ACDHH: A Model of Collaboration for Audiologists and Consumers



Author: Michele Michaels

As consumers take a more active role in their healthcare, it is essential for audiologists to form collaborative partnerships with advocacy groups, regulatory agencies, and other professionals who work directly with individuals with hearing loss. When all these groups work together by pooling ideas and resources, the result is often beneficial for consumers and families dealing with the consequences of hearing loss. These benefits include improved access to care for those with impaired hearing and greater public awareness of the services offered by audiologists. The state of Arizona provides a template for how other states can offer similar cross-pollinated partnerships that serve the needs of professionals and consumers alike.

The Arizona Commission for the Deaf and the Hard of Hearing (ACDHH) is a state agency established in 1977 to improve the quality of life of people with hearing loss. For 40 years ACDHH has worked with the public and private sectors to increase accessibility to communication for people who are Deaf, hard of hearing, Deaf-Blind, or speech-impaired. Major programs and services include awarding and monitoring the federally mandated Relay Service (AZRS) contract, providing a variety of free telephone and speech communication devices through the Telecommunications Equipment Distribution Program (AzTEDP), licensing American Sign Language (ASL) interpreters who interpret for Arizona residents, and providing outreach and education throughout the state. Through social media, the press, and community events, we reach over 6 million Arizonans each year.

Over the past 40 years, ACDHH has effected positive changes in many aspects of the lives of persons with hearing loss. We created the nation’s first television program for the Deaf, “Sign Out”, in 1977, which is now called Community View with short videos hosted online. The first TTY’s were distributed free to Deaf people in the mid-80’s well before the relay service was mandated by federal law, and we teamed up with the March of Dimes and other community partners to pass the state Newborn Hearing Screening law in 2005. In 2012, after successfully resolving federal housing concerns, we were proud to see the opening of Apache ASL Trails, an independent living community for Deaf, Deaf-Blind, and hard of hearing seniors in Tempe, AZ, one of only a few such communities in the United States. The Deaf-Blind community will benefit from enhanced training provided to Support Service Providers (SSPs) as a result of an SSP training curriculum developed through a partnership between the University of Arizona and ACDHH. Upon completion of the training SSPs will be certified by ACDHH. In addition, the Deaf-Blind community will receive additional SSP services due to the ACDHH’s successful budget request for funding of these critical services for Deaf-Blind citizens.

ACDHH is led by Executive Director Sherri Collins who has been with the agency for nearly 20 years and is ACDHH’s first Deaf Executive Director. Under her leadership, ACDHH has grown to 16 staff serving a population of over 1 million hard of hearing, Deaf, Deaf-Blind, and speech-impaired residents. Ms. Collins serves as the President of the National Association of State Agencies of the Deaf and Hard of Hearing (NASADHH) and is a frequent speaker both locally and nationally on issues related to the Deaf and hard of hearing. The 14-member ACDHH Board of Commissioners are appointed by the Governor and voluntarily serve 3-year terms, overseeing the work of the agency and providing general direction to Executive Director Collins. The Board membership includes representation by one audiologist and one hearing aid dispenser. Judy Huch, Au.D., and Bob Baber, Miracle Ear franchise owner, represent the audiology and hearing aid dispensing professions on our Board. Dr. Huch recently co-founded the Arizona Audiology Coalition, and Mr. Baber has been a key member of the Hearing Healthcare Providers of Arizona for many decades.

State Regulatory changes over the past 10 years have helped to ensure that consumers who purchase hearing aids are receiving professional services that are evidence-based, with information about device components that greatly benefit hearing aid users. While we sometimes pursue new or modified regulations, we more frequently engage in outreach and education throughout Arizona. Our staff often present educational and informational trainings and presentations to a variety of persons including consumers, church groups, educators, hearing healthcare professionals, public safety personnel, nurses, doctors, and hospitals.

Most recently, some may be aware that ACDHH made national headlines in opposing the Over-the-Counter Hearing Aid Act of 2017. While the media primarily reported that only hearing healthcare professionals were opposed to OTC hearing aids, ACDHH, on behalf of 1 million hard of hearing and Deaf Arizona consumers, filed comments with the FTC regarding this issue. A few other states followed suit. We also dialogued with management at the Hearing Loss Association of America about their support of OTC hearing aids, and reached out to our media partners to educate about this controversial proposal. Our Board of Commissioners adopted a Position Paper on this issue, which was submitted to the FTC. In July of 2017, Arizona’s largest newspaper wrote an article about the issue. Although the bill was signed into law, ACDHH remains concerned about the potential negative effects on consumer health, safety, and finances. Thus, we are embarking on a heightened public relations campaign to educate the public about the importance of having their hearing tested by a licensed hearing healthcare professional. A paid PSA will soon air on Arizona television stations with a link to a list of licensed audiologists and hearing aid dispensers, and other educational materials are being developed. To keep up on what is happening in Arizona, sign up for our weekly electronic newsletter at www.acdhh.org.

Other ACDHH Position Papers can be found online. You’ll see that in 2009 we became concerned about persons providing hearing healthcare services without being licensed. In 2012, we issued a position opposing online sales of hearing aids. In 2013, we issued a position on the necessity of insurance coverage for hearing aids and services. We also support the FDA Medical Evaluation as it protects consumer health.

In December of 2016, ACDHH funded the installation of inductive looping in the Senate and House chambers at the Arizona State Capitol, including looping the visitor galleries and all meeting rooms. We were the first state to loop all three areas. Our media partner, the Arizona Republic, wrote about the impact loops and telecoils had on State Representative Lela Alston. If Representative Alston’s hearing healthcare professional had not included and programmed the telecoils in her hearing aids, she would never have benefitted from the loop systems at the Capitol. Please tell your patients about the telecoil and how it can benefit them.

In the fall of 2015, the Association of Late-Deafened Adults (ALDA) held their annual conference in Scottsdale, AZ. Prior to the conference ALDA approached ACDHH for help in developing a novel panel idea, that of having high profile members of the hearing public experience being hard of hearing for a day and then participate in a panel discussion. Arizona Republic reporter Dianna Nanez volunteered to be fit with ear molds by Debbie Venkatesh, Au.D., and wrote about her experience. Other ‘hard of hearing for a day’ participants included a Phoenix Fire Department Captain, two local DJs, and Luis “Gonzo” Gonzalez of the Arizona Diamondbacks. Gonzo fans can find a video of him having ear mold impressions taken by Georgine Ray, Au.D. and walking around the ballpark with the impression material in his ears. The ‘hard of hearing for a day’ panel discussion was enlightening for many.

Every May we celebrate Better Hearing and Speech Month by highlighting hard of hearing consumers and professionals in the hearing loss field. Working adults, a teacher of the Deaf and hard of hearing, a licensed counselor, a veteran, and others have been profiled over the past three years.

The holiday season means toy buying, and every year we raise awareness about Noisy Toys. Local television and radio stations throughout Arizona invite us to demonstrate the noisy toys and talk about how to prevent hearing loss in children. Numerous magazines and newspapers pick up our annual Noisy Toys list and share it with their readers.

In 2007, ACDHH was instrumental in passing a state law that came to be called the “the telecoil bill”. This law required a hearing aid bill of sale to reflect that the consumer had been informed of the benefits of the telecoil, as well as the free telephone program. At the time, only Florida had a law regarding telecoils and it was not well known or enforced. Thus, Arizona became the national leader in ensuring that consumers would be informed about this important technology. The telecoil enables hearing aid users to utilize all loops, including neckloops at, among others, their local movie theater, playhouse, or courtroom, benefit from room loops, and utilize counter-top and drive-up loop systems.

ACDHH also supported the successful state hearing aid dispensing rule change in 2014 that requires documented verification of the effectiveness of the hearing aid (a dispenser must “evaluate the performance characteristics of the hearing aid as it functions on the client’s ear for the purpose of assessing the degree of audibility provided by the device and benefit to the client”). Audiology best practices include real-ear measurement and ACDHH strongly supports utilizing real-ear during hearing aid fitting.

In the 2018 legislative session, ACDHH will work to remove the state tax on batteries for hearing aids and cochlear implants. This small tax has a large impact on the budgets of families, caregivers, and cochlear implant users.

Future programs and possible legislation or regulatory changes will include a statewide aural rehabilitation program, a hearing aid voucher program for low-income adults, and hearing aid insurance coverage mandates.

In response to consumer concerns, five years ago we developed and implemented the delivery of a free 2-hour Healthcare Curriculum training. In the training we present information about the laws governing communication access for the Deaf, hard of hearing, and Deaf-Blind, as well as Deaf culture, hard of hearing behaviors, assistive technology, interpreter licensure, communication strategies, and the relay service. Over 1000 healthcare providers across Arizona have received this free training.

Further responding to consumer requests, two years ago we developed and implemented the delivery of a free 2-hour Public Safety Curriculum training. We were very pleased to receive the Arizona Peace Officers Standards and Training Board determination that the course qualifies for continuing training credit. Over 1800 public safety personnel, including courts, jails, fire department staff, and emergency preparedness personnel have completed this training so far and the Phoenix Police Department, with nearly 3000 sworn officers, is currently halfway through their training. No other police department has mandated this type of training.

ACDHH, along with the Arizona Department of Emergency and Military Affairs (DEMA), Maricopa County Department of Emergency Management (MCDEM), and the Arizona Department of Forestry and Fire Management (DFFM), identified a significant gap in services for Deaf and hard of hearing Arizonans during emergency response efforts. In 2016, these agencies collaborated to create the “Emergency Response Interpreters Credentialing Program” (ERIC) for ASL Interpreters and CART captioners wishing to provide services during emergency and disaster response situations. Because of this program, 23 trained and qualified interpreters and captioners are available to work in a variety of high-pressure settings, such as evacuation shelters, press conferences, active wildfire camps, and community meetings. ERIC Providers are integrated into drills and exercises hosted by various County and State agencies, as well as the centralized dispatching systems through which all other Emergency Response Personnel are deployed. This allows ERIC Providers to arrive on scene in a timely manner, thus ensuring that Deaf and hard of hearing citizens have immediate access to critical safety information. ERIC Providers assisted with communication access at 10 emergency response events in 2017 and participated in 6 emergency response drills. Arizona is the first state in the nation to have this type of program.

American Sign Language interpreters providing interpretation for Deaf persons residing in the state of Arizona, with a few exceptions, must be licensed by ACDHH. The Licensure law was passed in 2000 and became effective in 2007. Currently there are nearly 500 licensed ASL interpreters serving the Deaf community in AZ. The American Speech-Language-Hearing Association (ASHA) recently released guidance for healthcare professionals on the federal laws regarding interpretation. As a healthcare provider, you are obligated to provide qualified interpreters to Deaf patients and the cost of doing so is a cost of doing business, just as providing ramps, curb cuts, and elevators are elements of disability access included in your office rent. Your practice may be eligible for a federal tax credit for providing accessibility to disabled patients.

As mentioned earlier, including telecoils in hearing aids allows a consumer to benefit from a variety of loop systems and devices. Did you know that neckloops are required to be provided under the ADA Amendments Act of 2008, effective March of 2012? HLAA has an excellent summary. If your patient is having difficulty hearing at a place of government or public accommodation where a sound system is provided, that facility must provide neckloops to be used with their telecoils, or headsets if the person doesn’t have hearing aids or hearing aids with telecoils.

Does your state have a telecommunications equipment distribution program (TEDP)? Visit https://tedpa.org/resources to find out. Offering your patients something free is a win-win situation. Even if they don’t (yet) buy hearing aids from you, connecting them to a free resource generates good will and word-of-mouth. Traditionally states have provided free TTY’s to the Deaf and amplified phones to hard of hearing people. Some states now offer tablets and smartphones as part of their TEDP program, and alerting devices (e.g. loud phone ringers with wireless doorbells) can be found on some of the programs. Check with your state program for details on how the program works.

Speaking of phones, did you know that the FCC manages the Telecommunications Relay Service (TRS) fund and that the captioned telephones you recommend cost the taxpayer (that’s all of us!) $1.94 for every minute the phone is used? Captioned phones are a great solution for some patients, while most will benefit from an amplified phone. Click here for more info about TRS if you’re interested.

If you are concerned about your practice, your livelihood, and your patients, ACDHH encourages you to affiliate yourself with your state agency for the Deaf and the Hard of Hearing. Thirty-eight states have agencies, and in those states that don’t have a governmental program, look for an HLAA or ALDA chapter, or Hands and Voices or other type of hearing loss organization to connect with. You can also become involved with your local and/or national professional organizations such as AAA, ADA, and ASHA. Being an active member of any of these organizations will enhance your profile as a professional, connect you to consumers, and ensure that your patients receive the professional care they deserve and want. The ACDHH is proud to be a national leader in the field of communication access, support services, and community empowerment. Join us by emailing info@acdhh.az.gov or calling 602-542-3323.    
Michele Michaels is the Hearing Healthcare Program Manager for the Arizona Commission for the Deaf and the Hard of Hearing, 100 N. 15th Ave. Suite 104, Phoenix, AZ 85007. She can be reached at M.Michaels@acdhh.az.gov.