often is 3PD on some of these children. Um, I'm Julie might be able to talk about that a little bit more from the, you know, the functional aspect of it. But especially after Covid, the Covid 19 pandemic, we often had kiddos who got really sick. And when they came out of it, they would have this daily headache where they had a headache chronically every day. And in addition to that, they were dizzy every day, chronically dizzy. Um, and so that took that took on a new level for us. It wasn't just the Covid pandemic. Sometimes children have a event such as, um, I'll say neuritis. Maybe a teenager comes in with neuritis, and after the neuritis, they're having a really hard time compensating. They're kind of stuck in compensation. And so we really have to use this like multi disciplinary approach to helping these children.

Violette: [00:36:49] I know Carrie will probably ask that in a little bit about treatment options. Um, but certainly I think with our with our kids I know I'm getting off topic here. Um, but certainly with our kids, I think we have to really think of it as like a multidisciplinary approach when we're looking at their at their diagnosis as well. And the last thing I'll say regarding diagnosis is working with kids is, Is always interesting. So when I have a six month old baby come in, I really have to get the parents on board. I really have to make sure that the parents understand exactly what we're doing so that they feel comfortable, because the children always take their cues from their mom and dad. If the mom is stressed out, or if the mom is worried, then the child feeds right off of that. So I often call the parents ahead of time and let them know what we're going to do exactly, and that there's nothing that hurts the children, that we're going to be putting electrodes on, or that we're going to be watching their eyes in the dark, and that they get to sit with them the entire test. Um, but a lot of the success of our testing comes from their caregiver that comes with them, um, and just letting them know that the caregiver is comfortable so that if they're comfortable, then the child is comfortable.

Violette: [00:37:59] We also, um, give our weights worth in prizes. Um, we definitely need lots of stickers and toys and all kinds of cute surprises to keep them motivated. So sometimes with a four year old, It's all about, okay, we have this challenge, and after this we get to pick our next prize. And now we're going to do this challenge. And after that, we're picking another prize. So there's lots of fun ways that we keep the kids engaged and motivated. We use TV a lot. We use, um, like an iPod to watch a little video, especially when doing things like, Ovemps or Evemps, um, and kids love, you know, especially in the 2 to 3 year old range. As soon as you put on Miss Rachel or, um, cocomelon or something like that, they get really excited to watch and, and maybe some of the kids don't have a lot of TV at home, so this is like a special treat for them that they get to watch a show. So there's lots of ways we test children, but I would say that it's always about answering the question and not having to perform tests that are not necessary because we don't. We only have their attention span for a very short time.

Carrie: [00:39:06] All right.

Julie: [00:39:07] Chime in and just say really quickly that I, um, I appreciate your comments about, you know, and having a calming environment and involving the family. And that's very much the same for adults. We have adults who may be very anxious about their symptoms, anxious that we could reproduce their symptoms with our testing. And we have to be very mindful of that throughout our evaluation and, and have that same, you know, nurturing, calming, soothing nature and also being able to pivot with our test battery the same as you would for a younger patient who may not be able to tolerate all aspects of testing. We have to do the same for our adult patients as well. And that's where it really is. Having that, you know, moving away from everyone getting the same tests. Um, we really have to pivot it to what are we trying to answer and what would make the most sense for this particular patient? We don't have as many prizes in the adult world, but I probably motivate just as much as you do, especially for like my after lunch time patients that come in, they're sleepy and I'm sleepy and we're in the dark the whole time. I'm very much a cheerleader, and I have my same set of jokes I do with all my patients just for setup that my students want.

Carrie: [00:40:20] But, you know.

Julie: [00:40:21] It's always a hit that I try to get the patients to get on board and get through the test as much as they can.

Carrie: [00:40:27] Huh

Carrie: [00:40:27] Well, yeah. So it sounds like having a good toolbox and knowing which tools to use, depending on what the patient or the family is telling you the symptoms are and kind of moving a little bit forward, because I do want to be mindful of our time, too. Uh, I once you diagnosed, you both have talked a little bit about interprofessional teams and how important that is. And, um, you talked a little bit on that management piece with maybe some physical therapy, but I know it probably depends on what you find out from all of your questioning and your testing. Is there a common treatment plan or is it really just dependent all the time?

Julie: [00:41:20] I think in the adult world, and I can only assume it's the same in the kiddo world too. It really just depends on what we find with our investigation. Working closely because we're non-medical providers, working closely with our medical providers to formulate those next step plans, and having our thought process as far as what recommendations a patient might best benefit from. We look at it from the adult world of what do we need to do to help the patient functionally. So is this something that's, um, having an ill effect on their state, where we mean to be mindful of behavioral health for the individual and coping strategies and grounding strategies that help them as they're trying to matriculate through maybe a medical management program or a therapeutic program. Um, we'll often make recommendations if appropriate, for physical therapy in addition to occupational therapy, just to help these individuals with their activities of daily living and getting back to recovering and compensating and doing things that they once did before. Um, from a medical management side, I don't want to speak out of turn because I'm not a medical provider, but I think it really depends on if there's something conservative that's more a medical medication management. Although long term use of medications is often ill advised for patients as they're going through a compensation process, but there are some conditions where they have to be on medications to help control these cycles, such as migraines or such as Méniere's disease, something that's going to help keep and ward off these episodes from reoccurring so that they can have more success with other management.

Julie: [00:42:58] Um, and I think as patients change in age, we have to be mindful of other professionals that we want to refer them to for management, having colleagues and close connection with neurology to ensure that we're not missing anything that could be with the diagnosis. Thinking about their vision and how that plays into a balanced system, and having good ties and ensuring that they're getting corrective vision and taking care of visual problems if necessary. Excuse me if necessary, there could be cardiovascular concerns that we talked about. So that might be managing more in the medical side for that. Um, and then also just thinking about, you know, going back to kind of some of my work with falls and just having that as part of the management plan. And one thing we do with all our patients is we inform them of falling risk, and we help direct them to falling management. Um, if we feel that they're at higher risk for falls.

Carrie: [00:43:55] Yeah. So that quality of life piece is really a critical piece of that treatment management process to be Violette anything more to add on that pediatric side?

Violette: [00:44:07] Sure. Um, I think for pediatrics, the primary treatment plan is often physical therapy in approach, especially the first level of treatment. Um, most of the parents do not want to jump to migraine medicine in children under ten. I know neurologists are also a little more hesitant to prescribe a prophylactic treatment unless it is obviously very, um, disruptive to their daily life than they might. Um, I think our patients, because PT is our number one treatment option, we offer a child when they come in through the vestibular clinic, they're getting a combined evaluation. So they see audiology and physical therapy. And if it's feasible, we try to do it on the same day so that they can get both. Usually there's like a lunch break in between or a time to eat in between. Ours is usually first the audiology one is first, and the physical therapy one is often second. Sometimes they don't come in on the same day, especially if they live close by and they don't want to dedicate that amount of time to being here at children's. Um, but we, we try to give them both. And the reason for that is sometimes in our diagnostic approach, we will see a totally normal evaluation. And especially if they have migraine, our eval often is quite normal. And then they'll go to physical therapy. And they have tools that look at what makes the child dizzy. Um, they have a scale, for example, called the motion sensitivity quotient, where they look to see which motions specifically bring out the dizziness. And it's very interesting because our physical therapist has kind of adapted it for pediatrics for even very young pediatrics, um, even using the scale, the pain scale with the faces, um, as a representation of how much their vertigo increases as they are put in those different positions.

Violette: [00:45:58] And she'll develop a treatment plan based on that. And what we have found is that there's a very high correlation in our migraine patients with an increased level of motion sensitivity, and that helps her design a treatment plan of habituation. Um, we have done a study that actually shows that the kids who have vestibular migraine when they go through the vestibular therapy process, it hasn't always been popular to necessarily treat people with vestibular migraine with physical therapy. Um, but in our pediatric literature and our pediatric evidence that we've collected and published, we actually show that children with vestibular migraine do improve their motion sensitivity when they go through the habituation program that is targeted at the motions that they, that they have that provoke their symptoms. Um, yeah. So I would say in general it's physical therapy. We do involve the team. So in the cases, for example, that I brought up earlier of kids with 3PD, sometimes we have to bring in cognitive behavioral therapy. Sometimes we have to bring in medical management. Um, maybe neurology, maybe psychiatry. Um, so sometimes there is a medical piece like a, like a medication piece specifically that we have to add to their treatment program to really break them out of that chronic headache, chronic daily dizziness. Um, but in general, it's usually physical therapy.

Carrie: [00:47:18] Okay. And how long.

Carrie: [00:47:20] Does that typically a patient involved in a treatment plan. Is it for life. Is it you know, is it kind of an estimate.

Violette: [00:47:30] For children I would say usually on the order of 3 to 6 months, the children are usually free of their symptoms or their symptoms have greatly improved. Um, and that would be them participating in a home exercise program as well. So it's not just done weekly in therapy or even every other week in therapy. It's done through home exercises that the parents would help them work on at home as well, to help reduce that those symptoms. Um, for children who have bilateral vestibular loss from birth, We have a really unique approach. A lot of times the parents will come in in spurts, so they may come in in the beginning to help them learn to walk. And once they've mastered walking, they may take some time off and and enjoy their their free life without having to come for physical therapy. But then maybe around age seven, the children really want to learn to ride a bike. But the parents are struggling, teaching their child with a bilateral vestibular loss how to get their balance on a bicycle. And so our physical therapist really works with them on things like up training, the proprioceptive and the visual cues, because that's what they do have. So basically using substitution to learn to ride a bike so they may pop in then and get some some skills there, and then they may fall off for a while and then maybe around 11 or 12, they want to learn how to, um, be able to crouch down at the line on a football game and not fall over because they're perched on their toes and on a couple of fingers. Or maybe they want to learn how to hit a baseball and then drop the bat in turn, and then run successfully to first base without falling over. Um, and so there often are life skills that present themselves through the, the lifetime that oftentimes as parents, we are just not equipped. We don't have the instruction manual on how to teach a child how to how to do these things without a vestibular system. So oftentimes they'll pop back in for certain skills they want to work on.

Carrie: [00:49:23] That makes sense.

Carrie: [00:49:25] Julie. Is it kind of a I don't know, estimate for treatment?

Julie: [00:49:31] Yeah, I would say for somebody with, let's say a unilateral or asymmetrical vestibular dysfunction, those individuals may go through a therapy program that could be on the order of 6 to 8 weeks for them to start feeling better, but it's always as part of these therapy processes. And something that we try to counsel patients is that it's lifelong, where you want to maintain a level of activity you can decompensate, you can decondition if you're not keeping up with your balance system. And we want these individuals to be maintaining active movements, head movements, body movements as much as possible so that the balance system can recognize this and pick up on any error messages and help to correct for that. So I think it really depends on the individual. It depends on whether or not they have something like a bilateral loss like Violette was describing or unilateral loss. Or maybe it's something that's many sensory systems that need to be better integrated, that can have a more challenging therapeutic prognosis, where individuals may take longer just to start to have symptom relief.

Carrie: [00:50:45] Well, I think we've talked about a lot today, which is exciting from just a 360 degree view to just really what are some of those common reason why people present with vestibular disorders and and the next steps for diagnosing and treating. Is there anything that I didn't ask you that you think would be important for listeners to know? Either one of you, from the parent or from the child side, pediatric side to the adult side. I guess if you're thinking about our listeners who maybe might not be connected with a big center like Cincinnati or Cleveland Clinic.

Julie: [00:51:34] I'll just say one thing. There are wonderful resources on the web. So if, um, patients or parents want to go to vestibular. Org, there's a lot of information on there as far as what are common vestibular conditions. Um, there's even descriptions of therapy and some of the testing, and it also has resources on that particular website for support groups as well as how to find a provider. And they do a lot in the fall, they have a Balance Awareness Week to help raise awareness for these conditions that are not overt, their internal that patients deal with across the lifespan.

Carrie: [00:52:17] And I can definitely link that in the show notes. So people can go directly to vestibular. Org and get more information to be alerted. Anything that you wanted to add.

Violette: [00:52:30] I might just add that the number one thing an audiologist could do for a patient in the pediatric world would be do a hearing test, um, if they're under ten years old, in our in our own data that we've collected, it's unlikely that if they don't have hearing loss and it doesn't, it's not perfect. But in general, if they don't have hearing loss, typically, it isn't usually inner ear. And that's not true for the adult world. I know because things like bppv and and neuritis not do not necessarily have anything to do with hearing. But in the pediatric world, usually our data shows that the kids who have hearing loss are more likely to have inner ear related vestibular loss. And the kids who have normal hearing often have more central nervous system related vestibular problems. So that's just a generalized, you know, rule of thumb. It's not perfect. It doesn't work every time. And especially in the cases special cases of like CMV for example, doesn't work every time. But yeah, that's just a good way to to start, just get your hearing tested if you suspect vertigo in your child.

Carrie: [00:53:39] All right.

Carrie: [00:53:40] Good advice. And I just want to thank both of you for being part of the EmpowEAR Audiology podcast. I think our listeners are really going to enjoy this conversation. If anyone would have more questions. Are they able to reach out to you in any way? And I can link your information if you're willing, in the show notes as well.

Violette: [00:54:03] I would be happy to. Yes, I will share.

Julie: [00:54:05] Absolutely.

Carrie: [00:54:07] Okay.

Carrie: [00:54:08] Well, thank you both for being guests today. I really enjoyed this conversation. I think I could have had a hundred more questions. Um, but I'm not sure if we would have. Maybe we can have a part two someday, and we can really dive a little bit deeper into some of the, uh, more details of vestibular.

Carrie: [00:54:29] So thank you guys for being.

Carrie: [00:54:31] A guest today, I appreciate it.

Carrie: [00:54:34] Thank you so much, Carrie.

Announcer: [00:54:36] Thank you for listening. This has been a production of the 3C Digital Media Network.

Carrie: [00:00:14] Welcome to the empowEAR Audiology podcast, a production of the 3C Digital Media Network. I am your host, Dr Carrie Spangler, a passionate, deaf and hard of hearing audiologist. Each episode will bring an empowering message surrounding audiology and beyond. Thank you for spending time with me today, and let's get started with today's episode. All right. Welcome to the EmpowEAR Audiology podcast. I am so excited. I have two wonderful guests with me today as we kick off Educational Audiology Awareness Week for 2024. So first I have the president for the Educational Audiology Association Dr. Tori Ashton, and a little bit about Tori. She's in her 10th year as an educational audiologist with the Cooperative Educational Service Agency #4  in Wisconsin. She received a Bachelor of Science from the University of Wisconsin River falls and her Doctor of Audiology from the University of Wisconsin, Madison. She provided the educational audiology services to 12 school districts within a 60 mile radius. Tori is currently the president of EAA. As I've said before, and in addition to her role as president, she serves on many of the subcommittees within the Association, and in her free time, she enjoys her DIY projects, baking and reading. And I also have another wonderful EAA member with me today too, Dr Kristin Jolkowski, and she is an educational audiologist geologist serving southeast Nebraska. She received a Bachelor of Science degree in communication disorders from the University of Nebraska, Lincoln in 2004, and she received a Doctor of Audiology degree from the University of Nebraska, Lincoln in 2009. During her education, she was a research assistant at Boys Town National Research Hospital in Omaha, Nebraska, and then upon graduation, she worked at a busy otolaryngology clinic in Lincoln, Nebraska, serving patients of all ages. She found her passion for working with pediatric population and changed career setting to an educational audiologist in 2015. Kristin has a strong passion for interprofessional collaboration to improve outcomes for children who are deaf and hard of hearing. So Kristin and Tori, welcome to the podcast. I'm so excited to have you.

Kristin: [00:02:54] Thank you Carrie.

Carrie: [00:02:56] Yay! And as we kick off Educational Audiology Awareness Week, I would love, um, if one of you would just tell me if you want to just share a little bit about the Educational Audiology Association and why we are doing this.

Tori: [00:03:13] Yeah. So last year was actually our first year of celebrating, um, the Educational Audiology Association or not Association Awareness Week. Um, our goal with celebrating this week is to raise awareness about our services, hearing loss and students in the schools. Um, as well as just celebrating Ed AuDs in the work that we do.

Carrie: [00:03:38] Yeah. So I'm excited that we have this second year that we're, um, keep on doing this and raise that awareness. And I know that this year, um, we as an association really decided to focus in on, um, a couple of topics. One, just, you know, the general public and what educational audiologists do and how they impact in the schools. But we also took a deeper dive into hearing screenings. And I know most of our listeners will be familiar with this topic. But as we were talking a little before coming on the air, we all are from different states. And so how hearing screenings are done and impacted in different states is really diverse. So I guess one of my first questions for all of us, so we're kind of all on the same page is why would hearing screenings really be important for our school age kids?

Tori: [00:04:42] Um, I can kind of give like a broad.

Carrie: [00:04:44] That would be great.

Tori: [00:04:45] Answer to that one. Um, I think hearing screenings are essential for obviously identifying students with hearing loss, but I think especially those students who have been like, lost to follow up from newborn hearing screenings, or students who might have late onset hearing loss, as well as students who might experience fluctuating hearing due to middle ear, um, pathology. Um, I think hearing loss definitely can hinder academic performance. Um, and it can affect a student's ability to engage, comprehend and participate in the classroom.

Carrie: [00:05:21] Yeah. All very important reasons to, uh, screen for hearing and kind of like what you said. Um, you know, it can happen at any time. So just because they had a universal newborn hearing screening doesn't mean that later on they're not going to have difficulties with hearing, too. So, um, I guess just kind of thinking about it from a United States State perspective too. What is the current state of school based hearing screenings in the United States?

Kristin: [00:06:01] So I was looking at the American Speech and Hearing Association. They've got, um, some documents that talk about how the different states do things, and not every state actually mandates school hearing screenings yet. Um, they're still 7 or 8 states that have no requirement for hearing screenings in the schools at all. So we've got 37 states mandating it, about five that suggest it. But we still have, in my opinion, maybe too many states that just kind of let it be whatever people want it to be. And we all know that, you know, these students need to have that access to instruction to be able to make that growth in school. And so it's not something you can just observe and determine that hearing is impacting you. Really, the screening is vital to figuring that out.

Carrie: [00:06:52] Yeah, and I'm glad you brought that up, because I was just looking at our EIA awareness page online. And that is a link on the educational audiology awareness page. Is that map of the hearings? You know, the states that are actually have protocols in place and some that just suggest it and some of them that like you said, Kristin, are not doing it at all. So very interesting. But if I guess that takes me to the next question, would be those states that maybe are just suggesting doing it or not doing it and don't have any kind of hearing screening protocol in place, what would be that next step or what action steps need to take place?

Kristin: [00:07:52] So I think you have to find. Yeah, you have to find somebody who's got the gumption to kind of take on a project. And so, um, I think on the EAA page, I know the name. I can't remember what Ncam stands for. Can someone help me out?

Carrie: [00:08:09] Yes.

Carrie: [00:08:10] National Center for Hearing Care and Assessment, I think.

Tori: [00:08:14] Assessment and management.

Carrie: [00:08:16] Okay.

Carrie: [00:08:17] I was close.

Kristin: [00:08:17] So they're based in Utah, and I know that they do a lot to support with newborn hearing screenings and maybe like early childhood. And they've got some webinars, but I feel like they've got some good things to get like preschool kind of screenings in place that if you really need, I guess, a starting point, it has some training options to kind of figure out what equipment you might need, um, maybe even paperwork options on how to track it and that sort of thing. Um, school age wise, I think that's a bigger beast, because then you're dealing with the complexities of school districts and how to initiate that. But EAA, I think, has some information that can help support a why, if you need to bring that to the powers that be within your school district.

Carrie: [00:09:09] Yeah.

Carrie: [00:09:10] And it might be something too just from a legislative process to I can just speak for I live in Ohio and that was definitely it's a law. And, you know, there's laws and rules that indicate that, you know, different age levels and grade levels need to be screened in the state. So maybe another resource would be, um, again, with that ASHA link that it talks about the state hearing screening requirements and um, gives a whole list of all 50 states and what they're currently doing the as whatever state you happen to live in, you could look at that list and see exactly who you know, the ages and who can screen and all of those types of protocols, too. But I guess to kind of talking to both of you, what has been, I think, Tori, you said you live in a state that, um, doesn't have. It's just optional if they decide they want to do it or not. So what have been some of the barriers, do you think, for implementing a protocol?

Tori: [00:10:25] Um, I definitely think it's one of the major ones is we don't mandate it here in Wisconsin, so schools don't have to do them. Um, but in my experience, I found that other barriers have just been, um, resources. Some of my rural schools don't have the appropriate equipment to be able to even screen a student. Um, also, having trained people who are able to, um, complete a hearing, screening time has been a big one. Time, some of our schools have just one nurse or a health aide, and they can't get through all the students that would need to be screened. Um, so those are, I would say the major ones that I've seen is just resources, train people and then time overall to get them done. Um.

Kristin: [00:11:13] I would agree even Nebraska does mandate, but I think some of those barriers still exist that it is mandated. But it's very stressful because it's mandated because you don't always it's hard to find the time, and it's hard to find a spot in a building to actually do the screening and training. Um, all of that still becomes a, a burden that sometimes is hard to meet. We have to meet it because it's mandated, but it's still difficult.

Carrie: [00:11:50] Yeah.

Carrie: [00:11:51] And I guess, um. What could we, I guess, what is the why? I mean, like, I mean, do we go back to the why of why it's important to to do the, the hearing screening? Do you think that would make a difference if administrators or special ed coordinators or teachers understood from a crucial point of view why a kid sitting in a classroom who has unidentified hearing loss would be struggling?

Tori: [00:12:31] I definitely think so. I think I mean, hearing loss, not teachers don't always know as much or what to be looking for for a student who might have a hearing loss or are having trouble focusing in class. I think sometimes it just gets put onto being like an attention issue, when really it it might not be. So I think there's kids who have maybe been misdiagnosed or mismanaged, even in the school setting where, you know, had we done a hearing screening and identified that there was a hearing loss, their accommodations in the classroom and supports would probably look very different.

Carrie: [00:13:08] Mhm.

Kristin: [00:13:09] And I think the piece, just like with newborn hearing screenings, the I don't know if we say selling point, but the why and how you can help convince is the sooner you identify these hearing needs, the sooner you can put those accommodations and supports into place. And then the less impact that hearing loss has over time, which tends to save districts money because you don't have to put as big and as expensive as supports in and so trying to have that be a leading point if you're talking to. Um, administration or superintendents or legislatures about maybe a cost. Savings as a benefit can be a way to get the wheel moving a little bit faster.

Carrie: [00:13:59] Yeah. And I'm just looking at our infographic on the EAA website about. Hearing screenings. And it talks about the unaddressed hearing loss is expensive and like due to so due to the potential for academic underperformance and subsequent lost wages as adults. Unaddressed hearing loss can cost about $750 billion annually. So I mean, I know that's not per person, but still, if you look at it from that big like dollars and cents perspective, um, doing a what? Three minute hearing screening at a school can really save a lot of money in the long run.

Carrie: [00:14:43] Yeah.

Carrie: [00:14:45] And, eh, I guess if we kind of step back again in a perfect world. Um, let's just maybe talk about what hearing screening could or should look like within within the school type setting. Who would really be the ones doing the screenings, and what grades might you want to make sure that you're capturing?

Tori: [00:15:17] I think I most common ones that I've seen, if a school is doing a hearing screening, it's been the school nurse. Um, sometimes it's the SLPs. Um, I definitely think us as educational audiologists are the ones who can be completing hearing screenings, whether it's you partner up with your school nurse And SLP to get through students, or if that's a role that the educational takes on educational audiologist takes on themselves. Um, I also think that um, or like what grade levels the EAA or the Educational Audiology Handbook has a whole chapter on hearing screens as well. So that's another good resource to look into. But um, they've talked about, you know, like the early childhood age groups or like at Child Find. Some schools do those child find days before the kids come into school. Um, having hearing screenings done then um, at kindergarten, some of the other grades that were mentioned were first grade, third grade, fifth grade, seventh grade, or ninth grade as all options of populations that could be tested. Um.

Kristin: [00:16:31] I think that getting that early childhood, the preschoolers and the early elementary schoolers, because that's really where you want to there in those vital years of of learning to read and learning that language. And, um, you want to identify any hearing needs quickly in Nebraska mandates preschool for fourth grade every year they have to be screened, and then it becomes seventh grade and 10th grade. So it's a lot of that preschool elementary time. And then once in middle school, once in high school. But I think that that preschool early elementary, that's that's the the time you want to find this, you can put those supports in so that you can keep kids developing on track.

Carrie: [00:17:19] Yeah.

Tori: [00:17:19] I also think, um, another population to include a screening on is any student who is being evaluated for speech and language services. I definitely don't feel they should go through an evaluation without a hearing screening haven't been completed.

Kristin: [00:17:36] I would second that wholeheartedly. I even sometimes yeah, I sometimes even think, um, some of our kids that might have some behaviors in the school setting that I want them screened because I don't know if. Are they, are they having behaviors because they're not able to access and hear as well as they could? Attention, focus, all of that stuff. Speech, language, attention, focus, behavior, all of that.

Carrie: [00:18:07] Right.

Carrie: [00:18:09] Yeah. So essentially, any child that is being referred for any kind of specially designed instruction, um, would be good to do a hearing screening for.

Kristin: [00:18:24] Agreed. Yeah.

Carrie: [00:18:26] And then in Ohio, um, just a few years ago, we added 11th grade on. And it is interesting since we've added that on how many kids are being referred because of noise induced. So they're getting a little, you know, they're not passing at like 4000Hz. So it's interesting that we have this group of, uh, students who and the other end of the school age years who are not passing hearing screenings, too.

Kristin: [00:19:00] That is true. I kind of forget that they all hang out with their AirPods in and yeah, music cranked and loud music. Yes. Yeah.

Carrie: [00:19:11] So another awareness of uh, for educational audiologist is the impact of noise on hearing too.  You kind of mentioned a couple of these things. Kristin, you mentioned like some of those kids who may, you know, have some behaviors within the classroom that may be kind of a red flag of, hey, have you checked out their hearing yet? Are there any other red flags for either parents or teachers that we should be thinking about? For kids who definitely should be screened for hearing?

Tori: [00:19:49] I think the probably the easiest and most common would be for those students who seem like they're daydreaming or not following along. Mhm. Um, articulate.

Carrie: [00:20:01] Yeah.

Kristin: [00:20:01] Articulation concerns. So if you are having trouble understanding a child's speech, sometimes the speech that's produced is related to the sound that they hear. So you want to rule out or rule in any hearing needs that could be impacting that. I'm going to throw out there. Um, and I don't know if this is sort of a tangent, but, um, our neurodiverse population,  kids on the autism spectrum, I think, and I don't know the research that's there, but I think that they're later identified just because of the confounding nature, um, of just their development with the ASD diagnosis, that finding a way to have those kids screened for hearing.

Carrie: [00:20:51] Um, would.

Kristin: [00:20:52] Be good, too.

Carrie: [00:20:53] Yeah.

Carrie: [00:20:54] Because I think there's research that shows what, like 40% of kids who have additional needs have some sort of hearing loss. So whether it's conductive or sensorineural loss, um, that's probably a population that doesn't always get screened because they're more difficult to test. But it could definitely be impacting the bottom line of why communication is difficult or learning is difficult as well. I always think about our kids who are struggling to read and have any kind of phonological awareness like, well, are they hearing the sounds or are they not? So making sure that we're screening that population as well?

Carrie: [00:21:45] Definitely.

Carrie: [00:21:48] Well, let's just say that a student goes through a hearing screening process and they are a non-pass or they fail their hearing screening. What would be the next step of what would happen next? In a perfect world.

Tori: [00:22:10] Kristin, I want to turn to you since your state does mandate and mine doesn't.

Kristin: [00:22:14] So in in the utopia that I want, I guess that family would be notified that their child did not pass their hearing screening and given an array of contact information for an audiologist that they could contact and have a diagnostic hearing evaluation completed. And then whoever that audiologist was that completed the diagnostic would, you know, provide the resources for if they needed. Ent physician consultation, um, kind of what the next steps would be from there in regards to whatever the hearing findings were, that would be idealistic and they would do it in like two weeks and.

Carrie: [00:23:02] They'd.

Kristin: [00:23:02] Magically get into the ENT in a month. It would be great.

Carrie: [00:23:07] Yeah.

Carrie: [00:23:07] And then they would share the results back with the school.

Carrie: [00:23:11] Exactly.

Kristin: [00:23:12] Yes. They would. They would sign some releases of information where we could all collaborate together to support the student. Right. That would. That would be my utopia.

Carrie: [00:23:24] Yeah. I would.

Tori: [00:23:25] Even include, um, I have done it for some of my districts that are screening is they'll pull me in to do re screens. So any of the students who did not pass a few weeks later, they have me come in and re screen them. But then they also sometimes include like those difficult to test. So the students that they couldn't get tested, they'll ask me to test them as well. Um, so I even think, you know, waiting a few weeks and doing a re screen. And if they still are not passing, you know, you're notifying family again. I would notify them both times, but again that your child did not pass. And you know, here's what you need to do for follow up.

Kristin: [00:24:03] I would agree with that to our state. Um, at least with the districts I work with do like a two tiered screening. So they screen, wait a couple of weeks, screen again, and then would refer on after that. So yeah, because I think if you, I think having that two tiered kind of thing is important to keep the screening protocol and process from kind of going overboard and having a lot of kids that may pass the second time. Um, bogging down some of the community audiology availability.

Carrie: [00:24:43] Do either of you are you the next step sometimes in the process for more of an assessment if they don't pass a screen?

Tori: [00:24:56] I am. Um, sometimes it kind of depends. Sometimes they'll if they're in eval, they will add me on to the eval to do a full hearing assessment. Other times the districts with parent consent just ask me to come in and do more of an eval versus just a screen to get more information. And we go then then we go from there to see what we need to do. But now I would also say not in all cases.

Carrie: [00:25:25] Yeah.

Tori: [00:25:26] So I would kind of depends. Yeah.

Kristin: [00:25:28] I would kind of second what Tori said. So for students that didn't pass, but there's definite educational concerns and they're either doing like a mtss multi-tiered systems of support kind of intervention process, or they're moving into evaluation to look at that specialized special education situation. They'll bring me in most of the time. Um, for students where it doesn't seem to be impacting school yet, then it depends. Sometimes I get brought in and I become I've gone out and done rescreens or I've, um, contacted family to be kind of a more of a support of why it's important to follow up.

Carrie: [00:26:16] Yeah.

Carrie: [00:26:17] Yeah. Sometimes having that, I don't know more in in-depth testing at the school. And then if you have community connection with the clinical pediatric cardiologist at a hospital or clinic, we can help facilitate that conversation. And the importance, like what you just said with the parents of following up and why that next step is really critical in that hearing screening process. I was just trying to think, is there anything I missed with the hearing screening that we wanted to promote for Educational Audiology Awareness Week? I mean, I think we covered like the ages and why it's so crucial to have hearing screenings. And if you don't have it in your state, we have those resources on the website that really can help with advocacy and maybe getting moving the needle to more, um, screenings within within your state too. But yeah, just that foundation for literacy and phonemic awareness and academics. If they're missing auditory information within our classroom. Um, and then really involving us as educational audiologist to in that hearing screening process. Did I miss anything?

Kristin: [00:27:44] I can't think of anything. I feel like we kind of touched. We I think of the importance.

Carrie: [00:27:50] And.

Carrie: [00:27:51] I think it would be a great way to kind of plug into why educational audiologists are important for your school districts. To one of you guys want to give a little spiel about getting an educational audiologist or why you should have one on your team?

Carrie: [00:28:17] I mean.

Kristin: [00:28:18] That. Yeah. I'm going to defer to Tori.

Tori: [00:28:21] I will say Wisconsin does do a really good job at I mean, we have a number of educational audiologists throughout our state covering a lot of our, a lot of our state that most districts have access to an educational audiologist in some way, whether it's they're going through, you know, our state agencies that we have, um, we have some who have private practices that go into schools. Um, but I think sometimes for schools, it's we really need to advocate for our services and what we can do for them. Because I in my experience, most of the times, the schools don't really know all that we could provide for the students and not just students on IEPs, but students, you know, all of their students with like hearing screenings, but or, you know, classroom amplification systems or all things that we can cover and help districts with. But I think really just communicating with your administration on the different, different roles that we have in, in the schools and why, you know, yes, students might have clinical audiologists, but why do they also need a school audiologist? Is our roles differ a little bit but are also very similar?

Kristin: [00:29:41] I would agree Nebraska is pretty good with educational audiology in the more urban eastern side of the state because we're just a denser population. But, um, it's a little more sparse as we get to the more sparse rural part of our state. And I think, like you said, it's building that relationship with your school teams. I've even noticed that in my job, when I start to have more students in a building, then I also start to get like school psychologists reaching out to me like, oh, hey, I've got a question. And so it's that, um, when you're seen and your, your skills are seen, then people start using you more. And so it's hard for how do you, how do you build that in a place that doesn't have an educational ideology yet? Because I think if they did, then they see the value that we have and they start utilizing our services more, but it's building that capacity in the areas that don't have our profession as of yet.

Carrie: [00:30:46] Mhm. Yeah.

Carrie: [00:30:48] And I think in our state, um, I've really tried to network a lot with our partners, our speech language pathologist in the state, and they're in every school, uh, no matter what. And just really marketing and sharing like this is an IDEA related service and this is what I can do for you, to help you. And this is how you can help advocate for having an educational audiologist and within your district, or compact or whatever your school district is to. So yeah, I agree. Just getting out there, marketing and sharing all of the, um, different things that we can do for students, whether they are, um,  for specially designed instruction or just students sitting in the classroom that need to be able to to listen every day and communicate.

Kristin: [00:31:52] And I think we have a nice role in supporting families, because clinical audiology, in my experience, has a much, uh, there are just time crunched. It's it's a time crunch kind of setting where I've spent time trying to really help parents understand all of the jargon that they got fed at the clinical audiology side. Um, while I think clinical audiology tries very hard to to help that be clear and understood, there's just that time crunch that changes where I can take a little bit more time to help parents have a better understanding of how their child's impacted and what the supports that could benefit them in that sort of thing.

Carrie: [00:32:37] Yeah, which is another great point, like our connections with our pediatric and clinical audiologist and how we can help bridge that gap together so that our students succeed. And how do you. Right. You know, they can help empower parents to to advocate for having that service within the school. So if we kind of close up today with our podcast, I thought I would ask, Tori. What do you what what can people find on the educational audiology web page to really celebrate Educational Audiology Awareness Week?

Tori: [00:33:24] Um, we have some different links to documents specifically about hearing screenings. I know we mentioned the one from ASHA. We linked to that. We have a few that EAA has created. Um, there's like fun coloring pages you can print off for your students. So if any Ed AuDs are, you know, seeing their students within that week, they have some, you know, fun activity that they could do with them. Um, different social media posts that, you know, you guys can put on your own pages to help promote educational audiology, um, awareness as well as hearing screenings. Um, I think too on our website, if a good document and I have used it, you know, in talking with school districts is our scope of practice. Um, again, every state is different. How it looks in every state might be slightly different, but that's a really nice overview of all of the things that we can do as educational audiologists. Um, another thing I was going to mention is that this week, um, and so the National Center for Hearing Assessment and Management, along with ASHA and EAA, we're kind of co-hosting a webinar, um, that's entitled In Identifying Children with Hearing Loss the Key Roles of an SLP and Educational audiologist, and evidence based screenings and follow ups. So if you can't catch that one live, um, it will be on NcHAM's website to view too. So I would definitely encourage anyone to do that resource or webinar.

Carrie: [00:35:05] Yay!

Carrie: [00:35:06] Well, yeah. So definitely visit the EdAuD.org website and I'll link that in the show notes as well. And if you are out there on social media, make sure you use the hashtag #edaudweek or hashtag #edaudadvocacy so that our resources can get shared by many, many others. So as we wrap up again, um, I just want to say thank you, Kristin and Tori for joining me and the empowEAR Audiology podcast. And as we kick off Educational Audiology Awareness Week. So thank you for joining.

Tori: [00:35:48] Thanks for having us.

Kristin: [00:35:50] Yes. Thank you.

Announcer: [00:35:51] Thank you for listening. This has been a production of the 3C Digital Media Network.

Carrie: [00:00:12] Welcome to the empowEAR Audiology podcast, a production of the 3C Digital Media Network. I am your host, Dr Carrie Spangler, a passionate, deaf and hard of hearing audiologist. Each episode will bring an empowering message surrounding audiology and beyond. Thank you for spending time with me today, and let's get started with today's episode. All right, Dr. Barker it is so good to have you back for part two of this podcast talking about auditory processing deficits and disorders. And we talked in part one. If you haven't listened yet, please go back and listen to the first recording with Dr Barker because we really dove deep into, you know, what auditory processing is. And, kind of the foundation of why auditory processing skills are important and how to test for them and who to test. And now we're going to dive a little deeper into what's next. So a student or an individual gets tested Matt. And we find that they have a deficit or an area that is of need for auditory processing. What can we do next?

Matt: [00:01:37] That is a fantastic question. Um, so the there have been quite a few approaches to the auditory processing field to date. Um, all of them share. One kind of common quality is when you do the test battery that you perform, whether that be sort of some automated testing or some CD based testing or some audio testing through audiometric equipment. Um, the one sort of theme that is consistent through all of the approaches is once you discover where the concerns are in your student or client, those are really the areas that you need to target for intervention. So which makes perfect sense. If you go get some blood work done at the doctor, if there are some issues, they don't just give you random random interventions for. If you don't have low blood pressure, you better not be taking low blood pressure medicine. Right, right. So it's kind of the same for for all of the approaches is before you treat an auditory deficit, you need to discover what those deficits are. Mhm. Um and then focus in on those deficits with, with you can do home based therapy. You can do therapy through computer programs. You can do therapy through a clinical audio audiometer in a sound booth. You can do therapy in a language evaluation. So the first step is discovering okay what are the deficits. And some people say how do you treat auditory processing. And my my response is well which area. Where is it down. There's no like here's a program that fixes auditory processing because there are so many areas that that can be deficient or underdeveloped. You only really need to target what's down.

Carrie: [00:03:51] Um, which is my next question. Like what would those areas typically be for auditory processing that you would be intervening.

Matt: [00:04:00] Okay. Yep. So I would probably say there's three more prominent areas that that we test for, um, that seem to be surfacing again and again and again in the studies of if these areas are deficient, then you're going to see difficulties with language, with reading, and with classroom learning. Um, I there has not been enough data to say of the three, which is the most prominent, but the the most in my experience. And again, I'll have data on this later. But in my experience, the most prominent one is what we call a dichotic listening deficit. Now, there's a lot of confusion about this particular topic, because what we do in the testing Room is we create an environment under headphones that requires the listener to use the part of their brain that communicates between the left and right hemisphere. We call it the corpus callosum. Um, and to to. So we have pathways in our brain that go from the right ear up to the right side of the brain, and we have pathways that go from the left ear up to the left side of the brain. But those are not the major pathways. The biggest pathways go from your left ear to the right side of the brain, and your right ear to the left side of the brain. So what we've discovered is if you, um, place a, uh, some headphones on an individual and you, you give them auditory information in the right ear at the same time, you give them auditory information in the left ear.

Matt: [00:05:58] And when you do that, it suppresses those ipsilateral pathways. So you don't go from the left ear up to the left side of the brain or the right ear to the right side of the brain. You go contralateral. So it suppresses the the straight up pathways. And it uses the pathways that go across the brain. Now when we do that, when we present information like that, it requires the individual to get, um, uh, sorry to get that information from both sides over to the other side as well. So you have to use that corpus callosum. Now when the individual gets the information on both ears, if they have very quick neural speed, like the information is able to be transmitted at a normal neural rate, they can transmit that information back and forth so quickly they can understand both sides. They can use the information from both years when they can't use that information quickly, then, um, the the individual loses one side or the other, and there's sort of often there's a righty or advantage if the, if the information is language that you're, if you're giving words in each year, then there's often a right or advantage. But people that see a left ear advantage often think, oh my gosh, the it's the ear that's down. And that's not the case at all.

Matt: [00:07:31] Actually, what we're testing is the pathway in between the brain. So regardless of which ear is down, the transmission speed of the corpus callosum is really what you're testing. So there's there seem to be a bit of an emphasis on focusing on which ear it is. That's down and in in answer, it doesn't matter if it's the left ear on the testing that shows that it's down or the right ear, or both. It means that their transfer of information from both sides of their brain across to the other side, is happening too slow for them to retain the information as a unit and then they can't cope with it. So, um, very rarely in life would you have information coming into your left ear and very different information coming in your right ear. So it's literally just so we can measure that, that interhemispheric transfer speed. Um, but those kiddos that we talked about in our last meet up, that was so much fun. Um, the the the kiddos that have these slow, um, corpus callosum speeds in that neural transmission have dichotic listening deficits and testing, and they're the ones that are struggling or some of the ones that are struggling with language and struggling with reading. And we found 10% of them in in every single class, 10% had a dichotic listening deficit. So I wouldn't say it's the most important, but it seems to be one of the most commonly discovered or commonly seen deficits for whatever reason, whether it be environmental, whether it be, you know, genetic or what, but maybe a combination of both.

Matt: [00:09:24] But there's definitely a prominence in, in dichotic listening. If I had to guess, I would think the probably one of the next most prominent is kind of that localization, spatial hearing, where using your ability to focus on where somebody that you're talking to is coming from versus like, if you're in a restaurant or if you're in a classroom and you're trying to hear the teacher, even though you've got Sally Mae or whoever else. So off to the side talking to their neighbor. Using your ability to focus on where the the speech is coming from. They call that spatial hearing. Um, some don't have the capacity to use that information to really be able to focus well on what they're trying to hear. And there is some great work out of out of Australia. Um, uh, the NAL lab down there, Dr Harvey Dillon and kind of his brainchild, uh, has developed really effective ways to improve using your localization or your spatial hearing so that you can actually focus really well on what you're trying to target, and not so much, um, what you're what you're trying to dismiss. And I think that's probably like, we didn't even have that test. I was going in grad school just to sort of give your listeners how how far we're coming with that, but they have an intervention for that.

Matt: [00:11:05] Um, it's computer based. You can actually do this as a speech therapist in clinic with varying sound sources as well. Like it's it's kind of easy to do if you're already doing clinic, you can do it manually where you have, um, uh, some, some target sounds, whether that be the speech therapist reading a book with the individual. And you can be playing a radio off to the side and to make it more challenging, you sort of just slowly bring that radio up without you bringing stuff up and just training that in a routine fashion. They learn how to focus on where they want to focus, and by doing that, we can suppress information from other locations. So this was I had you know, in life you have those aha moments. Right. So when we I was in psychoacoustics class, I was still of the sort of elementary understanding where, you know, you have your motor systems and you have your sensory systems. And I was, you know, you're taught your ear is a sensory system. And by and large that's true. But when we go to grad school, we're actually taught actually we, we go, sorry. Um, kids, actually, um, we use that information to suppress our ear. So our ear has all these amplifiers in it that take sound that we want to hear, and it boosts it up.

Matt: [00:12:51] It actually amplifies that information. But in the scenario we were talking about where you're in a classroom where you're trying to focus on on the teacher and ignore all the extraneous noise around you. We actually have the ability to un amplify or suppress those listeners that were not focused on, but individuals that don't have that skill are really going to struggle. So Dr Harvey Dillon and his team have shown that actually, if you if you have a dedicated, um, regimen where you just slowly work on that skill, they get much better. And then when the time comes, they can focus on what they're trying to listen to and, and avoid avoid the other. Um, I didn't mention, but I will say now that the dichotic listening deficits are treatable too, and they're treatable in a variety of ways as well. For just for your listeners. So that's that. Those, I think, are probably some of the most prominent areas that we've sort of are finding that are really hindering development. If I had to pick a third one and again there's so many, but the third one would be what I call just auditory patterning. So a good example of this. In fact it's it's almost better example than I need. But um if there are individuals that have been trained Morse code.

Matt: [00:14:29] Mhm.

Matt: [00:14:30] They can take that code and turn it into language. So when I say auditory patterning, language is literally just a pattern of sounds. So if I say car r r right. In that order you hear car. If I take that order and I flip it around and I say R a Rack. Rack. The sounds are identical. I've just changed the order of them, and that changes the meaning. So in auditory processing, what we try to do is say, well, yeah, but that's language. That's using speech sounds. What if we test that ability to follow patterns without speech sounds. So in the case of Morse code you actually only have two stimuli. That's it. You have a short beep and a long beep. And the order in which you put those like Soas is is long, short, long I think like, no, it's dee dee dee dee dee dee dee dee dee dee dee like it's short short short long long long short short short. So that's soas um, I learned that from the dishwasher. Uh, commercial. Um, um, so, so to somebody that knows Morse code, if they hear that, they're like, oh, Soas That's SOS. They're giving me a signal. Whereas in in an auditory processing assessment, we might just tell them. Okay, tell me what you hear. I'm going to play you some sounds and you could say something like doo doo doo doo.

Matt: [00:16:06] So the individual would need to say long, long, short. Or often we use pitches instead of duration. So we can say or high high low right. So they can hum it. Mhm. Mhm. If they struggle to follow sounds that aren't language. So they're not speech sounds, they're just nonlinguistic sounds. Why are we surprised then that they're struggling with language which is just phonemes put in a specific order. So what we found is ah, they're they, they're phonemic classification is fine. Like they can tell the difference between mhm and buh But but the order in which those sounds are coming, they're struggling to put in place. So what we found is if we train the ability to follow nonlinguistic sounds, they can then follow linguistic sounds in patterns more successfully as well. And we see a big improvement in language development and reading development. And let me be I want to be very clear with the studies that I've seen in no study has an auditory processing deficit been administered where you see benefits in reading and there not be reading intervention as well. So an auditory deficit needs treatment, but that doesn't mean it replaces the language therapy or the reading intervention. Both of those are still needed, but the auditory intervention will make your success with those therapies faster and and you get higher scores.

Matt: [00:17:55] Um, so it I want to be very clear. Auditory processing deficits do not replace reading intervention or language intervention. That's it's they're literally on one continuum in that pathway. And we need to be looking at all of it from from the ear all the way up to Wernicke's area. Um, so we need both audiology and speech language therapy. Um, as a group. And I know that we've talked about sort of multi-professional teams. That's true. Uh, but in reality, that's hard to make work. There's not a whole lot of audiologists that do auditory processing work. Um, there's often cases where, um, you don't have, uh, educational psychology available. So if I was a, for example, a speech pathologist and I'm like, well, I hear what you're saying, I understand that I really should be incorporating some more auditory processing testing. I'm not an audiologist. How can I diagnose it? Well, as it my advice to you would be if you can partner with an audiologist. Fantastic. If you can't find those handful that exist that are happy to do that, um, you can test for deficits that is within your scope of practice. Absolutely. Even though you can't label a diagnosis, that doesn't mean you can't, um, discover deficits and intervene for those deficits. That's absolutely within your scope of practice.

Matt: [00:19:36] So I know the the first time I had parents ask me, I did all this testing in grad school and, um, I was explaining all the results, and I was really proud of myself because I sort of explained what we did and how they did. And, you know we found these areas of concern? And I was looking at the parents and they said, okay, what are we going to do about it? Like what's what's the point of of all this testing if we can't intervene? And I looked over there, their son and I thought, that's a genius question. Why have I not asked this in class like, well, okay, great. What's all this testing? What are we going to do about it. Mhm. Um, and that was really the, the impetus for pushing forward with why don't we make ways to treat these interventions. And I know I've been told like you've got it, you've got it for good. Well why don't we test those waters. Let's see if we can actually improve these skills. And if we can fantastic. Then we can actually focus more energy and time on if we intervene on skill. A, do we see a significant benefit in their life, whether it be educationally or socially or whatever? Or if not, well, what about skill B is that does that seem to be more impacted in their life? And I feel like that's where we are now.

Matt: [00:21:04] It's not that deficits occur and can you improve those deficits. Now we're trying to hone in on what's important. What do we really need to highlight for intervention or for discovering those deficits. What do we need to focus on. Like do we need a two hour battery to discover what we need to do, or can we do this in a more efficient manner? So yeah, I think our profession is really at an exciting part where we're we're finding we can improve stuff. So well, what happens if we improve localization? What happens if we improve these auditory patterning abilities? What happens when we improve that dichotic listening that interhemispheric transfer speed. What happens when we we improve that spatial awareness. And there are there are other areas like phonemic classification. Like if somebody can't distinguish in their brain the difference between A and A, that is going to really be difficult for them to parse when they're hearing language spoken at normal rates. So you have to sort of delve into where are these developmental milestones, strong or not milestones areas and where are they underdeveloped. And you sort of create a recipe for that individual as you, as you would for any other health issue.

Matt: [00:22:37] Right?

Carrie: [00:22:38] Yeah. And I mean, for those of us that do have educational audiologists working within the schools, um, I know personally like the power of having that collaborative team to kind of look at the whole child and then individualize what that student needs based on the results that we can get from an audiological perspective. But then also, like you said, the the psychologist and the intervention specialist and the speech language pathologist, all of them bring that important piece. And if you can, um, meet the need through what are those deficit areas for auditory processing through some of the intervention programs that you're talking about? Like how does how does that look for the outcome for that child in the classroom and with reading and more of those life functioning skills? Because that's what we want. We want them to be successful and how can we help them? Does that sound about right?

Matt: [00:23:35] Yeah, absolutely. Yeah. And and there's you have to blossom where you're planted is how my mom would say it. So if you're at a location where you have, like, an amazing Dr Carrie Spangler, or others. Um, that that can help on a team to do, to really hone in on where their expertise lies. And you have educational psychology and speech language, uh, specialists or um, or any other OTs like other. If you have a access to multiple professionals, it just gives you a better ability to know exactly how or prioritize in certain scenarios. Really, what you're wanting to focus on with, with that student in that in where they are. But you're you're absolutely right when you can intervene accurately. So you're sort of not just doing, let's just do general therapy here. Well, no, we know where the deficits are. We know where we need to target in your trajectory of success just increases for those students. And when you see that and see how well they've struggled for two years with developing reading, for example, I've heard this time again and again and again and we finally intervene with the auditory portion. And there's their gains in reading. Just go from a slow hill to a mountain in trajectory, and the parents are like, why haven't, you know, this is fantastic. We're actually seeing progress. The students get excited because they've been hitting their head against the wall. They're trying. It's not like there's a lack of of effort. They just think they're they're they're not a smart enough to do it, which is not the case.

Matt: [00:25:33] We just need to re redesign how they're processing that information and then voila, they can really shine and develop. And it's that's the goal. The goal is like let's target where we see these deficiencies and and also target the higher level stuff. You know like there's top down things there's attention if there's attentional difficulties those need addressed. There's working memory that, you know, if there's a working memory component is your auditory processing testing be affected from that. So all of these things have to be kept in mind whether you're lucky enough to be, um, working alongside psychology and audiology and speech therapy and others or you're, uh. Look, I'm, I'm the only professional at my district. We're a small school. Well, then you just have to do your best to try to fill in the gaps as good as you can. You like just saying. Well, I just won't do any auditory processing work or I won't do any. I won't check for any, um, cognitive abilities or any working memory skills. It's if it's in your scope. Don't be afraid to go out there. Even if you can't diagnose ADHD. You can still do some some measures to determine actually, there's some some concerns with attention here. And use that information to really, um, modify your approach for, for the students. There's there's no one approach to fix everybody. You need to have a deficit specific approach. So the more information that you can garner, the more accurate your deficit specific treatment will be for that individual. So yeah, fun times.

Carrie: [00:27:26] Exciting times. Well, I think what excites me so much is the fact that, um, we can get deeper into what their deficit areas are. We know that having that strong foundation for auditory skills is so important from a bottom up perspective. But then the impact that it has on reading and language and classroom performance. And if you develop some therapy, you know, specific programs to acoustic pioneer. And I know other companies have to to really like kind of just target those areas so that we can see the success. So we, we no longer can say like we can't do anything about it. We can't. And so that's the exciting part. I know we've talked a lot today, um, about auditory processing and therapy and things like that, but I want to give you just a chance to say, like, did I miss anything? Is there anything that, like, you wished I would have maybe asked that you wanted to maybe summarize? And then I also want you to share a little bit, um, how people can get Ahold of you and, um, where to find you, too?

Matt: [00:28:45] Sure. Sure. Let me start with that before I forget. So if. If you would like to get a hold of me, you can call me directly. My number is (806) 424-3436. You can call or text me if I'm not available. Just leave a message. Uh, you can email me at info info at Acoustic pioneer.com. And then there's all of course, the social media, the Facebook, the Instagram, all that sort of stuff we can check as well. Um, but yeah, email me, call me. I promise I don't bite. I try. I'm a friendly guy.

Matt: [00:29:24] So yeah, very responsive.

Carrie: [00:29:27] And what I can do is I can link all that information in the show notes, too, so people can go to the show notes and find that information as well.

Matt: [00:29:36] Perfect, perfect. No. Like, Carrie, this has been so fun. Like this is literally one of my favorite topics. So inviting me to come talk about one of my favorite topics since I was a little boy. It was almost like Christmas morning.

Matt: [00:29:48] Today I'm like, yay me!

Matt: [00:29:51] And how much it helps others if it. If intervention is needed. 

Carrie: [00:31:19] Well, I just appreciate your time today because I know this is such an exciting topic and your excitement shines through. So I know you have so much passion, um, and you have done so much to advance this part of the field and to the way you explain things. It makes it very applicable to real life for students and those that we are seeing in the school and what that impact is. So I think a lot of people will be excited to hear this interview today and get started wherever they can, and kind of just make an impact with students within the school, because as you said earlier, probably about 10% of those students sitting in the classroom have some sort of auditory processing deficit, which is impacting how they read, learn, process, language and some other things that impact the classroom learning or listening. So again, Matt, thank you so much for being a part of today's interview on the empowEAR audiology podcast.

Matt: [00:32:25] Fantastic. Thank you.

Announcer: [00:32:27] Thank you for listening. This has been a production of the 3C Digital Media Network.

Carrie: [00:00:15] Welcome to the empowEAR Audiology podcast, a production of the 3C Digital Media Network. I'm Dr. Carrie Spangler, your host and a dedicated audiologist who is part of the deaf and hard of hearing community. My mission is to bring you empowering insights on audiology and beyond. Today we begin part one of a series, a special two part series on auditory processing with Dr Matthew Barker, who is a passionate researcher and fellow audiologist. In this episode, we'll explore what auditory processing is, common red flags and how auditory processing deficit can affect individuals. In part two, we'll dive into what can be done once a deficit is identified. Thanks for tuning in. Let's get started. Hello listeners, I am so excited today to welcome Matthew Barker today, and I'm going to share a little bit before I bring him live on to the podcast. Dr Matthew Barker is the founder and director and he is an audiologist that specializes in testing auditory processing. He completed his doctorate from Texas Tech University Health Sciences in 2004, and Dr Barker saw how much of a negative impact underdeveloped auditory processing skills caused people when learning language and learning to read, and he found some strong evidence that indicates over 10% of elementary and primary school children struggle in learning because of an auditory processing deficit.

Carrie: [00:02:06] He also discovered that over 98% of audiologists were not doing any auditory processing testing, and he found out that most audiologists are put off by how long the testing took to administer, how long reports took to write, and so on. So that, coupled with the fact that there were no deficit specific therapies available, he raised the question, what good is testing for a problem if there's nothing that can be done for it? Moving forward, I just want to say that, you know, Dr. Barker, who said he was driving down the road minding his own business one day when God put into his head, um, that the idea to develop a way to test auditory processing skills and a fast and fun way and create some deficit specific auditory therapies to help. And so the. His company, Acoustic Pioneer was launched back in 2013. And today I have Dr Barker with me who is going to share a lot about auditory processing today as well as what we can do about it. So Dr Barker, welcome to the EmpowEARAudiology podcast.

Matt: [00:03:25] It is absolutely a pleasure to be here with you, Dr. Carrie Spangler. Thank you for having me.

Carrie: [00:03:31] Thank you for being here. And one of the things on my podcast when I interview professionals is my first question is, I am just curious of how you actually got into the field of audiology, because everybody seems to have a different road to get there.

Matt: [00:03:49] Yep. Um, mine was sort of. That's a great question. Uh, mine was sort of Faceted. Um, uh, growing up, one of my childhood best friends had a severe high frequency hearing loss. And, uh, when the first time I was around him without his hearing aids was an eye opener, like, I was like, you cannot function at all without those things. It was just. It was it was stunning to see how much they changed him in versus out. Um, and down the road, you sort of, you hum about different professions, right? You're like, oh, you know, law school would be okay or, or I want to open my own. I was going to sell mattresses at one point. Kerry. Um, there was there was an array of options. Uh, and my mom's, uh, school counselor, um, and she said, you know, there's a lot of testing that's available that you can sort of go see what your interests are, see what what you like to do, and it'll compare those results to other people doing other jobs. And on that list was speech therapist or speech language pathologist. And I at the time was down at, um, Texas State used to be called Southwest Texas. And the audiologist that was at the speech therapy, um, office that I was sort of asking about speech therapy stuff.

Matt: [00:05:22] She was like one of the coolest people I ever met. So I'm like, I think audiology is a really good road. Um, it seems to attract cool people. And, you know, I don't want to be in a profession where there's a bunch of uncool people around. Let's go to the audiology one. It'll be so. So just exposure to an audiologist, seeing what benefits it it did for for my good friend, it just seemed like a good fit. And my first year in grad school. After after you pick. You're always wondering, second guessing yourself, thinking, was this right? Was this the profession? I hope it was the right one after I took the psychoacoustics class. Most people hate that class. I loved it like I was that weirdo. Like, oh my gosh, the brain can do what the brain just does that automatically and we don't really think about it. So once I discovered how complicated the ear was, which, you know, I thought it just was like a microphone of sorts. Way more complicated than that, of course. Um, and how it functioned. I knew after that class that I was in the right profession, and I've never looked back. It's been it's been a wonderful road. It really has.

Carrie: [00:06:40] I love how.

Carrie: [00:06:41] People. And it just took one conversation with someone to really change how, you know, the trajectory of your career, right?

Matt: [00:06:49] Yeah. I could have been a speech therapist like it was. I almost flipped a coin.

Carrie: [00:06:55] Yeah, well, either way, you would have been cool. We love our speech pathologists, especially the ones who are listening today.

Matt: [00:07:03] So, 100%. 100%. And what's funny is I feel like the the reason I had difficulty choosing between audiology and speech therapy is because I like the therapeutic aspect of it as well. I like the science aspect and the therapeutic. So auditory processing is probably that that field or the portion of the the internal communication system, auditory communication system where the audiologist and the speech pathologist really share the most ground because it's, it's sort of that, that um, uh, relay race where this is where we hand the baton over, like we're both sort of in the auditory processing area together. So it's it's a good fit for me. Works well.

Carrie: [00:07:52] Good. And kind of going along with that. I know, at least in my experience of going through my audiology program, there wasn't a huge focus on like learning about auditory processing and that. So how did you kind of find out about that and learn about auditory processing? Mhm.

Matt: [00:08:14] Um, yep. So I've had a lot of conversations with audiologists globally about this. And at Texas Tech I happened to to have a professor that was very into the auditory processing area. So we had an entire class like a three hour class all semester long on it. We did a lot of practicum or like, you know, clinic with auditory processing testing. Um, I will say that my classmates, I thought my four classmates were oddballs because they would avoid the auditory processing area and they would trade me out. They'd say, look, I'll do two of your hearing aid patients if you'll do this, my APD assessment on Friday. So it was a funny bartering. Like they wanted to give all of them to me, and I wanted to take as many as I could get. So I thought they were the weirdos until I got out into the the field and realized that, oh, it's me and my professor that really are the more oddballs than the other way around. Um, so I kind of like, lucked upon a professor that was very into the to the field. I've had conversations with audiologists with their masters or Dr.ate that said that they had one class on on APD, but it was literally one afternoon class, like it was not an entire semester. It was. Well, yeah, we touched on it very briefly one day and I think like oral rehab or something like that. So. Right. So the, knowledge base across the profession in both speech therapists and audiology is very varied depending on on where you got your training and what what you were exposed to and things like that. But, um, the from my own data points, the exciting part is that more and more and more are getting involved.

Matt: [00:10:12] And I think it's like a just a just like anything in a profession if, if things are changing, especially organically, not like from a top down structural standpoint, it just takes a while for that information to sort of reach others. But the, the again, based on the conversations that I've had, a lot of the professionals that that have started to use some auditory processing testing and some interventions when they actually see the benefit in front of them. That's the, like the green light moment. Like, oh, this is actually helpful for my the students that I service or for my patients. And thankfully not just with Acoustic Pioneer, but there's there's we're 11 years past when Acoustic pioneer launched now. And there's there's other options available, not just acoustic pioneer therapies, but there's other therapies that have been proven effective. And like what an exciting time where we can be in a field where we can actually make some significant progress in these areas. Whereas when I was going to school, I was focused on how do you test it? How do you analyze it? How does how do you administer things? How do you really get the patient or the client really focused and engaged? So you're getting the best data possible? Um, to then like you read on the website. Wait a minute. If there's nothing you're going to do about what you find in the testing, what is the point of that? So. Yeah. So it's really exciting to be in a profession where we're kind of breaking down barriers and figuring out ways to help. What? What we couldn't ten years ago or more?

Carrie: [00:12:05] Yeah.

Carrie: [00:12:06] No, I agree, I feel like the ripple effect is definitely happening within our field. And, you know, I related fields to the information that's out there. But just for our listeners to kind of give a more like 360 degree like view. Um, can you just share just what is auditory processing like? Just a definition so that we can dive a little bit deeper on the same page with some other questions?

Matt: [00:12:34] Okay, okay. This is an excellent question. And there is there are very long like page long definitions like ASHA has papers that are literally pages long. To define this, and I don't think it's that difficult. I think it's easier to. Define if you the definition I use and I can defend this all the auditory information that enters your ear heads up toward your cortex, all of it. Eventually it gets up to the cortex, all of the processing that leaves your cochlea, your inner ear, the processing that's done from that point where the eighth nerve begins to fire all the way up to the auditory cortex, is is auditory processing. As soon as you get to one further step into the into Wernicke's area where language is processed, the auditory processing is finished and and the sound is now language. So if the auditory information has meaning to it, That's language. So I use as a as an example because some people say I don't understand the difference between language processing and auditory processing. So this is a very easy example to use. Let's say you're driving down. No, you're just walking down a sidewalk next to a road.

Matt: [00:14:02] If you're walking down a sidewalk and a and a semi-truck is coming up from behind you, you know that there's a semi truck coming up from behind you. You don't have to turn and look. You can see you can hear what it is. You know what? It's coming. And you can even tell, like what speed it's going, what direction. As soon as it's going to be near you and pass by, you can do all of that without looking. That's called we call that localization, right? So if somebody is in a park and you're walking down that same sidewalk and they yell out, hey, Carrie. You can localize where they're coming from too. So if you can do the processing to both speech and non-speech, then it's not a language processing skill. It's an auditory processing skill. So locating a sound in space has nothing to do. Whether the signal is somebody speaking or another noise made by a car engine or a jet or something falling over or anything like that. So my definition in summary is the the processing of the auditory information from the ear to the auditory cortex is where the auditory processing happens.

Carrie: [00:15:22] Okay. That's a great definition. And so kind of going along with that though. And I'm just going to put this out here at the beginning because I think this this question always comes up. Um, it doesn't always come up. I think it's getting better, but there has been some conflicting views in the past about does auditory processing really exists? So can we just dispel this once and for all? Um, that that I guess statement that comes up.

Matt: [00:15:56] Absolutely. Yep, yep. So historically there have been some research studies published in the auditory processing field that were fine studies, but there were, there weren't like the the scientific gold standard. There was a lot of anecdotal information or data, and rightfully so. Some other critical professionals said, well, look, these studies really aren't the highest standard. We can't really draw too many conclusions from them. There's a lot of variables that aren't accounted for. And fair enough. But the conclusion that auditory processing doesn't exist was also not their statement. Their statement was we actually, as a profession, need to raise our standard on on how we do research. So, um, there is a class that we spoke about this before we hit record, um, that every audiologist goes through and that most, I would say over 90% would say is the most challenging course that you take in graduate school. And it's a class called psychoacoustics. And if you ask any audiologist, is psychoacoustics real? They will all say, of course it's real. It's how we hear. It's the study of what our brain does with the sound that's going into the ear canal. And, um, auditory processing is a just a synonym of psychoacoustics. That example that I gave just before about. Are you able to locate a sound in space? No. Nobody that has a functioning cortex and has been alive on Earth would say that's not a skill that humans have. Like, everybody can locate sound unless there's, you know, significant hearing loss involved or unilateral deafness or whatever.

Matt: [00:17:54] But like people that have normally developed hearing develop the ability to locate a sound in space. That's auditory processing, that's psychoacoustics. They're they're one and the same. Um, I never threaten this, but if if somebody would say, look, auditory processing doesn't happen, then psychoacoustics doesn't happen. And if you if that were true, then you could remove the eighth nerve from your ear to your cortex and nothing would change. But that would cause some pretty severe issues, I'm pretty certain. So. So, yeah. Um, to me, it's it's it's just not defined well. And that's a problem. Uh, there's been studies, not all. There's been a lot of really good studies as well, but there's been a few studies that were were highlighted a bit too much about how the scientific gold standard wasn't followed. But, uh, in recent years, even we've seen studies with the highest, um, uh, gold standard in research where there's a placebo, uh, double blind, um, control groups, all of all of what has been considered lacking up until now. So the, the scientific rigor is really coming along. So my if I had to do what do they call that, an elevator answer. If somebody says is auditory processing real and does it really matter? I would say, well, if it didn't matter, why does helping the auditory processing improve their lives? Like if you make it better, you see significant benefit. So if it didn't matter, why would that happen?

Carrie: [00:19:45] Yeah, that thank you for kind of helping to dispel that statement that seems to come up every once in a while to kind of going along with that. You mentioned like localization and like how an intact auditory processing system is important for just everyday life. What happens when an individual struggles with auditory processing? What do you see then?

Matt: [00:20:13] Okay, that's a great question. So in hearing, just like in vision, there's a lot of varied skills involved. Localization is probably the easiest one to give as an example there. And that's a very basic skill. Like we locate sound very low in our brainstem, as you know. So that's a very early neural skill. Um, the higher that you go in the brain, the more complicated and more complicated and more complicated the analyzes become, so that we can do what we're doing right now having a conversation. The more you understand on how much is happening in your brain, for you to be able to hear me utter a whole lot of sounds and understand the meaning of them is a phenomenally difficult task. And we just like we just think, oh, this is easy. What do you mean? We just naturally do this? But as a as a scientist and researcher on this, the more you drill down into what's happening, to make that easy is unbelievably complicated. So, um, what a lot of the research mine, as well as many others are, seem to indicate as of late. And Asha has this listed at their website as well. If you have some underdevelopment in areas of your auditory processing system or psychoacoustic system, those those deficits have recourse downstream from where the deficit lies. So what we're what we see are about three major red flags.

Matt: [00:22:05] The first is if there's an auditory processing deficit you were very likely to see just struggled classroom learning. So they're in a classroom. They're trying to to follow along. It's just not easy. And the the um there was a study done where they wanted to get students recruited for potential therapies. And they thought, well, if we if we recruit a lot of those that are struggling in the classroom and test them for this particular deficit because they're struggling, we'll probably have a higher incidence rate versus testing the ones that are absolutely the top of the class. The likelihood that they're have an auditory deficit is probably lower. So so the researchers tested the bottom 20% of the classroom for one auditory processing skill, the Dichotic listening test. And that showed that 50% of those 20%, the bottom 20% in the classroom, half of them had that dichotic listening deficit. Um, so that's where on the website, when you said around 10% or more have an it's based on that data that if you test the bottom 20%, half of them will struggle with with dichotic listening. Um, and then they went on to, to do some research on can we improve that? And I'll let the cat out of the bag. We can we can make that better.

Carrie: [00:23:48] Which is exciting, right.

Carrie: [00:23:51] Fantastic. Really.

Carrie: [00:23:52] But that can and that was one of my questions too. Um, a lot of our listeners, um, work with the pediatric population. And so you kind of indicated some of those red flags that you might see. Um, I don't know if there's any more, but about 10% of kids who are in classrooms could be like having some kind of auditory processing. And what you said about, you know, that, I mean, I, I was visualizing a foundation Basically, when you are talking about the auditory processing piece where, you know, if we don't remedy, like it's almost like building a house and, you know, a foundation, a strong foundation versus building a house on sand. Right? Like, there's a very much of a difference. And if we're not looking at that strong foundation first, then everything else is not going to be built up correctly. Correct?

Matt: [00:24:49] 100%. So I didn't even finish answering the question. So I'm glad you kept going. So the other two, uh, red flags that you will see in in these cases, a very high likelihood of an auditory deficit are children that are also struggling to develop language. Mhm. And lastly you you said the house the foundation part. So you cannot develop auditory language without auditory input. Like it's literally impossible. What won't happen. So you have to have intact auditory input to develop intact language. So language is nothing more than understanding the utterances of somebody speaking through the auditory system. Typically unless we're talking Braille or some different system of input.

Carrie: [00:25:42] Mhm.

Matt: [00:25:43] Beyond that what's built on language is reading. So if you don't have an intact language set you are going to struggle with reading. So if you see a struggling reader or somebody struggling with language or somebody struggling in the classroom, you're going to have a very high incidence of finding a significant auditory deficit in those individuals. Um, because I when I try to explain how when people say reading is auditory, it confuses people a lot because they think I thought reading was visual, like you use your eyes and that's true. You use your eyes to look at the the letters, but then you use your auditory system to assign sounds to the letters and then group the sounds into words. And then you use your language system to extract the meaning from those words. So when I say reading is auditory, if you look at the brain scans, there's a there's a higher activity in the auditory cortex than there is in the visual cortex. But it's a I would yes, it is a visual skill, but it's also an auditory skill. One of my favorite examples is if you read a quote or a text or a letter from somebody that you're really familiar with, you will often even read it in their voice, like you'll hear them reading to you through your phone. It's really I mean, it's it that's obviously an auditory, Um, event. Not a visual one, but it involves the eyes as well. So. So yeah, those those three are the the big downstream ripple effects. If your auditory system is not intact, how can you build higher level systems that are reliant on that base to give the information or to process the information upstream efficiently and effectively is really the point? Yeah.

Carrie: [00:27:45] Yeah. Great.

Carrie: [00:27:46] So kind of taking those red flags you talked about like students that may be having difficulty in the classroom, students that may have difficulty with any kind of language, you know, skills or processing or reading skills. Those are kind of would those then be maybe the red flags that an educator or a parent might see in their own child or a student? Um, to maybe make a referral or look more into that?

Matt: [00:28:16] Yes, absolutely. So I've done multiple studies now on this, and your listeners are probably going to be shocked. I was shocked as well. I was kind of under the impression that the in the profession, instead of what recent data show, that north of 10% of an elementary or primary school population has a deficit. We were thinking closer to 1%. So when we started seeing the numbers a lot more substantial, uh, it was very surprising. I was not expecting that. Um, the, uh, studies that we've done, we've done three of them currently, and we did a, did a vast testing of individuals that that were already diagnosed with a language delay or disorder and had reading difficulties. And of the studies. Two of them came back with 82% of these individuals that were struggling with language and reading had a significant auditory. So two of them had 82% and the third one had 83%. So this has been replicated three times. And if if you speech pathologist out there, if you've never done auditory processing work and you want to hold my feet to the fire on this and say, are you sure if I test my kids, I'm going to find like about eight out of ten of them have an auditory deficit. I will I will work with you to test your your clientele. It's and then I'll have another study up my sleeve to show the same thing. So yeah, I will I will if you're interested. Contact me and I will. I will work with you to to show you what I've seen again and again and again.

Carrie: [00:30:18] Yeah.

Carrie: [00:30:19] And that 10% is. Yeah. When I was in grad school, I mean, we were learning, like maybe 1%, maybe 2% of the population. And when you kind of put it that way, um, it's much more prevalent. And then we think about all of those students who are sitting in classrooms with these, you know, reading and language and classroom learning difficulties. And we haven't maybe touched that foundation yet. And, and discovered what, you know, the key point in that is but thinking about that, like, uh, I know and when I was in school, we learned like who? Like who should be tested for auditory processing. And I know that has changed a lot over the last, especially ten years. Can you maybe give a background of, you know who besides these red flag kids like what? What would a profile of someone that needs to be tested for auditory processing?

Carrie: [00:31:22] Okay.

Matt: [00:31:22] Yep, yep. So, um, I want to I want to start by saying what I've seen in the field since I graduated, which I will say is literally 20 years from now or ago. Um, so the profession has changed quite a bit. When I was going through grad school, the general consensus was there are children that are struggling with reading. Those might be children with dyslexia, or there might be children struggling with language. So those are your receptive language, kids. Um, and then there's a group that struggle with auditory processing. So those are your auditory processing kids. However, the studies have shown again and again and again that actually. So one of my favorite eye opening studies was out of England and they wanted to see what is the profile. So that's your question is what is what is the profile of somebody with an auditory deficit. What do they behave like. What are the what are the issues. And they so they did a group of children that had an APD diagnosis. And they questioned them with questionnaires. They questioned them just with um interview. They talked to the parents and the teachers just to get kind of a functional profile, okay. These kids with APD. And remember back when the study was done, there weren't really interventions. There were just labels. So you have an auditory processing deficit. How do you perform? And then they had another group of kids, um, that had a language disorder diagnosis or a language delay diagnosis. So two two separate groups. One had an auditory processing deficit.

Matt: [00:33:14] The other one had a language deficit. And then they they did these profiles of of strengths and weaknesses. And both groups presented identically in how they were showing difficulty. So back then we thought, oh language is one thing and your auditory processing is something completely different. And now we're refocusing and thinking actually the auditory processing deficit is causing these downstream delays because you need those earlier processes to occur correctly and efficiently for those higher level skills to actually be processed well. And what these researchers concluded was these two skills are related, not these are separate groups. So they found the reason they got an APD diagnosis versus a language delay diagnosis was who the parent was recommended to go see. If the parent said, my kiddo is really struggling and somebody said you should go see an audiologist, they got an APD diagnosis. If the parent was recommended, you should go see a speech language therapist. They got a language delay diagnosis. So the biggest variable in that study was the referral route. If you were referred to both, you would have probably got a diagnosis of both. Because language is auditory. Auditory occurs before the language. So they're literally hand in hand. So yeah. Um, so that was pretty exciting. So if there's struggles in the classroom, if there's struggles in noisier environments, if there's delays in language, if there's delays in reading, there's a very high chance that some of those lower auditory skills aren't developed, but I the exciting part is we can help develop those with targeted intervention.

Carrie: [00:35:17] Mhm.

Matt: [00:35:18] Acoustic pioneer and others, they just show fantastic results. It's really cool. We can fix it. Yay!

Carrie: [00:35:26] Yay!

Carrie: [00:35:26] And I can't wait to get into that part too. But before we get there, one other question I have about the testing part or like who to test would be can you just share? I mean, should we be testing like we we can't test a one year old? Well, I mean, maybe through electrophysiologic ways. Yeah. But, um, yeah, maybe just share a little bit about, like, ages and then, um, the other question I have would be like other like students who may have an additional diagnosis.

Carrie: [00:36:00] Mhm. Mhm.

Matt: [00:36:01] So that is fantastic. So the um. Previously. Historically. Uh non-physiological testing. So behavioral testing really started around age seven historically. Um, and that was based on the norms and how low the norms went. So you can't test anybody if you can't compare to normative data because you have no idea what these scores mean.

Carrie: [00:36:29] Mhm.

Matt: [00:36:30] Today, um, generally we're norm down to about age five for, for what I would call specific auditory processing deficits or psychoacoustic deficits, simply because the individual has to understand enough about the task that you can actually get a, get a reliable measurement. And some of those definitions or instructions just get too complicated for kiddos that are below five. So we know as a profession. The sooner that you find a concern, the the faster or the sooner that you intervene for that, the better result you see later down the road. Like if somebody has a, um, uh, an auditory deficit that you don't treat until ten, that's going to have longer term effects than if you treated them at six. However, below five, because it's really too tricky to get those auditory processing or psychoacoustic measures on those individuals, then you really sort of lean on the higher level checks like your language checks and just normal hearing check, because we still think a lot of these under developments can be due to like an undiagnosed Most otitis media or an occluded ear canal that nobody knew was occluded for a year or months. So, so normal hearing checks as well. But if there are language concerns at a three year old doing top down intervention or even some bottom up language intervention are still very helpful for for helping develop the early years skills. So, um, two things have been shown to be phenomenally useful for your clients exposure to very good language and exposure to music. Not loud crazy music, but just general music is a fantastic stimulation of the brain. It uses skills like localization, you know, like when you get that stereo going on, where the drum solo is coming out, the left speaker in the guitar or whatever you like to listen to piano, it's coming out of the other speaker.

Matt: [00:39:06] It's developing all of those skills. So, um, as a as a parent, we, uh, allow our children to use audio books pretty much as much as they want, because the more that you bombard that, that language system with good, solid language input, it is, it is. There's never too much good language to give to those. So, um, if I had concerns as a speech therapist or as a parent doing a language eval as young as you can and doing any bottom up language intervention that you can, um, that is appropriate, as well as exposing them to as much good language and music as possible, is the best thing you can do at that young age. So when they are older, five, six and up and we can test those more nuanced auditory processing areas. Um, hopefully they're going to be good to go by that point, because they've had enough of that stimulation that their brain can develop those skills early enough. But if not, hey, that's okay. We can we can focus more specifically the the higher or the older they get, the more developed they get. So um, so yeah, this is a we kind of again, we talk about that that baton handover between a speech speech language pathologist and an audiologist. And it's whoever put us together in graduate schools knew already that our professions should be side by side. Hearing and language go hand in hand.

Carrie: [00:40:46] Absolutely. So for so for a more specific like diagnoses or like testing about age five, there are other students That maybe should not be tested or should be included, that might have some additional needs or diagnosis.

Matt: [00:41:09] So I try to take as practical of approach as possible when I'm trying to determine who should be tested and who shouldn't. Um, if somebody is performing well, like they're they're doing well socially. They're doing well educationally. If you tested them and found a deficit, it doesn't seem to be impacting them. And we know from the studies that the incidence rates are far lower for those kiddos that are being very successful. But if they're already successful, do they really need an intervention? Even if you even if you did testing and found oh yeah, you do have a bit of a deficit here, we should fix that up. Well, fine. Like I'm not opposed to them getting intervention, but if they're already doing really well with language and reading and social environments in the classroom learning, then they're winning, you know. Good for you, buddy. I'm proud. That's great. Uh, but I think focusing on the ones that are struggling with language and reading, um, or classroom learning, those are the ones that really are swimming. You know, they're trying to keep their head above water. They're just doggy paddling through that information as much as they can. So if we give them some better skills to where they can really hone the language and the reading, uh, more rapidly and successfully, that's really the goal is to help those that are struggling the most.

Matt: [00:42:44] Now, there are some that, you know, you have cases that are multifaceted and there's there are neurological development issues and, um, uh, all sorts of other variables that that make, um, the auditory processing skill maybe not their top priority. You know, maybe mobility is is a limitation and they, they need physical therapy. Or there are times when even me would say, yeah, the auditory processing in this case is not your top priority. So, um, one of one of the approaches to to acoustic pioneer in particular, it was very early on before we released that, we decided, you know, what this these tools, this set of, of programs that we're trying to develop. The one thing that we can't replace with the computer program is a professional brain. We need we need speech therapists, and we need audiologists or educational psychologists to be involved, to make decisions like, okay, what are what are the areas of concern for this client or this student and what's the highest priority for them? Mhm. Um, so all of our programs require a brain like yours. Amazing. Dr. Spangler. So you can use the information available and then make the best case for how to move forward with that, with that student in school or with that client out of school. Um, and it's we will never replace that.

Matt: [00:44:31] That's always we need a professional to help us make those decisions. So, um, along with that. So sometimes the auditory processing is not the most important in a case, but other times it it could be the most important. So if you were a speech therapist working on a kiddo with their language and they're really struggling to develop that. If you haven't targeted the auditory deficit, your your progress in your language development is going to be hindered. Same with reading. If you're trying to develop reading skills in an individual and you don't address the auditory deficit, the the progress track is going to be a lot slower than if you do treat the auditory deficit. So it's um, I've heard multiple professionals start to get into it to see what happens. And they they tell me they go in these meetings and there's usually like a reading trajectory for success or whatever the skill, whatever the education skill is, spelling or math or whatever, they have these trajectories, like the way they're progressing, we expect them to be here by the end of the year. And then you put in some auditory deficit and those, those trajectories of predicted success increase. And they're like what? We we change the auditory system and now they're going to learn how to read faster. Yes that's right.

Carrie: [00:46:02] And that's so exciting right.

Carrie: [00:46:04] Fantastic.

Carrie: [00:46:05] It's really cool.

Matt: [00:46:06] When when you get to see those those cases, it's it's exciting. It's sort of, you know, hair on your arm like oh my gosh. It's really this is fantastic. Yay. We're doing good by our clients. And I think the more data that that we show, more more of the population has this issue than we anticipated.

Carrie: [00:46:30] Mhm.

Matt: [00:46:31] We can actually fix the deficit, which was that that was highly debated 20 years ago. Can we can know that there were many that said if there's a deficit you have a deficit. There's nothing you can do. So that's been shown to be not true. Mhm. Um, and if we fix the deficit You.

Carrie: [00:46:51] See.

Matt: [00:46:51] Life like real life changing skills improve in those individuals. So yeah, it's just fantastic time to to be in our profession. I'm loving it.

Carrie: [00:47:03] Yeah. No I it is it is fantastic. Is there a certain criteria like for diagnosing auditory processing. And do you call it a deficit. Do you call it a disorder. Does it does it really matter what you call it?

Matt: [00:47:23] Um this is a great question. So this is where our profession needs to really go back to the drawing board and come up with an accepted definition of auditory processing disorder. Um, I've tested many, many children. Uh, and I only apply a label of auditory processing Reprocessing disorder. If they're not receiving services in an education system or otherwise, that they would receive if I gave them that label. So with individuals that are already receiving special services because of a language disorder diagnosis, if we do some testing and discover there's also some auditory deficiencies in this in these students, then we I just call it a deficit at that point. Let's treat the deficit. Because when we do treat the deficit some months later, when the when the intervention is finished, when we retest it, the deficits are not there anymore. So I try to avoid applying the label of an auditory processing disorder because it seems kind of permanent. Whereas if we say deficit kind of lends a little bit more like this actually might be something that that is interminable or fixable or treatable, whereas disorder doesn't. So the current definition by both Ashton triple A of of criteria to qualify for an auditory processing disorder is very stringent and and um requires multi skills to be down and very significant results on both skills or more.

Matt: [00:49:14] Um and a lot of the science on who can benefit from intervention is uses criteria that's a lot less stringent. So I, I think we need to go back to the drawing board and not not so much. Ask what is the diagnostic criteria for a label. But ask who can receive significant benefit from intervention and what's that criteria. And use that more as a as a diagnostic criteria versus I'm just going to draw, you know, a very difficult score in multiple areas as the criteria. I so I know ASHA has altered their criteria, their recommended criteria a fair bit. But we need to have one of those good old audiology meet ups and say, look, we've done a lot of research in the last 5 to 10 years, whereas these criteria haven't been updated for longer than that. So we really need to to modernize our our criteria. In my humble opinion, I would I would love to be on that committee to to help make it where it's, it's a, it's an, it's a criteria that is going to highlight those that can really see benefit um, and not really include those that even if they have some concerns, they're really not going to see a whole lot of benefit from intervention. That's really the approach I would take if I could.

Carrie: [00:50:50] Yeah, no, that's good. And you can answer my question too, about that long standing like once diagnosed with a disorder, you know, auditory processing disorder, they have it for life. And that's not the case, which I think is, um, a good stopping point for like right this second, because I want to do part two of this podcast, which would be really we talk a lot about what auditory processing is and um, kind of the diagnosis and, you know, the testing piece of it and what happens. But I would like to do part two with what do we do next. What do you think about that Matt What do you think we can do it part two?

Matt: [00:51:37] That sounds really fun. I would love to join you again. That sounds great.

Carrie: [00:51:41] Okay.

Carrie: [00:51:43] Thank you for listening to part one of our series on auditory processing. I hope you found our discussion on the basics, red flags and the impact of auditory processing deficits. Insightful. Be sure to catch episode 70 where Dr. Barker and I will continue the conversation, focusing on next steps for managing auditory processing challenges. Don't forget to subscribe to the EmpowEAR Audiology podcast so you never miss an episode. If you're enjoying this show, please take a moment to leave a five star review and share it with your colleagues and friends.

Announcer: [00:52:26] Thank you for listening. This has been a production of the 3C Digital Media Network.

Carrie: [00:00:14] Welcome to the empowEAR Audiology podcast, a production of the 3C Digital Media Network. I am your host, Dr. Carrie Spangler, a passionate, deaf and hard of hearing audiologist. Each episode will bring an empowering message surrounding audiology and beyond. Thank you for spending time with me today and let's get started with today's episode. Okay. Welcome everyone. On today's episode of Empower Audiology, I have a returning guest with me, Dr. Don Goldberg, and I'm going to give you a little brief background about him. And I am also going to refer you to episode 33 of empowEAR Audiology, where you can listen and find out much more about Dr. Don's journey and his field, um, and his journey into the field of his work, um, in that episode. But to give you all a little introduction, he is a professor, a full professor at the College of Wooster in Ohio, and he is a member of the professional staff for the Section of Audiology and Hearing Implant Center at the Cleveland Clinic Foundation. He has published extensively, including being a coauthor of a book, book chapters, and other public publications he's presented both nationally and internationally. Dr. Don Goldberg is a fellow of ASHA, and he's also received the honor of the AG Bell Association. So today, I'm just excited to have Dr. Don Goldberg with me on the podcast. Um, and we're going to really be jumping into, uh, his release of the Test of Auditory Functioning by BlueTree Publishing. So, Dr. Don, welcome.

Don: [00:02:06] Thank you. Happy to be here, Carrie.

Carrie: [00:02:09] Yes. So I thought, um, the last time when we talked, uh, a while ago, you were in field testing for The Test of Auditory Functioning, and now it has been released. So I thought this would be a perfect opportunity, um, to touch base again and kind of share with our listeners a little bit about the Test of Auditory Functioning. So to can you give our listeners just a big overview, and then we'll kind of get into the details.

Don: [00:02:39] Sure, sure. Well, the big overview is um, having been a clinician as well as a professor for many years, I was always struck with there was one test many years back called the Test of Auditory Comprehension, not the TACL but the TAC. And essentially I had used that for 20 plus years and it no longer was available unless you were old like me, and or happened to own one of those big orange TAC. It came with a cassette tape. And essentially it was a wonderful measure of a hierarchical measure for children with hearing loss. And essentially I still have my TAC, but I knew that there was a need for something else for a variety of professionals. I happen to be an audiologist and a speech language pathologist, and as we got closer to release, we obviously needed to figure out who should we pitch this to. And I think of several professions educational audiologist, for sure. And in fact, the very first public presentation when it was finally in real easel form was at the Educational Audiology Association in the summer of last year. And then in the fall, it was available for purchase at ASHA. And we really want educational audiologists for sure, audiologists who happen to be in a position to probably have more time than they often times do for assessing beyond a SRT and a word recognition score or word discrimination, which is the wrong term.

Don: [00:04:17] Um, as well as that speech pathologist, our colleagues who have an isolated 1 or 2 children with hearing loss in their caseload, as well as teachers of the deaf. So a pretty broad market, if you will. And what I think I had as a driving force was to start with really the most basic level of listening, which would be for the purposes of this test, was just identifying long versus short. There needed to be a test for children, which is my primary, uh, uh, population that I'm typically seeing, including two month olds and above. And I also wanted to make sure that some of the critiques I had of the TAC were addressed in the TAF. For example, very few of our colleagues test in noise. Oftentimes, cochlear implant audiologists have very rigorous assessment. But many others are happy to get an SRT and do a word recognition test with pictures. And then if the kid doesn't have receptive vocabulary, they often say could not test. We really should never get around to saying we can't assess something about a child's speech perception ability. And there's lots more to the world than phonetically balanced words.

Don: [00:05:37] So that was why I put it together. And because there were few tests that in one measure, had it all in one unit. That's where I went with the TAF, starting with very basic levels of functioning and then ending with three subtests with competing noise. And we can talk about the details of the subtests, but the TAC would only test at zero signal to noise ratio. As you well know. That would be the speaker was as loud as the background noise. And that is not easy for a hearing person. And we elected in the TAF to go with plus ten plus five and end the TAF at zero signal to noise ratio. So I put together a lot of other thinking and measures in one measurement that we can get into. If you care to know about any of the details of subtests. But that was my driving force, and it's not on a cassette, it is on a USB. I guess I should dry hang it, you can't see it, but USB drive and then you can on um, really just download it to your computer and then work with the easel and the audio files, which are on the USB drive that you can put on your computer.

Carrie: [00:06:58] Okay. Yeah, that was a great overview of all those main components of the test. So, um, it sounds like there's different levels. People can purchase it through BlueTree and can they get it through Amazon as well, or is it just through BlueTree Publishing?

Don: [00:07:15] Well, there's a short period it was on Amazon, and I won't go into all the details of artificial intelligence, but because of one subtest being called male female discrimination, it was my daughter in law's voice and my voice to assess fundamental frequency. AI spit it out. We think that it sounded like I was discriminating males and females, and it violated the AI rules of Amazon, so they pulled it off. But I heard it's back. The safest bet is to be going through BlueTree, especially when we have updates of any changes in the USB drive, because that's where the manual and the score sheets are. So my recommendation is going through, um, uh, through BlueTree, not Amazon if it comes back or if it is back. And later on we can talk about if you're members of two different organizations, there is a discount through the end of 2024 for the Taff.

Carrie: [00:08:18] Okay. Well, great. So we got the easel, we got the USB. Can you share a little bit more about. You said there's different subtests, but you know, maybe get a little bit deeper into the different subtests and, um, how someone might want to look at that for testing.

Don: [00:08:37] Sure, sure. And one of my favorite components that evolved, uh, we share a particular kiddo. She made a YouTube video, I went to her home. And every subtest is demonstrated by one of our favorite kids, a bimodal kiddo. And you get to see a taste of 19 subtests. I had to get an older kid who would get to zero signal noise ratio, but we started with number one, where all she had to hear was, uh, vroom vroom for a fast car or hop, hop, hop. So she looked a little bored and yawned a little. But essentially, if you do go to BlueTree and it sounds like I'm trying to. I didn't do this to make money, but if you get it from Blue Tree, I get $0.10. But the real issue is that when you go to BlueTree, there are samples from the easel and you can see YouTube videos of the subtest. It really does start for a younger child or even an older child who has limited auditory abilities long versus short, high versus low. And then it moves to identifying a male versus a female, or a male versus a female versus a child's voice. And it really does move with some very, uh, kind of basic listening abilities, including just environmental sounds. But what I love is it also includes measures using the Ling six sounds. I am convinced most everyone knows those six sounds, but they may not understand why those six sounds exist. So you can find out a lot with the Ling six sounds. And then it moves to really a section of tests with learning to listen animal sounds, learning to listen vehicles, and a whole segment of pattern perception. For those of us who've been working for a while, I'm sure maybe most people should know the early speech perception, the ESP by Moog and Gears.

Don: [00:10:38] Well, that's a wonderful measure. I've adapted some of the subtests of one versus three syllables Spondee recognition, and including getting to single words not unlike WIPI and NUCHIPSmeasures. There's identifying one word in a field, two critical elements, like a dirty shoe versus a picture that has a clean shoe and a dirty boot and a clean boot. Moving on up to sequencing and listening comprehension. And those are really, I think, the heart of some of the really good information. All of it will provide you with guidance of where you need to work. No child would ever be administered one through 19 based on guidelines in the manual. If you have a child who is able to do basic pattern perception, you might jump specifically to, let's say, subtest ten, where it's one versus three syllables. If you have a child who is able to do something like a  NUCHIPS or a WIPI, you could jump through just one critical element. Um, for a lot of the kids, I'm really interested in seeing how they do in noise to help justify. Although I don't think we need to justify that every kid should have a remote microphone in the classroom. But if you could show a child having trouble with noise, sometimes school districts are willing to say, oh, they're such good listeners. Well, it's hard to be a good listener when you're in a room full of kids and the teacher is not six inches from their head. So essentially, I have often times used tests with competing messages to really help say they're wonderful. But it's not so easy for any of us with competing messages. So I know I'm talking to the choir, but a remote microphone is non-negotiable for our children in the classroom.

Carrie: [00:12:42] Uh, definitely. And. Yeah. So. I love what you said about you're not going to do all 19 subtests. And friend that we both share. Um, that was in your video. I'm sure, um, could have really started at a, at a later level, but for purposes of demonstration, she did all 19. Do you kind of suggest like. You said that, you know, if you know where their level is, kind of start. Maybe what, like a level behind where you think they are so that you can kind of make sure that that's where they're, they're at. And then you then you go until they max out or when would you stop, I guess is my question. Yeah, a wonderful question.

Don: [00:13:28] So essentially, like a lot of tests, you can start at a sub-test and hopefully you're at a basal level that there's success. So essentially um, with the earliest subtests, I think you can just do it and quickly realize this is too hard or too easy for them, and you don't want kids crying. But essentially, if you were to start at, let's say, one critical element, you would want them to pass that sub test and then just move to the next sub test. The general criteria is to have at least two consecutive subtests passes, and then you get credit for all the previous subtests. And to stop when you have two successive or excuse me, two consecutive fails. But if you have a kid and you go to plus ten and they really break down in noise, I'm not going to torture a kid to do one more subtest. For each of the subtests, we're looking for an approximate 70% pass criteria. It does vary because sometimes there are nine items or ten items or even 15 items. It's all in the, uh, score sheet of what's criteria is for passing. If they haven't passed, you can go backwards, which is the nature of establishing a basal and you can use your judgment. Okay. We really are at a fail. That's a really poor score that we absolutely should stop, but that is available. Um, when I did the field testing, um, I would usually know from walking down the hallway, um, that I think this kid probably could go to number blank. And then if I was wrong, I'll go backwards. The average administration time, I didn't keep all the data on every kid, but I would say most administration times, if you start appropriately, should be approximately 10 to 15 minutes. Okay. And that's pretty good. In the busy caseload of speech pathologists and educational audiologists, it is.

Carrie: [00:15:31] And that sounds like you can get a lot of great information in that 10 to 15 minutes of time. So with all of that information, what do you what what goes next like, I mean, does it depend who's giving the test or how do you use that information.

Don: [00:15:52] Right. Well, I see two primary functions of administering the TAF. One is it is not norm reference, norm referencing and standardization with kids with hearing loss is a massive project because of all the variables age of onset, use of technology, age of the child and input. But the real takeaway is you get a criterion baseline data point. The maximum score is 200, so you'd be able to get a score and on a yearly basis re-administer the test. You have a general idea then of I should start at Blankety blank number, and that way you'd be able to demonstrate growth in auditory abilities on a yearly basis. So from a IEP and a justification of our services, it really does provide a yearly longitudinal comparison of child A to child A.  But what I'm planning to do and I can't promise it's next year. But as I retire from teaching, my goal is a companion document that would give examples of okay, when a child breaks down with basic sequencing, what are some of the therapy activities that you can do to not teach the test, but to teach the task. I was trained by Helen Beebe years and years ago, and what I found a good clinician does is not use a test for a number or a standard score alone, but knows where the child breaks down is a segue to where we need to reinforce. If you have a child not doing environmental sounds, then go out on listening walks or get some simulations of in various environmental sounds.

Don: [00:17:42] That's a tricky one, because your cell phone sounds different than my cell phone. But the real takeaway is it was built to be comparison of a child, and also guide a clinician or direct others who are doing the therapy of we need to work on basic listening comprehension. And listening comprehension is not just answering questions, but I also hope. To if I keep at it. Work to develop listening comprehension. That also goes to even higher level skills. Listening in noise is a good higher level skill. But what about listening and being able to conclude what's the main idea of the story? To learn vocabulary that's embedded in the story. When I'm telling you about a nocturnal animal, I hope the kid would know from context. That's an animal who hunts at night. So those are some of the takeaways that it's not to get a number. In fact, the number may be the least interesting part. But where can we go with the breakdown? And literally if you have a child not doing pattern perception, you're going to be needing to intervene before you can just get to word identification in a field. So that's where I'm thinking. And quite frankly, being a clinician who still sees kids every week, I think that's part of why I did this. I need to now work on such and such based on breakdown.

Carrie: [00:19:14] So, so criterion reference that you're comparing that kid to that kid that, um, for auditory skills development, what would you say? You work mainly with kids, but what would you say the age range would be and the population that you would want to be testing? Right.

Don: [00:19:33] It's such a great question. And if you hadn't asked, I'd want to make sure you heard it. I really had a wide range of children. My youngest kids who were successful in the administration were two years old. They were in parent infant programs. I do also have a superstar two year old, but he got to go really high. But the problem when I was field testing is it wasn't on an easel. It was all on the computer screen and they didn't know me. I was in four continents, so they were on a parent's lap, and if they weren't willing to touch the screen to show me their answer, that was a problem. Most kids in their twos get around to pointing to pictures, so I'm hoping the youngest would likely be two year olds. But I think if you are their clinician, you'll be much more successful. They may need to be older, but in my very extensive field testing and I've been doing the TAF on a lot of my older kids because I'm just dying to know how do they do with plus ten plus five and zero? I have yet to have anyone under 13. That's the oldest I've ever administered it. No one under 13 has ever gotten 100% of the final subtest items, so it appears to be a fairly wide range.

Don: [00:20:58] But interestingly enough, I have two subtests that you could administer to an adult. One is the first subtest of long versus short. The adult is not going to listen to a race car and a bunny. Go hop, hop, hop. But they go ah versus ah ah ah. We do have some late adult uh, later deafened, I mean, excuse me later implanted and long term deafened individuals that really may not get long versus short. Similarly with the Ling, the subtest of the Ling also includes an adult subtest where they're not pointing to an ice cream cone for um, but they're pointing to the M for that sound. So I'm not developing this for adults, but it is adaptable, and we are needing to realize not everyone gets an implant early. Not everyone has immediate amplification. So if you have a child with multiple disabilities or late identified late access to technology, this could go above a 13 year old. But the primary field testing was for 2 to 13 and I must go on record. Not every two year old gave me much information, but I tried.

Carrie: [00:22:17] Yeah, well, at least you can get a somewhat of a baseline and you can document it. And then a year later when you go back, you hopefully get more information and you have that comparison. Right.

Don: [00:22:30] And interestingly enough, I got great feedback from educational audiology colleagues at EAA. Some people asked, well, could you do it with tele administration? The concern would be the decibel level of presentation has to be preserved. And will a child, unless the clinician on site has the easel? I think there's some challenges, but someone said, could you just administer a voice? It was not developed to be administered live voice. There's a calibration tone, which you must do before the initial administration of any subtests, not each one, but the initial administration of your test time. Youtube video shows calibration. So if there's anyone out there going, I don't know how to calibrate, you can do it pretty easy with downloading a sound level meter or having a sound level meter, but you could practice with a child live voice and just make sure you noted that subtest one was administered live voice, not with the audio file at 76 DBA, and then maybe six months later you could administer it using the audio file. So I'm not against practice to make sure the child can do the task. But for a reliable and valid measure, you really are not going to be teaching the test. But and the test was not developed to be done live voice. But I had a really pretty impaired kid, and we went right to male on my voice for to make sure that the child could point to the male character. And then we tried male versus female on the audio file. We didn't give anything away.

Carrie: [00:24:16] Yeah. No that's good. And kind of the expand a little bit more on administering the test. Um, it is recorded, but for those, does it need to be in a sound booth. Where can you do the testing?

Don: [00:24:30] Well, as you can see from the YouTube, we did it in our friend's dining room. I would encourage a quiet area, so her little sister had to be quiet in the background. But the real takeaway is it was not developed to be in a sound booth. It could be a clinician space, be it an educational audiologist or teacher of the deaf or even a teacher could be administered if they have some experience, and I would experience doing it with a one of your own kids or a older child, just to get used to going to the subtests and the subfile for the playing the audio clips. But the real takeaway is it was not developed to be routed through an audiometer. It could be, but there is no need a quiet space and making sure that from the calibration tone that's embedded in the audio files, that you get to 76 DBA where the child is sitting. So you just position the computer and the space chair and put the sound level meter at the child's head. And there, you know, vary your volume control to get to that. Always administration at the same intensity level.

Carrie: [00:25:49] Okay. And I guess, um, another question would be. Uh, what are some of the challenges that you've kind of heard from people out in the field, like giving the test or, um, follow up with it?

Don: [00:26:06] Great, great. And I keep asking for more and more feedback. And I have an email where you can send me questions not just to the college or the hospital. Um, but the real takeaway is I have had good reports on the images. They absolutely are beautiful illustrations. The, uh, illustrator, um, is in China and didn't speak English, so it was quite interesting to giving her feedback about the various images I took into consideration DEI, diversity, equity and inclusion. That there are various individuals of color. Uh, and there are really pictures that I think when I'm going buck, buck, buck for a chicken, they'll know that's the picture of a chicken and they'll hopefully understand my bok bok bok is a chicken. So I have good feedback of the images. I would say I purposely, um, because of, uh, issues of developing, uh, test design. It is color coded on the right side of each image. So you'd be able to flip to what other whatever subtest you need to go to. It doesn't have tabs, but it's color coded, which turns out to be very helpful. I would say that the one thing that does probably take the most kind of practice is making sure on your computer, you can easily navigate to audio files, the listing of the subtests, and some of the subtests to a practice items.

Don: [00:27:37] So it's really a matter of getting to be able to navigate. And this almost 70 year old, if I'm able to navigate some of the audio files, I know everyone else can. But the real takeaway is there's a little kind of I use the word kind of, uh, kind of quirkiness until you really are great with your finger getting to the right audio file. But the flipping, the scoring in general has been well received by folks out there. And literally, with the exception of this, is almost humorous from a speech pathology standpoint. I now know there are no skunks in Australia. There is a story about a skunk, but I like to think everyone will identify that black animal with a white stripe is a skunk, and you do need to take into consideration. All of my field testing was on English speaking kids, including kids in Israel, as well as, um, you know, I had a lot of kids who are bilingual Spanish speakers in Texas, but English was a language they could understand or it wouldn't be appropriate. But when you do things like the Ling sounds, my English, not New York accent, but I am from New York.

Don: [00:28:50] My English of the production of vowels will be a different production than you might find in different parts of the world, so I'm alerted to the skunks and that my vowels don't quite sound like all the vowels in Australia. Um, and we aren't yet figuring out the exact solution, but it might be that we might be able to rerecord with other speakers. You know, long term. It'd be great that this was in Spanish, great if it was in Mandarin. But, um, I'm not going to live long enough to do all that, I don't think. But we certainly could do a Ling subtest with a rerecording. Um, but, you know, geographic, uh, accents are kind of hard to conquer throughout the whole world. But it was very interesting. I didn't know that in England, they really don't have that many railroad crossings like we have in the US. But the good news is the picture of the railroad crossing doesn't influence them getting the right answer. When the story talked about a car stopping at the train intersection. So you learn a little things culturally to be sensitive to.

Carrie: [00:30:03] Yeah, I'm sure that was a huge challenge when you're kind of basically doing an international like study, you know, data collection and the pilot of the test, and then you find all these little nuances that happen in different countries.

Don: [00:30:20] Yeah. And actually one of my favorite was in field testing. We had a few questions that showed emojis. Kids are so into emojis. But to be on the safe side, because I would point out that's a happy face. And that was a sad face. And that's an angry face. I have labeled each of the emojis with the term, so there's no confusion about frightened versus, you know, sick, you know, a green face emoji with someone who is sick. So that was interesting. And because of generational issues, I even needed to label the grandfather and the grandmother, keeping in mind they're not always called grandfather grandmother. But you know, a lot of people have pretty young looking grandfathers. I didn't want that to be confused with a youthful parent versus a grandparent in one of the images that they're identifying. So I learned a lot about just things that sometimes you never would think about because of the feedback from the kids who would look quizzically at this image going, I'm not sure which emoji you're talking about. So things have been updated before it went into the easel.

Carrie: [00:31:29] Okay. Yeah, just kind of going back to a question that I should have asked you at the beginning, for how long did it take you to do all of this? Because that is like a huge undertaking. And I know you've been talking about it for several years now, and it's been stirring in your brain for longer.

Don: [00:31:49] Well, it's funny because when it did come out, my favorite image that was reposted by Karen Anderson and her website was, it's finally here. And a lot of people go, yeah, it's finally here. Um, the actual assembling of the images, which, you know, took some time from our illustrator and, uh, uh, China. It was right before the pandemic and a sabbatical that I was getting all the images for the whole test. So that was probably a six month time period of approving the hierarchy of the images. The field testing was on another sabbatical, and I almost was trapped in Australia because it was literally the spring break that the pandemic came to us. And I guess I could have stayed in Australia for months, but I got home on the last plane before it would have been quarantined, but from me. Tired at the pandemic last two Decembers ago, I was in Seattle with Robert O'Brien, and literally the transfer of the images, the recordings that were done at a hospital setting in a recording studio. It came out between December of 22, and then we were meeting and that following summer that it turned into this easel with the audio file. So the ending went faster than the preliminary. But I've been musing about hierarchy of listening function probably my whole whole career. And I've always loved this TAC but I knew we needed an update, and it's an update. And some in my mind to say the least. With all due respect to the TAC developers and Karen Anderson, who is one of the greatest cheerleaders going, Don, you got to do this TAF and other people saying you were talking about standardizing the TAC, where's yours? And it was a multi year process slowed down by the pandemic.

Carrie: [00:33:56] Well, now it's in full form. So that's the exciting part of it. And, uh, people can get it too. Is there anything that I forgot or didn't ask you that you think listeners need to know about the, um, Test of Auditory Functioning?

Don: [00:34:14] Sure. I guess the two is. And this is not me being a salesman, other than I want people to benefit that if you are a member of EAA, you can go to the EAA website. And they have a recorded webinar that I did, I believe, in October. Uh, no, actually it was springtime. Um, I have a webinar from March and you can down or you can sign up and watch the webinar. And that was, uh, March of this year. And essentially, if you're a member of EAA, there's a 10% discount for the rest of the year to order it. And note I believe the code, but please check with the EAA folks. It was EAA 2024, uh, if you're a member. Similarly, with AG Bell, there's a 10% discount on all of BlueTree's material, including the TAF with AG Bell 2024. So that could be very helpful. Um, and I would also say if you're uncertain, you can get the links for the YouTube video and see the easel in action. It's a great picture of my friend doing every subtest, but, uh, the best site would probably be BlueTree publishing.com. I always embarrass because I don't always say that correctly, but I'm almost sure that's correct. Um, it's, uh, Blue Tree, one word publishing, and they're based in the state of Washington, so I'd say those would be helpful resources. And again, don't be afraid about the calibration. Uh, you can download sound level meters, for example, from NIOSH for free. And, uh, you know, I welcome questions and I also welcome feedback. In fact, I just was talking with one of Carrie’'s very esteemed colleagues in educational audiology, and she said she, you know, was having a little trouble with getting the audio files.

Don: [00:36:09] And I think that's nothing reflecting her. I have trouble, and I have pretty good experience with the audio files. But once you're once you're flying with the delivery and you're in the right subtest, which is guided by the manual, um, you definitely can do this in a fairly short period of time. And I'd say the last item, um, our mutual friend Carol Flexer gave me a wonderful review, so please feel free to read that. But I think she was being critical. And she said the idea that this really has been long awaited to meet a need. But quite frankly, um, I think it's one of those tests that I hope people value and will be important in their clinical practice. And what better to actually have someone who actually is still seeing those kids in that age range? Um, and, you know, I'm obviously very proud of the work it took, but I'm more proud that more colleagues who might not have learned much about auditory development now have a measure and can really, uh, have a dialogue. I would want to also mention that the Hearing First organization is doing wonderful, wonderful LSL and audiology webinars and courses. And I think through the middle of August, I'm pretty sure I have that right. You can sign up for a four week seminar I'm doing for hearing first about assessment and auditory development. And not just that you sign up for my course, but tons of incredible pediatric audiology offerings as well as LSL training. Uh, so Hearing First would be another resource to be aware of.

Carrie: [00:37:54] Okay. And what I can do and the show notes is I can link um, the EAA website for the webinar and AG Bell as well as Hearing First, um, and then I if you want, I can put your email in there, um, that you want people to get Ahold of you if they have any questions or feedback. Um, we can definitely link all of that up in the show notes.

Don: [00:38:17] And the manual and the score sheet and script are all on the USB. But in the meantime, I'll also provide you with the list of, uh, Ella and her YouTube, because essentially one through 19 are in different segments. Um, and I think although they're very brief segments, you really will get a sample of the sound as well as the easel and that, uh, how hard she worked to go from 1 to 19 in her dining room.

Carrie: [00:38:51] Oh, good. Well, I am so glad that we had the opportunity today. To get together on this podcast and really dive a little bit deeper into the Test of Auditory Functioning and how it can be used for, you know, a variety of different kids, um, from just the early listeners to maybe, um, late listeners who are going to be considering getting cochlear implants or hearing aids and just to kind of figure out, hey, what are some good IEP goals or therapy goals that we want our kids who are deaf and hard of hearing to get to next. And this is a great tool to, um, figure that out and benchmark and then come back to to see where the progress has gone. So thank you, Dr. Don, for doing if I.

Don: [00:39:35] Could, just as you're talking, I've thought of one other thing. From a population standpoint, children with every possible technology were part of the field testing, including two implants, two hearing aids, bimodal soft band kids, a fair number of kids with microtia and atresia that were using soft bands. And I would make the note that I did my dissertation research at a school for the deaf in Florida. And essentially, sometimes people are shocked to wow, you went to a place that there's a lot of signing. I look forward to people acknowledging that some of those children at schools for the deaf, which always will have a role, are also kids who may be getting cochlear implants and those kids or just even wearing some technology. Not all that. Those kids also have auditory potential. And essentially the idea of an auditory verbal therapist reaching out to our colleagues at schools for the deaf may sound surprising, but it's with great sincerity every technology. If you're totally not auditory, this would not make much sense. But we do have kids that people just need direction to demonstrate. They can hear a male versus a female voice. They can do a high versus a low, and where they are, they can move forward. And that's really how I look at every child. We all have our stars and I'm always proud. But sometimes those more involved kids who make the small gains might really be the ones we should take the greatest joy in. And I made that quite sincerely about all children with various degrees of hearing loss.

Carrie: [00:41:18] Yeah, yeah. No, that's a great point to bring up that it really can be used for, for all kids. And it gives us a benchmark for moving forward, um, in auditory development. So sorry for.

Don: [00:41:30] That late late Add.

Carrie: [00:41:32] Yeah that is great. Thank you. But um, again, it is always great to connect with you and find out what is happening. And I really appreciate your time today on the EmpowEAR Audiology podcast.

Don: [00:41:46] Thank you. Appreciate it.

Announcer: [00:41:48] Thank you for listening. This has been a production of the 3C Digital Media Network.

Carrie: [00:00:13] Welcome to the empowEAR Audiology podcast, a production of the 3C Digital Media Network. I am your host, Dr Carrie Spangler, a passionate, deaf and hard of hearing audiologist. Each episode will bring an empowering message surrounding audiology and beyond. Thank you for spending time with me today, and let's get started with today's episode. I just want to say welcome to Kellina Powell, who is known as the deaf Queen boss. Kellina is a young entrepreneur who loves to help people with their personal growth and educate others about the deaf community. At the age of four, she lost her hearing in both ears. She did not let anything stop her from what she wanted to accomplish. She has received her psychology degree from York University and her Post Graduate Certificate in Mental Health and Addiction. She is also an entrepreneur, starting her online life coaching business, and she is the author of Everyday I Am Just Deaf. Welcome Kellina to the podcast. It is such a pleasure to have you.

Kellina: [00:01:28] Thank you for having me today. Thank you for the lovely introduction.

Carrie: [00:01:31] Yes, well, I know that we kind of connected through LinkedIn, and I am just really excited about this conversation today and to learn more about you. And I can't wait for our listeners to learn more about you as well.

Kellina: [00:01:48] Thank you. I'm excited.

Carrie: [00:01:50] Well, I know we're going to talk a lot about the book, and I want to ask you more about your coaching business, too, but would you mind just giving everybody an overview of your hearing journey and how that started and any other feedback you want to give about that?

Kellina: [00:02:09] Yeah, honestly, I actually became deaf at the age of four. I was not born deaf. So they were things shift for me at a young woman had a baby. So I, a young girl, and I actually became deaf due to an infection due to the daycare not following the infection for the eardrop, unfortunately. So I did became deaf within that same day. So when I went home I was watching TV. My mom tapped me on my shoulder and that's when I realized that I couldn't hear my mom. My mom freaked out. She called my family doctor, actually, before she called my family doctor, she called my grandma, who was the nurse at the time, thankfully, whoa I wouldn't know what I'd be without. My grandma and my grandma knew instantly that I was deaf. She knew. And so over time when I got my hearing loss, I just struggled a lot with, um, being like having mental health in terms of anxiety, nervousness, confusion. Actually, that was a big thing I learned when I was growing up, especially going to a deaf school and a hearing school. And so my family really wanted me to learn how to communicate in two different hearing communities, to let me know who I am as a person. Especially, especially knowing that knowing my familyis deaf. So it was very hard, especially growing up, going into middle school and high school and learning who I am as a person, because I ended up going to the deaf school after grade three, so I actually ended up going to school full time. So it was a very hard, a little bit of struggle, but it was definitely worth it to help me shape who I am today. And, you know, now going to University, it was really great. Um, but yeah, so that's pretty much about me for now. That's the backstory, but we'll get into the rest of the story.

Carrie: [00:03:52] Oh, wow. Wow. Just hearing a little bit of your backstory, um, we definitely have some, some similar connections in, uh, certain ways. So just a little feedback. I, um, was born deaf, but I, they didn't find out who I was four, so that's when I was first identified and fit with hearing aids too. So I can relate, um, about going through, um, a more mainstream school and middle school and high school and some of the challenges that go along with that.

Kellina: [00:04:26] Yeah, yeah.

Carrie: [00:04:29] So as, um, did any of your experiences as an individual who is deaf or hard of hearing help you decide what you wanted to do now in life? And can you share a little bit about your job?

Kellina: [00:04:44] Yeah. For sure. So, um, so what happened was like now growing up, graduating from university and going to college, I did come across a friend of mine who is hard of hearing person, and we were talking about how there is a lot of lack of awareness about the deaf community and how there's not enough professionals in the mental health space field. And that's when I realized that, oh my God, it's so true. Because when I was in high school, I did look up for deaf or hard of hearing therapist for to help me with my anxiety, and I couldn't find nothing in my. For those who probably just wondering, I'm from Canada Toronto, so it's very hard to find, um, deaf and hard of hearing therapists in Canada. So what happened was I realized that I wanted to do something to make a difference in the deaf community walls and let them know that their voice can be heard, especially if those who are struggling with their mental health. And so that's what impacts me to really start my coaching business, and even working as a social worker as well. And that's because I wanted to make an impact on other people and really help those who need a voice and actually help them to get the access and the tools that they need.

Carrie: [00:06:02] Wow. I love how you kind of took your own experiences and were able to kind of further your education, but also help others too. And I would agree with you that there are not enough, um, professionals who are deaf and hard of hearing in the mental health space, whether it's social work or counseling, psychology, coaching, there's just not very many people. And do you feel like your experiences and going into this field has what's the impact that it has on your clients or the patients that you get to see?

Kellina: [00:06:45] Um, so I made a huge impact. And a lot of people I came across, um, I learned a lot more about myself, actually, while I'm doing the job. Right? Because sometimes everybody, every client, every patient you meet with are totally different. And every single one person I've ever worked with, they all think to me, you know, Kellina, you're very open and you are very honest. And you give me a voice. I always ask different question for everybody and let them know, like, okay, well if you can do this, how can we do this? How can we get a solution out of the problem? And that's something I love doing, is solving problems with a lot of the people I work with. And so that's what made me impactful on people to make them realize that their problem can be solved.

Carrie: [00:07:29] Yes. And I know we're going to get a little bit into your coaching in a few minutes. But before we do that, I do want to ask you a couple of things about your book, which I am so excited to have in front of me today, and it is titled Every Day I am just Deaf. So can you just share a little bit about your journey of becoming a writer and what inspired you to write?

Kellina: [00:07:58] Um, yeah. Oh, my God, that story is very funny. A lot of people. So what inspired me to write my book is basically, I realized, not growing up once again, that every time I pick a book, it's not by a deaf author. It's very hard to find that. And I realized that there are not enough books for teenagers or those who are young pre-teen who can relate to their story. So that's why I said no, let me write a book for those next generation, to let them know that their voice can be heard. If I can do it, you can do it as well. There's no way that you can't do it. That's because you are deaf and that's not. And because for me, I never had a role model, I never did. When I grow up, it was very hard. Like, for example, on TV Hollywood, there's nothing, you know, just recently, now they just started having deaf actors, deaf producers. They just started that slowly. It didn't happen when I was growing up, and I wanted that to change so much. And how I start writing my book was actually due to Covid. I was like, what? Yeah, so I actually wrote my book within three months because of Covid. I was very bored. I had to work from home, I quit a few jobs and it was just a lot of transition I have to do because of Covid and just because of the mask. So it was very hard for me to communicate while I was working. So I ended up having to work from home. And so my book took me three months to write because again, I was bored. In Covid, you can't go anywhere. And, um, I find a lot of, uh, resources through, uh, friends. Close friends. They refer me to a lot of editors, um, graphic designer, which is amazing. And. Yeah, and that's really how I started my book.

Carrie: [00:09:44] Wow. Yeah. I think a lot of, a lot of great ideas did start during Covid, even though it was a lot of negativity in it. There's like some positive things that came out of it.

Kellina: [00:09:57] Right, exactly. Yeah. So, um.

Carrie: [00:10:01] So looking at your book, uh, how did you decide to really come the format of your book?

Kellina: [00:10:09] So I always love reading poetry book. That's number one. I always love reading it. I could not read a chapter book. Believe me when I tell everybody that, like, people like, really? And I said I cannot read a chapter book, I just cannot. So what I said was, what is it? I want my readers to get out of this book. That's the first thing I thought right? Then I realized that I wanted my readers to understand what I went through, to let them let them know that they're not alone. So I said, hmm, maybe I can make it short and make it a poetry just because I love poems and make it like a poem. And then I honestly type it in on Google, um, Google Docs and I just type and I like, you know, I think this is it. I think this is my book. And I did have a lot of doubt because I was like, oh my God, who's gonna buy my book? This book going to look good. I was so nervous. Um, honestly, I was super nervous because I didn't know what to expect. And the editor end up reading the book and she said, this book is amazing. I'm like, it is? I think she and she said yes. So that's how I had that idea.

Carrie: [00:11:22] I love it because it is. It is such a great collection of different poems, like you said. But there's you can see, you know, some of your struggles in the poems, but then you also have a great balance of like building your self esteem and empowerment and resilience built into the book as well.

Kellina: [00:11:49] Yeah. Yes, yes.

Carrie: [00:11:52] So do you have, like a favorite, uh, part or a poem within the book? I know I'm putting you on the spot.

Kellina: [00:12:01] It's all good. Um, I would say the poem was one again. Um, so for everybody, there's so many pages in my book. Um, it was a poem about. I was thanking my family and friends for allowing me to be myself without having to second guess me.

Carrie: [00:12:19] Oh, I love that. So we all have our own journey and no matter what it is but and it's great to have that acceptance of who you are no matter what to you.

Kellina: [00:12:30] Exactly.

Carrie: [00:12:31] Yeah. And then obviously all of your personal experiences really influenced the writing process and the themes of the book. Just kind of the switch a little bit. In your opinion, what are some of the common misconceptions about deaf and hard of hearing individuals, and how does that book challenge those stereotypes?

Kellina: [00:12:56] For sure. So then the one data type that a lot of deaf and hard of hearing get is that we cannot achieve a lot of things in life. For example, we can't get a job right, and a lot of people think that they can't work. And to a lot of times people think that every deaf person knows ASL, where some of us don't know. Right. And so I feel like a lot of people assume that they cannot communicate with a deaf or hard of hearing individual, and that if that comes to me and they just look at my face and I'm like, hi, I can help you. And so they get confused when they see my hearing aids. And so a lot of times people don't know how to approach that. And again, it's not their fault. Right? There's a lot of lack of education about the deaf community and a lot of lack of communication like what it is. So yeah. And remember you have a second question. Remember the second question was kind of two question.

Carrie: [00:13:55] Yeah. And then um, you know, how does your book challenge those stereotypes then.

Kellina: [00:14:02] So it was a challenge, honestly, to writing a book as a poem, because I did not want the hearing community to feel like we are attacking them. But we're not right. We want to educate them and say, hey, this is what we go through. And it is true, right? And so I remember my editor saying, oh, there's something that you shouldn't say because some people may get offended. And I said, no, it's not offended. It's it's about education. And it's very important because a lot of deaf people I know go through the same thing, and it's not fair. Why should we shut a mouth so that other person feel comfortable, which is not fair. And so that's a little bit of a challenge when I write my book, because I didn't want it to be in a bad negative way for the hearing person who was reading the book. And I don't want them to think of it negative, but I do want them to know that it can happen to you as well. You could wake up tomorrow deaf too, or a broken arm or anything. Anything can happen. You're 1% away from being disabled as well. Mhm. Mhm.

Carrie: [00:15:04] Yeah. And I think one of the things someone said to me one time is you when you've met one deaf or hard of hearing person, you've met one deaf or hard of hearing person because like you just said, we're everybody is a little bit different. And that's what I really like about your book because you, you do challenge, I think the audience or the readers to kind of be in the shoes, but you have a beautiful way of showing it that, uh, that we are all different, even though we all have a commonality of being deaf or hard of hearing to.

Kellina: [00:15:44] Exactly, exactly. And that's really what I was trying to come across. I did not want people to feel like, okay, only, you know, it's also your truth and anybody else can feel that way as well.

Carrie: [00:15:56] Yes. So I have to ask you, how did you. How did you get your name, Deaf Queen boss?

Kellina: [00:16:05] That's. I get that question a lot. Okay? I get that question a lot. I'm sorry that you ordered that deaf queen boss, but how do you come up with that name? So what I did was, first thing, I just make sure I went on Google type in to make sure that no one had my name. Okay, so I did type in that queen and I actually had a piece of paper beside me also, and I had my little sister with me too. To me, her coming up with a nickname. So my sister wrote down, oh, that queen something, right? But I knew I wanted something in there with the Queen and deaf. I wanted those two words so much. And so we found one person that had, um, deaf, fdeaf queen or something. And then so I'm like, okay, I can't copy that name. And so my sister said, okay, let's change it up to Boss Queen. So I said, okay, well, I don't know. I don't consider myself a boss, but my doctor said, you are because I'm the oldest in my family. So. Yeah. And so I was playing with the words, playing with the names like content consistently for like two hours. And I'm like, I love the Deaf Queen Boss. And I love that. And I stick with it. And I'm not changing no more names because it was two hours. I'm like, yes.

Carrie: [00:17:18] I love it because, you know, it just fits and and the cover of your book and then it gives you that name in the community too. One thing, one other thing about, um, your book, before we kind of move on to maybe a little bit about coaching too, but how do you envision, like, the impact of your book within the deaf and hard of hearing community and then even within the hearing community, what kind of conversation do you hope it might spark?

Kellina: [00:17:52] Um, my hope is really just to inspire people to understand that no matter where you come from, just one, two, that you matter what you have. And number three, it doesn't matter what level you are in life, that you cannot achieve it. And while I wanted to impact, that's the most important thing is the impact. And I know that spark would give a lot of people to really understand. Like, wow, I never read a book by a deaf author. 90% of people I communicate with who I'm hearing, they tell me they're like, you know, you're the first that I've read. I'm like, really? And so that's when I realized that I knew my book was going to spark the hearing community because they never read a book by a deaf author. And a lot of them never interact with the deaf, hard of hearing person. So it's very interesting for the hearing community to see that and be like, oh, wow. So that is what my impact I really, really want my book to have.

Carrie: [00:18:48] Well, I think it definitely will. And I do love that you've targeted kind of I feel like, you know, a teenager or a young adult or an adult could pick this up and, and really gain a lot from it. As an educational audiology audiologist, I feel like there's definitely, um, more and more books for the younger part, like children's books that are coming out, which is awesome because they have that representation in books. But like you said, you know, the adult population or the teen population, there's not a whole lot out there, especially by, like you said, a deaf or hard of hearing author. So thanks to Covid that you got inspired.

Kellina: [00:19:39] Yeah, thanks to Covid. That's the one. Good thing about Covid. Everyone.

Carrie: [00:19:42] Well Kellina I got her book published in three months, which is like a record time for a book, I'm sure. So, but before we wrap up, I also wanted to ask you a little bit about your coaching business, because, again, that is something else that we have in common. I, um, just obtained my coaching certification, and I know you have a coaching business called Kellina Empowerment Incorporated. So can you share a little bit about your journey to becoming a life coach?

Kellina: [00:20:16] Yeah, definitely. So like I said before, everyone, I just spoke about my mental health. So I realized that I wanted to make a change. And so how I started was actually it was because of one of my deaf professors. So I had no idea he was deaf, to be honest. So what happened was he was teaching a lecture and he took one second. I have to change my hearing aid. So I paused for a second myself. I'm like, wait, did you just change your hearing aid in front of the whole lecture? And he and I was like, oh my God, he's deaf. Oh my God, I was so excited. And I honestly spoke to him. And at the end of class, I'm like, how you have the confidence. And we had a really great conversation about confidence and mental health. And he asked me, what did you want to do? And I said, honestly, sir, I wanted to impact people. I want to help the deaf community to get them stuff out there more, just like the way you and I are. And he said, why don't you become a coach or something that in the mental health space. So I said, okay, maybe I'm thinking about it.

Kellina: [00:21:21] And luckily a couple of months later, I met. I met my mentor and she recommended me to be a coach. And I said, okay, this is the time for me to do coaching now. So then I actually went back to school once I graduated from psychology degree to do mental health and addiction diploma or certificate. And so I said, you know what? Let me just go ahead and do it with a six month program. And I did it. And then I started it online. I started using my social media platform to market myself. I had no expectation, and a lot of people realized like, oh my God, you're a coach. Oh my God, you're so good. And I got a lot of referrals, referrals, referrals, like crazy. And I said, oh my God. And so I was very excited. Um, yeah. It was a struggle, especially in the beginning, because you don't know what to do because I was confused. And but I have a great network when I connect with a lot of people, ask them for their advice and how do they market themselves bigger? It was very cool and interesting journey.

Carrie: [00:22:21] Well, that is exciting and I love how you had two important people in your life who kind of directed you and you listened. So you then listen to your heart and you were able to do, um, something that would pass it or pay it forward to others, too. And that mental health space for coaching. I know coaching can be like a wide range of, um, areas too. For you What is your target client base then?

Kellina: [00:22:53] For sure. So I have multiple things in the business side for those who are like, okay, what does Kellina do? So I do one on one coaching for young adults with disability and without disability. So I work with clients from age 15 to 35 years old and had to do a workshop for organization, and I do consulting as well to help others to understand themselves. Um, I do work with organizations in terms of with my coaching. So I do budget with organization. So that's what my company is all about.

Carrie: [00:23:25] Okay and how long do you typically work with a client when you're working with them.

Kellina: [00:23:31] So it all depends on the clients, right. Every clients are different. So I do have two different packets. So I do have a standard package which is the very beginner package for someone who new. So that is the three month program. And then I do have a six month program for those who are interested. Couselor before, who knows what they want out of their goals, especially out of the house. So that is my um. Yeah, that's my 6 month program. So.

Carrie: [00:23:58] Okay. Do you have maybe just a little success story or anything that you can share from your coaching practice that really resonates with you?

Kellina: [00:24:11] Yeah, for sure. Definitely. I actually did coach, um, she was actually, um, a friend of mine who wanted to coach by me, and she did had, uh, struggled with her anxiety. And so she didn't know what to do in terms of how to network and go up to people. And she was afraid of saying no to people. She thought the expert thing. And so what I did was a three month program. We met. We met once a week, and we stood down once a week, and we go through all the things that she struggled through. Who does she have a hard time saying no to? We break it down. And so we practiced with role play. So our role play and she will role play. So that way she has an idea what it is and what may happen next. Because some people were indicted, they have to know what's going to happen next. Right. And they do need to practice. So I did that with her, and I did provide a worksheet for her to work on while she's at home. So this is where she had homework to do. Well, not really homework, but it's like a practice. And it's like activities where I break down, you know, who do I who did I say no to today? Who did I say yes to today? So that way she can visually see how many yeses she's saying in one day for her to realize, oh my God, this is too many. Yes. And I remember she realized and she, she came to me to follow me. She's like, oh my God, there's so many yesterday. This is so bad. Kellina and I just okay, it's practice, right? You learn, you have to register. And she thought about work and she was like, oh my God, this is this is amazing. Because for three months she realized and understood and yeah. And that's one of the story.

Carrie: [00:25:50] That's great. So the teach somebody what is the best yes for you right.

Kellina: [00:25:56] Yes.

Carrie: [00:25:58] We don't have to say yes to everything. But what is your best Yes. Right. What advice do you have for individuals who might be seeking out coaching? I mean, who is coaching for.

Kellina: [00:26:10] Um, coaching could be for anybody. It's really depend what the person needs help with. I always tell everybody, before you get a coach, please sit down with them and ask them questions. What are their success stories? How many clients succeed in your program because you do want to make sure that you're not wasting your money? That's the last thing I want people to do when they're working with me. They feel like we did not accomplish the goal. That's the worst thing I want. I know there are some coach who are overly priced and some people are like, oh, but they're the best. They said, it doesn't matter. Price should not be a guide. Price should not define someone's success. Right. And I also tell people there may be better people who may be affordable. And you realize that you get more than the expensive coach. And you realize that happened to me before I remember I hired, I think it was the Instagram coach and one of them wasn't. It wasn't good, but it was okay. And then I ended up having another business coach, and she was amazing. And she was affordable because I was nervous because I thought, oh no, it's affordable. Am I going to get a different result from a different coach? So always keep your options open. Talk to at least two coach when you're deciding, because that way you have better options and understand where can you go with it and what is your take that most likely will look like?

Carrie: [00:27:33] Yeah, that that's great advice to kind of check out a couple of people and meet with them and see if your, um, your connection's good too, right? Exactly, exactly. Yeah. So Kellina, this was such an amazing conversation between, like, meeting you. Um, I know we've met, like, through LinkedIn, but I can tell just from our meeting today that we would just click and I wish we were in real life in person together as well. Is there anything, as we wrap up that I missed or I didn't ask you?

Kellina: [00:28:12] Um, I think you asked me a lot of questions. However, you maybe did not ask me what is one piece of advice I would leave for someone? So my advice I would love to give to everybody who are listening is you have to remember like it's your life and your decision. Whatever you do, it's on you, not somebody else. You have to live your life like there's no tomorrow because tomorrow is not a promise. You never know when God's going to knock on the door for you to go home.

Carrie: [00:28:41] I love that live for today, right?

Kellina: [00:28:44] Exactly. Yes.

Carrie: [00:28:46] Ahh. Kellina if there if any of our listeners, they want to find you if they want to order your book, which I would highly recommend all of my listeners to definitely order the book because it is such a great quick read, but it has so many high points and advice in it that I think anyone should, whether you have a hearing loss or not, should pick up. Um, and gather more information from from the book. So let me know how people can get a hold of you.

Kellina: [00:29:24] Yeah, definitely. I really can get a hold of me on Instagram, which is Deaf Queen Boss. And second, you can find my book on Amazon. You can just type in Kellina Powell and my book would be right there for you. And lastly, if you want to check out my website it is Kellina empowerment. Com.

Carrie: [00:29:40] Okay. Well Kellina, I just want to say thank you for being a guest and the empowEAR Audiology podcast. It was such a pleasure to have this conversation today. And my listener, thank you again for listening to EmpowEAR Audiology. I really appreciate all of you, uh, giving me a five star review if you can, and sharing this podcast with anyone else that may be interested. So thanks again, Kellina.

Kellina: [00:30:13] Thank you for having me.

Announcer: [00:30:14] Thank you for listening. This has been a production of the 3C Digital Media Network.

Carrie: [00:00:13] Welcome to the empowEAR Audiology podcast, a production of the 3C Digital Media Network. I am your host, doctor Carrie Spangler, a passionate, deaf and hard of hearing audiologist. Each episode will bring an empowering message surrounding audiology and beyond. Thank you for spending time with me today and let's get started with today's episode. Welcome everyone! I have Gil Kaminski, with me today and she is a product management and Clinical Operations leader with over 15 years of experience in healthcare, artificial intelligence and machine learning. She is the co-founder of Humelan, a public benefit corporation committed to helping individuals navigate the complexities of hearing, health and wellness through its person centered approach, community support, and an AI companion app, Humelan provides a comprehensive solution to those experiencing hearing loss. Her career is rooted in technology, research and development and clinical operations, having contributed to various healthcare and medtech organizations including including Laguana Health, DaVita Kidney Care, Wide Med Limited, and the Israel Defense Force Naval Medical Institute. Gil holds an MBA from the Wharton School and a Bachelors of Science and Biomedical Engineering from the Israel Institute of Technology. Gil, welcome to the podcast today.

Gil: [00:01:56] Hi Gary. So happy to be here. Thank you for having me.

Carrie: [00:02:00] Yes, I'm so excited. And I, I'm excited that the fact that we got connected was through LinkedIn and through a common, um, colleague who was part of the Ida Institute for Person Centered Care. So it just kind of interesting how paths cross.

Gil: [00:02:22] Yes, 100%. Yeah.

Carrie: [00:02:24] Yeah. And I wanted to, um, dive really deep into Humelan today and all of that it has to offer. But as we get started, can you just share with our listeners what Humelan is?

Gil: [00:02:39] Yeah, sure. So Humelan is a public benefit corporation, and we're really focusing on supporting people with different hearing levels. And our goal is to really see everybody, um, getting all the information and the support that they need within the space of, of, uh, hearing loss.

Carrie: [00:02:58] Okay. And I know you have a story and an inspiration behind starting here Humelan, can you share a little bit about that too?

Gil: [00:03:07] Yeah, sure. So my, um, really journey with hearing loss started as a child and um, in my case, it's not my own hearing loss, but I as I was growing up, my mother was losing her hearing and really was growing deaf. And she was hearing using hearing aids since I can remember her. And for a while there, they were just kind of this accessory that was around the house on the drawer, you know, in the kitchen. But I can't say that they were really in use as much as one would have expected. And when I think that all changed when I was about 12. Um, she's also an ENT and a surgeon, and when she was doing her fellowship, that's when she really started to use them. She also continued to lose her hearing, so she needed them more and more. But I think really there was a change for her when she met the right clinician, the right audiologist, who really showed her, uh, kind of the the tricks and the best tips on how to really benefit from hearing aids. Um, and then fast forward, she did her fellowship in cochlear implants. Um, and she's a cochlear implant surgeon. And then fast forward, she continued to to lose her hearing, unfortunately, and ended up using cochlear implants herself. And so really, I was growing up kind of experiencing progressive hearing loss progression, really from hearing aids to then. I'm an expert on the FM system. I've used it everywhere you can imagine. Um, and then all the way to, to her first cochlear implant and then her second. And I've also over the years have worked with my mother when I was younger and she was building her clinic, her private clinic, and and so I've also experienced her as a physician.

Gil: [00:04:52] And so it's really all of those experiences that really kind of brought me back. And, and I would say even the very beginning of deciding to learn biomedical engineering and specializing in AI and signal processing, for me, a lot of it had to do with hearing aids and cochlear implants and getting really excited about what that can do. And to me, cochlear implants are kind of like magic because I've seen, you know, that year before you get them and and how that's like and then a month later and how that felt for, for me as a communication partner to my mom. And so for me, that was really kind of like my professional journey to choosing to, to become an engineer. And then fast forward, I was working on all kinds of other different technologies and kidney and sleep medicine and a lot of other stuff. And so for a long, long time really wanted to come back to the to the hearing space. And over the past about 12 months, I felt like, this is this is the right time. Like things are changing. Awareness is, you know, growing over the counter hearing aids are coming out whether we like them or not. They're they're there. And so that's such an interesting change. And then when you see what the World Health Organization is doing today and the Ida Institute and all of those things coming together, I was really, really inspired to go back to hearing to the hearing space and to collaborate with my mom again.

Carrie: [00:06:20] Wow. I love how you've taken just from a young age your personal journey, and really intertwined it with a professional journey that can really empower other people, which is kind of your your vision, which is powerful for Humelan  to empower human potential through communication, equity. And I know you have a lot of purposes and objectives or not a lot a several main purposes and objectives for Humelan, which include community knowledge and events. So if it's okay with you, I would love to kind of dive into those three areas and  see, um, how you how does Humelan foster these supportive communities. You shared a little bit about your own growing up and and being a support, um, communication partner for your mom, but I would love to hear how this is going to be a support for others.

Gil: [00:07:18] Yeah I know thank you for that question. So I think like for, for us, what was really interesting for me, unlike I think most other people, I didn't realize that having a different hearing evel is, is something that different people look at in different ways. For me, it was so natural growing up with my mom, with hearing aids, and then with cochlear implants, that it was just part of our lives. And I was always, um, really inspired by that technology. But I never thought of it twice. For me, hearing aids is kind of like putting on glasses. And I'm also very fortunate because my mom has so much knowledge about, um, hearing aids, hearing aids and aural rehabilitation. And where do you stand when you're talking to someone who has a different hearing level? And I'm always I'm always used to walking on people's, you know, on one side of everyone. And people sometimes almost find it weird. They're like, why are you moving to my other side? But that's my mom's better side. So that's the side I've always been walking on, and I'm always thinking of where do I sit so the other person can hear me and that I can hear them best? And I think all of those little things, um, when you bring them all together, all that body of knowledge, at some point I realized I'm so fortunate with my mother's hearing loss that she knew so much that she could teach us me and my siblings, my father, everybody in our family.

Gil: [00:08:52] Enough about it that we really have good communication. I mean, we live in different countries. We speak on the phone almost every day, and it's never been the communication aspect. And even in our relationship, it's never been a barrier for us. And. even And I think that that's I realize at some point that's not the norm for everybody, because there's a learning curve that you need to get through, um, to be able to do all those things. And then there's another circle, right, of going out and, um, listening to lectures, for example, or giving lectures and all those other steps and things in your day to day life that you need to do as a person with a different hearing level. And you may not know even that there's knowledge out there and that can support you in that. And so for us, it was really important to put a lot of a lot of different ways to provide that information to people. And you mentioned the communities and different events, and we're building an AI, um, hearing coach that would also be able to help people and enhance what the audiologist is already doing with people. And so all of that is really to provide people the knowledge that they need when they need it in a very personalized way and in different modes of, of, um, models of communication, of information, so that it's easy for people to get what they need out of it.

Gil: [00:10:20] And at the end of the day, the goal is to kind of help you ask what you don't know to ask, because sometimes you don't know, especially with communication. You don't know what you don't know if that makes sense. And so it's so specific to a certain point in life. Like you're you're new to college, you're walking into a classroom. If you don't know that there are certain things that you should be given, you're not going to know how to ask for them. And, you know, an example is. One of the people we were supporting through our coaching recently. That person was new to hearing aids and had no idea that there is microphones that you could use. And for those listening to the podcast who may not know what those are, we can get into that later. But basically, imagine there's a little microphone, um, that the person you're speaking with can use and they talk into that little microphone and that goes directly into your hearing aid. So if you're in a noisy environment, it makes it makes it so much easier to hear them. And. This person. Really, that was a huge help for them. But they would have never, never known to ask for it. And so for us, some of it is just guessing what people are going to need and being able to provide it at the right time.

Carrie: [00:11:40] Yeah, that just in time. Learning is such an important part of the the hearing journey and knowing like what you said to ask for and things like that. Um, one of the things as far as the, the communities go, who should be involved in the communities and know you did mention, um, individuals who are on that hearing journey, but should anyone else also be involved in these communities?

Gil: [00:12:09] Yeah, I certainly think, um, and the way we're building the communities is anybody can open one on our website today. So if you go to Humelan.com, you can just open one or you can join one. The way we're thinking about them is both people who are experiencing, um, hearing loss or have had a different hearing levels for a while, but also people like myself who have a family member who has hearing loss, and maybe they're new to it or they've they've had it for a while, but you need to you want to learn more, or maybe you just want to have a community of people who are experiencing a similar thing. And I think there's just a lot of shared life experiences for both family members and people with hearing loss, and no one else would have had those specific experiences. And I think that's really important. Um, and I also envision at some point having communities for professionals who are responsible at different institutes to make sure that there is accessibility, because I think they must have a lot of questions. And I think people are really, really well intentioned to do the right thing. But there's just so much you need to know around hearing to do the right thing. And I think those communities could be a great place as well for people to go and just ask the questions.

Carrie: [00:13:29] Yeah, what a great way to support so many different people. You also talked about Humelan and creating like a knowledge hub too, that provides a lot of information on hearing, health and wellness. What kind of topics of knowledge would someone be able to find in your knowledge hub?

Gil: [00:13:50] Yeah. Thank you. So we're we're really thinking about what kind of questions someone with hearing loss and their support system might have. And so we started with things that are very, um, very common for people to ask, like, do I have hearing loss? Does my partner have hearing loss? We're having a family dinner and I have a guest who has hearing loss. What do I do? We want to cook together. What what does that look like? And none of it is straightforward. So some of it is just those type of tips. Some of our blogs as well are more kind of touching the semi clinical meaning none of them are going to replace clinical advice, none of them are replacing an audiologist or a physician, but some of them would be on topics like what is sensorineural hearing loss? What does that mean? Kind of like your your guide to sensorineural hearing loss without reading the 80 page guidelines. Yeah.

Carrie: [00:14:52] So everyday language of what sensorineural hearing loss is or other types of hearing loss to. Yeah. Well it's great to have that unbiased information in one place so that people can go to and like you said, probably um, digestible information too. So you're not reading somebodies term paper to figure out something like, how do I cook with somebody that has a different hearing level?

Gil: [00:15:20] Yeah, yeah, yeah, yeah. And sometimes we even get questions like, we recently had someone email us with a question about hearing loss and music. And so we kind of put together all the knowledge that's out there on that topic, which is a really complex topic. It's not a straightforward topic. Um, and try to really to really provide like a good, a good kind of summary of that for them.

Carrie: [00:15:46] Okay. And then the other, um, kind of area that you want to focus on is events as well. And I know and I was able to attend, um, you and some others launched an event on World Hearing Day titled um, and I might get it wrong. Is it heart the heart initiative or hear-t initiative?

Gil: [00:16:11] It's a either way the the hear t but with a twist on on heart. Yep. Okay. They hear technology. Yeah.

Carrie: [00:16:19] Yeah. So pioneering the future of hearing health care. Do you want to share a little bit about that recent event that you had.

Gil: [00:16:28] Yeah, sure. So So HearT is another really great initiative that's, uh, um, a few of us, um, women in the space of hearing health and really are the main thing we're looking there at is, again, person centered care, which is really the center of everything that I'm involved with these days. And you mentioned Ida Institute before, which we love, and we look at their resources a lot to HEART is really what we're trying to do there is to bring, uh, both clinicians and, uh, people with different hearing levels to the same events, to the same, uh, place, and also people who might be using hearing aids or might be using cochlear implants or not, might not be using any technology right now and just bring everybody to the same place, because we think in this space of audiology today, um, there's not enough in, in my view at least. So just speaking for myself right now, there's not enough of, um, having all of those people in the same place at the same time. And so we really put HEART together with the thought of, how do you how do we do that? How do we bring everyone together, um, to the same discussions. And so that's where that started. And we're going to have more events, um, coming soon for HEART. So be on the outlook for that as well.

Carrie: [00:17:52] All right. And then I know that you and I have an exciting event coming up. Um, and I'm excited to talk about it on today's podcast. So if you happen to be listening before April 4th of 2024, we are going to be Gil and I are going to be co, um, hosting an event from 7 to 8 Eastern time targeting teachers and educators. Uh, and it's titled Hearing Health for Teachers How to Hear Better in the Classroom. Do you want to share any about anything about that?

Gil: [00:18:26] Yeah, sure. And I'm super, super excited for that event. Um, and I, I don't know if I shared with you, Carrie, just yet, but some of the comments from people who are attending are are really awesome. So, you know, you and I looked at where there is either lack of awareness, which population needs more awareness or who really, um, hearing loss is affecting their ability to work or impacting, you know, their ability to work, their burnout, things like that. And, and just from our conversations with people through the coaching that we're doing, we found out that teaching is and it makes sense, right? You're standing in front of a class and if you don't hear well, um, it's very uncomfortable. And so actually, my dad, who used to be a teacher and also has hearing loss, one of the things he told me when I first asked him, I was like, what made you get your first hearing aid? Because he's a stubborn guy, um, as many people are, but he certainly is one. And he said, you know what it was? I was standing in front of a class and he was teaching high school, and they were all talking, and I could not tell where the voice was coming from, so I could hear what they were saying.

Gil: [00:19:39] I thought I understood what they were saying, but I couldn't tell which which student was saying what. And so for him, that was really impacting his ability to work. And so luckily for him, he's married to my mother, who knows a lot about hearing. So his path to getting the the support he needed was a very fast one. And he was he was on the right kind of path very quickly. But that made me think about teachers in general. And then as you and I were having conversations with different people, I think it was just very clear that it's a huge there's a huge gap there, and people could really use help understanding what kind of accessories they can use and just understanding more about it. And, and really also how to combat, um, burnout and listening fatigue. So we're going to talk about all of that very soon.

Carrie: [00:20:28] I know. And then I think that was there was a statistic that I found that 27% of educators suspect having hearing difficulties, which in turn impacts the ability to connect with those students and the coworkers. So I'm excited, too, because I'm kind of on the other side of it with being an educational audiologist. And I'm always helping kids in the classroom hear and understand better. But then the kind of flip it around and be like, oh, so many of these strategies. We can definitely be sharing with teachers too. And it would be like a full circle to help the kids, as well as the teachers who we will be sharing that information with. So I'm excited about that event. One thing I wanted to ask you, and I don't know the answer to, is these events that you are having, are they available after the event or is it just a live event?

Gil: [00:21:25] Yeah. We definitely our goal is to make all of them available after. So sometimes it takes a couple days or a week or so to get them up there. But yes, definitely. Um, that's the goal.

Carrie: [00:21:39] Okay. And so if you're listening to this podcast today and you're interested in the event, either the live event or afterwards, what do they need to do?

Gil: [00:21:51] Yeah. So the best thing to do is to go on the Humelan website. It's w w w dot m e a n a m e l a n.com. And then if you scroll down, you'll see events and just sign up. So even if you can't make the live event, if you're signed up, you will get a link to the recording later. And so either way is is valid. So just go for it.

Carrie: [00:22:15] Okay. And I will definitely link the website to in the show notes so people can easily access that as well. So thinking about Humelan and some of the key initiatives and projects, um, that you're working on, is there anything looking ahead, what are some of your long term goals and aspirations that you have?

Gil: [00:22:40] Oh man, the long term goals and aspirations are really, really big. I mean, I, I want to get to a point where everybody. Um, in, around the world really is following WHOs recommendation and we're screening everyone, you know, according to the recommendation, over the age of 55, she should be screened. I believe it's every year or so. So I want to get to that point. I want to get to the point where, um, primary care physicians are screening us for for that. And not just blood pressure. I think communication and loneliness and everything that comes with having a different hearing level, that's un, you know, you're not aware of is is big and important. So that's one big goal is to be involved in that, to be the go to hearing engagement platform. And so that's the long term you know vision for us. Then on the short term right now we're doing a bunch of events. We have our communities and we'd love to see more people, uh join. So please feel free to join them. And we're going to have a wait list for our, um, AI hearing coach come up on the website very soon. So if you know of anybody who has hearing loss and wants to try that out, um, please do. It would be on the our website shortly.

Carrie: [00:23:56] And can you expand a little bit on what that would might look like for someone that would sign up for a hearing coach?

Gil: [00:24:05] Yeah.  So there's a lot of different hearing coaches, Carrie, like you're what you're doing and your hearing coach practice is a little different than what we're doing. And, um, I'm very excited for that whole field of hearing health and wellness and coaching in general. I think it's really, really needed. And there's so many of us out there doing really great work for Humelan. Our coaches are via text today only, and so really it's a complimentary service to an audiologist who's providing you with everything else. Um, and then what we do is we come in and help people in different stages. It could be someone who has a spouse and you think, maybe my spouse has hearing loss, but I don't know how to talk to them about it. And so you would be using the hearing loss, the Humelan, uh, hearing coach to just ask those questions and to to understand how to speak with them about this. And so we can help with that. So it's really a texting, um, service or a chatbot on our website right now that can help with that, for example. But we also help people who are new to hearing aids get used to them.

Gil: [00:25:11] We also help people who have had hearing aids for a long time but have a life change. For example, they're going into a new job and they just need support around that. Or maybe they have a new grandchild and they need to figure out how do you what do you do now? Um, and we've had a lot of people who have had hearing aids for a while. And what they want to understand is, is it time for cochlear implants? And what does a cochlear implant mean? For me, there's a lot of a lot of different questions. And so I would make one important point. We're not here to replace clinicians. None of the advice we give is a clinical advice. It's really a peer advice. It's really a hearing coach advice which is a very, very, very different. And sometimes it's just helping people understand. Is it the right time to go to an ENT or an audiologist? Um, if they're not sure, maybe they just need a little push to to go.

Carrie: [00:26:07] Yeah, what a great service. And like you said, it just really goes back to your vision. I think of Humelan to really empower that human potential through communication, equity and having the the community and the knowledge and the events to really, I think, fulfill that mission and vision. So Gil as we kind of wrap up today, is there anything that I didn't ask you that you wanted to share?

Gil: [00:26:41] No. I'm just so happy and delighted that you and I connected. Um, I think it's been, like, great talking to you today and, and prior to today. And it's it's really interesting as someone who has been part of the, this community right of hearing care, but not really for me, um, coming into this community, it is one of the best health care communities out there. And it's really fascinating to see how engaged clinicians and advocates, um, in the hearing space are and how collaborative everybody is. So you're, you're, you know, one of those amazing, amazing people in this space. And so just thank you for being you.

Carrie: [00:27:31] Uh, well, thank you. I really appreciate that. And I'm so excited that we got connected as well. And I could just see that we're just going to have more ideas that really spin off of different events and and collaboration. So I'm excited to see what the future holds.

Gil: [00:27:50] Yes.

Carrie: [00:27:52] Well, thank you again for being a guest today and the Empow

Ear Audiology podcast. I really appreciate you coming on and sharing all about you, Humelan, and all of the important, uh, events and knowledge and growth that you are working on, um, with your team. And I'm excited about that. And listeners, if you want to learn more, the website will be in the show notes. So please, um, click on that, explore the website. Uh, join a community and come to an event and find out what is what it is all about. Um, and if you know of anyone that needs to listen to this podcast, please share with anyone that needs to hear it. Thank you for listening.

Announcer: [00:28:39] This has been a production of the 3C Digital Media Network.

Carrie: [00:00:14] Welcome to the empowEAR Audiology podcast, a production of the 3C Digital Media Network. I am your host, Dr. Carrie Spangler, a passionate, deaf and hard of hearing audiologist. Each episode will bring an empowering message surrounding audiology and beyond. Thank you for spending time with me today and let's get started with today's episode. Okay, I have a very special guest with me today, and I'm going to tell you a little bit about Dr. Jasmine Simmons. She is a deaf blind audiologist and an author. She originated from Columbus, Ohio, and she now lives in Jacksonville, Florida. Inspired by her life journey, Dr Jasmine has created a captivating children's book series that sheds light on Usher's syndrome, a condition causing deafness, blindness, and balance balance issues through her unique perspective, Dr Jasmine Story embodies strength and resilience, teaching young readers how to better interact with those who may be different from themselves. Dr. Jasmine's book introduces a diverse cast of characters that takes children on an incredible journey of understanding and empathy. Her characters, both relatable and inspiring, help bridge the gap between children and individuals with diverse abilities, opening doors to to compassion and inclusivity. So, Dr. Jasmine, welcome to the empowEAR Audiology podcast. I'm so excited for you to be a guest today.

Jasmine: [00:02:03] I am so excited to be here today. Thank you so much for having me.

Carrie: [00:02:07] Well, it's so fun to reconnect with you because we have a lot of history together.

Jasmine: [00:02:14] Yeah, we definitely have. Oh my goodness. We met at University of Akron during, uh, my undergrad. Right. That's crazy.

Carrie: [00:02:24] I that was a while ago. And I still remember the day that you came to my door when I was working at the university and introduced yourself. I think you might have been taking a class that you were, um, not excited about taking.

Jasmine: [00:02:46] Yeah. Oh, my goodness. I just I just remember, you know, you being at Akron and just being my mentor, like, it was such a profound time for me. And it was just amazing just having you alongside my journey.

Carrie: [00:03:04] Well. I am so glad that I could be a small part of your journey. And yeah, I'm so excited for everything that you have become. Um, since we met way back in your undergrad, uh, career. Uh, but every time I have someone on the podcast that has gone into audiology, I love to hear their story. And I think our listeners do, too. So do you want to share a little bit about how you decided to have the pathway to audiology?

Jasmine: [00:03:39] Oh, absolutely. So I was born profoundly deaf, and at the age of two, I received my cochlear implant. And throughout my life, I always knew I wanted to be a helper. I knew I wanted to be in the healthcare. And it was when I was in seventh grade, my mom and I were in the car and, you know, you know, little me was thinking like, what should I do with my life? I want to do something, but I just don't know what. And she was like, Jasmine, like, what about audiology? And ever since then, like, oh my gosh. Yeah. Like it just clicked for me. So I just knew that that's what I was destined to do. And I went ahead and achieved that goal.

Carrie: [00:04:26] Yes, he did, and so much more. Do you want to share a little bit about where you're at right now? Working. Uh.

Jasmine: [00:04:36] Yes. So I currently work at Jacksonville Speech and Hearing, a nonprofit clinic, and it's such a great job because, you know, we work with the underserved populations. And if, um, a patient is, um, under the income means and they live in Duval County and Jacksonville, they are eligible to get a free set of hearing aids. So it's just a very rewarding job. And also they can get free speech therapy services, um, through different grants. So it's just very enjoyable to work at the company I am. And just to help people, you know, be able to hear and, um, for them to be able to communicate with their loved ones.

Carrie: [00:05:22] Wow, what a great service to that area. And I'm so glad you're there. Just, um, thinking about, like, before we get into your book and everything, which I really want to talk about, but I know you said like I was a mentor to you, but I know that you have been an incredible mentor to so many people along the way. And I just remember talking to you about being a part of the campUS experience, which, um, Dr Gail Whitelaw and I co coordinate a overnight camp that was at Ohio State University, and we needed counselors who were deaf and hard of hearing. And I remember asking you if you would be willing to volunteer. And I don't even think I told you what you were volunteering for, but you said yes, and then you volunteered your brother.

Jasmine: [00:06:16] Absolutely.

Carrie: [00:06:18] Yes, I sure did. Yeah. You're like, oh, my brother, my brother could be a part of this too. And then, um, but you and Justin were just, like, such an integral part of, like, the startup and of the campUS program and mentoring so many high school students who were thinking about going to college or going to work and had never met anyone else who was deaf or hard of hearing. So I just wanted to thank you for like, your participation in that, because I feel like you were a counselor for at least like 3 or 4 years, maybe even longer.

Jasmine: [00:06:57] Yeah. It was I mean, it was such a wonderful experience. And that was the first like the start of me being a camp counselor. And it was just wonderful being able to see these teenagers bond. And like you said, some of these teens have never met other people with hearing loss. So it's it's only two days. But those two days were such impactful moments for these teens. So I thank you and Dr Whitelaw for even, you know, hosting camps like these because it is so needed. It is so needed. And I know these kids, I, I am Facebook friends with some of them. I see them, you know, in college and, you know, working. I'm just like, oh my gosh. Like I'm just so proud of these kids that go through these programs. And I know they remember these moments because I remember going through camp when I was younger, and I still remember it to this day, and how it has such a empowering or impactful impact on me.

Carrie: [00:08:06] Yeah, definitely. Especially when you're a one and only and a place and you don't have the opportunity to meet someone else, and then you come here and you realize, whoa, like there's other people like me out there in the world. So which is kind of a great segue into your book. So audiologist and author Dr Jasmine Simmons, I'm so excited for you. Because so and I just have to say, I got my book and I am in love with the extraordinary Jordan and her bionic ears. From the character to the illustration to the storyline, everything is phenomenal. So tell me Just for our listeners, can you just share a little like an overview and then we'll dig deeper into into your book.

Jasmine: [00:09:03] Yeah. So, um, I just what really inspired me to write this book. Um, I remember I was an educational audiologist in North Carolina, and I met this family of a little girl who had usher syndrome. And I just remember the mom, just like I signed her up for everything, and I just. I don't know how to explain this to my kid, like, there's nothing really out there. And at that moment, I just knew I was going to write a children's book. I was just knew. I just didn't know when. But I knew it was going to happen. Um, and this past February, I was diagnosed as legally blind. And I was just, you know, sitting there like, what do I want to do? Like what? What will, you know, help me get through this? And that was the time I decided I was going to write the Usher Syndrome series. I just knew it was time. And, you know, as I was writing this book, I actually met a, um, girl. Her name was Jordan, and she was going through some bullying in school and just. You know, dealing with the confidence issue with her hearing loss. And I just knew that that was going to be my character's name. And, you know, just in honor of her. Um, but yeah, it's just it's a really great story, and I can't wait to talk a little bit more about it.

Carrie: [00:10:37] Yeah, I love that. So you had, like, your own personal background, plus your experience as an educational audiologist and then meeting a family who was kind of struggling with how to explain this, and then another person who kind of was having this bullying experience. So kind of a combination of lots of different things. So absolutely. Yeah. Just a step a little bit backwards for a second. Do you want to share a little bit about your hearing history and how like how it's progressed over the years.

Jasmine: [00:11:17] Mhm. So um, I was born deaf. I got my cochlear implant at age of two. At the age of seven, I was diagnosed with a condition called retinitis pigmentosa. Retinitis pigmentosa. And it affects your, um, nighttime vision and it also affects your peripheral vision. So as I got older, my vision has progressed. So that's, uh, at the age of 25, I was officially diagnosed with usher syndrome and through genetic testing. So that's just kind of what prompted me to write the Usher Syndrome series as well, because many people don't know what Usher Syndrome is. So it's definitely was one of my mission to spread the word. What is usher syndrome? So that way, you know, more research can be done, more people can learn about this, and hopefully, you know, they can find a cure one day for sight loss, you know? So that was really my mission to behind this series as well.

Carrie: [00:12:29] Um, and I love how you said earlier too, that this you you knew you always wanted to write this book, but at the same time, you said this was kind of part of your own healing process, too. Can you share a little bit more about that?

Jasmine: [00:12:46] Yeah. So writing this book has been so healing for me. Um, it's just this became my my distraction. This became my baby. Um, you know, so everybody has to find their ways of coping with, you know, a diagnosis. And, you know, writing this children's book was my way of coping and coming to terms with my vision loss. And it actually helped me gain more confidence as I share my story. And it's just, you know, hearing other people going through something similar or could be a few steps behind me or a few steps ahead of me, and it's just so beautiful to be able to communicate with others and just help each other along this journey.

Carrie: [00:13:37] Yeah. It really I love how you talked about those people in front of you and people behind you. That and walking alongside of you that are on this journey and can help with that process too. So extraordinary. Jordan in the book. Um, what is like the main message or theme that you are trying to convey to those who are reading your book?

Jasmine: [00:14:07] You know, as I read this book, I learn there are so many different messages behind this book and I'm like, oh yeah, this is a great for this and this is great for that. Um, but, you know, overall, I wanted kids to show or kids to be confident in who they are. You know, just you are extraordinary. Like that is the overall message. Just be confident and you know, you are going to have some challenges and that is okay. But you will overcome those challenges if you are confident and who you are.

Carrie: [00:14:47] Mhm. Yeah.And I feel like Jordan can represent lots of different areas of confidence. So whether it is, you know, her um bionic ears as you call them when she calls them in the book or it's another area of challenge that like you can still be extraordinary in whatever challenge you have.

Jasmine: [00:15:12] Exactly, exactly.

Carrie: [00:15:16] Um, so as far as, um, the book goes, I you said, you know, the as you keep reading through it, you have found some other like themes and, and ways, um, that people might be able to, to use the book. Do you want to share a little bit more about your the themes in there?

Jasmine: [00:15:40] I mean, it's a great book for social, um, emotional learning. Um, I think it's just it also it's also great book for kids who aren't familiar with, you know, differences, you know, something that's different from them. You know, like Ben in the store doesn't know what this device is. So obviously he's going to act different towards it. But then, you know, he learns more about it. So it's just acceptance and just understanding. And also it's important to I want to relay that kids aren't mean. They just don't understand. And and that's okay. That's when you want to teach those kids that, yes, there may be somebody that looks different from you or have something different from you and just be able to understand and they are unable to understand what is happening.

Carrie: [00:16:42] Yeah and I know that part of part of the book, and I don't want to give it all away because I know people need to read it. Um, but Jordan remembers that, like her dad had said, you know, that you're extraordinary. And she kind of remembers that as part of, you know, kind of getting empowered to stand up for herself and be confident. Is that another message, like for parents, guardians, like teachers, different, you know, mentors and, um, figures in their life to, to teach this?

Jasmine: [00:17:18] Oh, absolutely. It's. Words matter. Kids pick up on positivity and they also pick up on negativity. So just empowering kids is so important because that really affects alters their confidence and helps them be more confident. So definitely like affirmations, you know you are extraordinary. You know you're hearing loss doesn't make you less than like you are extraordinary.

Carrie: [00:17:51] Yeah. So on a personal level, does Jordan reflect you at all?

Jasmine: [00:17:59] Um, there is definitely some personal moments in that story that I personally experienced that I wanted to convey in that story, and that also was healing, just talking about it, you know? So and just I know I'm not alone in this. And so I want kids other to see this and be like, oh, you know, it actually it has happened. That happened to me. Or, you know, I just want them to be confident. Um, that's just really, truly the overall message I really want to convey is be confident in who you are. Because, you know, my parents instilled that in my brother and I, you know, that is why I am the person I am today. Because, you know, my parents have never made us feel ashamed of who we are and just taught us to embrace it. So that's also with the parents, you know, positivity that also conveys through my parents as well.

Carrie: [00:19:03] Yeah. And I know both of your parents and I can see how they would have instilled that in you, um, throughout, throughout your life too. So I love how that shines through in the book, too. So kind of talking about the nuts and bolts of the book, like, were there any challenges that you had, like getting started writing your book or all of that? You said it was a long process, but what were your challenges?

Jasmine: [00:19:35] Oh my goodness. Um, the day I decided to write a book and I had no idea how much work it went into writing the book, you know, just you have to worry about, you know, copywriting, the book and, you know, getting the ISBN numbers and, um, you know, getting beta readers, like, I didn't know you had to do all that. It was just all trial and error, you know, just learning as I go, asking different authors, hey, you know, what should I do? And one was like, yeah, you need beta readers. I was like, oh, I do. Okay. Um, and it's just beta readers really help shape your book. You know, you have all these different visions and, you know, they help like, whoa, whoa, whoa, slow down. Okay, let's talk this through. It doesn't make sense, you know, put it together. So it was just very helpful. And gain editors, developmental editors, there's a lot that goes through writing a children's book, but it was very rewarding.

Carrie: [00:20:46] But it was. And your illustrator too, was amazing. How did you find her?

Jasmine: [00:20:55] Oh my goodness, I, I truly lucked out with my illustrator. Um, I went on the platform called Upwork and oh my goodness, she was the very first person that actually reached out to me. And I was like, okay. And I did a little bit more research. And then I just saw that, um, what really drew me in was she had a just a person who had, um, an amputated leg. And I just like, wow, okay. So I'm like, you know what? Let me check her out. And she exceeded beyond my expectations. She just I love her, and she did an amazing job.

Carrie: [00:21:42] So did you ever meet her in person or. This was all, like, visual, like videos or virtually.

Jasmine: [00:21:49] Um, I have not met her in person. She lives in California, so I hope to meet her in person one day. And I hope we can work together on other projects as well.

Carrie: [00:22:04] Yeah. And you kind of mentioned, um, when when I read your bio too, that this is the Usher Syndrome series. So what did that mean for Jordan?

Jasmine: [00:22:17] So actually, Jordan is I actually want to do different people for my books. However, Jordan will appear in my final series. Um, so I my vision is to as I meet people, I want to name my characters after people I have met. Um, and so that way those kids can see them in the book and feel inspired.

Carrie: [00:22:49] Ah, I love that. So what is, um, the real Jordan that this book is named after? Has she, um, given you any feedback about the book?

Jasmine: [00:23:02] Yeah, she absolutely loved it. And I remember the day I told her that I was naming my character after her. She, her mom was was telling me that she was so excited that she went and told everybody at her school saying, you know, I have a character named after me. And it was just heartwarming just to see how her face lit up when she found out that her her name was being used.

Carrie: [00:23:32] Uh huh. Well, that sounds like you need to be doing a book launch at that school.

Jasmine: [00:23:38] I'm working on it. I'm working on it.

Carrie: [00:23:42] Yeah. And so at the time of this recording right now, um, for our listeners, I mean, your book is just gone out, like, you've kind of released it, like people are receiving it. What kind of feedback? What kind of feedback have you received so far?

Jasmine: [00:24:00] Um, people have mentioned how much they loved the illustrations. The illustrations are phenomenal and they love the message behind the story. Um, uh, they also just love just the characters and the how, the ending, the how it ties it in at the end. I can't give it away, but they just love the ending. Um, and lastly, they love the, um, five ways to be More Inclusive. Um, so yeah, great. Great feedback so far.

Carrie: [00:24:39] Yeah. As an educational audiologist, I just got this book this week, but I can see how this would be an extraordinary teaching tool, um, to do with, you know, to read with students and just reread and, and go back and really dig deeper and ask questions with them, like, how has this ever happened to you? Or can you relate to Jordan anyway? So this has so much application for, um, teaching and empowering students with any kind of differences, but specifically our deaf and hard of hearing children.

Jasmine: [00:25:18] Absolutely. I, I really want to write this book to target kids with hearing loss. However, I also wanted to target just kids in general, so that way they can learn about hearing aids and cochlear implants because, you know, some kids don't. They don't know what it is. So I just want them to understand that not everybody is going to look like them. So it's it's yeah.

Carrie: [00:25:47] Yeah. And so you you touched on it, but you talked about five ways to teach about inclusivity. How did that come up as far as like a great way to kind of finish off your book?

Jasmine: [00:26:03] Yeah. So originally I wanted to end off with, you know, affirmations. You know, I just wanted to figure out ways to help empower children. And but I feel like it was very popular. Everybody was doing affirmations. So I wanted to do something a little bit different and leave it off as a teachable moment for not only the kids, the adults to like, oh, how to be more inclusive. Um, so that's just the idea I came up with. I was like, oh, why not figure out a way to teach them how to be more inclusive? And that's how I came up with it.

Carrie: [00:26:45] I love it because it really does kind of, um, make you think a little bit deeper about the book, I think, too, and then apply it.

Jasmine: [00:26:58] Yeah, I definitely wanted to, um, you know, just adults to teach kids. Okay? Like, if you have to be kind, um, you know, just actions, like at your actions matter. Like, you know, showing that adults, kids are watching. So if you implement it, they are going likely model what you're doing. And, you know, reading my book helps, you know, teach kids to be more inclusive. So I just I just thought that was a very important message.

Carrie: [00:27:33] Yeah. And that is a great way to, um, like, kind of wrap up everything in the book with a nice bow at the end. Right. Uh, is there anything that I forgot to ask you that you were hoping I would ask about? Whether it was you personally, or the book or your process.

Jasmine: [00:28:02] Um, you can if you always. If you have any questions, you can always reach out to me. Um, you know, I'm an open book. I always like to share about my experiences as a deafblind individual. Um, and you can always reach out to me on my Instagram at Dr Jasmine Simmons. Uh, it' DR and then my full name or also Dr Jasmine Simmons. Com on my website. And I'm always available to us answer some questions.

Carrie: [00:28:37] And what I can do is I can definitely, um, put that information in the show notes so that people can click on it and go directly to your social media and your website and, um, order your book as well and get that shipped directly to them.

Jasmine: [00:28:57] Absolutely. And I really, truly hope you guys enjoy this story. And this was my baby is is my baby. And I just hope you guys enjoy as much as I did.

Carrie: [00:29:11] Yeah, well I know just reading this book, um, and getting it. I cannot wait to share this book with the students that I get to serve, um, throughout my work. And I'm already thinking about the ones that I really want to share it with. So I'm going to be ordering some more copies, um, in the very near future. And, um, with that, I also want to just say thank you, Jasmine, for everything that you do and everything that you are. I'm just so grateful to know you, um, for such a long time. And you just hold a special place in my heart. So thank you for being part of the EmpowEAR Audiology podcast.

Jasmine: [00:29:55] And I just want to say thank you as well. And you've been instrumental. So thank you for having me. And it's it's an honor.

Carrie: [00:30:06] All right so listeners, make sure that you hop on to Dr Jasmine Simmon's website, her social media, and be sure to reserve your book of extraordinary Jordan and her bionic ears. And if you love this podcast, please be sure to share with anyone who would also enjoy listening. Thank you.

Announcer: [00:30:33] Thank you for listening. This has been a production of the 3C Digital Media Network.

Carrie: [00:00:15] Welcome to the empowEAR Audiology podcast, a production of the 3C Digital Media Network. I am your host, Dr. Carrie Spangler, a passionate, deaf and hard of hearing audiologist. Each episode will bring an empowering message surrounding audiology and beyond. Thank you for spending time with me today and let's get started with today's episode. Okay, today I have with me a friend and colleague, Dr. Andrea Warner-Czyz, and she is an associate professor in the Department of Speech, Language and Hearing in the School of Behavioral and Brain Sciences at the University of Texas in Dallas. Her research investigates communication and quality of life in children and adolescents who are deaf and hard of hearing, and use cochlear implants. Her primary, um professional goal centers on a whole person approach drawing and speech language, pathology, psychology, and audiology to develop data driven recommendations to improve social well-being in patients who are deaf and hard of hearing. So, Andrea, welcome to the podcast.

Andrea: [00:01:29] Thanks so much for having me.

Carrie: [00:01:31] I'm excited. I know we've been trying to coordinate our schedules for this podcast for, I don't know, some time now.

Andrea: [00:01:39] It's been a while. Yes, but I'm excited to be here.

Carrie: [00:01:42] I'm excited to have you. And I was kind of trying to figure out when we met. I felt like it was at an ASHA convention initially.

Andrea: [00:01:51] That sounds about right. Yeah, that was a long time ago, too. I think we met through a friend of a friend, but I can't remember who the intermediary was. But thank you to whoever it was they.

Carrie: [00:02:02] Were, they were great, whoever it was. So, um, but I am so glad to have you today. And one of the things that I usually ask my podcast guests who have gotten into the field of, um, hearing sciences or audiology, do you have a backstory of choosing audiology?

Andrea: [00:02:23] I wish I had something like there was someone who was super inspirational when I was a kid, and it really wasn't that. When I was in undergrad, I wasn't quite sure what I wanted to do. I thought I wanted to do journalism, and then that wasn't for me. And I went and talked to my advisor and and she asked me what I wanted, and I said I wanted to work with something that would let me work with people that I could do psychology and something science wise. And she told me to take this intro class to speech and hearing, and that was it. I was completely hooked after that. It was that one little introductory class at University of Illinois, and I. It just made sense. It was one of those things that just clicked. And, um, and then when I started my master's program in audiology, which I didn't know if I wanted to do audiology or speech, to be honest, which probably makes sense why I do what I do, because it's not all hearing, like all audiology, and it's not really speech and language, and it kind of has psychology mixed in. And that's just the intersection that makes me happiest. I think that's where you really get to see where things come to fruition in the real world.

Carrie: [00:03:30] Yeah, yeah. No, that is great. That one person, an adviser, just said, take this class and it changed the whole trajectory for your profession. So that is awesome. And, um, yeah. So one of you kind of going into that, that research around that quality of life and your passion for that research to, uh, as it relates to cochlear implants and quality of life, you also run a lab at the university called the CHILL Lab. Can you share a little bit more about that?

Andrea: [00:04:07] Absolutely. So, um, it's called the Children and Infant Listening Lab. And so when we started it, it was all about the infants and we were studying babies. And that was really fun. Um, I loved the babies. But then I realized as my kids were getting older, the age of my participants also got a little bit older. Um, and then I got to adolescence, and it was absolute heaven, which I know nobody says that because who likes adolescence, but I actually really, really do. Um, but what we have done, we've looked at speech perception and music perception. We've looked at speech and language outcomes, and then quality of life has really been the stalwart for like the last 15 years. And really, like I said before, that's where I feel like everything kind of comes together. Um, and part of it came from what I was hearing from the parents, where the parents were telling me their children were having this issue, or they're having trouble making friends, or they didn't feel like they yeah, they just didn't feel like they were fitting in or how they were communicating. And I think all of that from getting the information from the parents and then just talking to the kids themselves, that really has changed what I look at, just really listening to them, I think that's the most important part, is learning from them what what they want or what they're experiencing helps change what I do as well.

Carrie: [00:05:27] Yeah. And I know today for the podcast, we really wanted to take a deeper dive into the role of social skills and emotion regulation and relation to children and adolescents who are deaf and hard of hearing. So how do deaf and hard of hearing children or adolescents, their social skills compare to their counterparts who have typical hearing?

Andrea: [00:05:51] Yeah, so it's been really interesting. There's not a ton of work on that. Um, in looking at their social skills, I think part of it really stems from language. And do they have the language skills to be able to communicate with their peers? And I think one of the most striking, um, pieces that I got was actually from a parent who said that their child was communicating that their best friends were always 1 to 2 years younger than they were. And so then it made me think, is that a language issue? Is it a social skills issue? Um, so a lot of the research has been trying to really disentangle what's going on with them. What we know about social skills is that the they have more difficulty making and maintaining friends. They tend to report more peer problems, like they're getting picked on more, or they're just more socially isolated or lonely. And that's kind of been what's what's been reported for the last 40 plus years. And that didn't matter if they were using hearing aids, if they were signing, what kind of residential school they were in, you know, was it general education or residential? It didn't really matter. Those were the types of things that kept coming out. So that's still the case. Even with as good as our technology is and early identification of hearing loss, we're still seeing some issues that kind of need to be teased apart, in my opinion. Yeah.

Carrie: [00:07:16] And it's interesting because like what you just said, we have early intervention and newborn hearing screening and technology, and a lot of these kids are probably graduating from like a more clinic program for their maybe speech and language skills. However, how does that translate into the real world then? Do you have anything to say about that?

Andrea: [00:07:41] I, I do, I think we prepare them really well to respond to us when we're when we're in the Audiologic booth and they're, you know, responding to questions. And it's really kind of a contrived situation. So even if they have noise, it's a really controlled and they know what to expect. They know exactly what's coming. And in speech and language testing, they can do really well on those tests, but they get all the time in the world, they can have as much time as they want, and that's not what real conversation is like. So even if they do really well in the clinic, I don't think those skills are always 100% transferring over, especially when they're communicating with people their own age versus adults who are going to fill in those gaps for them. So I don't want anyone to think that I'm saying they're doing horribly, and I don't mean that at all, but there is a little bit of a disconnect between or there can be a disconnect between how they're performing in clinic and how they're performing with their peers in day to day. Interactions.

Carrie: [00:08:44] Yeah. And does their level of auditory status impact that at all? I know you said, um, you know, as far as, like peer victimization and things like that, it really, you know, was kind of the same. But is there any evidence with that?

Andrea: [00:09:05] Do you mean like if they're deaf and signing versus using hearing aids or cochlear versus cochlear implants? Is that.

Carrie: [00:09:11] Yeah, that or like unilateral or mild versus more severe to profound.

Andrea: [00:09:17] So that's a really good question. Most of the kids in my studies are ones who are have severe to profound hearing loss, who use cochlear implants. So in our peer victimization study, we also had children who used hearing aids. So there was a broader degree of hearing, um, access for that particular study. But most of what I do is is working with children who have and adolescents with cochlear implants. Um, so is there a difference in in our study for peer victimization? There wasn't a difference. If they used hearing aids versus cochlear implants, there didn't seem to be a big difference between them. Um. I can't answer that question. I'm not trying to avoid it. I just can't answer it.

Carrie: [00:10:01] Maybe there isn't an answer for that. Um, right now, I was just curious if there there happened to be anything, you know, related to that challenge or whatever. Um, well, you know, we kind of shared about, like, the difference between clinic and then going into the real world setting. Um, and you mentioned how, um, communication is really different outside of the audiology booth. So what are some of those common challenges that you've heard from parents or from students, um, facing, you know, the real world situation for those social interactions?

Andrea: [00:10:40] So I think one of the big ones is with when we as adults are working with these children, if they're struggling, if they're if they need a moment to process that information, we are willing to be patient and wait for that. And that's not necessarily what you're going to get. So I think the timing is a big part of that, that temporal, um, access to the information and response time. So if they're taking a little bit of time to process what they've heard, especially in a noisy environment, that's going to throw off the timing of the conversation. So I think it's partly that, um, I think communication breakdowns for them to recognize the problem there, a breakdown has occurred and to know what to do about it and to do something about it. That's a three part task that they don't always do. Sometimes they just don't feel comfortable. They're worried about what other people are going to think about them, and so they're more willing just to let it slide and not get the information they need to participate in the conversation. Um, I think the other thing is opportunities for them to have to practice those skills.

Andrea: [00:11:46] So there was a a kid, he was in ninth grade, and I just remember him telling me point blank that the first five years of his life he spent going to therapy and and getting his device, he had cochlear implants and working with his audiologist and his speech language pathologist and this therapist and that therapist. And he spent all the time doing that, and he didn't spend the time in playgroups and learning how to play with others his own age and, and how to navigate the social situations with his peers. And for me, that was, you know, coming from a ninth grade boy who would have thought I'd ever say I really learned from from this ninth grade boy, but I really did, because it was such a huge aspect that we spend so much time with them in, in clinic and in therapy that they need to be kids also, and, and making sure that they're really fostering that aspect as well. I think it's important to emphasize that to parents, too. Um.

Carrie: [00:12:44] Yeah, that's a really good thing to learn from a ninth grader. I mean, that's huge to learn that. What are some. So, you know, you talk about the clinic and going to the real world, but what are some techniques or strategies that parents or educators or, you know, maybe related service providers that are working with these students in the more inclusive school environments? What could they be doing to maybe help build this in a different way?

Andrea: [00:13:20] So I think one of them is to make sure that there are those social activities with other kids their own age. And there was a mom years ago, and she said she felt like she had to be the concierge, so she would be the one that would arrange for the play dates or the Or when they got older, to go to the amusement park or go to the mall or whatever it was, because then, number one, she always knew that her kids were going to be included. And number two, she could also, um, make sure that, you know, those things were happening and that she could kind of be around in case they needed some help with those interactions. So I think making sure that they're involved in those activities, if they can be involved in some type of group, seems to be another one. Um, so that could be a sports team. It could be, um, band if they like music, you know, there are different ways that you can do that. It could be in any other type of group. Um, the other so those are things that parents can do, what clinicians can do. I know that there are certain groups, um, certain cochlear implant teams or teams for children who are deaf and hard of hearing, and they have social groups for their kids. And so they let them all get together. And that way they get to be with other children who are deaf and hard of hearing. They get to do something together, and they get to see that they're not the only ones also, but it gives them a kind of a place away from clinic that they get to practice those social skills.

Carrie: [00:14:47] Yeah, and it's such an important part of the whole person picture when they realize that they're not the only one and that they can kind of develop some positive self esteem in that way, too.

Andrea: [00:15:01] I think that's also oh, sorry, something that you see with the a lot of the kids in general education is a lot of times they don't have other peers who are deaf and hard of hearing in their class. And so having that reminder that that they aren't the only one that you can get that through those local groups. There's also lots of camps. And I know you, you have a camp, um, where you are, and I've been working in camps in Dallas and in Colorado as well. And I think that's another place not just for the kids, but also for the families to get more information on. And, and just, I don't know, learn, learn from each other. I think they learn from each other sometimes better than they learn from us, to be honest.

Carrie: [00:15:43] Yeah, well, I think that's true. No matter, um, whether they are deaf or hard of hearing or typical, um, they're going to learn from, from their peers more than they're going to learn from adults. But, you know, you're saying that and I love that you are so involved at your place as well with that social groups and connecting teens and kids together, because I that was a huge part of what I was missing, like growing up as someone that had hearing aids and going to a general or, you know, my neighborhood school, never knowing anyone else. Um, and it really impacted me, um, socially and emotionally through especially those transitional years of going, you know, trying to figure out who I am as a teenager and then thinking I'm the only one in the entire world that has to wear hearing aids and really kind of propelled me into making sure that the kids that I get to work with are connected in some way. And I feel like even if they're connected once with someone just realizing that they're not the only one one time, it could make a huge impact.

Andrea: [00:16:59] It can. And I think also with those camps, they forge those relationships. There are some kids that have gone to the Dallas camp since they were itty bitty like toddlers, and now they're in their 20s and they are still as I there are some of them and they're just still a super close knit group, you know, almost 20 years later, which is pretty amazing that they have just developed that so early. And I think it's it's that bond of having that commonality. Is that why you did that camp? Is that why you guys started the camp up there?

Carrie: [00:17:32] Yeah, I started a program more like a local program. That was a day kind of a thing or a half a day that we would meet a couple times a year, and we would bring middle school and high school kids together and do just self-advocacy, development. So our group was called Alps Now, advocacy, leadership and peer support for deaf and hard of hearing. And it's like, um, I want to say it's where the magic happens. I mean, you cannot. Replicate what happens in this group any other way, but by bringing them together and you come up with a couple of activities, but you give them the space to be who they are and connect with the others. And like you said, they make these lifelong connections. And with social media and different, you know, things like that, they stay connected. Yeah.

Andrea: [00:18:33] I agree that it is magical. I know we're not supposed to say that because in a way we're setting it up to be that way, but it just is.

Carrie: [00:18:41] It is? Yeah. And I have kids who were, um, you know, dragging their feet. They didn't want to go. And I'm like, just come one time. If you don't like it, you never have to come back. And I would say 95% of them have come back.

Andrea: [00:18:59] Yep.

Carrie: [00:19:00] So the hardest part is getting them there.

Andrea: [00:19:04] I agree I agree.

Carrie: [00:19:07] Yeah. So we talked a lot about like the adolescent phase too. But how important is it to address this early like early intervention and preschool for social skills.

Andrea: [00:19:24] So I think that's what we're looking at right now, because a lot of the research that I've done is really focused on the adolescence. Um, just because they will tell you anything you want to know or things that you don't want to know. Um, which again, is why I like them so much. And I think some of the things that we see. Are things that could be addressed really early. I think a lot of times what we do is as audiologists, we want to make sure they're getting the best signal and speech language pathologists that they have nice, clear articulation and that their language is on par. And that's great. But then that social piece doesn't always fit into the, you know, as far as those high priorities. And I think those early play groups, I think there are things that we can work on in clinic to make sure that they know how to self-advocate early on. I mean, they can tell you when their device is working versus when it's not, or if they're having trouble. I think those are things you can work on really early and teaching them to know how to interact with other people. I think Theory of Mind and some of the not not just being able to identify their own emotions, but to identify emotions in other people. And that's that's a skill that as parents, we need to talk about, too. As you know, when you're reading books or if you get mad about something to explain it and, and explain to them how you're thinking, I mean, you don't have to say I, I'm feeling mad right now, but, you know, but but I'm feeling upset and this is why. And, you know, then they can see this is how someone shows it, either in a movie or a book. Like, I think there are lots of ways that we can address it really early. Um, and there's lots of books on emotional intelligence. I think that's one of my favorite things right now to even in preschool books.

Andrea: [00:21:11] My, um, I mean, I, I vividly remember there's a book called my, My Many Colored Days by Doctor Seuss, which I didn't remember until my kids were little and someone gave them the book. And when you first read it, you think it's all about colors, but it's actually all about emotions, and it attaches the emotions to the different colors. My son read the cover off that book, and I think those are things that I mean, then that was a board book. So those are things really early to have those conversations and if they can recognize it, I think sometimes the children who are deaf and hard of hearing need to be explicitly taught some of those things, and I think those are really good avenues to do it is you can take those little opportunities. It doesn't take a lot of time, but it has a huge impact on how they interact with others, whether they're their own age or whether it's an adult. That was a really long answer. Sorry.

Carrie: [00:22:01] No, that's great, but I know that, um, you know, to add on to that, you have been doing some research kind of in that area, um, with what is it like, more like visual recognition. Recognition and emotions. Do you want to share a little bit about that?

Andrea: [00:22:20] Sure. So what's really interesting when you look at visual emotion recognition. So we show them different faces. And and there was no difference between the groups for visual emotion recognition at all. It like for accuracy or reaction time, they looked exactly the same whether, you know, for static photos. But then when we use dynamic videos and they looked at the image and they had either part of the image or all of the image, there was a difference between the groups. And what I mean by that is that the group with typical hearing, these are all adolescents. The group with typical hearing was faster and had higher accuracy when they had 80% of the video. So they didn't have all the video. They could make the decision and be accurate faster than the group with cochlear implants. So even with visual emotion recognition, they just need a tiny bit longer for the cochlear implant group to be able to get the right emotion identified. Um, for auditory emotion recognition, it's all over the place. But we included, um, kids with typical hearing, with hearing aids, and with cochlear implants. So, um, and we didn't have we need to collect a little bit more data on there. So there's a lot of variability in the deaf and hard of hearing group. But overall they aren't as good as emotion recognition at emotion recognition compared to their peers with typical hearing. And I think Monita Chatterjee has been showing the same exact thing that, um, it's just hard, especially with a cochlear implant, to pick up some of those emotion cues auditorily. And that's when everything's straightforward. But what happens when you have sarcasm and you have a mismatch between what's going on visually and auditorily? And I don't think we've actually nailed that down for how well they do as good at recognizing things like that. When there is a mismatch, I think that's the next thing we need to look at.

Carrie: [00:24:23] Yeah, which kind of makes sense when you think about, um, cochlear implants aren't as good as giving a lot of low frequency information. And when you think about emotions and inflection of people's voices, right, that it would be harder to recognize that, especially if it's a nuance and somebody's being sarcastic and their face doesn't match what they're meaning to say. Right?

Andrea: [00:24:51] Right. And some I mean, there are some people with typical hearing who aren't savvy at that either. They miss it all the time. So you have to pay attention to that too. But I think that's really important for kids who are in middle school and high school because sarcasm and making jokes, I mean, that's that's the bread and butter for that age group, right? I mean, whether they're talking to their parents or to their friends, there's always jokes or sarcasm going on. And so it's really important for them to know how to navigate that as well.

Carrie: [00:25:23] Yeah. Which kind of is a great segue into um, I know you've done some work and some, uh, research in the area of like, bullying and that kind of, uh, you know, written about it. Is there a higher incidence of, um, bullying or peer victimization in this population when compared to, um, typical hearing or other populations?

Andrea: [00:25:54] There. There is. So in the general population, it's about a third will report that they've been picked on at least once. Um, when we look at special populations. So any kids with Exceptionalities, regardless of what that exceptionality is, it's somewhere between about 47 and 70%, depending on the group that's included. Um, and so we ask the same exact questions of children who are deaf and hard of hearing, who used hearing aids or cochlear implants and half of them. So 50% of them said that they had been picked on at least once. So that's compared to it was 28% in the typical hearing population. And the way that they get picked on the most is they they're excluded. They're socially excluded. I should say they feel socially excluded. Now, it doesn't really matter if they were or not, but it's their perception because it's the same sense for them. Right? Um, so yeah. So, uh, it was 20 I think it was five, five times the rate of feeling socially excluded in the group with cochlear implants and hearing aids compared to typical hearing. So 25 versus 5% or something like that. It was crazy. It was it was I was unbelievable how high that was.

Carrie: [00:27:13] Yeah. Which is really important for providers for parents to to recognize that. So how would we as professionals really, um, capture that or make sure that, you know, you have an adolescent coming in and you're doing their annual checkup and then you oh, everything looks great and you have them leave or what else? What else should we be doing?

Andrea: [00:27:44] Well, I'm nosy, so I'm always going to ask about, you know, do you have friends? Do you, do you get along with people? Do you have a boyfriend? Girlfriend? You know, but that's kind of just my personality. I don't think we have to do it from a nosy standpoint. Um, but I think those are questions you can ask. Um, you know, how how are things going at school? Do you have friends? I think those are really valid questions to ask. And if they say they don't have friends, then that's when you can maybe probe a little bit more like, oh, like, you know, are you getting picked on? Is everything okay? I think there's an easy way to do that. And actually, there was a group you were involved with, right? With Carol Flexer and Jane Madell years ago. Um, I remember I think it was Kris English.

Carrie: [00:28:30] Kris English. That's right. Yeah, yeah. And we looked at like and actually had like a bullying questionnaire that you could use in the clinic just to ask some of those questions. And if, like you said, if they said, you know, no, I don't really have any friends. And here's a follow up question, how can you kind of expand and get more information too.

Andrea: [00:28:52] Yes. And I think it's also really important to know, um, that one of the things that came up in our research, we would have the kids complete the surveys on an iPad and sometimes the parents would be around. And some I mean, of course we got consent. Don't worry. Sometimes the parents would, you know, look over their kid's shoulder to see what's happening. And one I remember there was this one parent who came and said, she said that she has lots of friends and that's not true. She only has 1 to 2 friends and the others are acquaintances. And I think that's something else that we need to kind of pull apart. Is are these true friends? Do they have true friends or are they just acquaintances? And do they have someone to kind of share their inner thoughts with, to share time with, to do things after school? And I think sometimes you can dig a little bit more into that, but I think it's more than just do you have friends? I think kind of digging into are these is it a true friendship or not? Is it and is it bi directional? Right.

Andrea: [00:29:51] Do you want to be with each other or not?

Carrie: [00:29:54] Yeah, exactly. Well, and I think that's a bigger like conversation in the general like population for this, this next generation, because they're so involved with their phone and texting and Snapchat. So yeah, you have how many people following you or snapping you. But you could say I have 400 friends, but you haven't talked to anybody in real life.

Andrea: [00:30:22] Oh I yes, yes. I mean it's the same thing for us old people on Facebook, right? Um, I'm friends with lots of people on Facebook, but I'm not really friends with them. I mean, I am, but some of them are really acquaintances at this point. I'm friends with a lot of them. Don't be offended if we're friends on Facebook.

Carrie: [00:30:42] You're going to get all these un friends in a minute.

Andrea: [00:30:44] I know, please don't unfriend me.

Carrie: [00:30:48] Oh, but I think, you know, I when you ask that question in a clinic, it makes.

Andrea: [00:30:57] Yeah. But I but I think those are questions that we can ask. And it doesn't have to be like it's a prying. I mean, these are kids. These are adolescents that you're spending a lot of time with. You know them sometimes they know you and they're more willing to confide in you than maybe there are their parents, because sometimes the parents can become kind of helicoptering and they're so concerned and they, um, push their concerns onto what they're they think their child is thinking, too, right? They, um, what is that called? Do you know? Oh, there. Anyways, so they think that their kids have the same exact concerns that they do, and that's not necessarily the case. So sometimes I think the kids will hold in and not tell the parents if something's going on, but they're more willing to tell you, kind of as a trusted outside adult who is safe to tell things to.

Carrie: [00:31:47] Yeah. And sometimes they might not want the parents to worry or go into the school and maybe make it a bigger deal. I mean, there's probably a lot of that that might be going on as well.

Andrea: [00:32:04] Exactly, projecting. That's a word I wanted.

Carrie: [00:32:07] Yes, projecting. Thank you. I was thinking like executive functioning, but that wasn't it either. Oh, so it's been a long week, right? So we're getting through. Um, but just I guess, you know, we've talked a lot about, like, social skills and and bullying and you know starting early, but are there any other specific strategies or supports that you can kind of think about that we may want to be? Teaching our students or clients.

Andrea: [00:32:47] Um. I do think making sure that they're they're involved in something. Um, when you're on a team and this is kind of across the board, whether it has nothing to do with hearing loss. But basically, if you're on a team or you have, um, some type of group, intramural group, whether it's with the school or outside the school, that kind of gives them a little family where those kids are going to have their back and they have each other's back. And that's something that's been shown in the friendship literature. Um, for kids, with typical hearing in the general population. And I think the same is true for these kids. Um, I do think that's, you know, I expect it to be better in the future, kind of as we go forward, as we have earlier identification, we have earlier fitting of devices and better communication and a lot of these, these kids. So I think kind of the next generation, I would expect that to be better. I think the other thing is this generation, um, is more accepting and more inclusive than I think some past generations. And I think that's something that's going to bode well for these kids, that those things that were viewed as huge differences, you know, when you and I were growing up aren't necessarily as big of a deal. And I think, you know, making them aware. You talked about self-advocacy before, um, having them where they're not necessarily hiding their devices and they're proud of them and they can talk about them. I think that openness really opens up a lot of avenues for them as well.

Carrie: [00:34:25] Yeah. And like you said, that can start in preschool with just like reporting whether or not their devices are on or not working and then building those, you know, developmental self-advocacy skills, which is going to help with their self-perception and identity of who they are and hopefully help with the lesser peer victimization, because they're going to be very confident.

Andrea: [00:34:52] Exactly, and knowing how to describe their hearing loss or their hearing aid or cochlear implant and how it works. You know, these are like glasses for my ears. I think there are things that we can give them the language for, to help them kind of figure out how they want to handle that as well. But it's going to differ. Just like everyone, you know, adults are different. All kids are different too. And so trying to match that strategy with who the child actually is from a temperament standpoint is important to do as well.

Carrie: [00:35:23] Yeah, but what a great skill to develop and be able to role play. Or just like you said, give them some of that language that they would be able to build within themselves and then personalize it as they grow.

Andrea: [00:35:37] Right, absolutely.

Carrie: [00:35:40] So is there anything that I didn't ask you that you were wanting me to ask you.

Andrea: [00:35:50] Oh, I feel I like how this conversation went. It was a little organic and how it evolved, but I feel like this was covering exactly what we had talked about before is just giving a little bit of a shout out to looking at things beyond just speech, language and hearing and how they actually implement those skills in the real world. Um, I think that's just important for us to think about.

Carrie: [00:36:14] Yeah. And I just applaud your work and your passion in this area because it really is the end result, right? We as human beings, we want to be able to interact and have meaningful relationships with other people. And if we're not addressing this, um, and helping support this, then it's going to the outcome isn't going to be the same. So to be able to just, I don't know, have a way to really strategically look at it and then, um, implement it into the clinic setting into the school setting is really important for us. I children who are deaf and hard of hearing because they need that extra support in social and communication a lot of times.

Andrea: [00:37:05] They do, they do. And I think we're the right people to help. But I think it's also important to get the parents involved and sometimes the siblings too. The siblings know a lot more than we give them credit for so yeah.

Andrea: [00:37:17] They're a big key to this as well.

Carrie: [00:37:20] They are. And just to kind of wrap up, are there any like specific resources that you would recommend or networks that you would recommend? I know you talked a little bit about your camp and things like that, but anything that you can think of that people might want to look into.

Andrea: [00:37:41] Sure. So there are camps all over the United States? I'm sure there are around the world too. I just haven't looked into the global global camps. But I think looking into camps is one thing. Looking into local resources for support groups. The Dallas Hearing Foundation, for example, has a teen squad that they get together. And I know you you mentioned that that you have one up in Columbus as well. Um, I think there's also some websites that are really helpful. The supporting success for kids with hearing loss is and I know I'm sure you've talked about that a million times. Um, and there are websites like that I think just provide great resources for the families so they can kind of get what they need and connect with others. There's also lots of groups on Facebook for the parents, and sometimes there's also ones on Reddit. I haven't looked at those in detail, but I think there's good information there as well. But, um, I think pretty much anything online, lots of social media platforms will have different resources for the families.

Carrie: [00:38:48] Yeah, well, Andrea, I thought this was an incredible conversation and a very important conversation to have, um, on the Empower Audiology podcast. And I just want you to I want to thank you for being an incredible guest today. And it was an amazing conversation.

Andrea: [00:39:06] Thank you. It was fun connecting with you, too.

Carrie: [00:39:09] All right. Thank you, listeners, for listening to the Empower Audiology podcast. If you like this, please give a five star review and share it with, um, those who may also benefit from this conversation today. Thank you.

Announcer: [00:39:25] Thank you for listening. This has been a production of the 3C Digital Media Network.

Carrie: [00:00:14] Welcome to the empowEAR Audiology podcast, a production of the 3C Digital Media Network. I am your host, Dr. Carrie Spangler, a passionate, deaf and hard of hearing audiologist. Each episode will bring an empowering message surrounding audiology and beyond. Thank you for spending time with me today and let's get started with today's episode. The airing of this episode also marks the beginning of 2024. Happy New Year, everyone! This episode that you will be listening to was recorded a little while back with Dr. Kari Morgenstein. This episode actually motivated me to sign up for her energy leadership, assessment and personal coaching session. Wow, what an insightful investment to dive deeper into ensuring that I am the cause rather than the effect of my life. These sessions with Dr. Morgenstein also propelled me into exploring becoming a certified coach. As you listen to this episode today, take inventory of you. A certified coach can help you redefine your career goal or personal goal, overcome obstacles, help you clarify and make difficult decisions, increase leadership and energy, and become confident as well as develop deep self knowledge and awareness. Tune in today with Dr. Kari Morgenstein and stay tuned for future empowEAR Audiology episodes as I will be sharing my coaching journey as well. Okay, before we dive into today's episode, I wanted to take a moment to give everyone a background about my guest that I have today, Dr. Kari Morgenstein.

Carrie: [00:02:08] Dr. Kari Morgenstein is an experienced, genuine, and goal oriented certified coach and speaker. She received her coaching certification from the Institute for Professional Excellence in Coaching, or iPEC, and is a master practitioner of the Energy Leadership Index Assessment. Dr. Morgenstein is the co-owner of DB coaching Group with over 15 years of experience teaching, mentoring, presenting and coaching and her coaching group, she helps early career to mid-career health care professionals find their voice so that they can lead with confidence, courage and she began her career at the University of Miami Department of Otolaryngology as the founding director of the University of Miami Children's Hearing Program. Under her leadership, she designed, developed, and led a multidisciplinary team of healthcare hearing healthcare professionals. In this role, she managed a multi-million dollar budget while gaining international recognition. Dr. Morgenstein was the youngest individual to have served as the president of the Florida Academy of Audiology, and sit on the American Academy of Audiology Board of Directors. She is a proud member of Women in Academic Medicine, and was chosen in 2019 to attend the AAMC Early Career Women Faculty Leadership Development Seminar. Dr. Morgenstein has a passion for supporting women in medicine and challenging the status quo. I am so excited to have you today. Thank you for joining me.

Kari: [00:03:52] Oh, I'm so happy to be here. Thank you for having me.

Carrie: [00:03:56] Well, I love your passion statement, supporting women in medicine and challenging the status quo. And that's another reason I'm excited that you're going to be on the EmpowEAR Audiology podcast. And I'm sure all of the guests listening today will really enjoy everything that you have to say. But as I read in your bio, one of the things that you started out as a career in audiology and I just love to hear how people somehow get started in that direction. Do you have a story behind that?

Kari: [00:04:32] Yeah, I do have, um, I do have a little bit of a story. So, you know, just like many people, I was trying to figure it out in undergrad. And, um, at the time, I really knew that I wanted to help people. Um, from a very young age, I knew that I wanted to be in a profession that helped, um, others, whether that was children or adults. And, um, you know, so through that one thing kind of led me to another. And I was at home in Chicago and was able to do, uh, shadow a pediatric audiologist. Um, her name is actually Beth Dr. Beth Tournis at um Children's Hospital of Chicago. And I give her a shout out because she she forever changed my life. Um, I was able to shadow her for a couple days. She was mostly pediatrics, a little bit of, you know, audios and hearing aids, and then a lot of cochlear implants. And just getting to see a kid hear for the first time, and how it has the ability to forever change the life not only of the child, but also of the parents and the extended family. Um, I was sold, I was I was like, I, you know, I could do this. And I was super excited about it. So I'm forever grateful that, you know, they let me come in and observe. And that Dr. Tournis was so willing to let me learn and just be a part of her days for a couple days.

Carrie: [00:06:12] Well. Wow. And then you landed in Florida, obviously, and had a career at, um, with children who have hearing needs too in Florida. So how long were you there?

Kari: [00:06:28] Yes, I did my graduate work at University of Florida and then did my last year externship at the University of Miami, and I was there for about ten years. I ran and directed the children's hearing program there, and, uh, it was awesome. It was a really neat opportunity. I was able to step into leadership early in my career, which had it was amazing and awesome, and it had its own struggles. So it was really, really neat to be a part of a large university and to just be part of such a well rounded, incredibly smart, amazingly supportive team.

Carrie: [00:07:17] And I'm sure all of those stepping stones in your early career with leadership kind of got you to where you are now. And in your bio, you mentioned that you're a full time with DB coaching group and that you wear many hats in your own family. You're a survivor of several life threatening health conditions. You're a former Division one college athlete. You're a TEDx speaker alum, and a recovering workaholic, as you call it. Did any of these personal characteristics, characteristics that you mentioned with you and your website lead you to pursue what you're doing now, which is coaching?

Kari: [00:08:01] I, I think yeah, it's a good question. I think in many ways, um, for all of us, like our, our past experiences, especially our past hardships, often mold and shape the direction that our lives lead. Um. And I was no different. I, um, I think a big part of, uh, for me was being always an athlete. Um, growing up, I was always involved in athletics, went on to Indiana University to play college volleyball. And it was through that experience that I, I remember at any given time, just having six, seven coaches surrounding me, and there was coaches there for conditioning and strength and your mental health and you know, your your specialty coach. Right? So if you play defense, you had a specialty coach, then you had the head coach. And it just felt like an environment that was so rich in supports and, um, grace and compassion and also people there that were willing to challenge you to make you better. And when I got into the real world. I guess I was a little naive because I felt like, yeah, like this, this sports bubble is going to be, you know, in, in, in the real world. And I remember just kind of like looking around and being like, wait, like, where are my coaches? Like, where are my people? And I remember thinking that like, wow, like this is really hard to navigate without a coach, without a playbook, without kind of guidelines to, you know, boundaries to kind of work within. And then you had mentioned I, I battled a few health conditions that were life threatening. And I think through that experience, you just see the world completely different, you know, for good or bad. And I remember through one of the conditions I was battling, um.

Kari: [00:10:23] A colleague had a coach and part of that part of that of having a coach. The coach, um, met with me and talked to me just to get input. And I'll never forget, she said to me, like, have you ever thought about coaching? And I was just sitting there like, no, I'm just trying to get through the day, you know? Like, I am just trying to survive. Like you have no idea, like what's going on in my life right now, like coaching? And I remember getting off the phone with her and saying to my husband, like, do you know that there's like, professional coaches? Like it's not just, you know, on a field or arena or a court, like there are people that are coaching professionals. And I remember thinking, gosh, two things. Gosh, that makes so much sense. And the second thing I thought is, could I do that full time? Because that sounds amazing. And, you know, through my illnesses, it was just always it was always on my mind. And then I, you know, I, I when I got healthier and stronger, I looked into different programs. And that's kind of what led me to IPEC and, uh, started the coaching group with my business partner, Dr. Amy Badstuber. And it's it's just been so much fun and such a neat experience. And so, yeah, I think the answer is, yeah. Like my lived experiences being an athlete, battling health issues, having different leadership roles early in my career, and then also being a mom and transitioning to that role and wearing that hat. I think all of it kind of led me to where I am today.

Carrie: [00:12:11] Yeah, that makes so much sense about your college career and coaching and having all of these people supporting you. And then you get out into the real world and you're like, wait, I need to have these people to kind of get me to the next level or to keep me going and whatever path I want to go, or thinking bigger however that might be. And I feel that coaching is really kind of a growing certification or a career pathway in different areas. Can you you you mentioned professional coaching and can you just maybe share a broaden a little bit more about how professionals and individuals might view coaching? Because I think what you said coaching typically you think about athletes, right? But you don't think about, oh, wait, there's a whole other world out there that people can benefit from coaching.

Kari: [00:13:10] Yeah, totally. I always I always say this line, I always say professional athletes have coaches. Professionals need coaches. and the so coaching really you're right Carrie. It really has taken um it's become more popular and it's become almost like a buzzword that people talk about. Or some companies, you know, say, oh, we offer coaching. Um, and I think it's important to recognize that. True coaching is very different than, let's say, consulting or mentorship. Um, so consulting, right. It serves a purpose. It's great. But it's really hey, here's a roadmap. This is how you're going to do it. And here's our advice. Mentoring also serves a purpose, right? I have incredible mentors that supported me and my career and still support me. But the issue that can happen with mentors is that sometimes it's a let me show you how I did it and hey, come with me, which can be okay and it can be really helpful. But if your path and your desires and your interests are a little bit different than your mentor, that can be kind of how you go on a path that might not be a good fit for you. Um, and then the other one that gets thrown in with coaching a lot of times is therapy or counseling, and that is a bit different too, than, than coaching.

Kari: [00:14:41] Um, therapy really is something that kind of stays in your past. It looks at your your past experiences. What about your past is showing up today. It often takes people from dysfunctional to functional and with true coaching, the coaching that we do with our group, it really gets at the core of who you are today and where you want to be tomorrow. And the neat thing about coaching is that it's a true partnership so we don't guide it. We're not telling you do this, do that. It's really having that person to ask the right questions, ask the tough questions so that you can kind of go inside and say, hey, you know what? For the first time, I'm listening to myself, my heart, my head, and I'm choosing to move forward a certain way. And so coaching, they often say, takes people from functional, right? They're they're doing pretty good. They're functional and makes them more optimal. So that idea of taking someone good to great. Hmm.

Carrie: [00:15:53] I love that and I, I think I know your answer, but why? Or who should get a coach or want a coach?

Kari: [00:16:05] I mean, obviously everyone.

Carrie: [00:16:08] I thought that was going to be your answer.

Kari: [00:16:12] You know, and we laugh about it and we joke about it. But man, like, it's so true. Like, everyone could benefit from a coach. Um, you know, I guess I guess there's three things that stand out to me. Um, I think besides everyone, I think somebody who's. Looking to be to show up, like to just show up in their life and show up authentically and show up in a raw form. And it's just like, okay, bringing all of themselves to the session or to the appointment, the good, the bad, the otherwise right. They're just ready to, to be, to, to show up all of themselves. They don't want to put a mask on anymore. They really want to dig deep and show up. Um, I think the second thing is someone who is just open to growing. You know, I think a lot of times lately we hear about this growth mindset. And for me, it's just having the ability to to have the courage to self-reflect because my goodness, it is way easier in this world to just go, go, go work, work, work and not stop and think about your feelings, your emotions, your actions. It is your thoughts. It is so much easier to just hit fast forward and go, go, go. I'll worry about that later. I'll worry about that later.

Kari: [00:17:54] That's not my problem. I worry about it later. And so I think someone who's ready to have a mirror held to them, which is not always easy, you know, and to do to do the work of reflecting and being willing and open to grow. And then I think the third thing is they're ready to accept a partnership. You know, we know in health care that there's many professions, one of which is audiology that is dominated by women. And women often struggle with asking for help and asking for support. And so it seems like such a. Simple thing, but we often have clients that'll say, like, I just had a client last week who said to me, wow, for the first time in my career. I'm asking for support, and it finally feels like I'm not alone in my career. And so I think someone who's ready to accept that support and they don't have to be like, oh my God, I'm ready, you know, let's do this. Yeah. Give me all the help. But just like has an openness to it that like getting support and having a partnership in your career and your leadership journey and your transitions that happen in your life and in your career. They're open to getting support and collaborating in a true partnership that is coaching. Mm.

Carrie: [00:19:33] That's a great explanation of the everyone but drilling down to really, who you know, may benefit being open and ready to kind of, um, have that mirror held to them. Is that the person that you've probably looking for in that partnership? So if there's someone who's out there who's listening and thinking, yeah, maybe this is something that would be beneficial for me. Can you share what maybe a coaching session might look like or how does that work?

Kari: [00:20:09] You want to do one now?

Carrie: [00:20:12] We could I don't know how good it would be. Yeah.

Kari: [00:20:15] We'll do that for the next podcast.

Carrie: [00:20:17] Okay. There you go.

Kari: [00:20:19] Um, yeah. What does it look like? So. Logistically it is typically 60 minutes. We um, with our coaching group, we have two different programs. Um, we have a program that's three months or 12 sessions and then a program that's six months, 24 sessions. And the reason that it's the three month or six month commitment is that it in order to see sustainable changes for yourself, it's really requires a good amount of sessions, you know, to look at things, to kind of pull back the layers and get to that core of what your blocks are, what your limiting beliefs are, what your assumptions are. Because we all show up with filters and baggage that we see the world with. And coaching, you really need that time and that commitment to identify those blocks and those limiting beliefs and to break through them. Um. Outside of the logistics. And of course, we have people who are like, I just want to work on this problem. And so we offer some smaller opportunities where there's 2 or 3 sessions where we might do an assessment and then offer 2 or 3 sessions. And that's really for people who are like, I have a meeting in a month. And I, you know, I want to ask for a promotion. Can you support me with that? So it's really specific to a specific issue or problem that they want to work through. And then, like each session, looks a little different. The client really guides the sessions and what's on their mind, what's showing up for them personally, professionally. And it's kind of becomes this harmony, this like beautiful, beautiful song that just comes together with the client and with the coach, and you just harmonize through your journey together to figure out how you can best support them to achieve whatever their goals may be.

Carrie: [00:22:27] Mhm.And how do you is there ever like a determination of who would be a good client or that kind of thing. I know the harmony and I can't imagine anybody not clicking with you because you have this personality that just shines. And I feel like I could just spill out anything to you right now, and you would be such a great listener. But I'm sure there's just different personalities. And how does that work?

Kari: [00:22:58] Oh, that's a great question, Carrie. So we do, um, we do offer, uh, complimentary, uh, 45 minute intro call. And in that, in that call, like, we can, we can figure out, you know, is coaching right for that person? Um, maybe they need some other support. Maybe coaching is not the right fit for them. Um, and then, like you said, you know, if there's. You know, different. You know, everyone has different styles, right? Just like different athletes click and resonate with different coaches, right? I know even for me there's some coaches I had that like it just it just worked. You know it was I appreciated the how they gave me feedback. Um, I appreciated the way that they they connected with me, the way that they coached me. And so you yeah, you see that a little bit with clients as well where maybe it's not a great fit. Um, but I most of the time, people that reach out and jump on these intro calls with us, most of the time it does work, it does click. And the reason for that I think, is, well, two things. Um, we're unique. We have more than one coach, so we have myself and Amy. And so Amy and I are both different, right? She has a different personality than me. And so maybe they click with her and they don't click with me. So we're really unique that it's not just one person. If they feel more connected with her or they feel like her skill set might be better for them, then she can see them, or I can see them, you know, vice versa. And so we're really, really unique in that sense that most of the time, like whether it's either a good fit for me or it's a good fit for Amy. And like I was saying, most people that jump on these calls like they're ready, you know, they're just they're tired of feeling drained and overwhelmed and anxious and they're ready to show up with having more peace in their life, finding more joy, and not being that workaholic that I can so relate to.

Carrie: [00:25:13] That. Yes, that makes a lot of sense. And I can see how when somebody sets up that 45 minute call with one of you, they've already done a lot of thinking and research, and they're just ready to take that next step. So I can see how that would click really quickly to. In your bio, you also mention that you are a master practitioner of the Energy Leadership Index Index. How does that play into your coaching?

Kari: [00:25:46] It is. It is plays in a ton. Um, so the ELI so the Energy Leadership Index is a really cool, really powerful assessment. It's different than a personality test. So I think many of us are used to personality tests, maybe a disk or a Myers-Briggs. And it's different because this is an attitude test. So it looks at the attitude and the filters that you show up with on a day to day basis. And then what's really cool is it shows how you show up and what energy you bring when you're under stress.

Carrie: [00:26:36] Mm.

Kari: [00:26:37] And what's really important about having this assessment for us in our coaching group is that we know that many people in health care are kind of living in that constant state of stress.

Carrie: [00:26:49] Mhm.

Kari: [00:26:50] And so we, we care of course, how you're showing up on day to day. But we really want to know how you're showing up under stress and what stress is doing to your energy and to your attitude. And the other thing that's really neat about this assessment is that, you know, with a personality and you have kids Carrie like I think in a lot of ways, like they're just kind of born with their personality. Wouldn't you agree?

Carrie: [00:27:18] Like, oh yeah, both my kids are so different. And I'm like, they've been raised but under the same roof. But I'm like, they definitely were born with their personality too. They're enhanced by us, but they're definitely different kids.

Kari: [00:27:38] Mhm I love that I love that word enhance right. You're right. So like it's almost like a work with approach. Mhm. Right. Like this is your personality. Like let me do all that I can do to enhance that. And so. Well, it's it's kind of difficult with a personality test. You're like, well, that's your personality. And like, we're going to do our best as the, the, the leader here to kind of work with your personality and enhance it, like you said. And the neat thing about attitude is that we can all change the way that we it's a choice, right? The attitude that we show up with on a day to day is a constant choice. And so what's neat about the ELI and the debriefs that we do is that it just you just gain a lot of awareness, a lot of clarity about how you're showing up. And then you can choose if you want to change that. And so we're, we're, we're it's a really, really, really neat, really powerful assessment. And. Yeah, it's. I can't say enough about it.

Carrie: [00:28:43] Well, I know that you had put that bug in my ear a while ago about the, um. ELI. And you're making me excited to, uh, connect with you about doing that and kind of pulling, seeing what filters I have and what I bring to stressful situations. Because, as you said, in health care and in our jobs, we just are under the, you know, like under a lot of stress. And what you said earlier, we don't take the time to think about anything. We just kind of get up and go and never have that reflection time. So I'm sure that shows up too, within the assessment, too, of how we look at life.

Kari: [00:29:31] Absolutely. I'm ready for you. Let me know.

Carrie: [00:29:33]  I know you are. I know you are. We'll set this up for sure. This would be like a whole another reveal after, um, see what's happening. But I know that you said that it's Amy, right? Is your, um, the other coach. And tell me a little bit about your name. Do you dB coaching group and where did that come from?

Kari: [00:29:57] So D is my married last name. So Dermer and Amy's last name is Badstubner. So there's the D, there's the B, but it's of course lowercase and capital like decibel. And it's done on purpose. We both Amy and I met in graduate school at University of Florida, and Amy went on to, um, build and run her own audiology practice, which she recently successfully sold. And I obviously had a very fruitful, amazing career in audiology on the academic university side. And it was really important as we were creating our business, to have a tribute to audiology and kind of where we came from. And for me, I'm forever grateful for all the people in audiology that shaped me as a person and as a professional and ones that continue to to I mean, just last week I was talking to a mentor of mine, um, and, and it was just really important to both of us to just kind of give a shout out to where we came from and to not lose our connection with audiology, which, as you know, is such an amazing profession and has given me so, so much. And then the last thing was dream big. And I think, Carrie, when we first started, I think you said like think big.

Carrie: [00:31:27] Mhm.

Kari: [00:31:29] Um, which I was like, oh like I totally yeah think big, dream big. You know, Amy and I live by that. We really try to challenge each other within our business and on our team to challenge the status quo. To what? No idea is too big, no thought is too crazy and just kind of see where it lands. You know, life is too short to play small and to, you know, be timid. And so it's a reminder of, hey, you know, building a business might be hard. It has its own ups and downs, but never to forget that dreaming big is important.

Carrie: [00:32:11] I love that with it. Keeping your roots in audiology with the with the name, and then having a partner that happened to be in grad school with you. So that is so cool. And I know on your web page you and within your bio, you said you focused a lot on supporting those early career to mid-career professionals in healthcare. Why did you kind of use that as a focus?

Kari: [00:32:40] I think it was, you know. I think because that was the area that we found that we needed the most support, and it wasn't always available or easy to find. I think that group is interesting. Um, you know, early career, you're trying to figure things out. You're trying to figure out your professional fingerprint, mid-career. Sometimes your personal life changes, things get a little crazy, and that might show up professionally and I think. It's a group that needs a lot of support. There's a lot of things happening, a lot of transitions, again, personally in people's lives or professionally and or professionally. And Amy and I really wanted to be support to that group and make sure that. You know, I don't believe that you need to learn things the hard way. A lot of people say that, that you just got to figure it out yourself and that you got to figure things out the hard way. And it's I don't believe that. And so I think that if you know someone is in their early career or mid-career and just trying to figure it out, if we can make it a little bit easier, that feels incredibly rewarding. Mm.

Carrie: [00:34:20] Do you have any other target groups that you have besides health care professionals? And I know you like women is a big part of of your group too. And supporting women who are in leadership positions too. But outside of that, do you have focuses?

Kari: [00:34:37] Yeah. We're really focused right now on health care. You know, there's such a need, especially post-pandemic. We have clients that range from nurses to audiologists to speech language pathologists to physicians. And there's a lot of patterns, you know, that they're showing up with. And there's a ton of burnout and a ton of just kind of reflection happening. And so for right now, our group is really focused on health care. You know, who knows, maybe in a year from now or two years from now, you know, Amy and I have different interests and different passions. We both have pretty diverse backgrounds and we have ideas in mind. Um, but for right now, we're really focused on supporting those early career and mid-career professionals in healthcare.

Carrie: [00:35:29] Well, that's where your dB comes back into play, right? Your dream big.

Kari: [00:35:34] Exactly.

Carrie: [00:35:36] If listeners wanted to get connected where they're like, hey, this sounds like something I would like to explore or get more information about, how can they get in touch with you or with Amy?

Kari: [00:35:49] Yes. So they can go to our website. Our website is dB coaching Group. Com, or you can find us on LinkedIn. Uh, I'm on LinkedIn. Kari Morgenstein Dermer, you can send us a message. Um, Amy, is Amy Badstubner. Um, and you can send her a message. We love just talking to people. You know, we do, like virtual coffee dates and things like that. And, you know, I really encourage any of your listeners that if they just are, they just want to chat or want to hash something out, or they heard about coaching, but they don't really know what coaching is and they want to just talk about it, reach out. We're we're we're super available. We want to have conversations. It's really fun to meet new people. And, um, yeah, just send us a message and we're we would love to connect.

Carrie: [00:36:42] Well, I can definitely link the website or the your website in the show notes too Kari. Is there anything that I forgot to ask you that you were hoping I would ask you?

Kari: [00:36:56] No, I think you covered it all. It was so fun. It was so good to talk to you.

Carrie: [00:37:01] Thank you. I'm so glad that we had this conversation. And I'm sure there are a ton of listeners out there who are just feeling that burnout, whether it's if they're the healthcare or the schools or whatever. But as professionals who are, um, in this focus in speech and hearing, who just really want to kind of see what their next step might be or just kind of make it a little bit easier. And I hope that they reach out to you guys. So I just want to say I am amazed at what you guys have done to, um, with dB coaching and just kind of, you know, taking, I guess, that, um, dream big that you both had together and just making a move and, and going in that direction. I know that takes a lot of courage too. But obviously it was the right thing for both of you and how exciting to kind of have your roots in audiology, but really go in another direction to, to to help more people in a different way. So thanks for all that you do.

Kari: [00:38:08] Oh, absolutely. That's so kind of you. Thank you. Thank you for all you do, Carrie. You're incredible. And yeah, and you're changing so many lives. So I'm really grateful for the opportunity and to be able to chat.

Carrie: [00:38:21] All right. Well, thank you, listeners for listening to the Empower Ideology podcast, and I hope that you will visit Dr. Kari Morgenstein at her website and reach out to her in the future. Thank you.

Announcer: [00:38:34] Thank you for listening. This has been a production of the 3C Digital Media Network.

Carrie: [00:00:15] Welcome to the empowEAR Audiology Podcast, a production of the 3C Digital Media Network. I am your host, Dr. Carrie Spangler, a passionate, deaf and hard of hearing audiologist. Each episode will bring an empowering message surrounding audiology and beyond. Thank you for spending time with me today, and let's get started with today's episode. Okay, today I am excited to introduce to all of you Sydney Bassard and she is an ASHA certified Speech-Language pathologist. She received both her Bachelor of Science and Public Health and her Master of Speech Pathology from the University of South Carolina. Sydney is licensed in Virginia, North Carolina, and South Carolina. Her clinical focus areas are working with individuals who are deaf and hard of hearing, and those with literacy challenges. Her motto of listening, learning, and advocating stems from the three principles that guide her clinical practice. Sydney, I want to welcome you to the empowEAR Audiology podcast. Thanks for being here.

Sydney: [00:01:29] Thank you so much for having me, Carrie. I'm really excited.

Carrie: [00:01:32] I'm excited to have this conversation with you, too. Before we dive into today's topic of health literacy, I would love if you could share with our audience a little background of how you ventured into the field of speech-language pathology, and then your interest of working with children and individuals who are deaf and hard of hearing.

Sydney: [00:01:56] Yeah, so I have like an unconventional way that I came into the field. So I actually went to school to be a pharmacist and thought that that was going to be what I was going to do. And then over time, my brother, who's younger than me, got diagnosed with dyslexia and ADHD. So I ended up working for a literacy intervention company and loved the work that I was doing there. It was far better than the hard sciences that I was having to take in order to try to become a pharmacist. So I ended up switching my major and became a public health major, and then ultimately went to grad school to become an SLP. So that's kind of how I got into speech language pathology. And then specifically with the deaf and hard of hearing population, I met a professor who does research in that area, and she was looking for people to help volunteer in her lab. I signed up and said, sure, I'd love to. Like I want to make connections. And that's where I started learning a lot more about this particular population, specifically looking at listening, spoken language and literacy outcomes. And ever since then, I've been here.

Carrie: [00:03:03] Well, yeah. That's exciting. I love hearing everybody's stories of how they kind of venture into it, because everyone has such a lot of people have an unconventional way that they get into it. I also wanted to ask you a little bit about your listeningSLP. I feel like that's how I know you because of a lot of your social media, which is amazing what you put out there. But can you just share about your work experience and your business?

Sydney: [00:03:32] Yeah. Thank you. So I used to work outpatient pediatrics on a cochlear implant team, and I loved what I was doing. But coming from a public health background, one thing that I always was able to notice is when people had a good grasp and understanding of some of the things that they were being asked to do for their child with following up for audiological appointments, whether it was going to weekly speech therapy sessions, charging the device, all of those different things. Right. And so when people had a good understanding, you saw that they did them pretty naturally versus when people didn't have a great understanding. Sometimes it came, it could come off to professionals as if they didn't care. They weren't trying when really it wasn't any of those things. It's that they didn't have a good understanding or knowledge of what they were supposed to do. So I was like, you know, I have all of this knowledge about hearing loss and working with the population from grad school. I would love to just share like little tidbits and things that people could do at home. So it really started on. I just wanted to share about listening and spoken language on Instagram, and it's kind of morphed since then, as my own thinking has morphed a little bit too. And now our goal is really just how do we support language development for deaf and hard of hearing children, and then also to how we can find different resources and supports that families may not know about.

Carrie: [00:04:59] Yeah, well, I know your little tidbits are just like those little bytes of information kind of stick with people. So it's nice to have that. And I know today we had talked ahead of the podcast and wanted to dive deeper into a conversation about health literacy and how that can impact a lot of the families that our listeners are working with. And I can see now that your combination or your background with public health and Speech-Language pathology really kind of tie into this. So on a general level, can you just share with the audience what is health literacy and what are some of those key components of health literacy?

Sydney: [00:05:45] Yes. So health literacy just actually got a new definition. So we can think of it as two kind of constructs. You have personal health literacy. And that's just really more so about the degree to which an individual or a person is able to find, understand and use information in order to make health-related decisions and actions for themselves and others. And then the other one is about organizational health literacy. So that's being able to understand how to navigate and work within a system in order to make those informed healthcare decisions for themselves and for other people. And both of those are based on the CDC definition of what health literacy is to this point. So when I think about health literacy, there's the three A's that we can always have. And this is what I encourage people to think about when we are looking for information or creating information. It should always be accurate, accessible and actionable.

Carrie: [00:06:46] I like that acronym or the accurate, accessible and actionable and. For having those three A's. How can how does that impact the well-being for families and and individuals? How can we make the three A's come alive for families?

Sydney: [00:07:09] Oh, I mean, I personally think that having a good understanding of whatever is going on is like the driving force to really committing to care, but also understanding the importance of it. So when we think about like information needing to be accurate, right, we know that sometimes pseudoscience is excuse me, we know sometimes that pseudoscience is out there. So that just means like information that's not accurate. So whenever we're sharing things we want to make sure that it is accurate. It's based on evidence that's based on the science that we know is there. So that we want to share with families like things that they're actually able to understand from that perspective. Then it should be accessible. So accessibility sometimes is not always in like just the print form. That may be multimedia. It could be video. And then we should always think about the fact that the average reading rate is around eighth grade for adults across the US. So when we are looking for resources, if they have a higher reading level and in order to understand them, meaning that they're filled with professional words and jargon that may not be accessible for people, like for the general public or population and then actionable. So one thing that we know, like coming out of the field of public health, is that information alone is not enough. So it's great that they have accurate information that it was accessible for them. But if there's no actionable steps based on what's being presented, what exactly are they supposed to do with that? And so sometimes too, when we don't talk about what is actionable, that's maybe where we see like a breakdown in communication and fall off with care.

Carrie: [00:08:53] Yeah. Which is kind of leads directly into my next question is like, what are some of the challenges that families face as it relates to health literacy, too? I mean, you talked about this breakdown with actionable items, but it probably breaks down on all of these three A levels.

Sydney: [00:09:17] I think the biggest one that I've seen is like lost to follow up with care. So we see a lot of people who we know in the US. We're really fortunate that we have a newborn hearing screening program that's universal in all 50 states, but people go through that, right. And then there's no sometimes kids have no follow up and no follow up can happen for many reasons, right? The parents just don't follow up. People move. Things happen. Like somebody may be feeling overwhelmed with having a newborn and then also having to do an additional appointment. In addition to like the well-baby appointments, there's so many things that can happen. But when we're talking about after the screening, if it just says your child, you know, did not pass, this is what we want you to do. But it's not like written in a parent-friendly way. If it like the steps are not actionable in the sense of like you just told them that they should follow up, but like a list wasn't provided or hyperlinks to a website for them to make the appointment online weren't provided. Is that actually actionable? Maybe. Maybe not. So we see that, I think on the early end, but then even to his kids kind of progressed. I mean, sometimes people have difficulties where they don't go to mappings or they're not able to make it to mappings. Do they understand the importance of like why we do CI mappings, why going to those appointments are important? Do they understand the importance of speech therapy and not just being like, oh, so my kid can talk, but to have like a better and more accurate understanding of exactly what they're supposed to be doing in order to benefit their kid. And if they're not provided with that information, maybe they just don't know, especially if this is their first encounter with like, children, or if it's their first encounter with like navigating the deaf and hard of hearing space.

Carrie: [00:11:09] Which is statistically about 90% of our families who are kind of navigating through that space. Because a lot of times that the child is the first person that they've met who happens to be deaf or hard of hearing. Do you see? Um. Any other barriers as it relates to maybe cultural differences or language differences that kind of contribute to the health literacy challenges too.

Sydney: [00:11:44] Yeah. So we know that these kind of what sometimes are called disparities in the field exist across the board. And so we see it even with health literacy and how it comes into play, is that information being presented in a way that is culturally mindful. So just because I have an infographic, maybe knowing that, like a family might have distrust of the medical system or people is like giving them a handout and sending them out the door. The best way to do it? Maybe not. If I have a video version of the same thing that shows real people talks about real experiences, maybe that would resonate more, especially if we know that there are people that like, look like them or that are within their culture kind of represented within those spaces. Um, I think too, sometimes, like we as professionals tend to be some of that barrier when it comes to health literacy and health information. We want to think that we're not gatekeepers of information, but I've sat on many different sides with many different families, and sometimes it's the professionals like we are not freely sharing all of the different resources in a responsible way. We might just start rattling off about 5 or 10 things, but what we never did was spend time to send a follow-up with actionable hyperlinks that people can go and look for more resources, or even sometimes to like after you give people information, asking them what questions do you have and not do you have any questions? Because most people will be like, no, no, no, no. Like what questions do you have? Most times somebody at least comes up with one and it kind of opens that door for a conversation.

Carrie: [00:13:23] Yeah, those open-ended questions are really important in that kind of a situation, and probably giving some wait time to just let them process and think about all of that. You shared a lot about some of these barriers, especially as professionals that we kind of, you know, put up, I guess, are kind of gatekeepers of information. Do you have some specific strategies that could be employed in order to enhance health literacy for families, especially our families who have children who are deaf or hard of hearing?

Sydney: [00:14:02] Yeah. So I always think that before you provide anything, you need to have gone through it yourself. That sounds a little silly to say, but in being transparent, I've done it like I have done the thing of like, you just pick up a resource, you skim over it really quick and you're like, okay, this looks good enough. And you, you hand it to somebody because we know that we're busy and sometimes things happen, but really making sure that we take the time to read this through, is it riddled with a bunch of technical terms that may make it difficult for a family, that maybe that's not one that I'm going to share, or I might modify it in a way and like on my own, make notes on the side for somebody to be able to follow along with it. So looking at it from that standpoint with accuracy and making sure like the readability of the information is good, I think with accessibility, especially with individuals who are deaf and are hard of hearing, not just always providing things in printed form can be helpful. And then even like an aside, thinking about where the printed materials are. So if they're readily available but they're, you know, not in a place that's easily seen, that can be challenging.

Sydney: [00:15:14] So having them in multiple different places around the office could be good. But then also thinking about the way that the media is presented. So printed form tends to be the way that we do things. But we know that like the reading rates for adults are low in this country. We also know too that most people don't actually read. I mean, think about when your doctor gives you something about your health, or even better, when you get medication from the pharmacist. And it's like, here's this pamphlet for you to learn all about it. And you do what? You rip it off and you throw it in the trash. Same thing is happening with most people. So if you can provide something in a video format, and then we know that with videos we always want to make sure like captioning is available. So looking to see if those things are kind of out there as well. And then always, always, always there's something actionable that there's a website or even a statement like, you know, call your pediatric audiologist now or contact your local speech-language pathologist for questions. Here's how you can find one. If you don't have like, give the people something for them to have to do after they've soaked in that information.

Carrie: [00:16:20] And you talked about the different ways of presenting it, like print and like video and different ways like that. Do you feel that actually sitting there with them is helpful too, or that's just probably not always. A way to do it or it's not available. You're not with them?

Sydney: [00:16:44] Yeah.I think sitting with people as they watch it is really beneficial. Well, one, you can assure at least if nothing else, they got the information right, but two, then you're there for whatever questions they may have. I think the internet is a beautiful place. I don't know what I would do without the internet. It provides lots of great resources, but the internet is not a replacement for a professional. So sometimes if we give somebody a resource and we're not there to help guide and scaffold their understanding of what is available, they turn to the internet. And sometimes they may get really good responses and advice, and sometimes they're getting advice and responses that were going, oh no, that's definitely not where we need to be. So kind of handholding. I don't see it as hand-holding. I see it more so as like you're ensuring that people at least have the baseline of what they should.

Carrie: [00:17:45] And. Going off of that. You know, I know all of us use like social media, whether it's, you know, Instagram, Facebook, TikTok, all of that good stuff that is out there. How how can families really discern reliable and accurate health information because they're getting it from these different avenues?

Sydney: [00:18:12] Yes. And I think that's where the tricky part comes in. Right. Because as professionals, to a certain extent, we have a little bit of training of how to evaluate for this information of being good. But if you're a family and you're like, I'm just grasping for anything, you may not have the skills to do that. So the one thing that I look for when I'm looking for any type of support is, is this citing other resources? Right. So one person should not be like the sole idea bank, even when you look at the CDC website, which is very helpful when looking at different information, they are citing research articles or other places for where they got some of the things that they're supporting. So for families, I think always looking to see like are they referencing some other bodies of work in some aspects is going to be good because you know that they're not just relying on themselves, they're using something else. To kind of seeing like across different things. And now this is going to take a little work. Sometimes we like having that one stop shop of I got this and I'm good to go and I'm walking out the door, but especially if you don't know a lot of information about it, I think getting a couple of different things. And pulling from multiple places is going to be beneficial and helpful, because then you're able to do a little bit more of a comparison of what this particular resource says, that this resource says and what this resource says as well.

Carrie: [00:19:41] Yeah, which can kind of be overwhelming for families. As we shared at the beginning, you know, 90% of families, this is the first time that they're going through that. And if they have these different resources that they're looking at, how can families really make that informed decision as far as like, which one should I be? You know, I guess believing or kind of investing so that they're making the best decision for their child.

Sydney: [00:20:16] Yeah. So I think that doing your own research is good. I am a big personal believer in, like, we are our own health advocates. Like we have to have understanding, but that's where professionals come in too. So like, even if you've kind of looked at a couple of different resources and you still have questions, reach out to reach out and get professional support and help. And I know that sometimes that comes with a cost, but there are definitely opportunities out there that are not as expensive. Um, or places I think where you can like basically phone in a question and see if you're able to get a response. I think that that helps alleviate a little bit of the burden on families like your goal is to be informed, but your goal is not to become the doctor. So you may have to do a little bit of your own research, but you don't have to take on fully understanding and comprehending everything on your own.

Carrie: [00:21:10] And kind of on the flip side, to help families along, what can we as communication professionals, speech-language pathologists, audiologists, teachers of the deaf, anybody kind of related in our field? What role can we play in educational programs or initiatives to really address health literacy with families?

Sydney: [00:21:33] Yeah, I think the biggest thing is looking at the readability of text and start curating resources. So I always like to have multiple resources that talk about the same thing, but they might talk about it in a slightly different manner. So depending on who's in front of me, I'm not just constantly saying like, here's here's this information on this, it's no, you're able to modify and adapt for the individual and the needs that are in front of you. And then I think we have to spend time. And I know that time is limited. Like, this sounds lovely. And in a perfect world, we do this, but we do need to have time within our days and our schedules to look for these resources we do not know at all. Like I love audiology. If I could, I would be dual certified, but there's so much that I don't know and it would be an injustice to the people that I serve to try to like, give them all of this information and say, here you go. Like, no, no, maybe I have 1 or 2 pieces of information about audiology, and then I'm putting it back on, like referring to the professional helping to direct them and kind of guide them back. And then we as professionals too, can whenever we see some of these initiatives or things take place, like reach out and figure out how we can support and help, and then also to kind of learning from these other people that have started doing some of this work, how to present information that way. I mean, 90% of the things that have come from the Listening SLP are because I couldn't find it somewhere else. And but these were things that I needed or things that I wanted for people to know or to be able to share. So being able to kind of create your own is also something that you can do too.

Carrie: [00:23:24] Yeah. And kind of looking forward. I know you're you have creative mind and the comment that you just made of like I couldn't find it anywhere else. So I did some of that accurate research myself to put something accessible together that might be actionable for someone else. But how do you envision the future of health literacy as a whole?

Sydney: [00:23:51] Oh, I see health literacy coming into play more and more, and I'm really excited to hear that more grad school programs are doing a little bit more with public health and realizing, like the impact of public health within our field, public health impacts every aspect of an individual's life. Being able to have good understanding, like the decisions that we're asking people to make when it comes to health-related things, are going to impact them or their child for the lifetime. So we can't take these things lightly and just be like, okay, well, you're making a decision like, no, people should be able to make well-informed decisions, and the only way they can do that is by fully understanding and grasping all of the information there. So as we see like the not the invention, but like more prevalence of people using video as a way to communicate and things like that, I think we're definitely going to see more of an increase for all populations, but especially like this population, about what exactly like initial steps look like, what follow up looks like and supports that are there.

Carrie: [00:25:04] You. And hopefully, with all of that, we will have more informed parents who, like you said, that have the direct impact on the outcomes of children who are deaf and hard of hearing because they are the number one advocates and they're always going to be there for them.

Sydney: [00:25:25] Yeah, absolutely.

Carrie: [00:25:28] So Sydney, as we kind of wrap up today, is there anything I didn't ask you that you wished I would have asked you?

Sydney: [00:25:37] I don't think so. Um, no. I was just so happy to be here and kind of chat about health literacy. Like, this is definitely been my first love. Um, long before doing anything like super speech-related. I've always loved health literacy and just have seen it as such an important thing that we as professionals just don't talk about enough. But we are now. And so that, I think, is the the best thing that we can do.

Carrie: [00:26:12] Well, Sydney, if there are listeners out there who would like to get a hold of you, how can they do that? How can they find you?

Sydney: [00:26:26] Uh, so you you can find me at the Listening SLP on all social media platforms, dot the listeningslp.com. Or you can send me an email at hello at the listening slp.com.

Carrie: [00:26:41] Okay, well, I will definitely make sure to put those links in the show notes so that people can directly link and follow you and all of your social media platforms, as well as get a hold of you through email. And Sydney, thank you so much for being a guest today on the EmpowEAR Audiology podcast. It was a great conversation about health literacy and where how we need to be thinking in order to be advocates and in our profession, but also for the families and children that we work with on a daily basis.

Sydney: [00:27:20] Yeah. Thank you so much for having me. Really appreciate it.

Announcer: [00:27:24] Thank you for listening. This has been a production of the 3C Digital Media Network.

Carrie: [00:00:14] Welcome to the empowEAR Audiology Podcast, a production of the 3C Digital Media Network. I am your host, Dr. Carrie Spangler, a passionate, deaf and hard of hearing audiologist. Each episode will bring an empowering message surrounding audiology and beyond. Thank you for spending time with me today, and let's get started with today's episode. All right, welcome to the empowEAR Audiology podcast. I am going to read a little bio about a return guest that I have on the podcast today, and I'm really excited about our conversation that we are about to have. I have Valli Gideons with me, and she is an author, speaker, and mother of two teenagers who were born with hearing loss with a degree in journalism she transitioned from everyday stories to sharing her family's hearing loss journey to date. Her work has reached millions of people across multiple platforms with an engaged community. She is passionate about her role as an advocate for children who are deaf and hard of hearing. Valli is also the author of the children's book Now Hear This Harper Soars with Her Magic Ears, which she co-wrote with her daughter. Um. And you can also follow her journey at mybattlecall.com. So, Valli, welcome to the empowEAR Audiology podcast.

Valli: [00:01:47] Thank you for having me back.

Carrie: [00:01:49] Well, I'm excited to have you. And for all of our listeners out there, I actually had the opportunity to interview Valli, and she was a guest for episode 29, and we talked a lot about her, um, social media and her blog called The Battle Call. And since that time, she has become a author of the book Through the Fog Navigating Life's Challenges While Raising Kids with Hearing Loss. So I just wanted to encourage all of our listeners to go back and listen to episode 29, which I will link up in the show notes today, and you can hear a lot more about her story of raising her two children with cochlear implants, and also about her social media reach with my battle call. But again, welcome. Thank you for being a return guest. I was excited that your book was published. I know it was in the works the last time we were together. Um, and I'm still bummed we haven't met in person yet.

Valli: [00:02:55] I am also bummed because I see you in pictures at conferences, and when one I'm always sad I'm not there, I have the biggest FOMO. And then also you're always in other. You're in pictures with other people who I may know virtually but haven't met in person, and I just get very jealous. So someday.

Carrie: [00:03:15] Someday it's going to happen. It's going to.

Valli: [00:03:17] Happen one day.

Carrie: [00:03:18] Going to happen.

Valli: [00:03:18] Yes.

Carrie: [00:03:19] Well, I know that people can go back and listen to episode 29, but just to give everybody a frame of reference for Through the Fog and what we're going to talk about, is there anything you just want to give a background about for your kids or your backstory?

Valli: [00:03:38] When was episode 29? What was the date? I couldn't goodness.

Carrie: [00:03:43] I'd have to go back and look. I want to say, I mean, it was before you had your children's book. You were just releasing it and remember I had just ordered it.

Valli: [00:03:58] Okay, because that was February 2020.

Carrie: [00:04:01] Okay. So I think it was right after that because you talked about having to cancel all of your, like, book. You know, you were going to go on your tour with Harper and then we shut down.

Valli: [00:04:14] Yes. Wow. That seems like yesterday. And it seems like a lifetime. So, yeah, I mean, I'm not going to bore your audience. You're my bio. My gosh, that's embarrassing. It's kind of long, but, yeah, I'm just, uh. Now my kids are. Well, now a junior and senior in high school. Battle and Harpe;  Battle’s the oldest. He's who the blog is named after. And I started writing about kind of what it was like raising two kids with hearing loss and being a military wife and, um, all different aspects of my life, but particularly, you know, focused in on what it was like to raise two kids with hearing loss. So.

Carrie: [00:05:00] Yeah. And so you went from this blog and social media presence to, hey, I'm going to write a book. So how did that what prompted you to go from that blog to a book?

Valli: [00:05:14] It probably depends on what day you asked me if the story changes. Um, because it's a blur. It's a bit of a fog, but I didn't actually have any motivation to write a book, so it's just kind of still baffles me that one came to fruition. That was my story. I thought our next book would be another children's book, this one about B attle, because the first one is about Harper, and we're creatively that one's in the works. But. I think what it how it initially came to be was I was doing a lot of speaking engagements, and I thought it wouldn't it be nice to have something when I am there to, for people to leave with? There was more about my story, not my kids. And so I talked to one of my best friends from college, Vinnie. She writes the opening, the introduction in the book. She had helped edit my children's book, and I asked her if she'd be willing to help me edit some essays that I'd already written together, and just I was going to self publish and it wasn't going to be a big to do. Oh my gosh, I think it must have been getting Vinny involved because what she did, she does nothing.

Valli: [00:06:36] Halfway. She printed out everything that she dug and dug and printed out everything I had written. And she's like, I'm going to send this to you. I want you to print it, and I want you to lay it out on your dining room table. And when I did that first I was overwhelmed. It was like 25,000 plus words. And the themes were just jumping off the pages, which was navigating, navigating through the fog. It was just I didn't purposely have that metaphor. It was just all over the place. And then she's like, I think this is more than just putting some essays together. I think you really should rethink this. And then that's kind of where we started adding, you know, I added more stories, lengthened stories. It if I had been more patient, the book probably would have been fleshed out even more because, you know, you put these kind of deadlines in your head. And so I was trying to really make that deadline. Um, so and at a certain point, you think, okay, I'm done, I need to just stop or it'll never. You hear people or spend 20 years writing their book.

Carrie: [00:07:49] Right.

Valli: [00:07:50] So that's kind of how it evolved.

Carrie: [00:07:53] Yeah. So you were talking about spreading everything out on your dining room table, and then the theme kind of popped out like through the fog. Do you want to expand any more on the title and.

Valli: [00:08:08] Well, I think I realized that in every experience in my life, I had gone through, like most people, like, periods that felt like you're kind of in a fog. You don't have your footing, you can't see clearly. And then after the fog comes the light, the rainbow, after the storm. And like I realized that pattern was just kind of throughout every experience I had had. And it I mean, it was really profound. During the initial hearing loss, when Battle was identified with hearing loss at birth, it literally felt like we were living in a fog. I mean, like I can remember like yesterday and he's 18. Like I can remember just feeling a fog and then just realizing how we got we got through that. And then there's another fog and then we get through that and it's just a constant all. And so the theme for me is just always keep looking for the light like fog was going to come and go. It'll be dense sometimes it'll be hazy sometimes, but there is always light. You just have to believe. Yeah. I mean it's so corny, but it actually, no.

Carrie: [00:09:22] It's not corny.

Valli: [00:09:23] It was an actual pattern in my life that I didn't ever really put together.

Carrie: [00:09:30] I was thinking about you. I was just sharing that. We drove down to Charlotte from Ohio a couple of days ago, and I would say 80% of the trip is going through West Virginia and Virginia, and you're driving through the mountains. And it was I knew we had this podcast coming up about through the fog. And I'm like, this is so true, because that's exactly what I was going through, through the mountains. I mean, it's just a good visual. And you're driving through the mountains and it's clear and then like one second later you can't see in front of your headlights because there's such dense fog. And then you get through and there's little patches of fog and then there's sunlight. So it is a very good visual for your book. And I was thinking about you as I was driving.

Valli: [00:10:15] I love that, you know, I just hadn't thought of this either. But we live. I write about it. I think in the opening chapter about we have settled in our favorite little beach town in Southern California that's known for what they call June Gloom. It's a coastal fog, and we kind of live up a canyon, but we can see the ocean like I'm looking at it right now, but the fog rolls in. It's just part of what living here is like. And then almost always, you can it's guaranteed that eventually it's going to part and you're going to see the sun. And I've never stopped appreciating like that. Cool coastal dewiness reminds you where you live. You know, you can smell it, you can feel it, but you can't see the ocean. And then it clears and it. And I'm grateful for it every time. Like my kids are annoyed by I'm. It's my favorite sun. It's my favorite sunshine day. Like, because the sky gets blue. The air is crisp. It's like it's so perfect and I live. This is where we live. We live in a fog of coastal fog.

Valli: [00:11:27] Yeah.

Carrie: [00:11:27] So again, a great analogy for the title of your book. So and so when you had all this on your, on your table with all of these papers and different stories and essays that you have written, can you share how you really thought about your chapters and how they were set up that collection?

Valli: [00:11:53] My process was kind of an interesting one. I think initially it would seem that it would have made sense to start in chronological order, but then somewhere along the way, I just left that whole idea and kept adding stories from childhood. Or as when I'm a newlywed or.

Valli: [00:12:20] Um.

Valli: [00:12:22] Because what that really and one of my editors was not such a fan of that. She's like, I think it would be, you know, here we are in chapter 15, and I'm talking about my marathon before I have kids, and I got hypothermia and went down. And it's a whole kind of signature kind of part in my running journey. She's like, I think if that came before, it would make more sense about some of the feelings you're having once you have kids. And I'm like, but for me, what makes sense is. I didn't learn the lessons in life linearly. And so I didn't want the story to read. I didn't want to say. For you to be reading it and go, oh yeah, that makes sense. Oh, it makes sense that you married someone in the military because your were military child, it's like, um. Because I think even talked about my childhood. Being in a military family comes somewhere in the middle, middle of the book, where I start with meeting my husband in the beginning of the book. So I feel like it was just organic how that kind of came together. It did annoy a couple people who wanted those, you know, to be more of an obvious, I shouldn't say, annoyed. But, you know, they wanted the metaphors to be more obvious. And I was like, but it hasn't been obvious.

Carrie: [00:13:53] And probably some of those stories, you didn't really know what the message was until you were later on and reflecting on it. You didn't know what that was in the moment. So it makes sense that when it kind of was clear to you to put it at that point in your life or the book.

Valli: [00:14:12] Yeah. And I would I would be curious. My daughter just reread the book this summer.

Valli: [00:14:18] Oh, did she picture.

Valli: [00:14:19] Of her sitting in our backyard in our pomp? What are the pompous chairs?

Valli: [00:14:24] Oh, yeah.

Valli: [00:14:25] A papasan chair. It's like those big cushion chairs, outdoor chairs. And she's sitting in it reading. And first she was like, mom, that's a really good book.

Valli: [00:14:39] Which I thought was cute.

Valli: [00:14:40] She complimented me, but she said, yeah, I didn't even realize like some of the the themes till I reread it the second time. Like it made more sense and I thought, oh, that's kind of cool. She knows me. And she still picked up on something different.

Carrie: [00:14:56] And that was one of my questions later on too, is did your kids read the book and what what was their reaction reading about themselves from your point of view.

Valli: [00:15:10] Yeah, so battle hasn't read it. I think he might have read his one chapter. That's like kind of a love letter to him. I left it on his bed with a little note and said, I know you're not going to read the whole book, but, you know, I think it was on his birthday. And I was like, but this is for you. Like, I don't know if he read it, but Harper was my first reader. She read it when I got my a proof copy, and she read it when it first came out, and then she just reread it. So like a year later. And her reaction, she's like, it's really weird to read because I know you, but you're you're you're a mom. But then you were like a you were like a person. You were a child.

Valli: [00:15:52] You were.

Valli: [00:15:53] A newlywed. Like I you know how kids don't really see them, their parents that way. And she's like, and you're talking about me. And it's weird because I was there, but I don't remember that. And so it was I think it just a lot of light bulbs went off for her.

Valli: [00:16:11] That's so neat.

Carrie: [00:16:12] Well, hopefully that's supportive. Yeah. Well Battle read it like when you know he's 35.

Valli: [00:16:20] Yeah.

Valli: [00:16:21] And if he doesn't want to read it I think he's not not reading it for any reason other than just. Hasn't made the time to do it, so.

Valli: [00:16:31] Yeah, but.

Valli: [00:16:32] She's more, you know, she's my writer, so I think. It was more interesting for her because she's. And she probably likes that she's, you know, the star of a book.

Carrie: [00:16:43] Well, throughout the book, you also write a lot about what you were so vulnerable and open, sharing different stages of, you know, grief and shock and just kind of coming to terms with things. What was. How was it to write about all of that, knowing that anybody can buy this book and read it?

Valli: [00:17:09] I think the only way you can publish a book that's so personal is you can't think about that. You cannot be self-conscious. Like sometimes. Now I'll think, oh my gosh, what if I decide I actually don't want to share that? I can't. That's out of the, you know, the genie's out of the bottle, but I just didn't think of it that way. I just was telling my story. And I'm not telling anyone else's story. I think that's the key is to stay true, to like my siblings see certain things differently than I do. My mom sees things differently. Sure, my husband would. My kids. I'm not very careful not to tell their story because I didn't.

Carrie: [00:17:58] Ask you about your husband. Did he read the book?

Valli: [00:18:01] I don't think he's read it completely either. I think his fear. Is it'll make him feel bad for. Are guilty for so much of the time not being there because of his military career. And I think he already feels guilty about that. And I think he fears that this will make him feel certain way. And I'm like, well, don't flatter yourself. It's not. It's not that much about you.

Valli: [00:18:35] It's about my experience.

Valli: [00:18:36] But that is a. That was a big part of what made it so hard. I was often doing it alone. Yeah, it was hard.

Carrie: [00:18:44] Yeah, well, I mean, putting those words out for other people who are going through the fog in their own journey, I'm sure is helpful to know that, hey, there's other people that have gone through the struggles but have seen the the light too.

Valli: [00:19:03] Yeah.

Valli: [00:19:05] I, I just love storytelling, I always have, I love reading and hearing other people's stories. And so probably the most meaningful thing that's happened besides having this for my kids, for them someday, is having people who connect in different parts resonate parts you would never expect, like the story I shared about being on my yoga mat and having a complete breakdown. I've had quite a few people say I have had that moment over something different, but literally come to Jesus moment on a yoga mat. And runners of the parts of my marathon training have resonated with runners. A lot of people about grief, of losing people because my dad and he. It's not a I'm not giving anything away, but he dies when he's 50 and that really shapes me. And people who have lost loved ones particularly young, that really resonates. And I love that because it just connects us.

Carrie: [00:20:18] Yeah, well I had I'm going to ask you if you have a favorite chapter, but I picked out a couple of points that kind of resonate, resonated and I thought would resonate with listeners too. So do you want to share your favorite chapter, or do you want to hear some of the things that I picked out?

Valli: [00:20:37] Oh, really excited and curious to hear what you have to say, and I would. I have some chapters. Like every once in a while I'll skim through it when somebody refers back to something because it's almost like it's a big blur. You would think I would know where every single word was, but like someone will say, I loved this part and I have to go digging for it, and sometimes I'll skim and. And there are still parts that make me cry. And I would say one of the most. Poignant moments.

Valli: [00:21:13] Um.

Valli: [00:21:14] There's a lot, but. I love the story I shared about my dad in the van, my mom backing into his car. With her custom van. And then I also love the description I use sharing me and my son snorkeling together and seeing that sea turtle and him putting his hand on my shoulder and giving me like a thumbs up that you've got this mom, because that visual is still crystal clear in my head. And now I have it in like an essay. So, you know, when I'm, you know, God willing, 9500 years old, that memory will still be there. But they're like your kids. They're all your favorites.

Carrie: [00:22:04] Okay, well, I have a couple of things that I thought I would ask, so. And I and I wrote something down. So I'm going to read a couple of things because like you said, you probably need to jog your memory. Right. So in chapter 16 it was titled I Am here. And you talk about throwing up the white flag and dragging yourself into a therapy room. And I think as women, as mothers, as caretakers, we sometimes think we need to carry all of that weight and be strong at all times. Can you share how you came to the realization that we, whoever is listening, also need to throw up that white flag in certain situations?

Valli: [00:22:48] I hope I have friends that write about it. They write about therapy. They write about depression, mental health. Like a lot of my online circle of authors and friends write a lot about it. And I think the more we normalize. These discussions that motherhood. Parenting is hard. A military. Being a military spouse is hard, like losing a loved one is hard. Having a child identified with something out of the ordinary that requires extra medical is hard and just being allowed and safe to say. It's hard. It's both. I think I do write about it can be both. It can be hard and amazing and it doesn't make you feel. It shouldn't make you. Anyone think you're a bad mother. You're complaining. You don't. You're not grateful. Um, I think therapy. I'm a huge fan of therapy. I am a huge fan for my kids, for my marriage, for myself. Like I think it's so even when things are good. To just reflect and make sense of things. I think it's just I think it's really healthy. So I went a long time in life thinking I just needed to suck it up and put on this. I don't know, perception that I was just so strong. And I had a moment. I'm not going to go into it, but where I was walking my dog when it happened, and I just felt the weight of what I had endured on my shoulders like. This has been hard. This has been really hard.

Valli: [00:24:43] We need to talk about the hard more. So people don't feel as alone because most likely someone else is going to throw their hands up and say, oh my gosh, me too. Like, I had a my first piece I wrote about military being a military spouse and deployment.

Valli: [00:25:30] Went.

Valli: [00:25:31] Viral.

Valli: [00:25:33] And.

Valli: [00:25:33] I could not believe how many people were saying, oh my gosh, me too! I've always wanted to say this, but I was afraid I was going to be judged. People were going to say, well, you knew what you were getting into or you're not, you know, you're not supportive, you're not patriotic, you're not this, you're not that. And it was like almost like ripping the band aid off to say, yeah, I, I'm married to a colonel in the Marine Corps. I've been with him his entire career. I've never stood in the way. I've been a supportive spouse, and it's been hard.

Carrie: [00:26:11] Yeah, well, I think putting that out there so other people realize it's okay to put the white flag up and wave it and be like and have a community of people that you can go to and talk to. And whether it's professional or your so-called friends and family around you is so important too. Yeah.

Valli: [00:26:34] For sure.

Carrie: [00:26:36] And then there's another chapter that you talk about being in the trenches and how one day you woke up and you have teenagers. So and that chapter, you reflect on decisions and emotion that you had and have as a hearing parent raising two deaf kids. So statistically speaking, that's probably like 90 to 90% of families. What can you say to parents or professionals listening today of like being in the trenches at the moment? And then all of a sudden you have they they grow up, but reflectively as a hearing parent, do you have any anything that you want to say?

Valli: [00:27:18] Oh, geez. Well, first, you know, it's very annoying when you have two toddlers, but when people say go so fast. But it's true. The day, the days are long and the years are fast. Is that the saying? But. Particularly people who are in a really hard maybe phase or season. You know, I can think back to like the pulling the devices off, if that's the route that, you know, if you're dealing with hearing aids or cochlear implants and. You just think it's never going to end and it totally ends. It's like phase. And I think that's why another theme in addition to The Fog is grace. And it took me a long time to be able to give it to myself. And I think that is what I would tell parents is to just give yourself grace through the process. It's, you know, it's challenging and it's okay to. You're going to make mistakes. You're going to sometimes maybe feel judged. You're going to get the opinions of so many people who want to tell you what you should do, how you should do it. I mean, that's just true in parenting in general, but. And with the internet because my babies you know, it's I write about it that, you know, it's before Facebook, it's before there's no social media groups and people can't comment and tell me, you know, I've made the wrong choice, or I should do this or I should do that. Like sometimes. Maybe parents now need it can be helpful to have that social media and. That connection, but it can also be too noisy. Letting the opinions of a few. Drown out what you think you know you've decided is best for your family.

Carrie: [00:29:22] Yeah, that's good advice. I like that it's it is noisy and so how can you kind of clear some of that fog. Right. That you, you talk about so you know and feel in your heart that you've made the best decision for your family.

Valli: [00:29:38] Yeah. I think also be willing. I feel like luckily we were pretty open to pivoting. And learn as we go. I didn't think I had to know it all. And if we had tried something that didn't work, we were kind of open to trying something different. So don't dig in and be set. There's not one way. And each kid is so different. I mean, I have two kids, same syndrome, and they experience it so differently. It's really they should be studied these two. They really should. I mean, I think siblings would be a really interesting. Thing to look at is just how different their experience is.

Carrie: [00:30:32] Right? Yeah, I know we always say like, especially if you have a boy and a girl like you do, like they live under the same household with the same family members, how can they be so different in different things? But it would be interesting to as far as hearing loss goes, to see if there's anything that stands out that way.

Valli: [00:30:53] Yeah, I think it would be. Um, and then the flip side, they're so different. Yet sometimes, like last weekend, we were at my brother's house and the two of them were in the pool together. It was just the two of them. And they were talking. It was probably for like two hours straight.

Valli: [00:31:12] Um.

Valli: [00:31:13] Floating and talking. And I'm like, they have a connection that is like nobody else in this world has, like, the two of them. It's it's really fun to see.

Carrie: [00:31:25] So just a side question. Did they do they have water devices for the cochleas or were they like just trying to read each other's lips or what were they doing.

Valli: [00:31:37] So in this case, they both had their devices on without the water cases, which, you know, normally I'd be like, you know, we're on, we're on a trip. This is a bad idea. But it was like kind of they kind of controlled the environment of just floating.

Valli: [00:31:51] Yeah.

Valli: [00:31:52] But even when like. So Battle will use his water ear and Harper because she still has residual hearing on one side. She's only single a single. What's it called.

Carrie: [00:32:04] Bimodal or. Yeah.

Valli: [00:32:06] Bimodal.

Carrie: [00:32:07] So yeah.

Valli: [00:32:08] Yeah.

Valli: [00:32:09] So she still has a residual hearing which she shouldn't really be able to make out speech as well as she does. But it's as if she's still wearing her devices. It's strange. They can communicate.

Valli: [00:32:25] Um.

Valli: [00:32:26] Yeah. It's.

Valli: [00:32:27] Yeah, it's.

Carrie: [00:32:28] Well, that was a little side note when you said that. I was like, oh, that's interesting. That connection between between them.

Valli: [00:32:35] But parents piece of advice, if your child is not 18 and doesn't understand actually, you know, impulse control and all this stuff, I would never let them be in a, in the water with their devices on and think they're not going to go under like.

Valli: [00:32:51] Right. Yeah. It's been a lot of.

Valli: [00:32:53] Years in the making and all their cousins know and everything. So like you're not going to jump in and Cannonball and.

Carrie: [00:33:00] Yeah yeah yeah.

Carrie: [00:33:02] And then you have a mini heart attack in the process. Right. Thinking about that. Oh so you did know earlier that the days are long, but the years are short. And since writing and publishing this book, Battle and Harper are a little bit older and entering almost into, like the young adulthood of you, late teens and 20s. Before long, if you could add another chapter to Through the Fog, what would that title be and would do you have any thing that you jumps out to share?

Valli: [00:33:40] Oh, dear.

Valli: [00:33:42] That chapter still being written because now we're in the Battles going into senior year, and he's been been pretty heavily recruited for football. So we're going through this whole process pretty I mean, it's early in. He still has a senior year ahead of him. But it's the preparing to launch. And I know this is going to be filled with lots of stuff.

Carrie: [00:34:09] Yeah.

Carrie: [00:34:10] So that's the title preparing to launch.

Valli: [00:34:12] Right to launch.

Carrie: [00:34:14] Love it.

Valli: [00:34:15] I'm tethering. Just trying to mentally prepare. Um, baby steps I can't imagine. I mean, I still can't imagine.

Carrie: [00:34:26] Yeah, it goes like you said. It goes really fast. I have a daughter who will be a senior this year too. So that lots of decision to be made in the next year.

Valli: [00:34:38] Yeah. It's again, how did we get here? I'm so proud of the kids though. I mean, I'm it is really this stage in life is so fun to see who like they really are. You know, you see who they're becoming. And I love hanging out with them. You know, it's traveling is fun. Like, just hanging out is fun. They're really interesting, cool people. I like the people they are so.

Carrie: [00:35:08] Yeah.

Valli: [00:35:09] Worth the wait.

Carrie: [00:35:10] It's worth the wait. In the moment it's hard. But reflectively you get through and you're always going to be their mom. So you're always going to have some kind of fog that you're going to be looking through.

Valli: [00:35:25] Exactly.

Valli: [00:35:26] That's what my mom says. She's like, you think kids are stressful? Wait till you have grandkids. You know, you worry about them even more. I'm like, oh dear goodness. But that's what for anyone who's in the fog, you know, and you in the young, you know, the younger years.

Valli: [00:35:45] Um, it's.

Valli: [00:35:46] Just like, stay the course. It's gonna pay off everything you invest in your kids. It does. It pays off.

Carrie: [00:35:53] And then you enjoy it differently later. Later on.

Valli: [00:35:58] Yes.

Valli: [00:35:59] That's the goal.

Carrie: [00:36:00] Yeah.

Carrie: [00:36:00] So wrapping up today Valli with today's episode. Do you have any final thoughts that you want to share?

Valli: [00:36:09] Besides, I hope we get to see each other in person.

Valli: [00:36:12] No.

Valli: [00:36:14] I don't know. I hope that people will support the book. It's, you know, it's a labor of love. I don't have a marketing team. It's just me. It's available on Amazon. I love hearing people's feedback. Um, the reviews are very helpful. And then just following along on social media so we can connect. I really read every comment. I respond to as many as I can. My message is like, I love connecting with people and hearing their stories. So, um. I would love to hear from people.

Carrie: [00:36:51] Well, I just want to say thank you again for being a guest on the empowEAR Audiology podcast. And like I said earlier, I will link up the previous episode if people want to go back to that. And as you said, people can get onto your web page, My Battle Call and I can link that up too. And they can find your book on Amazon and order it and have it delivered right to their house, too.

Valli: [00:37:19] Oh, I know.

Valli: [00:37:19] What I was going to say is for organizations, audiologists, class classes, groups, I can also do bulk author copies for a better rate and ship them right to those. I've done it for quite a few. Our audiologist has a stack of them on hand that she gives out to new parents, and so somebody if anyone's interested in that, I'd love to offer that for people. They can contact me through my website. I think my email address is on there or through any of my social media. They can message me, just say they heard about the book. Book bundles.

Carrie: [00:37:57] All right. Well, that's a great way to get the book out there, and probably a great tool for parents to have and read. So again, thank you, Valli, for being a guest. And, um, I can't wait to meet you in person sometime soon.

Valli: [00:38:14] Thanks, Carrie. Take care.

Announcer: [00:38:16] Thank you for listening. This has been a production of the 3C Digital Media Network.

Carrie: [00:00:14] Welcome to the empowEAR Audiology Podcast, a production of the 3C Digital Media Network. I am your host, Dr. Carrie Spangler, a passionate, deaf and hard of hearing audiologist. Each episode will bring an empowering message surrounding audiology and beyond. Thank you for spending time with me today, and let's get started with today's episode. Welcome everyone. It is Educational Audiology Awareness Week and this is going to be from October 16th through the 20th and it's 2023. And it is an honor to be able to coordinate with the Educational Audiology Association leadership to spread awareness. The goal of the Educational Audiology Awareness Week is to foster public awareness and knowledge of educational audiology services, including the benefits that these essential services provide children, their caregivers and other professionals. And the mission is to educate our stakeholders by enhancing interprofessional perception of educational audiology and strengthening community knowledge through promotion, outreach and advocacy efforts. And today on the EmpowEAR Audiology Podcast, I have leadership from the Educational Audiology Association. Joining me today, I have Dr. Tori Ashton, who is the president elect of EAA, and Dr. Kathi Riley, who is the vice president of Advocacy. And I'm just going to share a little bit about both of them, and I'm going to welcome them onto the podcast.

Carrie: [00:01:57] So we have Tori, who will be starting her ninth year as an educational audiologist with a cooperative educational service agency number 4 in Wisconsin. She provides services to 12 school districts within a 60 mile radius. Tori started as one of the Wisconsin state reps for EAA and then became the VP of Membership and Public Relations for three years, and she is currently the president elect for EAA. And I also have Kathi with me, who was an educational audiologist for 34 years in Delaware, where she provided services to students at the Delaware School for the Deaf and provided outreach and consult services across this tiny state through Delaware statewide program for the deaf, hard of hearing, and deaf blind. She now teaches educational audiology and oil rehab at the university level. Kathi has been an EAA state rep for Delaware for many years and she joined the advocacy committee a number of years ago and accepted the role as VP for Advocacy two years ago. So Kathi and Tori, welcome to the podcast and I'm so excited to collaborate for Audiology Educational Audiology Awareness Week.

Tori: [00:03:19] Hello.

Kathi: [00:03:21] Thank you.

Carrie: [00:03:22] Thanks for being here. What an exciting week as we kick off this week and just to kind of get the conversation started, I thought I would ask Tori or I mean, Kathi, how did the idea of Educational Audiology Awareness Week come about?

Kathi: [00:03:42] Well, it actually happened very organically. We had a member who on our community page, our listserv posted a request for ideas and templates for creating a PowerPoint. She was asked to do a professional development activity for her school district and she was looking for some ideas. That then led to several responses and one member kind of sparked this idea that we could create a national EAA day or a week to promote our profession. So the idea was approved by the board, and then a subcommittee was set up for this project and it was placed under the advocacy umbrella.

Carrie: [00:04:29] All right. And that's how you've been really involved in this. And Tori for listeners who might not know what the Educational Audiology Association is, can you share a little bit about this great group?

Tori: [00:04:43] Yeah. So we are an international organization that consists of audiology or audiologists as well as related hearing professionals. So that could be speech language pathologists, our teachers of the deaf and hard of hearing. We provide a full spectrum of hearing services to children, primarily those in educational settings.

Carrie: [00:05:05] Okay. And so when we have an educational audiology week and we're really focusing on that, how is that different than maybe a pediatric audiologist or a clinical audiologist? I feel like there's so many different roles that audiologists can play, but what is kind of that difference with education?

Tori: [00:05:26] Sure. So the difference mainly is or I feel is the location that we work in. So for educational, obviously we're primarily in the schools. Um. You know, we do a lot of similar things to clinical or pediatric, but there's also things that we do that aren't done at the clinic. So we might assess how a student is hearing in a classroom, um, provide accommodations and modifications for them so that they're successful in those classroom settings. Um, we also help schools with hearing screenings and promoting good listening environments with classrooms. Um, and then just making sure our students have the full access to their education. Where clinical is more in the clinic testing, hearing, fitting the hearing aids. There is um, collaboration between the two, but also a lot of cross of what we do. Kathi, i f you have anything you want to add to that?

Kathi: [00:06:29] Sure. You know, I think one of the issues is that programs, most of them do not have strong educator national background provided in terms of educational audiology. So the learning curve is very steep from being a clinical audiologist to being an educational audiologist. Educational audiology requires you not only to know all of your audiology, but also to understand the entire education system and how it works. We all know both regular and special ed law. We focus on classroom acoustics and how the environment impacts access to instruction. We coach teachers on effective teaching strategies. We manage and fit their hearing assistive technologies across the school day, which might look different in different environments. We take data on the effectiveness of those and we make recommendations for changes to their IEP or 504. We sit in on those meetings and we are an advocate for the student.

Carrie: [00:07:41] And does a student legally need to have an educational audiologist on their team, or is this just something that might be nice to add?

Tori: [00:07:56] I mean, legally it is in IDEA that they have access to educational audiologists. Um, each state does have different criteria that to for a child to receive an IEP or to qualify for a 504, you do have to go through the steps and show the evidence that they do need those added supports. Um, but legally, yes, they can all have access to it if they qualify for it.

Kathi: [00:08:24] Right. Right. That makes.

Carrie: [00:08:26] Sense. Go ahead, Kathi.

Kathi: [00:08:27] We are also working on strengthening the regulations around children who have 504s and their access to educational audiology. Educational audiology is by far the least utilized service that appears in IDEA. And there's a misconception that it is only a medically based service rather than an educational service. So we are working hard as an organization to change that perception and part of our EAA awareness week is to get the word out about who we are and what we do.

Carrie: [00:09:05] But that makes a lot of sense.  In addition to the advocacy that we do as educational audiologist for students who are deaf and hard of hearing, who have maybe auditory processing, different auditory needs within the classroom, educational audiologist are also concerned about ALL kids who are learning in the classroom. And I know through the advocacy work that EAA has done, you have been working on a couple of different projects that really promote access for any child that is being educated. Do you want to share a little bit about some of those other projects that EAA is working on?

Kathi: [00:09:53] Sure, um, part of our role in the advocacy committee is to create resource documents that provide best practice or best guidance, best practice guidance for educational audiologists in a wide variety of situations and responsibilities that we encounter. And we hope that those members then can use those documents to advocate for specific practices and share that with administrators, teachers, school professionals. So one of the things we've been working a lot on lately is hearing screening importance, and ASHA is actually rewriting their guidelines for the practice portal. So we've been involved in that. And oversight of the hearing screening program is one of the responsibilities that is written into IDEA for audiology. So we've been working a lot on that arena, especially on a document that explains the legal rights of hearing screening for children with significant disabilities who are often overlooked or marked as could not test. We also have another subcommittee that's working on classroom acoustics. So we have a committee that has not only audiologists but researchers and an architect and an acoustical engineer. And we are working hard to update classroom acoustic regulations across the US. So part of that work we created a one page document that explains the components of acoustics and how it decreases auditory access for deaf and hard of hearing children, as well as other children with special learning needs, such as kids with auditory processing disorders, children who are English language learners, children who have attention issues, and a whole host of other kids. So we're really proud of that and we hope that educational audiologists will share that with their school teams.

Carrie: [00:12:00] That mean educational audiologists really wear quite a few hats when you think about it in the school and educational setting from the advocacy piece to actually working directly with students and teachers and teams and parents and everyone that is involved. So it's exciting to be in the schools and be an educational audiologist and this week is so amazing because we get to really promote everything that we are doing. And one of the things that I thought we could talk about next would be what are some of these activities that we have planned for Educational Audiology Week? Does somebody want to just share some of the excitement that's going to be happening this week?

Tori: [00:12:52] Yeah, I can touch on. So for like social media, we are encouraging, you know, all educational audiologists to share on their social media throughout the week. Um, you know, whether it's sharing those advocacy documents that we have, um, different graphics that might be posted up by EAA if they reshare them and just kind of getting the word out that way. Along with that, We do have two primary hashtags that people can use when they're making their posts. We have hashtags for #EdAuDweek and then at #EdAuDadvocacy.

Kathi: [00:13:31] Right? The other things that we're working on is a Zoom background that educational audiologist will be able to download. And we actually have come up with three of them. One is for Educational Audiology Week, and then the other two are simply Educational Audiology Association and those are going to be approved by the board hopefully next week and then they'll be posted on our. You'll be able to, to find them by using the QR code that we have created. So the educational audiology QR code right now that page is blank, but we are working on getting everything uploaded into that. Unfortunately, Facebook has really restricted who can have a ribbon. So you know that frame for Facebook, you have to be an approved and recognized organization. So that won't be able to happen this year, but we hope to have it in the upcoming years because we do expect this to be an annual event in the third week of October.

Carrie: [00:14:48] Okay. So that was another question. Is this going to be an annual event? And Kathi, you just said that it will be. So that is that is exciting, too. For the activities. Do you guys have different topics that you're going to kind of be sharing out on social media every day that really highlight educational audiologist or educational audiology week or that a surprise for all of us to see this week?

Kathi: [00:15:17] We actually are targeting different groups every day. So our infographics will be hopefully valuable to a variety of stakeholders. So school administrators, parents, clinical audiologists. I actually forget what the other two are. But we have a different we have a different focus for every single day. And we have different team members from this subcommittee who are putting together the resources for that.

Carrie: [00:15:50] Well, what a great way to share out and for educational audiologists to have access to important resources to share with their school teams and families and whoever they might might might need to raise that awareness about for educational audiology during that week. Is there anything else that you guys can think of that you want to share as we kick off Educational Audiology Awareness Week?

Tori: [00:16:18] I think we're all just very excited about it. This is something new and a great way for us to obviously bring what educational audiology is more out there to everyone, you know, whether it's our schools, our families, just explaining what we do and then how we can support schools and our students.

Carrie: [00:16:41] And how would people make sure that they're getting that information if they maybe if they're not a member of EAA, how can they find membership information and how can they make sure they stay in the loo this week as we kick off Educational Audiology Awareness Week?

Tori: [00:17:01] And they can always go to our website which edaud.org. And there's all kinds of information not only about this week and what will be taking place and different links to our um, you know, like our zoom backgrounds like Kathi mentioned and those different. Outreach advocacy documents, but also about our membership and who we are and just more information about us as an organization.

Kathi: [00:17:31] And don't forget social media. So we have a team that works on social media. And so there will be posts on all of our social media sites. So that's a great way to take a quick look at what's there and download it and share it with colleagues.

Carrie: [00:17:51] Yeah, share it, put the hashtag out there for everyone and it would be a great way to promote. So Tori and Kathi, thank you for joining today for the kickoff of the Educational Audiology Awareness Week. And we're just hoping that all of our members and hopefully new members really join us and promoting everything that we have to offer as educational audiologist in the schools. So thank you.

Tori: [00:18:20] Thank you.

Kathi: [00:18:21] Thank you.

Announcer: [00:18:22] Thank you for listening. This has been a production of the 3C Digital Media Network.

Carrie: [00:00:14] Welcome to the empowEAR Audiology Podcast, a production of the 3C Digital Media Network. I am your host, Dr. Carrie Spangler, a passionate, deaf and hard of hearing audiologist. Each episode will bring an empowering message surrounding audiology and beyond. Thank you for spending time with me today, and let's get started with today's episode. Today I have two guests from North Carolina with me, and I am going to take a second and read a little bit about their bios. They are an SLP and audiology duo. I have Erin Thompson, who has been working with the Children's Cochlear Implant Center at University of North Carolina since July of 2004. She earned her bachelor's from Appalachian State University and her master's in speech and hearing science from UNC Chapel Hill. She became a listening and spoken language specialist in 2009. Erin conducts listening and spoken language parent participation sessions, speech and language diagnostics for children who are deaf and hard of hearing. A passion has been mentoring students and professionals across North Carolina, the US and abroad. Erin has been a member of the Global Foundation for Children with hearing Loss and has traveled to Vietnam on three occasions and also Mongolia on one occasion to help provide mentoring and training abroad. She has spent time coaching a team of speech language pathologists in Auckland, New Zealand. Erin expanded her interest in 2019 to include the role of Family Care coordinator for the Children's Cochlear Implant Center at UNC. She helps manage, facilitate and coordinate cochlear implant consultation referrals supporting all families through the CI consult process at UNC. I also have Dr. Erika Gannon. She is earned her bachelor's and doctorates in theology from the University of North Carolina at Chapel Hill. She is a pediatric cochlear implant audiologist at the Children's Cochlear Implant Center at UNC. In addition, she is the Audiology Clinic manager and program director of the CDP Grant. Erika's research interests include pediatric cochlear implant, device use and pediatric electric acoustic stimulation. Erika enjoys teaching and mentoring students. She co-teaches the cochlear implant course to UNC's audiology graduate students. So Erin and Erika, welcome to the EmpowEAR Audiology podcast. I'm so excited to have both of you.

Erin: [00:03:03] Thank you so much for having us. This is really great.

Carrie: [00:03:07] Yeah. So I know before the podcast started, we spoke a little bit and I had heard Erin talk at, I believe, the AmErikan Cochlear Implant Alliance Conference as well as the EDHI conference. And then as I reached out to Erin, she also looped in Dr. Gannon and Erika. And we to talk about two important topics today. And I am really excited for our listeners to hear all about their work with full time use of hearing technology and its impact on language development, as well as the importance of co-treatment and strength based coaching to impact device where time and probably many other things with strength based coaching. So I am glad both of you are here and because this is kind of a audiology, professional and related services podcast, I always like to find out from my guests, how did you actually venture into the field of audiology and speech language pathology? So I don't know. Erin Do you want to start with your venturing into speech language pathology?

Erin: [00:04:23] Sure. This is kind of funny because I think it's kind of a throw out to like all the moms out there who encourage their kids or think, Hey, you'd probably be really great at X, Y or Z. And my mom in high school was like, Really I think you'd be great as a speech pathologist? And I took one of those, or she had said that and I had taken one of those personality typing, What should you be when you grow up kind of thing? And speech pathology and audiology were in the top three and I was like, Oh, absolutely not. My mom wants me to do this. No way am I doing this. So I went in. I went to Appalachian, undeclared and undecided. And my roommate at App my freshman year was in the speech pathology program. And so I got to see what she was doing and I was like, you know what? Maybe I do want to take some intro classes. And so I did and loved it and then had the challenge when I graduated from APP. On whether I wanted to go into speech or audiology. I was really torn and then found my my perfect match at UNC as a speech pathologist working with kids with hearing loss. So kind of a perfect fit. So that's a.

Carrie: [00:05:43] Great story about my mom's, right? Yeah. I was just going to say, your mom's always right. Right? Yeah. Um, Erika, how did you venture into audiology?

Erika: [00:05:55] I knew I always wanted to be in health care. I originally thought I wanted to be a nurse and figured out quickly that I don't do needles or blood. And so as I was trying to explore other options that still left me in health care, I had a friend who was in the audiology program and recommended I observe a little bit and I was volunteering at the hospital and got to observe someone like two weeks out from their cochlear implant activation. And I was I was hooked ever since.

Carrie: [00:06:26] Another great story, too. So both of you are at UNC. Do you want to do you want to share a little bit about the Children's Cochlear Implant Center? There you have a lot of great people that are part of your network. So one of you wants to take that lead.

Erika: [00:06:46] Sure. So the Children's Cochlear Implant Center at UNC. We've been seeing children with hearing loss in North Carolina for over 30 years and have performed over 2000 pediatric cochlear implants. We are a part of a multidisciplinary team and we have both pediatric cochlear implant audiologists, speech language pathologists that specialize in listening and spoken language. We also have a pediatric research group in the office as well, and we are a teaching clinic for both audiology and speech language pathology grad students, and we work with a greater interdisciplinary team at UNC, with our pediatric pediatric diagnostic team and our ear, nose and throat physicians.

Carrie: [00:07:30] Yeah, lots of opportunities to see lots of kids and be involved in a lot of research, which kind of is a great segway into the things that both of you are interested in, and that is that language development and how that impacts kids who are deaf and hard of hearing. And I think when you think about the world of pediatric deafness, a lot of the studies talk about the importance of early identification. We have newborn hearing screening, all of those important things. We talk a lot about technology and early interventions as part of language development, but one of the things that is typically not talked about that your group has spent a lot of time on, is that focus on on wear time can you one of you start sharing a little bit about your research and clinical experience in this in this area and why this is really important to consider?

Erika: [00:08:26] Sure. So wear time or getting the objective data from the speech processor regarding device usage for cochlear implants is a lot more recent than it is for hearing aids. We've only had access to this since maybe around 2014 or 2015. And so as this as a clinician, as this information became available, we felt like this was really a game changer because we're like, is this explaining why somebody isn't doing as well as we would want or not making the progress that we'd expected? And so we just we had all of this new information about patients we were seeing, you know, different where time and trends for babies versus teenagers. And it felt like we really had this key piece to something important. And so we really wanted to dive harder into that. And so we've looked at some some wear time information for this youngest group of babies, like birth to three. We have several articles on that. And also have looked a little bit about where time and the single sided deafness population.

Carrie: [00:09:32] So when, as you said, you know, for cochlear implants, this is been about 2014, 2015 that we've been able to have this data logging and hearing aids was a little before that. But again, a lot of great information. Do you as practitioners, whether from speech pathology, audiology? Do you ever ask parents like, Hey, how often is your child wearing the cochlear implant? And then do you ever see kind of a mismatch between what you're pulling up on the computer and what a parent might be reporting?

Erika: [00:10:09] Yes. We always try and ask the question, How's it going? How? How is wear time device use, especially, you know, use of like retention Aids. And unfortunately there is a trend that. Over or over reporting device usage. Parents often say they're wearing it more than the objective data shows. This is a trend in more than just cochlear implants. It's also present in hearing aid literature as well. And I think it's likely just little ones are so dynamic with eating and napping and multiple care providers. I think it's I think it's easy to overestimate the usage.

Carrie: [00:10:47] And that's kind of another way that you started thinking about looking at this was looking at this concept of hearing hours percentage. Can you share or explain what this is and why this might be a better way of looking at things rather than like kind of full time usage?

Erika: [00:11:10] Sure. So full time usage in the literature, it wasn't consistent. We were seeing, you know, 8 hours or 10 hours or clinicians were using phrases like eyes open ears on, which is a wonderful phrase and a and a great goal for parents. But sometimes, you know, that vague term isn't concrete. And then 8 or 10 hours, we were just seeing that, you know.

Erika: [00:11:34] It.

Erika: [00:11:35] Sleep wake time is so different for babies versus teenagers that.

Erika: [00:11:41] You know what is.

Erika: [00:11:41] Actually the best way to talk about wear time. So we noticed trends are like teenagers are wearing their equipment, more toddlers are wearing their equipment a little less. And we started to incorporate the sleep wake into how we define full time use or this hearing hours percentage. This was first published and Lisa Parks age at full time use predicts language outcomes better than age of surgery. In children who use cochlear implants and essentially the takes where time as a percentage of wake time based on the age of the child. So an example is a 15 year old is awake 15.5 hours a day on average. A 12 month old is awake 11 hours a day. If you take eight hours, if we were using, you know, full time use at eight hours for the 12 month old, that's 73% of their waking hours. But for a 15 year old, it's only 52% of their waking hours. So HHP better reflected the age of the patient.

Carrie: [00:12:43] Wow. Just out simple example right there with the difference of the age and the average sleep time really is telling of the you know, what we want to achieve. Is there a. I guess, percentage that as audiologists and speech language pathologist you would like to see for the hearing hours percentage.

Erika: [00:13:09] We would always love it to be 100%, but we are practical. Our research has found 80 to 100% is really the goal.

Carrie: [00:13:19] Okay, that makes sense. So it kind of factors in maybe bath time, shower times, those waking up and just kind of getting started with your day and then kind of going to bed having a couple of hours right there.

Erin: [00:13:33] Yeah. And that's where we really saw the research to show that kids had typical language scores when they hit that 80%. And that's where we were really seeing kind of the magic number kind of all align. 80% equaled some of those those stellar language scores.

Carrie: [00:13:52] Okay. And yeah, I would love to dig a little bit deeper into that as well. One of the other questions I know, Erika, you had mentioned that you there was some different research, too, with single sided deafness. And, you know, we're seeing younger kids get cochlear implants who have maybe typical hearing in one ear and a profound hearing loss in the other ear. Does the hearing hours percentage matter for those kids, too?

Erika: [00:14:25] Yes.

Erika: [00:14:26] So. The information we have for the single sided deafness. Population isn't for language scores on the whole, but we have that linked with single word scores for CNc, and so the higher the hearing hours percentage, the better the CNC outcome. There's also a positive correlation with HP and spatial release of masking scores. So a true measure of binaural hearing. So we are seeing that HP is a factor for those things in that single sided deafness population.

Carrie: [00:15:00] Okay. Do you see that? This is just a sidebar question to more acceptance of the cochlear implant if they increase their wear time to. What have you not looked into that.

Erika: [00:15:14] For.

Erika: [00:15:15] Patients or in.

Erika: [00:15:16] General, just.

Carrie: [00:15:18] Patient? Because I know sometimes they may not always kind of acclimate to the cochlear implant, but do you find that with the increased hearing hours percentage, they may acclimate or be better users of the cochlear implant?

Erika: [00:15:34] What we saw was.

Erika: [00:15:35] That as kids got into their teenage years wear time dropped. And we think that's just a matter of calling attention to something and kind of those really vulnerable teenage years, but started to see an uptick as patients got a little bit older. So I'm hoping once they get past some of those teenage years, we can expand our data and and look a little bit more into that. But honestly, a lot of it was related to age.

Carrie: [00:16:01] Okay. That makes sense too. So I know that article that both of you authored with some of your colleagues titled Age at Full Time Use predicts language outcomes better than age of surgery and children who use cochlear implants. And you kind of touched on this a little bit, but you found that for both receptive and expressive language, age of full time use was found to be a better predictor of outcomes than than the age at the surgery. So in your literature, you also found that it took an average of 17 months for children to establish that use, and only 52% reached that milestone by the age of three. So as you guys are thinking about where you're at in a big cochlear implant center and co treating and certain occasions and thinking about that whole child and the family and everybody else that's involved. Educators, early interventionist. What are some of those factors that might contribute to that statistic? Because I feel like. That is kind of a lower statistic overall.

Erin: [00:17:13] Yeah. So a couple of things there. I'm going to take over for a second and kind of jump in. Um, one of the things is that I want to touch on because I always stress this in our presentations as well whenever we're talking about this. We were finding that full time use is a better predictor of language outcomes at age three than age of surgery. We are just clear, always clarify. We are not questioning or saying that they shouldn't have surgery later, that we still absolutely you know, are proponents and promoting earlier is better. We aren't questioning that. We aren't looking we're not changing that at all. But they do have to wear it after surgery. You can have surgery at any time at six months. Not that we're doing them at six months right now, but eight months, 12 months. But if they aren't wearing it, then it does impact outcomes. Um, but back to the, you know, it takes an average of 17 months to reach full time use and only 52% did that by age three. It's almost, you know, the question of what are the factors that contribute to this.

Erin: [00:18:20] It's almost in reverse of what doesn't impact this. Everything impacts it. Um, some of the first things that we that I think folks notice or think about are any additional diagnoses. Are there other things that are even more of the higher priority for a child's health and well-being is and taking care of of those other health factors. Um sensory needs we find impact where time we of course see differences with different socioeconomic factors, parents schedules, um, kids at home versus in daycare potentially pending what education or what the what the what the the families or the child care providers have been taught about the importance of where time not that they aren't educated, but what have they been taught about where time and how important that is. Um, distance from school, distance from clinics, those kinds of things. Then the access to that education about the importance of, of wear time and then sometimes just the differences in counseling techniques and coaching techniques and, and how have their school providers, clinic providers, private providers, audiologists, um, pediatricians, ENTs explained the importance so many things have have impacted and can impact this these statistics.

Carrie: [00:19:58] Yeah, which is, I think, a great way to kind of get into what your team at UNC has really looked at to try to maybe close some of those gaps and increase the number that reached that milestone by three years of age. And I think our conversation about hearing hours percentages is really an important factor in that too. But one thing that you have shared is that you have talked about the need for strength based coaching, and that's really helping with working with families. Can you share a little bit more about this model too, of co treating with audiology and speech and how this really impacts families as a as a whole?

Erin: [00:20:46] Absolutely. So the the quick, easy definition of co treating is audiologists and speech pathologists working together in an appointment and treating a child and family at the same time. Um, it's something that has kind of been brewing at UNC since 2011 when we actually got to hear Dimitry Dornan and the Hear and Say crew from Australia talk at the AG Bell Conference in Scottsdale, Arizona back in 2011. But then we weren't able to kind of put it into practice at UNC until a few years later. We had our director at the time had to work to find some grant money to help us be able to account for our time because you couldn't bill for coach reading. Um, and so we were able to, to put that in into play in 2015. But in depth it's speech pathologists and audiologists collaborating. We talk ahead of time before an appointment to see what are the needs of that child and family. What are some things that we want to work on together? Um, make a goal. Make a plan. We collect information during the appointments about auditory skills, we use our functional listening index to track audiological audiology skills, audition skills. Um, we are providing caregiver support and that's where our strengths based coaching comes in. And then we are also communicating afterwards. We're talking to local providers, sharing, updating school professionals, educational audiologists, early interventionists, private therapists. So we're all kind of working on the same page. Um. And then that kind of leads into that strength based coaching. Yes.

Carrie: [00:22:44] So share a little bit more about that and how your team's kind of been trained and how that impacts family connections.

Erin: [00:22:53] Um, yeah. So we have all and Erika has done this as well. Think all the audiologists have had some level of training exposure to the formal, um, program, which is through the Center for School Transformation. Um, and it is an Evocative Coaching, strengths based coaching program that we have all been through. Um, and it is looking at things and very asset based, strengths based taking what is important and a strength for a professional, a parent and building off of that. Um, in all very positive ways. Um, it is learner driven. It's what is important to the family and it's based on evocative coaching and positive psychology, adult learning theory, appreciative inquiry and nonviolent communication so that you should do versus how could you what would you want to do? What would that look like moving forward with your family?

Carrie: [00:24:02] So if I would put both of you on the spot here as kind of thinking about all of the topics we've talked about in particular, like maybe you have a family who comes in and says, hey, you know, I'm wearing my child's wearing this device all the time. And as your co treating together, you realize this really isn't what's happening. Would you be able to roleplay maybe a short conversation that you may be having to discover, um, maybe the hearing hours percentage or, um, you know, what are some factors that might be happening that is reducing that  time? Could you use some of those strength based skills to kind of role play for listeners?

Erika: [00:24:53] Sure.

Erin: [00:24:56] All right. I'm going to be the clinician and Erika is going to be our parent or guardian in the clinic. And so I'll take that start of the scenario, Carrie, of, you know, looking at. Okay. All right, Erika, it's good to see you guys today. Pierce is now six months out from getting his implant. You know, you talked about coming in that you're feeling like things are going well and that you're looking at full time. You know, he's wearing it a lot and wearing it all the time. And, you know, we we looked at the data logging and and it looks like it is up from your last appointment. Last time it was around three hours a day of an average and now we're up to four hours. Um, and based on his awake time, um, of about 11 hours a day, that gives us a 36% HHP. And again, that's up from last time. Tell me something that has gone really well over since you were here last time.

Erika: [00:26:05] Yes.

Erika: [00:26:05] So since the last time we were in, we've started using a headband and I have found that that has been helpful. I find that the the easiest time is in the morning. It's a little hard to get it on when we're trying to get breakfast and everybody awake and out the door. But once once it's just he and I in the morning and we have some time to really have one on one interaction. I'm finding that we're we're more successful at that time, especially with the headband.

Erin: [00:26:34] I'm really glad to hear that the headband's been helping. I know that we talked about that last time and you were going to try it out. So I'm really I'm really glad to hear that that has been has been a benefit. Um, and that it sounds like some one on one time together in the morning has is is good as well. So what tell me about a time that's a little more challenging. What is a time of the day that's more challenging but also kind of something that feels important to you where there's a lot of language or just a special time with family? What where is a time like that during the day currently?

Erika: [00:27:12] Yeah, I.

Erika: [00:27:13] Think maybe the hardest, the hardest time of the day, but the time that we could all get the most benefit from is like the dinner prep and then dinner time. It's hard with older sister and then playing and maybe being kind of far away from me in the kitchen when I'm trying to cook and that their interaction together, it's just hard for me to keep it on them during that time. But there's lots of talking and as we're talking about dinner and you know, how is your day? I feel like that that would be a time that we could improve on. That would be important.

Erin: [00:27:45] Dinner, that dinner time after work, school time is so language rich. A lot of times that is at my house as well. So with my guess, he's probably already you're probably trying the headband after dinner right now would be my guess. Okay. Well, that's good. That's good. I'm wondering, what do you think it is about the morning time that's going so well that maybe we could add in and kind of brainstorm a way to add that into that dinner time.

Erika: [00:28:16] Yeah, he's he's playing with sister a lot, and they're in the living room and I'm in the kitchen, which are kind of connected, but, you know, a little bit farther away. I don't know. I'm wondering if while they're playing, if we could kind of try and bring them a little closer to me and have her maybe not put the devices on him, but just maybe help me monitor it more or just her interaction one on one interaction with him. Um.

Erin: [00:28:41] I like it. I like that idea. So that sounds like some one on one attention is what's been helpful and how do we create that around dinner time? And maybe, maybe Emmy, um, who knows, She might be able to put equipment on at three or so. She's four now, isn't she? How old is five? Oh, my gosh. Okay. She's five. Um.

Erika: [00:29:04] But she.

Erika: [00:29:05] Could probably.

Erika: [00:29:06] Play with him. And he loves books, so I'm sure she could sit with him and he loves to be read to. So if she could sit with him and maybe flip through some stories and books, I think he would really enjoy that time. And maybe that would help distract him.

Erin: [00:29:18] Yeah, maybe he wouldn't. Yeah. Leave him. Leave him be. I think that's a great idea. How do you feel about trying that out between now and our next? Um, next time you guys are here?

Erika: [00:29:31] I think that feels reasonable.

Erika: [00:29:32] We've got, like, a basket of books that we could kind of position in a spot that would kind of be close enough to me, but they could still have their their place to play and I definitely think that's something we could implement together.

Erin: [00:29:45] All right. Let's try it out. Let's see. Let's see if taking what we know has been helpful in one part of the one part of the day and see how that kind of can maybe carry over and and maybe Emmy won't be ten by the time you come back.

Carrie: [00:30:04] But that was fabulous role playing Erika and Erin. And and I love it. But I guess just listening and thinking about what you guys did and I want you to jump into I loved Erin, how at first you kind of laid the facts down, right? I mean, in a very good like, you know, easy to understand way. And then right after that you were able to ask or like what, you know, celebrate those small successes. So even though it wasn't where probably you would want to see it, it had increased since the last time. So, you know, celebrating those small, you know, successes all of the time is probably really a critical piece of that strength based coaching. Um, but I love how you always reflected too, on what the parent said. So you would just kind of, you know, letting Erika share and then you would just really rephrasing or reflecting and what she said. So you would. And then from there you would kind of jumped into like, can you tell me some of those challenges? You told me your successes. Tell me your challenges. And, you know, she brought up the dinner time and things like that, but then you went right into, you know, validating, you know, oh, this would be a great time to, you know, try out some more language and maybe help with that.

Carrie: [00:31:27] And then I love what you say, too, that you're like, I'm wondering. So you kind of get that wonder piece in. But for the parent and how you know, how I wonder if you, you know, can you know, and kind of help them wonder, too, in that situation. And then that really led into mom coming up with her own solution. Right? Like her own goal for what that next step was. And then Erin validating again and rephrasing, um, that was helpful, you know, for think, Erika, to kind of process that and then just asking, how do you, you know, how do you feel about this? Do you think this is something that you can do and, you know, kind of how are we going to check in next time? So does that mean feel like that was kind of what you guys were sharing?

Erin: [00:32:19] That was our hope. That was our hope. And that's always kind of our hope. And we know that families really are trying. We don't have a single family that's really literally not ever trying to keep devices on. So we know there's always something to celebrate. There's always a success in there. And pointing that out because we could focus on the hard part and the quote unquote negative, but that's not going to refresh them to keep trying harder. So finding out what is what went well for them, their success, what was great for them might not be what we would have picked out as being a success and what is motivating or an important time of day. I might have all kinds of ideas of what would be a great the most perfect language, rich time of day to focus on. But if that's not the important motivating part for the family of what is important in their home and important to them, then it might not be as motivating for them to go home and try. So we do try to to focus on what is important to the family and it is their goal for their child. This is not my goal. It's what they have they're choosing to pursue. And so I do reflect back on a lot of those things. And we do. We all do so.

Carrie: [00:33:39] And if it's their goal, I'm sure they're more likely to implement it and follow through with it. I mean, that's the hope of it as well. What happens when you have a family that you've been doing co treating with and they aren't moving as quickly as you want? Do you see that more often? Do you bring them in more often? Do you connect with them virtually more often? Like how does that work to kind of keep the, I guess, ball going in the right direction?

Erika: [00:34:11] Yes.

Erin: [00:34:14] I think and again, you know. Erika, please jump in. Um, think I think we do think it always is just very dependent family to family on why or what seems to be the hurdle or hurdles. And then if it's distance or scheduling, then we might not try to get them in more often. It might be more phone calls or touching base or connecting with their local early interventionist or school provider or something like that to or phone calls or emails or. Kind of trying to figure out what the hurdle is and then not creating more of a hurdle, but some sort of bridge. What do you think, Erika?

Erika: [00:35:00] For sure. And if there's.

Erika: [00:35:04] I don't want.

Erika: [00:35:05] To put a bigger burden by having more appointments, but I also would want to be mindful that if we're not meeting the goals that we that we'd hoped, you know, continuing to touch base and maybe having like a shorter duration between appointments if that was feasible. Um, there's also some good feedback from the cochlear implant manufacturers on the apps so you can kind of help point the parents towards that and some goal setting and letting them have some reflection of that at, at home and really just talking through, you know, what are the barriers. We tried this, okay? That didn't work. You know, let's brainstorm again. You know what? What can we continue to brainstorm through and how can we work together?

Carrie: [00:35:50] The great. So one other question kind of before we wrap up. I know that you have said that you implemented this co treat model not just a few years ago. And so have you noticed that by implementing this, you have seen, you know, greater success with just whatever you're trying to measure, whether it's hearing hours, percentage and goal setting and things like that and moving in the right direction.

Erin: [00:36:24] Do we have that data?

Carrie: [00:36:27] Or maybe you just it doesn't really need to be data, but just as clinicians in general, like do you just feel like from that family perspective and working with families over time since implementing this co treat? Do you feel like you're making a lot more progress than if you were just kind of in your own silos of like speech pathology over here and audiology over here?

Erin: [00:36:50] 100%.

Erika: [00:36:51] Absolutely. I feel like the family feels more supported as the audiologist there. They want to hear so they can talk. So I'm the hearing piece, but having the talking piece there is so important. So, yes, I definitely I feel like there's been a lot of success with that.

Erin: [00:37:09] We get a lot of positive feedback from families. We get a lot of positive feedback from the professionals that we talk to that they're local professionals. We are tracking their auditory skills. So we have a lot of children that we see. There's a red dot on the graph every time we see them and we can see things going in the right direction is going in the right direction, even if it's very slow. We do get a lot of. Positives from it.

Carrie: [00:37:41] Yeah, I do. I've always believed that, that the relationship between the speech pathologist and audiologist is so critical and is like what you just said, such a valued input for the families to, to have everybody kind of working together to. But as we kind of wrap up with today's episode, is there anything that you would like to add that I didn't ask you?

Erika: [00:38:11] I think it just.

Erika: [00:38:12] Really takes a village in that communication with the entire care team and the family is is vital, especially with these young ones. There's a lot of dialog with the early interventionists. Other resources, family caregivers. I think just the open communication with everyone is just really important.

Erin: [00:38:33] I definitely agree. And there's no one size fits all approach to where time or retention aids. There are so many different companies out there on Etsy and and different things to help and just, you know, figuring it out on what works best for each individual child and family. And if one doesn't work, that's okay. Try another one. And connecting families, we connect a lot of families to talk to each other because we can talk all day about things that have worked or we've tried or have tried worked for other people, but we haven't, you know, haven't experienced it ourselves. So.

Erika: [00:39:21] No.

Erika: [00:39:21] I've also reframed some of my counseling, at least from the beginning, as someone is starting the cochlear implant process to at least say the wear time on the front end will be a challenge just so it's not a surprise. And so if we easily move past it, then great. But sometimes I think parents are a little surprised by the need for the retention aids and the things like that. So I'm just kind of trying to set up the. The brainstorming.

Erika: [00:39:49] Later.

Carrie: [00:39:51] Yeah, which is probably helpful when you go through the the strength based coaching with the families. You've already kind of planted that seed before they've even started that journey, so they expect you to be asking about it later on.

Erika: [00:40:05] Yeah, and.

Erin: [00:40:06] We talk about it ahead of time, so it's not a surprise when it's a challenge later like.

Carrie: [00:40:14] If our listeners want to get a hold of you or do you guys have any resources for for just the topic that we talked about today, like hearing hours, percentage or anything that you guys use in your toolbox that's out there for others to use?

Erin: [00:40:35] You can definitely reach us via our email addresses. I think we've shared. You have those, please. You know, we are fine with sharing those. We definitely have social media for our clinic, um, and Instagram, Facebook and Instagram for the clinic. Um, Erika has designed some infographics, don't know how where those technically live, but.

Erika: [00:41:02] I'm happy to share infographics with anybody. You can reach out to me via email. Um, is it helpful to go ahead and state my email now?

Erika: [00:41:10] Is that something you want.

Carrie: [00:41:11] To go ahead and do that? And then I can definitely link it in the show notes as well.

Erika: [00:41:16] Sure. My email isErika, Erika dot Gannon g. A g n o n. At Unk Health unk.edu. And I'm happy to share any infographics and resources we have to help with this dialog.

Erin: [00:41:32] And my email address is is the same as Erika's. Except Erin. Erin Dot Thompson. Thompson.

Carrie: [00:41:45] All right.Well, Erika and Erin, I want to thank you both for being wonderful guests and participating in role play and and the EmpowEAR Audiology podcast. That was in wonderful conversation. And I'm sure all of our listeners will be very excited to hear all of the information and hopefully they will reach out if they would like more. So thanks again for being a guest.

Erika: [00:42:09] Thank you so much. Thank you.

Erin: [00:42:10] So much.

Announcer: [00:42:11] This has been a production of the 3C Digital Media Network.

Carrie: [00:00:14] Welcome to the EmporEARAudiology Podcast, a production of the 3C Digital Media Network. I am your host, Dr. Carrie Spangler, a passionate, deaf and hard of hearing audiologist. Each episode will bring an empowering message surrounding audiology and beyond. Thank you for spending time with me today, and let's get started with today's episode. Hey, welcome to the EmporEAR Audiology podcast. I am really excited today to have a friend and a colleague with me, Dr. Jace Wolfe, and I'm just going to read a little bio about him before he comes on the air and shares a little bit about himself as well. But Dr. Jace Wolfe is the senior vice president of innovation at the Oberkotter Foundation and Hearing First. He is an adjunct professor at Salus University. He previously served as the editor for the American Speech Language and Hearing Association Division 9 Journal and is currently a co editor for plural publishing Core clinical concept series and cochlear implants. He is the author of the textbook entitled Cochlear Implants Audiologic Management and Consideration for Implantable Hearing Devices. And he is the co editor with Carol Flexer, Jane Madell and Erin Schafer. And for the textbook pediatric Audiologist, Audiology, Diagnosis, Technology and Management. The third edition and Pediatric Audiology Casebook. The second edition. He is also a coauthor of the textbook entitled Programing Cochlear Implants The Third Edition. His areas of interest are pediatric amplification and cochlear implantation, personal remote microphone technology and signal processing for children. So Jace, welcome to the empowEAR Audiology podcast. I'm so excited to have you.

Jace: [00:02:17] Thanks, Carrie, so much. I'm excited to be here. As I've told you before, I think the world of you both as an audiologist, even more so as a wonderful person and as an advocate who's passionate about advancing the outcomes of children with hearing loss. So it is an honor to be able to talk with you today and to be a guest on your podcast.

Carrie: [00:02:40] Well, thank you for being here too. I want to say thank you. And I met oh, goodness. It's been probably. I want to say it was like 12 or 13 years ago over in Berlin.

Jace: [00:02:53] Yeah, that's true. We're getting old for sure. I can't remember. I was. Yeah, it could have been 12 or 13 or 20. I'm not for sure, but it's been a long while now.

Carrie: [00:03:01] It has been. So what? Seasoned professionals now, Right.

Jace: [00:03:06] See, I like that a lot. That works a lot better than old.

Carrie: [00:03:09] Yes, exactly. Well, since you are a seasoned professional, I always like to ask audiologist or other professionals who come on the podcast, how did you venture into the field of audiology? Do you have a story behind that?

Jace: [00:03:25] Great question. I knew for certain, even when I was a small child, that I wanted to do something in the health care field. And gosh, in elementary school I can't remember the exact grade, but I started wearing contact lenses and I loved my optometrist. And so for a while, while I thought I'd be an optometrist, but when I started my freshman year at the University of Oklahoma, I took a survey course and every week a different health care professional would come in and talk about their discipline. And one week, a gentleman named Dr. Stephen Peyton came to the class and talked about audiology, and he was just on fire about audiology. He's very, very charismatic person. He's very well-spoken. But you could tell he loved what he did and he talked about what he did and really kind of entertaining and exciting ways. And it got me interested in audiology. And so I went and shadowed him a couple of times. And watching him work, you could see his love and passion for his work, even more so in the clinic than when he was lecturing about it. And his patients loved him. And you could tell the difference that he was making in such a positive way in his patients lives. And so I really have to say that a lot of my interest in audiology, I really attribute that to meeting Dr.

Jace: [00:04:48] Peyton and just observing what he did. And I will say that I probably stayed in the audiology program because he was an instructor at the University of Oklahoma where I attended and got my master's degree in audiology and then eventually my PhD degree. He introduced me to my wife and yeah, I stayed and got a PhD degree because of him as well. So I owe him a ton and you know, I have no regrets. I'm so grateful that I didn't skip class that day that he came and talked about audiology because I love my job. It's been a perfect fit for me. I know I'm biased, but I think audiologists are so important just in really promoting the quality of life of the patients that we serve. And that's true if you're a pediatric audiologist. But as we've seen even most recently with the presentation of the results of the Achieve study with older adults, our work makes such a big difference in the quality of life and the cognitive and neurological health of adult patients with hearing loss as well. So very grateful to be an audiologist, very grateful for Doctor Peyton as well.

Carrie: [00:06:02] Well, that's just a great testament for anybody listening out there. If you're asked to go into a college or a university class and talk about what you do, if you're passionate about it, you may get someone like you who is interested and follows that path.

Jace: [00:06:22] That's true. I hadn't even thought about it from that perspective. But yeah, we are definitely walking advertisements for the field of audiology, so it's probably important to always put our best foot forward.

Carrie: [00:06:34] Right, exactly. So I know recently you've kind of made a little shift in your role as an audiologist and you do have a new role with the Oberkotter Foundation and Hearing First, do you want to share a little bit about what you do and maybe a little bit about hearing first as well?

Jace: [00:06:54] Sure, sure. So you're exactly right. I did, about four months ago, make a big professional career change For the 20 years prior to that, I had worked at Hearts for Hearing, which is a great place. And I still think the world of hearts for hearing. It's a speech and hearing clinic that serves both children and adults in Oklahoma. I love the people I worked with at Hearts for Hearing. It was a great experience. Still, obviously no regrets there, but I had worked there for 20 years and I'd kind of reached a point in time in my life where I thought that a change might suit me well in this position. This opportunity came along with the Oberkotter Foundation. It just really suits my skill set and my passion for where I think I can make my biggest difference for children with hearing loss in particular, which is always been my biggest passion. I've worked with both children and adults, but my my focus for most of my career is really kind of resided more in the pediatric space. So in March of this year, 2023, I accepted a position as the senior Vice President of innovation at the Oberkoter Foundation and the Oberkotter Foundation. It's a private family foundation. It was started by Paul and Louise Oberkotter back in 1985. So almost 40 years ago they had a daughter named Mildred or Mildie Carter, who was born with hearing loss and Mildie through a lot of work, learned to listen and talk. And she became a very successful, independent, very charming adult. But back then, it was really challenging to learn to listen and talk because we didn't have things like cochlear implants and universal newborn hearing screening and and even the type of hearing aid technology that we have today.

Jace: [00:08:49] And so this foundation was really developed to try to really optimize the outcomes of children with hearing loss to help them reach their full potential, to learn to listen and talk and just their overall outcomes that they would achieve in life. The organization has evolved over time as technology has evolved. Starting in 2013, they formed a subsidiary called Hearing First and Hearing First is a fully online digital community that has aimed to provide information for the families of children with hearing loss and then also the professionals who serve those families and those children as well. Up until about a year and a half ago, the primary focus of hearing first was to provide education and information both for families and listening and spoken language specialists or little providers. But more recently, there's also been an increased focus to provide information and education for pediatric audiologists as well. And that's one of two areas where I'm going to play a big role is in leading our efforts to provide best in practice educational experiences for pediatric audiologists. Also to I think they'll be really well received by the community still and educators and early interventionists, maybe in some cases physicians as well. And then eventually I will also lead an effort to support science and innovation, development of technologies and services that will hopefully address some of the challenges that we faced for many years and maybe move the needle or improve outcomes and quality of life for children with hearing loss. More on that later as that develops. But at the current point in time, my focus is really on the learning experiences for pediatric audiologists.

Carrie: [00:10:49] Yeah, and I know hearing first has really been a great resource for a lot of families out there for listening and spoken language professionals and those who work with children who are deaf and hard of hearing. I know I've taken quite a few courses and I've had the opportunity to present as a professional to for the hearing first community and love the learning community and the resources that they have and materials their podcast, their on demand learning. There's so many resources to explore within the hearing first community. But one of the things that I know you mentioned as your new role as innovation would be to really develop the audiology content or offerings that that hearing first is going to have. So can you maybe share a little bit about some of these upcoming learning courses that you have in the works, or is it a secret?

Jace: [00:11:51] Yeah, no, it's not a secret. We've got our calendar for the entire 2024 year finalized now and I am so excited about it. Carrie I think that that you'll be excited about it too, and I hope the pediatric audiology community is excited about it as well. And as we were developing that calendar, we really wanted to come up with subject topic areas that were really relevant and timely. We wanted to identify the areas where audiologists felt like they could benefit the most from from education, from new information. We wanted to identify areas that maybe weren't covered comprehensively in many of the pediatric audiology education programs, and that's no slight to the audiology programs. When you think about audiology and the way technology has expanded goodness, the scope of practice has become so large. And to be able to cover everything that an audiologist might do even in three years of courses and then a fourth year with the externship is really almost impossible to do it at a really in depth level. And so we're trying to identify some of those areas where either because there's not enough time to allocate to that in the programs or maybe technologies just changed so much in the last few years that there's a need to maybe bring everybody up to speed in the latest that's happening in a certain kind of sub topic area within pediatric audiology.

Carrie: [00:13:30] Okay. So I kind of think of that as maybe just in time learning when you're out there in the field and you have, um, whether it's your patients or you're getting your feet wet, you realize what some of those gaps you might have that you didn't get within your audiology program.

Jace: [00:13:51] Yeah, I hope that we meet that need for sure. We want to start out with the bang. And as I talked to a handful of people in the pediatric audiology space over and over again, I heard that genetics was a really big area of interest for for pediatric audiologists for a number of different reasons. I mean, one, maybe because it wasn't a topic that was covered in depth or in detail in their program, but also we're seeing such an increase in the number of children who are getting genetic testing. And as we will talk about in the course, there are new resources available to allow children to get genetic testing where in the past it may have been cost prohibitive to do so because sometimes the testing can be so expensive. But I can even speak from personal experience that when I receive the reports from those companies that do the genetics testing, sometimes those reports make my eyes kind of glaze over in my head spin because they're pretty complex, you know, in the way they describe the test findings. So our goal for this genetics course are really courses. It's really three fold. And one, we want audiologists to be able to review those reports and understand every aspect of the report so that they have a clear understanding of how the genetic testing would would really impact the long term outcome of that child. And we want to do that because we want the audiologist to know how they can best serve that child.

Jace: [00:15:30] Number two, And that would be just understanding how the diagnosis or the etiology might affect the child's outcomes. What type of management strategies might be best help the child to overcome any kind of challenges working with other professionals, interdisciplinary teams to address some other problems that the child might experience relative to any kind of genetic cause of the hearing loss. And then also to be able to inform families in a very family centered and also evidence based way as well, because oftentimes families have a ton of questions about those reports. And we want audiologists to be able to speak intelligently about what those reports mean for just the overall quality of life and outcomes of that child. And then finally, in third, we want audiologists to be equipped to be able to talk with other professionals at a high level about genetics and understand when genetic testing might be helpful and what the results mean as far as the management of that child is concerned. So super excited. In January, we're going to have a course that just talks about the basic fundamental science behind genetics. So it'll be chromosomes and DNA and RNA and transcription and the Molecular inheritance patterns, all the different things that you would need to know to really understand and have a good kind of foundational knowledge of genetics.

Jace: [00:17:04] And so that'll be good for a number of different people. And we're going to offer that course not just to audiologists, but everybody in the pediatric hearing health care community, including physicians and nurses and physicians assistants. Then in February, we'll follow that up with a course that talks about genetics as it relates to childhood hearing loss. So we'll talk about all the different types of recessive and dominant causes of childhood hearing loss. X-linked We'll talk about the different Nomenclatures like DF and A and DF and B and Gjb2 and what all that means. We'll talk about genetic counseling. We'll talk about how to counsel families. We'll talk about genetic therapies that might be on the horizon and what the timeline looks like for that as well. And that'll all cover the first couple of months of the year. And we were able to talk Hela Azaiez, who is one of the foremost researchers in genetics as it relates to hearing loss. She's at the University of Iowa, which has a phenomenal, just wonderful program, genetics program that focuses on childhood hearing loss. And I've heard her present before on the topic. She's a wonderful presenter. She can take really complex information and share it in a way that's easy to understand. So I think the. The pediatric hearing, health care community and beyond will really love these first two courses that we're going to offer.

Carrie: [00:18:36] And how are those courses set up? I know in the past when I've taken courses, they've all been free. You have to be there to attend to get your, you know, professional hours. But how are these how are these set up?

Jace: [00:18:50] Great question. So they're all free of charge. There's there's no cost to take the courses and every course will provide CE credits. And the way we're going to set them up for 2024. And this we have ongoing discussions right now about the length of courses and the type of courses that we would offer. We we used to have 90 minute lectures and for busy clinicians, that's a big time commitment. So we're scaling it down. And each week, like the genetics course in January, will be four weeks long to cover all the basic science behind genetics. And there will be four 60 minute recorded lectures that the audiologist can watch on their own time. And then each week there will be a live session on Monday, and that happens at 8:00 Eastern Time. And that live session will give participants an opportunity to interact with the instructor. And that'll also be 60 minutes long as well. One huge difference for what we're going to do in 2024 compared to the past is that we will make the live sessions available after the fact. So busy clinicians with busy lives they might have a child who has basketball practice on Monday night at eight Eastern, or they might want to go see a show or something like that or watch The Bachelorette on Monday night, you know? And so if they have something, some kind of conflict on Monday night, they'll be able to watch it later and they'll have 30 days after the end of each course. So for the January course, you'll have all the way to the end of February to watch all of those lectures, both the recorded and the live lectures, and you'll be able to get full credit for that.

Carrie: [00:20:41] Oh, that's nice because I know like, yeah, that's been a challenge sometime for me is to in order to get all of the credit, I wasn't able to attend every single, you know, lecture. And then if you miss one, you don't get the credit. I mean, you still can get the information, but you don't get the credit.

Jace: [00:20:58] Yeah, you know, we want to we our primary goal is to to improve the outcomes of children with hearing loss. That's that's the primary mission. And so I think the best way to do that is to make sure that the information is as accessible as it possibly can be and that it's convenient as it possibly can be to access. And so we need to make sure that when clinicians are going to invest time in this, that they can get the full benefit and reward. And part of that is getting CE credits. You know, you only have a finite amount of time and as a busy clinician, you know, at the end of the day, you might just simply be tired or you might not feel well. And, you know, even if you don't have a conflict, it might be difficult to do it at a certain night, but you might find yourself waiting outside of your daughter's volleyball practice with 30 minutes to spare in the parking lot. And you could watch the lecture at that time, you know. So and we're also experimenting going forward, probably not in 2024, but with micro learning, because right now, especially younger generations, they learn in, you know, 140 or 280 character chunks, you know, on Twitter or they watch videos for 15 or 30s on TikTok. And so how can we package the most important information in a really concise way, too, so that, you know, it comes across on your social media feed or an email and you get the highlights that could really make a difference in how you serve children with hearing loss. So more to come on that front, too.

Carrie: [00:22:32] Yeah. So that were all of your innovation comes in into play, right?

Jace: [00:22:38] That's going to be a part of it for sure. Um, and you know a lot of pie in the sky stuff. I mean, with artificial intelligence. Now I've played around with, you know, presentations where you can create a PowerPoint presentation and then you can have a digital avatar that is indistinguishable from a real human, and that digital avatar can give your presentation. And so the sky is the limit on what we can do in the future. I think we might be able to create programs that would be digital avatars of parents and maybe professionals could practice providing, you know, news about, you know, a new diagnosis of a child with hearing loss and new identification. And they could get real time feedback from a digital avatar, and that would give them an opportunity to experience that before they have to do that, live with real people. And again, that's kind of pie in the sky. There's still a lot of development that would be necessary to make something like that happen. But those are the types of things that I think we can do in the future and types of things that we're considering for professional education may be a program that would generate simulated ABR waveforms, and you could mark those and analyze those on the fly because there's obviously so much knowledge and experience required to do that well. So I think it's going to be a lot of fun as we leverage some of this explosion that we're seeing in AI and technology and how we can apply that to the education of audiologists, both in professional settings and at the level as well.

Carrie: [00:24:10] And there's so much to explore at such a fast pace, too.

Jace: [00:24:14] Yeah. Oh, yeah, yeah.

Jace: [00:24:17] Without a doubt. But I'm so excited. I don't know. You know, there's 12 months obviously in the year and so we have a different topic for every month. But yeah, I would love.

Carrie: [00:24:26] To hear about you kind of talked about the first couple of months, but you, you got us through the winter here. Jace What what's coming up in the spring?

Jace: [00:24:39] Well, you tell me to stop when you want me to stop because I could stay here all day and talk about what we're going to do with the learning experiences in 2024. But in March we're going to have a learning experience on autism and the optimal audiology management of children who either have autism or there is a suspicion that the child has autism because so many kids, you know, if they're not speaking and the language doesn't appear to be developing, one of the first steps is to get a hearing test, to rule out hearing loss before they move on and have neurodevelopmental testing to diagnose autism. And so we were fortunate enough to get Jim Bodfish, who is a psychologist and a neuro developmental specialist at Vanderbilt. He's invested his entire career in studying autism, and he's going to give a lecture just kind of on the fundamentals or basics of autism. And then that's going to be followed up by two weeks where Ann Marie Tharp will talk about assessment, audiology, assessment issues with children who have autism. And then in the third week, management of children with autism, special considerations for fitting hearing aids, cochlear implants, that sort of thing. So I think that will be well received because I know as somebody who recently was in the clinic, that that can be really challenging to make sure you provide the best care for for children sometimes who, you know, are kind of averse to that care being provided.

Carrie: [00:26:09] Right? Yeah, We see a lot of that in the schools Having that dual diagnosis or trying to get a dual diagnosis I guess would be another challenge too. So we've got genetics and autism. What else do you have? Do you have a summer summer thing?

Jace: [00:26:26] Yeah, well, we can keep rolling in April. We're going to have a best of in the 2023 pediatric audiology literature. So we're going to have an all star cast. Jay Hall, Marlene Bogado, Renee Gifford and Ryan McCreary. And they're going to review some of the best articles that were published in 2023 and diagnostics and hearing aids and cochlear implants and then in miscellaneous issues. And so that should be a lot of fun because again, oftentimes when you're super busy in the clinic, it's hard to keep up with the literature. And there are so many journals out there, Even if that's all you ever did, it would be impossible to find all the best that's out there. So I think that this will provide something for everyone who would participate in that course, because I'm almost certain that at least some of these articles will be articles with which the participants aren't familiar. After that, in May, one of the things I'm most excited about a gentleman named Anthony Alleman, who's a medical doctor, he started out as a cochlear implant surgeon. He had completed a Neurotology residency and fellowship, but then went back and got or completed a fellowship in radiology as well. And he's a diagnostic radiologist now, and he's going to talk about imaging of the auditory system. And the goal will be the audiologists will be able to look at an MRI scan or a CT scan and identify all the relevant structures of the ear and be able to determine if it looks atypical or if it's typical and what that would mean for the management of the child as well.

Jace: [00:28:01] So I think that will be really exciting because that's something that we typically don't get a lot of in the program and it can kind of be intimidating if those kind of images are are put up in a staffing with other professionals and it just looks like a big black and gray bob on the screen. And it's kind of challenging to know what you're looking at. So I'm hopeful that that will be helpful as well. Um, and then in June, we're going to have a series of classes on optimizing the outcomes of children with exceptional needs. And we're going to have Angela Bonino from Vanderbilt University, who does great work in this area. Children with neurocognitive disorders, visual disorders, motor disorders. And she's going to talk about assessment and management for two weeks. And then Schuman He and Holly Teagle are going to finish up that course talking about cochlear nerve deficiency and how that's diagnosed and ideal management for that. So that'll take us through the first half of the year.

Carrie: [00:29:05] Wow, that's a great lineup. And are all of these going to be I think you mentioned Monday nights for the genetics or are they kind of different depending on the speakers?

Jace: [00:29:16] That's a great question. Most likely we'll have Monday night that will feature new courses for audiologists and then many months we will also have a Thursday night course that will be a repeat of a course that's been offered in the past. So like a repeat on middle ear measurements and otoacoustic emission measurements and a repeat on programing cochlear implants as well. So it's going to be a really full calendar. And I don't want to again, I don't want to bore your listeners, but we're going to have the rest of the way. Balance Assessment Management. Violette Lavender at Cincinnati Children's. I just want to say this because I'm excited about the topics and I don't want any of our great instructors to be left out, but I think that will be a really interesting course. Dr Lavender is an expert in that area and also sees patients clinically at Cincinnati Children's. In August, we're going to have a three week course on auditory Neuropathy spectrum disorder, led byThierry Morlet, who has worked his entire career with Chuck Berlin. And Linda Hood just published a two series article in ear and hearing looking at outcomes of 260 children served between 2005 and 2020. He's a subject matter expert in that area, and I think it'll be great. I know a lot of clinicians have a lot of questions about how to best serve children with auditory neuropathy. September, we're going to have a summary of the latest outcomes of some of the biggest studies in audiology. The LOCHI study out of Australia will cover that the outcomes of children with hearing loss study. Elizabeth Walker at the University of Iowa will cover that research out of Melbourne, where they look at outcomes of children who have been implanted before nine months of age with Shani Dettman and then the child development after cochlear implantation study, which was started by John Niparko many years ago.

Jace: [00:31:21] But they have outcomes now for children who are well into their teenage years. And Andrea Warner-Czyz is going to talk about that. Three more months October single sided deafness with Hillary Snapp at the University of Miami, who's an expert in this area, particularly with bone conduction devices and cross devices excuse me. And then Lisa Park, who is an expert in this area as well, particularly with cochlear implants, November, we're going to have beyond the audiogram Ben Hornsby and Hillary Davis of Vanderbilt. We'll talk about fatigue related to childhood hearing loss. Andrea Warner Czyz will be back to talk about social emotional issues, including self-esteem and quality of life and bullying and how to help children in those areas. And then we will have Irina Castellanos, who worked with David Pisoni for years. She's now at Ohio State University. She's a psychologist and a neuro developmental specialist. And she's going to talk about executive function, theory of mind, working memory and sensory integration as well. And then the very last month, we will have Kelly Baroque and an anesthesiologist from Cincinnati Children's, and they're going to talk about sedated ADR assessment and best practices in that area. So if you can't tell, I'm excited about this, I can't wait for it to start. I'm going to take all the courses myself, and I hope it's really beneficial for professionals and even more so, I hope that this information is beneficial ultimately for the children we serve.

Carrie: [00:32:59] Wow. Yeah, that's an incredible lineup and I know many of those presenters. So you definitely have top people who are presenting their research and their clinical expertise coming up. So I'm excited too. I'm going to have to like carve out my Monday night starting in 2024.

Jace: [00:33:23] Well, thanks so much. You know, in the future, we're going to have to get you on as well to talk about everything everyone needs to know about educational audiology and the latest and greatest in that topic area. So I will definitely be getting back. Can touch with you.

Carrie: [00:33:37] Yeah, well, I would be happy to talk about my passion and purpose as well. So thank you for. For that too. But if people are interested in this lineup, can you just share a little bit more about how they can find the lineup and how they can, you know, sign up for these classes?

Jace: [00:34:00] That's yeah, that's a great question. You can go to hearing first.org and there's a professional learning community there and you register as a professional in the professional learning community. And then if you wish, you'll start getting updates or regular correspondence via email from hearing first. And we we are targeting the fall as the point in time where we'll start really promoting these learning experiences and providing more information. So they'll definitely be more to come in the not so distant future, but between now and 2024, we also have some great courses that professionals can take. Now there's one ongoing right now where Nancy Young from the University of Chicago, where they have maybe the largest pediatric cochlear implant program in the country, is talking about medical management of children with hearing loss. And it's been great as well. So you can go there now and get involved with the courses that we have scheduled between now and the end of the year and then there'll be more to come. Once you're registered, you'll get that information in the future and we're going to have a really big marketing effort to to reach out to the pediatric hearing health care community starting in the fall to make people aware of these offerings and the opportunity to get the latest and greatest information at no cost with credits as well.

Carrie: [00:35:26] That is great because I know getting CEUs sometimes and the cost can be a challenge and to be able to really have a focus on that pediatric audiology population is going to be amazing and a great addition to the hearing First Community, Are you guys still going to be targeting like the deaf educators and speech language pathologists and parents as well?

Jace: [00:35:52] Yes, Yes. Without a doubt, there will still be a very concerted effort to have lots of products and cutting edge information for providers. And then, of course, families. We want to be a lifeline for families who are newly diagnosed or children with hearing loss. And then as they progress through the journey up until adult independence. And so that will definitely still be a core focus in the middle of the wheelhouse for for hearing first. And we will continue programs that have been exceptionally successful, like the Starts Here program, which seeks to educate expectant mothers about the importance of hearing and the hearing screening prior to the child. Even being born as well. And we've been able to touch almost a countless number of expectant mothers with that program over the past two years. You can learn more about the Starts Here program and how you might be able to get involved with that at the hearing first.org website as well.

Carrie: [00:36:53] Oh, good. Well, I'm glad we were able to touch base today. And I know you are new to Oberkotter to the hearing first. Um. And being able to get your skills and use them in a different way. I'm sure it's going to continue to grow over there. Hearing first, and I'd be interested to hear what your next round or your next innovation with science and technology and how that continues to evolve too, in your role.

Jace: [00:37:24] Well, let's do this again next year and I'll be able to tell you more.

Carrie: [00:37:28] Okay, We can definitely do that. So. Well, Jace, I just want to say thank you again for being a guest on the EmpowEAR Audiology podcast. And people can get on the hearing first website and get a hold of you if they have any other questions, and then find out about all of the resources and offerings that will be happening starting in August and leading up through 2024.

Jace: [00:37:53] Well, you're very welcome. And Carrie, thank you so much again for the privilege of being on your podcast and for your friendship. It's been an honor, and I've really enjoyed it.

Carrie: [00:38:02] All right. Well, thank you, listeners, for listening to the EmpowEAR Audiology podcast. If you enjoy this, please take a moment and give a five star review that helps other listeners to find the podcast and share it with others. Thank you and have a great day.

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