Hearing Impaired Handbook

24412_KP_ccc_hearing_cvrFNL.qxp:kp_ccc_cvr.qxd 10/6/08 7:46 AM Page 2 A Provider’s Handbook on Culturally Competent Care PEOPLE WITH HEARING LOSS 1ST EDITION Kaiser Permanente National Diversity Council and the Kaiser Permanente National Diversity Office 24412_KP_ccc_hardhear_3.qxp:KP_ccc_guts_web.qxd 10/7/08 9:17 AM Page 1 A PROVIDER’S HANDBOOK ON CULTURALLY COMPETENT CARE 24412_KP_ccc_hardhear_3.qxp:KP_ccc_guts_web.qxd 10/7/08 9:17 AM Page 2 TABLE OF CONTENTS INTRODUCTION......................................................................................................................1 DEFINITIONS AND DEMOGRAPHICS ...........................................................................2 Who are People with Hearing Loss? Definitions and Terminology: Past & Present How We Hear Causes of Hearing Loss Types of Hearing Loss Degrees of Hearing Loss Functional Aspects of Hearing Loss Demographics and Trends Health Care Provider Tips CULTURAL PERSPECTIVES, BELIEFS, AND BEHAVIORS....................................18 The Costs of Hearing Loss Stigma and Barriers to Treatment Loss and Grief Coping Beliefs Adherence Stages of Change Health Care Provider Tips COMMUNICATING WITH PEOPLE WITH HEARING LOSS ................................24 Effective Communication Behaviors in Communication Legal, Regulatory, and Accreditation Requirements Physical Settings Health Care Provider Tips RISK FACTORS ........................................................................................................................33 Perinatal Issues Congenital Hearing Loss and Associated Syndromic Losses Infections Drug Exposure Noise Exposure Head Trauma Age-Related Hearing Loss Health Care Provider Tips 24412_KP_ccc_hardhear_3.qxp:KP_ccc_guts_web.qxd 10/7/08 9:17 AM Page 3 OCCUPATIONAL EXPOSURE, DISABILITY, and LEGAL ISSUES .......................38 Types of Hearing Loss Evaluation and Assessment Referrals Disability and Impairment Management and Recommendations Compliance and Legal Issues Health Care Provider Tips IDIOPATHIC SUDDEN SENSORINEURAL HEARING LOSS (ISSNHL) ............42 Health Care Provider Tips AUTOIMMUNE HEARING LOSS......................................................................................46 Health Care Provider Tips PEDIATRIC POPULATION.................................................................................................48 Education Auditory Neuropathy Recurrent Otitis Media and Hearing Loss Newborn Hearing Screening and Speech Development Pediatric Hearing Loss (Non-Otitis Related) Auditory Processing Disorders Health Care Provider Tips TREATMENT OPTIONS.......................................................................................................68 Cochlear Implants Hearing Aids The Baha® System of Direct Bone Conduction Assistive Devices Health Care Provider Tips CONCLUSION..........................................................................................................................74 RESOURCES..............................................................................................................................75 School-Based Hearing Screening Information Auditory Behavior Index for Infants Hearing Loss Frequency and Intensity Chart National and Regional Resources Kaiser Permanente Resources BIBLIOGRAPHY......................................................................................................................93 ACKNOWLEDGEMENTS..................................................................................................101 EVALUATION........................................................................................................................103 24412_KP_ccc_hardhear_3.qxp:KP_ccc_guts_web.qxd 10/7/08 9:17 AM Page 1 INTRODUCTION aiser Permanente is committed to providing linguistically and culturally competent care to its increasingly diverse membership, aimed at eliminating disparities in health status and health care K delivery. Culturally competent care refers to the delivery of health care services in a manner that acknowledges and understands cultural diversity in the clinical setting, respects patients’ health beliefs and practices, and values cross-cultural communication. Linguistically competent care is the ability to communicate effectively in the patient’s language, recognize that language and culture are interconnected, and understand how language reflects culture and simultaneously shapes it. Culture shapes our thinking; furthermore, our thinking shapes language. This powerful interrelationship affects all human interactions. Considering and respecting a patient’s cultural and linguistic needs are key elements to patient-centered care. Ensuring effective communication in the clinician-patient encounter is pivotal to quality of care, patient satisfaction, and patient safety. Our dedication to linguistically and culturally competent care and services is aligned with Kaiser Permanente’s mission to provide personalized care and to improve the overall health of the communities we serve. The goal of the Provider’s Handbook series is to provide Kaiser Permanente’s health care clinicians with an overview of the cultural and epidemiological differences that characterize major cultural groups represented within our membership. In no way is our intention to stereotype patients by groups. Rather, the handbooks focus on common characteristics of each group that may have implications for health care organizations and practitioners. The handbooks present health care research, practical information, and tools that can help our providers become more aware and knowledgeable about the health care needs of our diverse membership. This is the first edition of the Provider’s Handbook on Culturally Competent Care: People with Hearing Loss. It is part of a series of educational resources. This handbook evolved from a series of initiatives to help providers and staff increase their cultural and clinical understandings of people with hearing loss. It begins with general overviews of cultural and epidemiological aspects of this diverse population. Subsequent chapters highlight hearing loss risk factors and diseases, present better ways to understand hearing loss, and summarize improved interventions for children and adults. Also outlined are legal issues, guidelines from the Americans with Disabilities Act, and resources found throughout Kaiser Permanente to support members with hearing loss and their care providers. The information provided in this handbook comes primarily from four sources: articles published in medical and health care journals, state and federal publications, information from government and community agencies, and Kaiser Permanente experts. An editorial board composed of Kaiser Permanente physicians, staff, and community experts reviewed and contributed to this handbook. 1 24412_KP_ccc_hardhear_3.qxp:KP_ccc_guts_web.qxd 10/7/08 9:17 AM Page 2 DEFINITIONS AND DEMOGRAPHICS Who Are People with Hearing Loss? t is difficult to summarize in one handbook all the important aspects relevant to providing care to patients with hearing loss. This is particularly true because of the complex sociocultural and clinical Ifactors that contribute to hearing loss. For example, great diversity exists among people with hearing loss, with ranges of hearing ability and differing cultural identities. Those who identify themselves as part of the Deaf community, for instance, see themselves as having a distinct cultural identity, whereas the majority of people with hearing loss may still identify with the hearing mainstream. The reasons for this phenomenon are complex but could be related to the fact that the overwhelming majority of people with hearing loss once had normal hearing capabilities. Within this group, however, some of these individuals may see their hearing loss as a distinct identity. They may commonly identify as hard of hearing or as people with hearing loss. People with hearing loss are from many diverse groups reflecting different generations, races, ethnicities, immigration statuses, socioeconomic statuses, religions, and sexual orientations. In many instances, individuals may not identify themselves as people with hearing loss nor see their hearing loss as a particular illness or defining characteristic. It is important to note that individuals with hearing loss may also exhibit other common simultaneous health concerns such as visual impairments, loss of natural teeth, depression, or ear infections. These may have existed prior to or concurrently developed with the hearing loss. Be aware, as concerns like these can be easily overlooked when the hearing condition becomes the clinical focus. Prevalence Although statistics vary, hearing loss affects a large portion of the general population. According to the “Summary Health Statistics for U.S. Adults, National Health Interview Survey, 2005 Report” there are 36.5 million non-institutionalized adults with hearing troubles. This represents about 16.7% (1 out of 6) of U.S. adults, 18 years of age or older. Within this group, an estimated 2.2% of individuals (803,000 persons) are deaf. The remaining individuals have hearing loss which ranges from mild to profound. The report “MarkeTrak VII: Hearing Loss Population Tops 31 Million People” by the Better Hearing Institute (BHI) published in July, 2005 estimates that there are more than 31.5 million people in the U.S. who find it difficult to hear without the use of a hearing aid. As of 1995, hearing loss ranked as the third most common chronic condition in the U.S,

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