Subscribe
Share
Share
Embed
Podcast by The Hearing Review
Melanie (00:01.518)
Welcome to the Hearing Horizons podcast from The Hearing Review. I'm the chief editor of The Hearing Review, Melanie Hamilton Basich. I'm joined today by Bec Bennett, PhD, a clinical and research audiologist at National Acoustic Laboratories in Sydney, Australia, to talk about a program she and her team developed to help audiologists incorporate talking to patients about mental well -being into their practice. Thank you for joining us today, Bec.
Bec (00:27.508)
Thanks, Melanie.
Melanie (00:30.382)
So why is it important for audiologists and other hearing care professionals to acknowledge and ask about their patient's social emotional well -being?
Bec (00:40.116)
Well, I guess for us audiologists sitting in the clinic.
The experience of hearing loss we can sometimes assume is very hearing specific because when our clients come in we think about the audiogram and the hearing aids that match the audiogram and we really focus on the hearing aspect. But often for the person with hearing loss the experience of hearing loss is far more than whether they can hear or not hear certain sounds. And so their experience of hearing loss is how the hearing loss is impacted.
on different aspects of their life and sometimes it will be
simple hearing activities like they don't hear the car indicator hasn't turned off while they're driving or they don't hear the beeps of the washing machine when the load's finished. But for most people those sorts of sounds can be somewhat inconsequential and it's when the hearing difficulties start to impact on the social interactions or on the emotional well -being that people start to really feel the weight of the hearing loss. So as we
we know as audiologists and our clients will often tell us is the hearing loss can start to make it difficult to communicate in daily activities but importantly it can also make it difficult to communicate in those social interactions. So people with hearing loss we might miss the punchline of a joke or we might miss some of those important social cues and we can start to feel rejected or isolated or
Bec (02:17.724)
inadequate in some of those social interactions.
And when there's a build up or these sorts of interactions become more frequent and the intensity of these negative impacts of hearing loss and our social well -being or our work functionality, when these negative impacts build up over time they can start to impact on emotional well -being as well. So we know that adults with hearing loss, almost all of them say that at some point their hearing loss has caused them to mishear something and feel embarrassed.
or they've been frustrated with how the hearing loss has impact on a communication. And for a lot of people with hearing loss, it can also impact how the quality of their social interactions and their emotional wellbeing. And it's kind of like an iceberg for a smaller proportion that social and emotional impact is even more intense and it can start to lead to things like social anxiety, generalized anxiety, depression, loneliness.
social isolation.
Melanie (03:25.425)
In your research, what did you find were the major reasons that many audiologists don't ask their patients about their mental well -being?
Bec (03:35.956)
There was a lot of different reasons. So we used a framework called the COMB. So it's a behaviour change framework that looks at the capability, the opportunity and the motivation for individuals to actually do the behaviour you're looking at. So we were looking at what are some of the barriers and facilitators relating to capability. So do audiologists have the skills and the knowledge to ask about mental wellbeing? We looked at the opportunity.
So do audiologists have the opportunity within their work environment, within their timeframes, within the interactions that they're having with their clients to ask about mental wellbeing and also the motivation. So do they feel as though it's within their scope of practice? Do they feel as though it's beneficial to them as clinicians? Do they feel as though it's beneficial to the clients to raise conversations about mental wellbeing? And do they feel well supported by their managers like
they are going to be rewarded rather than scrutinized for spending time talking about mental well -being in those audiology appointments. So not surprisingly with lots of things there's a time barrier so clinicians feel like they don't have time to do any extra things but the really interesting part about that one was
After we developed the AMR intervention and rolled it out in a clinic, a lot of the clinicians actually said that it saved time because asking how the clients were going with their hearing loss socially and emotionally from the outset helped them build rapport more rapidly, but also helped them to really understand what was driving the client into the clinic in the first instance. And so it made that conversation about hearing rehabilitation options more relevant to the client. They could talk about how
hearing aids can help you to hear better in those social situations and not miss out on those social cues if that's what's really important to them. Whereas prior to that often audiologists we were speaking with would say when they were trying to ascertain the client's goals they would ask things like do you hear the TV? Do you hear in a noisy restaurant? Do you and they were very hearing related goals and so the hearing aid discussion would be focused on hearing related goals. Whereas by
Melanie (05:54.513)
Right.
Bec (05:59.43)
drawing out the social and emotional well -being impacts of hearing loss from the outset meant that when they came to the point of talking about hearing aids or communication training programs or hearables, whatever intervention options you're talking about, when it came to that discussion, they could talk about the intervention options using the examples and the needs that the client was actually experiencing in their real life that they brought to the conversation. So in some ways,
it felt like they were saving time and getting to the crunch of things.
more quickly within those appointments. So other than time, there was one of the major ones was a lack of skill and confidence around the language, which I found really interesting. I guess there are some of us who just growing up, we talked about feelings and emotions and feel comfortable talking about feelings. Or some of us might have done psychology and our undergrad science degrees, myself included. Or some of us
might have done counselling courses or some of us just naturally feel comfortable talking about feelings and we have the language to express empathy and concern and to have those conversations about heavy feelings. We don't feel as though we have to take it on board or solve everyone's problems but we're comfortable having a conversation, an awkward conversation about someone else if they're feeling unhappy or feeling lonely or feeling anxious about things.
But not everyone has those skills. Not everyone has had the opportunity to develop the language or develop the skills or have that practice talking about feelings and emotions and sitting with that discomfort when someone talks about how lonely they are or how socially anxious they feel because of the hearing loss in really challenging situations. And so it takes a lot of emotional maturity in ourselves to be able to develop those skills. And we found that was actually the number one barrier. So that's a big part of what we
Bec (08:03.59)
put into the aim or intervention is to help people develop the language in how to ask about mental well -being and then the skills for how to respond with empathy and comfortably discuss those emotional talking points or how people are feeling and how to support them on that journey kind of thing.
So there were other barriers, there were a lot of other barriers. They were probably the main ones that were affecting a large proportion of the audiologists that we interviewed. But to a lesser degree there were some...
question marks around scope of practice and how to make sure that these conversations stayed within our scope of practice and then questions around whether their bosses were happy with them talking about well -being and spending time talking about well -being and then there was another piece around the clients so whether the clients were comfortable or would expect them to ask about well -being and how the clients
might respond if they started opening that discussion around well -being.
Melanie (09:21.972)
That's interesting. So you've already talked a little bit about how this can be helpful. Can you explain a little bit more about AIMER itself and how hearing care professionals can use the AIMER framework to help overcome some of the challenges they might be experiencing that you discussed?
Bec (09:22.26)
Thank you.
Bec (09:40.372)
Yeah, certainly. So the AIMA framework stands for, the AIMA stands for Ask, Inform, Manage, Encourage and Refer. So essentially it's kind of five steps in that process of how to provide social and emotional wellbeing support for your clients. So the A is around ask, so asking your clients about their wellbeing. The I is inform, so informing clients.
about the link between hearing loss and social and emotional well -being. And the reason that's important is because we've found that when audiologists start to educate their clients and tell them about the common link between hearing loss and social and emotional well -being, then the clients feel really validated and seen in their own experience. Often when we run focus groups for our research or when we run group communication trainings and
and talk about that wellbeing in those group sessions. One of the main things that the participants or the clients say they love about those sessions is just that they feel really validated. They had always thought they were the weird or the odd one for feeling embarrassed or feeling rejected or feeling left out and just to have an audiologist or a researcher validate that experience and tell them they're not alone. It's common for people to have these social and emotional impacts. It's so empowering for them.
and one of the real benefits of those group rehab sessions that a lot of audiologists run is that the adults with hearing loss get to hear other people's stories which validates their own experience but then they also get to hear other people's success stories which helps them build resilience and strength and learn and draw from from other people as well. So we've got the ask, the inform, the is for manage so to help clients manage their social and emotional
wellbeing and so this is where the audiologist would look at the individual clients needs and look at how they can support them as an individual and that might be things like providing them with links to websites like beyond blue or lifeline websites around
Bec (12:01.108)
social and emotional well -being. I know here in Australia we've got an advocacy group called Deafness Forum and one called Soundfair. In the US you have HLAA, have I got that acronym right? The Hearing Loss Association of America, HLAA. And in the UK they've got RIND. So there are lots of beautiful advocacy and support groups around the world and so it's really important that audiologists are aware
aware of these and connect their clients to these when indicated. There are also, depending on the experience, there are also some great local and global resources. For example, clients experiencing loneliness, which is really, really common in people with hearing loss. So we have here in Australia a group called Ending Loneliness Together, and they're part of an international consortium called the, it's called GILC. So the Global Initiative
of on loneliness and connection I think is the acronym stands for and so definitely worth looking them up and so sometimes there'll be things that the audiologist can do from an audiological perspective so communication training or hearing devices and all of these things can help people improve their social and emotional well -being as well and then sometimes there are client needs outside of our skill set outside of our scope of practice and so we might need to
connect our client or refer them on to a counselor, psychologist or back to their GP to talk about a mental health care plan or something like that. So there are lots of different things that we can do to provide to help with that management of those social and emotional impacts and we talk a lot about
all those different things and what they can look like in some of the aim of work. But it's really about having that individual, what the client individually needs.
Bec (14:03.124)
And so then the E in AMA stands for encourage. And so really important that it's not just a dump of information, but it's this kind of support and encouragement to actually take the next step to do something with this information, to click on the link and go and read the website. So actually reach out and go and see the counsellor or whatever the recommendation and support has been to really encourage them to take that next step and do something. And then the R is around referral. So again, just making sure
we understand our scope of practice, we're working within our skill sets and our scope of practice and we're referring our clients to other professionals when required. Have I answered your question? Was that was a question? Yeah just around the aim of framework and the difference.
Melanie (14:50.103)
Yeah.
Yeah, no, that's great. Then I wanted to also ask, what kind of feedback have you received from hearing care professionals who have used the AIMER framework and what have their results been for themselves and their patients?
Bec (15:06.484)
Yeah, yeah so I recently wrote an article that sort of describes the process that we undertook and some of the key findings from the AMR intervention.
And so you can see that in the article here. But there are also a series of peer review publications that go into a lot more detail that are referenced in the article. But that also, if you don't have access, please feel free to send me an email and I can send you copies of those papers as well. And so one of the studies we did was we implemented the AIMA in a hearing clinic in Perth.
there were around 50 audiologists across 15 or so clinics in Western Australia and all of the staff were trained in the AIMA.
intervention and we conducted surveys before and afterwards and also interviewed a proportion of them afterwards to find out their feedback and see what they thought of the process. And the feedback was really glowing so a lot of the things they said were beneficial was
One of the things that really struck with me is you may recall earlier in this interview I talked about that COMB framework and the being motivation. And one of the barriers was that some of the clinicians felt like, well, who am I to talk about mental wellbeing? Do my clients even want me to? And so one of the intervention elements we developed was we interviewed a whole group of adults with hearing loss who have been seeing audiologists in clinics for years and asked the
Bec (16:59.302)
to describe how their hearing loss impacts on their social and emotional well -being, ask them to describe what their audiologist has or hasn't done to find out about that and help them with that and ask them what they would like their audiologist to do to help them or not help them if they don't think that that's what's required. And the video is very very moving actually we can it's it's on YouTube so we can post the link
underneath the podcast here for viewers that might want to look at it. But the video we've got about five I think it is adults with hearing loss who
Melanie (17:32.952)
show.
Bec (17:41.62)
very bravely share their stories about how their hearing loss is impacting on their social and emotional well -being and then talk about how their audiologist has never asked them about it and they assume their audiologist isn't aware or just doesn't care and how they really wish their audiologist had asked them about it and if their audiologist had any tips or advice or guidance on how to navigate these big feelings then they would welcome that and would would really love their support.
And so in the feedback we got from the audiologist after we rolled out the AMR intervention, this was one of the main parts of the intervention that the audiologist said just stuck with them, that they hadn't realized how much of a disservice they were doing their clients by not asking. They hadn't realized how much their clients wanted that safe space to talk about those big feelings and those impacts of hearing loss. And so that really motivated
them to start asking and when they did start asking
a huge proportion of their clients opened up and shared their story and felt that stronger connection and affinity with their audiologists. And so it not only helped them from a clinical perspective in their workflow, but they talked about how it also helped them to feel more fulfillment in their role as an audiologist because they could feel that they were really helping people beyond just fitting hearing aids. They were helping people unpack
and understand and validate their emotional impacts and helping them to explore and support and better manage those social and emotional needs. And so they felt more fulfilled in their role as audiologists to be doing that little bit more and supporting their clients that little bit extra, which was really a beautiful thing to read in the data.
Bec (19:41.748)
Some of the other feedback we got was, as I mentioned earlier, it ended up being a time saver, not a time waster. They also talked about how in the past, if a client had disclosed more significant mental health...
conditions such as anxiety or depression or if a client was having a really bad day and had really offloaded some of their trauma that they had been experiencing that the audiologist felt ill equipped to handle that sort of thing and in the past they perhaps may have just shut it down and moved on because they didn't know how to have those difficult conversations and so they said while a lot of the aimer is designed to
Melanie (20:25.594)
Right.
Bec (20:29.83)
to train them in having conversations about, dare I say, more the milder social and emotional wellbeing impacts. There is a segment of the training that goes into what you can do and resources and tools you can use if a client is disclosing more intense or more problematic experiences or showing...
concerning signs of depression or suicidal ideation and how to manage those more difficult situations. And so they said while they don't anticipate seeing...
those situations regularly they feel a lot more secure in themselves by having those skills and those resources in their back pocket should that situation arise in the future. And so that was nice to hear as well that it was around that feeling more secure for the future if those sorts of situations come up.
And then a big part was around just that language, having those tools and that opportunity to practice. They felt much more confident in having the language to talk about emotional wellbeing and realising that if a client says,
they're feeling really lonely or they're feeling really socially anxious and they're withdrawing or if a client discloses what they're going through, the audiologist doesn't have to fix it. They just have to acknowledge it and offer how they might be able to help, but we don't have to take it on board and feel responsible for fixing everything. And so helping them to feel confidence in the language to create that safe space for clients to disclose what they're going through was great to see that improvement in skills in that.
Melanie (22:18.523)
Those are some great points. Where can people find out more about the AMR framework so they might be able to use it themselves?
Bec (22:26.42)
Yeah so we talk a bit about it in the article and then there's also a link in that article to a website where all of the aim of resources, the different training tools or clinical resources that we developed such as information fact sheets or brochures or discussion tools, all of those sorts of resources are freely available, downloadable online from that website that's listed
in the article and there is also a more detailed description of how we develop the tools and how we applied them. The bit that's been really hard to share is the way we conducted the program is I with a colleague of mine who's a psychologist we delivered the aim a training and so it included some videos but also a three or
or maybe it was a four hour in -person workshop. And so we did that as part of the initial AIMA intervention, the research project. And since then, quite...
excitedly, we've had about five or so different hearing clinics from across Australia who read about it and wanted it rolled out within their clinics and so I have presented it at quite a number of conferences now but I've also gone out to a few clinics to do a full day or a half day workshop with their staff to help train them but of course
While I would love to sit down with every audiologist around the world and train anyone who's interested, that's impossible from a time and a location logistics perspective. So what I'm trying to do is to get some research funding so that we can develop a digital version of the training so that we can develop some videos and some interactive training modules so that clinicians around the world would be able to access all of the tools and all of the training
Melanie (24:14.013)
Hmm
Melanie (24:21.085)
Right?
Bec (24:37.67)
training and all of the resources but research funding is hard to get so I'm still working on that one but hopefully hopefully I'll have some good news soon if we can have some success in that space. I was talking to a colleague of mine recently who was saying that this sort of topic area is becoming
more of interest in the States and he was asking whether I might be interested to come to one of the conferences next year which sounds wonderful. So hopefully if that goes ahead then I might be able to come to the US next year and run a workshop or something on the AMR just as a preliminary information and to share what I can within that time frame. But yeah hopefully fingers crossed we'll see.
Melanie (25:31.997)
That would be great, but it's also great that you do have some of the resources available for people to access now. So that's great. Well, thank you for sharing your insights. I really appreciate it, and I'm sure our listeners do as well.
Bec (25:36.564)
Yes. Yeah, definitely.
Bec (25:47.284)
Yeah, no worries.
Melanie (25:50.461)
You can find out more about the research that was used to develop the AIMER framework in the June 2024 issue of the Hearing Review. The article is also available online at www .hearingreview .org, where you can find articles, news, and more for hearing care professionals. And you can listen to more Hearing Horizons podcast episodes on our website or wherever you listen to podcasts.