SISB Lec 20: Understanding Diversity

Transcript Study Notes

Introduction

  • Transcript is provided by the University of Melbourne under section 113 p of the Copyright Act 1968.

  • Recognition of the class environment and confirmation of recording.

  • Overview of topics discussed: patient education and counseling (previous class) and diversity in human rehabilitation (current focus).

Course Structure and Upcoming Assessments

  • Mention of upcoming weeks focusing on technical content related to REMS (Rehabilitation Engineering) and test box measures.

  • Reminder about the online test which is open book and multiple-choice format.

  • Release of video assignment grades.

Learning Outcomes

  • At the end of the session, students should be able to:

    • Recognize when rehabilitation processes require adaptation due to cultural and linguistic diversity or different abilities.

    • Understand the resources available for supporting these individuals in accessing hearing care.

    • Deliver more culturally sensitive and client-oriented services.

Sensitivity Warning

  • Topics might be culturally sensitive or triggering, including:

    • Cultural practices' impacts on audiological care.

    • Patient experiences and accommodations.

    • Unconscious biases affecting clinical decisions.

  • Encouragement for students to leave if needed for emotional comfort.

  • Emphasis on fostering an inclusive and respectful environment.

Diversity in Hearing Rehabilitation

  • Focus on diverse groups including:

    • First Nations communities.

    • Refugees and asylum seekers.

    • Deaf and hard of hearing individuals.

    • People with additional sensory or motor impairments.

  • Discussion on adapting practices to ensure effective service delivery.

First Nations Communities

  • Acknowledgment of First Nations as original owners of Australia with distinct cultures.

  • Higher rates of ear-related pathologies and lower life expectancy noted.

  • Key issues:

    • Accessibility barriers linked to socioeconomic factors and geographical isolation.

    • Use of mobile health clinics and telehealth services as solutions.

  • Training Aboriginal individuals to conduct hearing screenings and technical support.

  • Discussion on incorporating community input in rehabilitation.

Group Discussion Prompt

  • Prompts for discussion include:

    • Strategies for providing culturally safe services in remote Aboriginal communities.

    • Importance of community engagement and respect for cultural practices.

Adaptation Practices for Indigenous Groups

  • Strategies include:

    • Utilizing mobile health clinics and telehealth.

    • Training local community members in basic screening and device maintenance.

    • Providing flexible scheduling and tailored appointment services.

    • Culturally safe intake forms tailored to community specifications.

  • Importance of posters and artwork in clinics to create an inclusive environment.

Asylum Seekers and Refugees

  • Definitions and context:

    • Refugee: Individual fleeing conflict or persecution crossing international borders.

    • Asylum seeker: Individual seeking protection but not yet granted refugee status.

  • Current numbers in Victoria vs. available support services.

  • Considerations affecting access to hearing services:

    • Interconnected barriers including financial instability, language barriers, and health literacy.

    • Mental health considerations and trauma backgrounds affecting communication and service uptake.

Community Resources for Refugees and Asylum Seekers

  • Availability of community health resources including:

    • Asylum Seeker Resource Center.

    • Soundfair and Hearing bank services for low-cost or free hearing aids.

Deaf and Hard of Hearing Communities

  • Definitions:

    • Deaf (capital D): Identifies as part of the Deaf community; primarily using sign language (Auslan) as a first language.

    • Hard of hearing: Individuals with some hearing loss but not severe/profound.

  • Historical context of negative experiences leading to distrust of audiologists.

Adaptation Practices for Deaf and Hard of Hearing Individuals

  • Importance of having Auslan interpreters for appointments.

  • Need for practitioners to learn about Deaf culture and communication preferences.

    • Transition from a ‘hearing loss’ to ‘deaf gain’ perspective.

  • Use of visual communication aids and technology adaptations for devices.

    • Considerations for personalized ALDs and sound awareness technologies.

Sensory and Motor Impairments

  • Considerations for patients with vision loss or physical impairments in accessing audiology services:

    • Attention to dexterity and mobility issues affecting hearing device handling.

    • Importance of visual or tactile support in clinical settings.

  • Strategies for improvement:

    • Assessing for potential use of larger aids and ease of use in design.

    • Referral to relevant disability support services (e.g., Vision Australia).

Summary of Resources Available

  • Comprehensive resources include:

    • Hearing Australia and NDIS support services.

    • Access to community activities for social engagement for all affected groups.

Conclusion

  • The focus on culturally competent care will enhance service delivery and patient outcomes across diverse populations.

  • Encourage continuous reflection on assumptions and biases for holistic patient-centered care.

1⃣ Overview and Context

  • Focus: Diversity and inclusivity in audiological rehabilitation.

  • Builds on patient-centred care and counselling from previous sessions.

  • Aims to:

    • Recognise when rehabilitation processes require adaptation for culturally and linguistically diverse (CALD) clients and those with different abilities.

    • Understand resources and supports available.

    • Deliver appropriate, equitable, family-oriented clinical services.

  • Reminder: Topics may be culturally sensitive; goal is fostering inclusive, respectful learning and clinical environments.

2⃣ Lecture Learning Outcomes (aligned with LOs 1, 3, 4 & 5)

By the end, students should be able to:

  1. Identify when audiological rehabilitation must be adapted for diversity.

  2. Recognise unconscious bias and reflect on its clinical impact.

  3. Locate resources supporting access to hearing care for marginalised groups.

  4. Apply culturally safe, inclusive, equitable practices.

3⃣ Inclusive Practice Foundations

  • Reference: 12 Tips for Inclusive Practice in Healthcare Settings (Margatti et al., Western Sydney University).

    • Quote: Healthcare workers must avoid assumptions that hinder an accurate, holistic picture of a person’s medical and personal background.

    • Unchecked assumptions = barriers to service access and patient-centred care.

Unconscious Bias

  • Biases are automatic associations that affect judgment.

  • Making unconscious biases conscious improves:

    • Clinical decision-making.

    • Practitioner–client/family relationships.

    • Inclusivity and ethical responsibility.

  • Every client’s needs are unique — “one solution doesn’t fit all.”

Equity, Access & Suitability

  • Ensure services embrace:

    • Equity → affordability, fairness.

    • Access → physical, linguistic, cultural access.

    • Suitability → services and devices appropriate for client’s context.

  • Continuous reflection on conscious / unconscious biases is required.

4⃣ Focus Populations Covered

  1. First Nations peoples

  2. Refugees and asylum seekers

  3. Deaf and hard-of-hearing community

  4. Clients with additional disabilities (vision, motor impairments)

5⃣ First Nations Peoples

Background

  • Original custodians of Australia; distinct social, cultural, political identity.

  • Higher prevalence of ear-related pathologies and lower life expectancy.

Access Barriers

  • Socioeconomic factors (historic & structural).

  • Geographic isolation → limited service access.

  • Cultural mistrust toward Western healthcare.

Existing Solutions

  • Mobile health & tele-audiology to reach remote communities.

  • Indigenous health clinics / Aboriginal Medical Services (AMS) with Aboriginal governance.

  • Cultural safety → welcoming environments, Indigenous artwork, trained staff.

  • Community liaisons assisting in communication, follow-up, rehabilitation planning.

  • Training Indigenous health workers for screening, device maintenance.

Class Discussion Highlights

  • Cultural safety practices:

    • Acknowledge land and learn local language phrases.

    • Flexible scheduling (respect “sorry business,” community obligations).

    • Offer appointments for multiple family members.

    • Co-design intake forms with community input.

    • Undertake Cultural Safety Training (mandatory for clinicians).

    • Collaborate with elders/leaders to build trust.

Audiological Adaptations

  • Common middle-ear disease → consider bone-conduction aids (headband/softband).

  • Use low-maintenance BTEs, hearing hats for young children.

  • Provide spare devices, simple assistive listening devices (ALDs) (e.g., Bellman Audio).

  • Sound-field systems in classrooms → benefit all.

  • Train community health workers for screening & basic maintenance.

  • Cultural training before outreach (example: lecturer’s own experience providing training in Casino, NSW).

Support Programs

  • Community support: Indigenous liaison officers, trained health workers.

  • Funding:

    • HSP Community Service Obligation (CSO) → children 0–26 yrs & adults ≥ 50 yrs.

    • HAPEE Program → early-years hearing assessments (0–6 yrs).

    • Listen to Learn Program → education outcomes for Indigenous children.

  • Victorian Aboriginal Health Service (VAHS) and VACCHO/VAO (umbrella body).

  • ACCO Model – Aboriginal Community-Controlled Organisation:

    • Principles: community control, holistic care, cultural responsiveness, trauma-informed, strength-based, empowerment, self-determination.

    • Outcomes: improved health, reduced intergenerational trauma, strengthened cultural identity.

6⃣ Barriers Affecting Uptake of Services (Class Reflection)

  • Normalisation of ear disease → not viewed as requiring intervention.

  • Lower life expectancy → different age profiles.

  • Gender factors → women may prefer female clinicians.

  • Cultural priorities → family and community events > appointments.

  • Mistrust of Western systems.

  • Physical & linguistic access issues.

  • Need for family-centred, not just individual-centred, care.

7⃣ Refugees & Asylum Seekers

Definitions

  • Refugee: fled conflict/persecution → cannot return home safely.

  • Asylum Seeker: awaiting official refugee status; often on bridging visas.

Statistics (Victoria)

  • ~5 000 refugees / yr.

  • Up to 20 000 asylum seekers on bridging visas.

Barriers to Hearing Services

  • No permanent residency → limited access to Medicare, HSP.

  • Financial instability and unemployment.

  • Language barriers, low health literacy.

  • Unawareness of available services.

  • Psychological trauma, mental health issues.

  • Competing priorities – housing, safety, food before hearing care.

  • Distrust / fear → reluctance to share personal details.

Resources & Support

  • May access state-funded health services, but rarely HSP (federal).

  • Asylum Seeker Resource Centre (ASRC):

    • Multidisciplinary services – GPs, allied health, mental health, eye & hearing support.

  • Soundfair Hearing Bank: refurbished hearing aids for free/low cost.

  • Consider collaboration with trauma-informed services and interpreters.

Case Study – Laila

  • 33 yo, from Iran, seeking asylum. Family Hx of progressive SNHL. Referred for “bilateral HL & tinnitus; bulk bill.”

  • Issue: required to pull back headscarf for otoscopy/PTA; two student observers (male & female).

Approach:

  1. Ask for her comfort level before assuming.

  2. Offer female-only clinician or request male student to step out.

  3. Respect cultural modesty.

  4. Check English proficiency → speech tests (e.g., LiSN-S) may not be valid.

  5. Management:

    • Use non-linguistic/quiet speech tests or interpret cautiously.

    • Funding via Soundfair for hearing aids.

    • Be mindful of English-based test bias (SNR requirements).

8⃣ Deaf and Hard-of-Hearing Communities

Cultural Identity

  • “Deaf” (capital D) = identifies culturally as part of the Deaf community; uses Auslan.

  • “Hard of Hearing” = some residual hearing; oral or sign communication.

  • Sign language = a language and a cultural identity.

  • Some adults with acquired severe/profound HL later align with the Deaf community.

Historical Context

  • Past techno-centric focus → negative attitudes toward audiologists.

  • Preference for cultural pride, Deaf Gain perspective → not a “deficit.”

Clinical Considerations

  • Some may reject hearing technology; others use it for sound awareness / safety.

  • Narrow dynamic range → easily triggered discomfort.

  • Devices often old; infrequent updates.

Practice Adaptations

  • Offer Auslan interpreter (or trained staff).

  • If none:

    • Use real-time transcription, writing, gestures, lip-reading cues, enhanced lighting.

    • Confirm literacy in English before relying on writing.

  • Respect cultural identity; avoid framing hearing loss as “deficit.”

  • Technology:

    • High-powered HAs for demo; DSL v5 / NAL1 rather than NAL2.

    • Frequency lowering to avoid dead regions.

    • Adjust compression & MPO carefully.

ALDs & Safety

  • Many use devices for:

    • Sound awareness (one aid or ALDs only).

    • Home safety: alarms, doorbells, baby monitors, vibrating alerts.

    • Streaming/communication in mixed environments.

Tools & Resources

  • Family-Oriented Communication Assessment & Solutions Form (Phonak).

  • HHIA/HHIE questionnaires → social impact.

  • CSO Program → funding for >80 dB HL.

  • NDIS support, social groups (Deaf Club, Expression Australia, Soundfair meetups).

Case – Thomas (75 yo)

  • Severe-to-profound SNHL, lives alone, socially isolated, aids not working.

  • Issues:

    • Communication breakdown in clinic.

    • Wax filters blocked — unclear how to change.

  • Management:

    • Improve lighting; write, gesture, use visual aids.

    • Demonstrate wax-filter change → do together → provide pictorial instructions.

    • Discuss safety devices (doorbell, smoke alarm alerts).

    • Consider ALDs for emergency awareness.

9⃣ Clients with Vision Loss

  • Common in syndromes (e.g., Usher’s).

  • Impacts lip-reading, facial cues, hearing-aid management.

  • Consider:

    • Rechargeable aids.

    • Large left/right markers.

    • Magnifying glasses.

    • Large-print instructions.

    • Bright, consistent lighting.

    • Family involvement.

    • Adjust phone font sizes.

  • Support: Vision Australia, NDIS, AB (Australian Blindness) Australia.

🔟 Motor / Physical Disabilities

  • Reduced dexterity → difficulty handling small devices.

  • Solutions:

    • Larger aids, earmolds with locks.

    • Rechargeable options.

    • Ensure ALDs compatible with physical abilities.

    • Collaborate with occupational therapists.

  • Funding/support: NDIS, CSO specialist hearing services.