Thinking Outside the Booth: Three Overlapping Categories of University Audiology Outreach

Interventional Audiology Services: University Outreach  | October 2016 Hearing Review

Ideas for broadening hearing care outreach for the benefit of your community and state

By Melanie Buhr-Lawler, AuD

By extending hearing healthcare beyond the walls of the traditional audiology clinic, an audiology outreach program demonstrates genuine professional care about the well-being of individuals throughout the state. Similarly, by extending learning far beyond the halls of the university, the audiology outreach program has become a valued component of the university’s AuD experience.

The “Wisconsin Idea” is the philosophy that education at the University of Wisconsin should extend beyond the walls of the classroom into the larger community, state, and world.¹ This expansion of the traditional classroom is achieved through outreach efforts across departments on the University of Wisconsin (UW) campuses. The UW audiology clinical faculty have established a number of audiology outreach projects that embody the Wisconsin Idea. These projects have allowed the UW audiologists and students to bring hearing loss prevention, hearing health education, and hearing healthcare far beyond the halls of the university. The projects benefit the public, students, audiology faculty, AuD program, and the university.

Overview of University of Wisconsin Audiology Outreach

The first audiology degree was granted by the University of Wisconsin-Madison in 1961. The program transitioned from a master’s degree to a 4-year Doctor of Audiology (AuD) in 2005. Clinical outreach has long been a component of the UW audiology program. In recent years, the outreach projects have expanded substantially and become an integral component of the educational experience of all AuD students.

The outreach is planned and overseen by audiology clinical professors and conducted in conjunction with AuD students, with outreach falling into three overlapping categories: 1) Provision of hearing healthcare services outside of the traditional clinic; 2) Hearing loss prevention projects, and 3) Raising public awareness of hearing health issues (Figure 1).

Hearing Healthcare Beyond the Walls of the Traditional Audiology Clinic

Many individuals in Wisconsin do not have easy access to traditional audiology services due to geographic or financial reasons. One objective of the UW audiology outreach is to offer clinical services to those who are unable to get to a traditional audiology clinic. The UW audiology outreach clinics serve many age groups, cultural and demographic backgrounds, and geographic areas.

Rural communities. In particular, the clinics serve individuals in rural areas. Since June 2012, the UW audiology department has offered “out-of-hospital” clinics in cooperation with the UW-Madison Waisman Center and Wisconsin Sound Beginnings, Wisconsin’s Early Hearing Detection and Intervention (EHDI) program. Hearing screenings and diagnostic evaluation services are offered about twice annually in rural locations across Wisconsin in the homes of local midwives or in community meeting houses. The majority of individuals who attend the clinics are members of the rural Wisconsin Amish and Mennonite communities. Children in these communities are born at home with the assistance of a midwife, and approximately 40% do not receive newborn hearing screenings. The primary focus of the clinics is on children; however, individuals of all ages are seen in the clinics, particularly if there is a concern for hearing loss. Through these clinics, a number of individuals have been identified with hearing loss. Several have received hearing aids, and one has received a cochlear implant.

Head Start program. Another focus of the outreach clinics is on children in urban low-income families in the Madison/Dane County area. The UW Speech and Hearing Clinic (UWSHC) has a 25-year relationship with the regional Head Start program. Each year, hearing screenings are provided for every child in the Dane County Head Start program, which includes approximately 1,000 children ranging from newborns to age 5. These screenings and after-care ensure that each child in Head Start receives good access to hearing healthcare. Additionally, the screenings provide an excellent opportunity for students to develop their pediatric hearing testing techniques.

Senior care facilities. A third area of UW audiology outreach clinics is to senior care facilities in rural areas around Wisconsin, including assisted living, nursing homes, hospice, and long-term care. This outreach has been a two-pronged attempt to improve hearing for facility residents. The first is providing immediate services to residents in the form of free hearing aid cleanings. If a hearing aid requires extensive services or repairs, or if otoscopy reveals a medical concern, appropriate referrals are made for the individual to follow-up with local care providers. The second component of this outreach is providing trainings for nursing staff on how to do simple hearing aid checks, cleanings, and battery changes. The trainings last approximately 5-10 minutes and are tailored to the needs of the specific care providers. Feedback from residents and providers indicates that they have been extremely satisfied with the audiology services. The senior outreach will be in its third year this summer. This outreach is supported by a UW-Madison Wisconsin Idea Statewide Outreach Incentive Grant, so there is no charge to residents.

Kids’ camp. A fourth UW non-traditional audiology clinic is the UW Speech and Hearing Clinic (UWSHC) Dramatic Playgroup. This is a week-long, camp-style clinic for children who are deaf/Deaf and hard-of-hearing. The Dramatic Playgroup utilizes acting and stories to facilitate language development in the children who participate. This clinic is offered on the UW-Madison campus once each summer. It is a unique service in the state, and it is attended by children from a wide geographic area.

Hearing Loss Prevention Projects

The second area of focus of the UW audiology outreach is hearing loss prevention, with a specific aim at serving individuals not reached by traditional hearing conservation programs. These hearing loss prevention projects include outreach at a rural tractor pull competition, a motorcycle rally, and at an urban outdoor rock concert series.

Agricultural/occupational hearing loss prevention. According to the most recent (2012) agricultural census conducted by the US Department of Agriculture, there are 69,754 farms in the state of Wisconsin. Workers on farms that employ 10 or fewer employees are exempt from traditional hearing conservation programs as regulated by the Occupational Safety and Health Administration (OSHA) under the Appropriations Act (OSHA).² Farm tractors without cabs are 100 dBA on average, as are the squeals of pigs.³ Further, many farmers are exposed to other high noise levels recreationally, such as hunting and motorsports.

In an effort to reach farmers in rural Wisconsin, a hearing loss prevention program was developed and implemented at the Dairyland SuperNational Tractor Pull in Tomah, Wisconsin (commonly referred to as the “Tomah Tractor Pull.” (Figure 2) A tractor pull is a competitive motorsport in which engines are modified to pull extremely heavy weights. Tractor pulls are very loud events, with our own measurements recording levels of 128 dBA+ at the “light” (quietest) tractor competition. Many of the attendees are farm and other rural workers all-too-familiar with high noise levels. There were two points of focus for the UW audiology outreach effort: 1) Provide immediate hearing protection for the attendees and the participants at the event via handing out free personal earplugs, and 2) Encourage long-term healthy hearing habits in tractor pull attendees.

The tractor pull outreach is in its third year, and the group has distributed between 2,000 and 4,000 pairs of earplugs each year, depending on funding levels. The group labels the earplugs with an informational positive message, such as, “Push these in while you enjoy the pull…it’s never too late to protect your hearing!” These messages, along with materials and personal conversations attempt to make lasting changes to the culture and attitudes surrounding rural noise. The groups have also attempted to provide hearing screenings via a portable audiometer. (So far, these were unsuccessful due to high levels of ambient noise at the event.) The outreach is supported by UW-Madison Baldwin Mini-Grant and Wisconsin Idea Outreach Grants.

Recreational hearing conservation. The community-focused hearing loss prevention efforts initiated at the Tomah Tractor Pull have expanded to other events with the same goals: to provide immediate protection at extremely loud events and to encourage lasting healthy hearing habits. These include outreach to a Harley Owner’s Group (H.O.G.) motorcycle rally and at a live, outdoor concert series (“Live on King Street”) held in the summers in Madison. Similar to the tractor pull outreach, the hearing loss prevention efforts at these events focus on the immediate provision of hearing protection (earplugs) and imparting knowledge and positive attitudes about the prevention of noise-induced hearing loss. The outreach group moves through the crowd of motorcyclists and concert attendees with bags of earplugs, which are labeled with a message similar to that of the tractor pull: Protect your hearing while you enjoy this event (Figure 3).

Raising Public Awareness of Topics in Audiology

As hearing care professionals are acutely aware, there is room for improvement in the public’s opinion about hearing loss and hearing aids, according to MarkeTrak 9.? The goal of the third facet of the UW audiology outreach is to expand public knowledge about hearing, hearing technology, and hearing loss prevention. Although all of the projects described previously have an ancillary goal of raising public awareness, the outreach has undertaken several projects that focus specifically on public education in topics in audiology. The group approaches this goal by giving presentations, by participating in local and state-wide public events, and by hosting an annual symposium for the public.

One of the most straightforward ways to provide public education on audiology issues is to directly speak to community and statewide groups about topics in the field. Examples of such UW audiology outreach include talks at clubs, such as the Kiwanis and Lions’ clubs, public libraries, and senior centers. One recent and unique presentation on hearing loss prevention was part of a UW-Madison educational lecture series. This project succeeded in reaching a large audience, since it was videoed and aired on Wisconsin Public Television.

Another approach to public education through outreach is via participation in events, such as community health fairs, the Wisconsin State Fair, University of Wisconsin Science Expeditions (a widely-attended day for families on topics in science), and other community conferences or exhibitions, such as those hosted by the UW Madison Institute on Aging. At these events, the UW Audiology group typically has a table where they provide materials, resources, and fun educational activities tailored to the crowd at the event. For example, at senior health fairs, the group offers hearing screenings (via a portable audiometer and a semi-enclosed table-top sound booth). At a family-friendly event that includes young children, the outreach focuses on “a journey through the human auditory system” and hearing loss prevention with hands-on activities, such as building a cochlear hair cell with candy and a marshmallow.

The final component of the public education outreach is a UW Speech and Hearing Clinic (UWSHC) public symposium on a topic in audiology. This is a one-day, public event planned and executed by second-year AuD students under the guidance of their audiology clinical professors as part of a leadership and mentoring course. The students work together as a group over the course of a year to select the symposium topic, plan logistical details, create a budget, market the symposium, and conduct the event. Held at the UW Speech and Hearing Clinic, the symposium is entering its fifth year. Past topics have included hearing technology, hearing loss prevention, tinnitus, and the human auditory system and hearing health.

Benefits of Audiology Outreach

The UW audiology outreach has benefits to a variety of individuals and organizations in a number of areas.

Audiology outreach benefits the public. The provision of hearing healthcare services to the underserved—whether they be in the rural Amish and Mennonite populations or the urban low-income population—improves access to hearing healthcare for many who would not otherwise have it. Further, the provision of hearing protection at noisy events such as a tractor pull gives people immediate means to protect their hearing, while also encouraging long-term change. By raising awareness of audiology issues at public events such as senior health fairs, science days, and large group lectures, the general public is able to get accurate, evidenced-based information about issues in audiology. This outreach is generally very well-received by the public. The feedback from collaborators and participants attributes this to the positive attitude and message of the group, as well as the usefulness of the services and information.

Audiology outreach benefits UW Audiology students. Students are involved in all aspects of the audiology outreach, from the planning and organization of the events to the execution. This level of student involvement provides numerous opportunities for leadership experiences. The outreach events also give students the opportunities to interact with individuals with varied backgrounds and to see the benefits of audiology outreach in the community.

The students’ experience broadens their definition of the potential of clinical practice, and their background working in these areas provides them with skills that may be helpful in potential employment. Students report that they gain confidence talking to the public through the outreach opportunities; they are able to experience, in an authentic and first-hand way, the benefits of community engagement. Clinical outreach has become a valued part of the AuD program, and students have earned leadership positions in local and national audiology organizations due to their experiences with leadership in the outreach programs.

Audiology outreach benefits the profession. All audiology clinical professors provide traditional audiology clinical services at the UW Speech and Hearing Clinic. The clinical outreach projects are often additional volunteer activities, although in some cases, various events can be built into part of a day’s clinical schedule. The outreach events provide interesting and enriching challenges, and it has become a way to give back meaningfully to the local community and the larger state. The goodwill and relationships developed through the outreach have increased referrals and visibility of the in-house clinic. On a larger scale, the publicity that the outreach projects have received has helped raise the visibility of the profession of audiology in Wisconsin.

Audiology outreach benefits the AuD program. An unexpected benefit of the outreach is that it has recently received positive media attention. For example, there was a front-page Milwaukee Journal Sentinel article entitled “UW audiology team wants farmers to hear its message” on June 28, 2015.5 The article described the outreach and also included a video component. The university has highlighted some of the outreach in its alumni and college publications and website, which has raised the visibility of the AuD program to others within the community and beyond. The UW audiologists regularly post photos of AuD students on the clinic’s Facebook page (www.facebook.com/UWSHC). This has been a great way to showcase our students, as well as reach alumni and the public. The outreach events themselves are authentic opportunities for teamwork, and the projects build a sense of community amongst the AuD students and audiology clinic faculty.

Audiology outreach benefits the university. The UW Audiology team’s outreach creates positive relationships with the individuals and organization that the projects have served. The outreach has direct, positive impacts on the students and audiologists involved in the projects. By extending hearing healthcare beyond the walls of the traditional audiology clinic, the audiology program demonstrates that the University of Wisconsin genuinely cares about the well-being of individuals throughout the state. By extending learning far beyond the halls of the university, the audiology outreach provides has become a valued component of the university’s AuD experience.

Acknowledgments

The author thanks the UW-Madison Department of Communication Sciences and Disorders for its unwavering support for audiology outreach projects and the Wisconsin Idea. She especially thanks UW-Madison and UW-Steven’s Point faculty and clinical faculty, in particular, Amy Hartman, AuD;  Jon Douglas, AuD; Amy Kroll, AuD, and Rachel Lee, AuD. She also thanks all of the wonderful UW AuD students, community partners, and outreach participants and collaborators.

References

1. University of Wisconsin. The Wisconsin Idea. Madison, Wis: University of Wisconsin. Available at: http://www.wisc.edu/wisconsin-idea

2. US Occupational Safety and Health Administration (OSHA). Occupational Safety & Health Administration Directive CPL 02-00-051 Enforcement Exemptions and Limitations under the Appropriations Act. May 28, 1998. Washington, DC: OSHA/US Dept of Labor. Available at: https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=DIRECTIVES&p_id=1519#ENFOR

3. National Institute on Deafness and Other Communication Disorders (NIDCD). It’s a Noisy Planet. Protect Their Hearing; Noise: Keeping it Down on the Farm. 2011. Bethesda, Md: NIDCD. Available: http://www.noisyplanet.nidcd.nih.gov/parents/Pages/KeepingItDownontheFarm.aspx

4. Abrams HB, Kihm J. An Introduction to MarkeTrak IX: A new baseline for the hearing aid market. Hearing Review. 2015;22(6):16. Available at: https://hearingreview.com/2015/05/introduction-marketrak-ix-new-baseline-hearing-aid-market

5. Herzog K. UW audiology team wants farmers to hear its message. Milwaukee Journal Sentinel. June 28, 2015. [Online.] Available at: http://www.jsonline.com/news/education/uw-audiology-team-wants-farmers-to-hear-their-message-b99527151z1-310501721.html.

Melanie Buhr-Lawler, AuD, is an audiologist and Clinical Associate Professor at the University of Wisconsin – Madison where she coordinates the Wisconsin Idea audiology outreach clinics each summer.  She also teaches courses in the UW AuD program and provides clinical education in the UW Speech and Hearing Clinic.   

Correspondence to HR or Dr Buhr-Lawler at: [email protected]

Original citation for this article: Buhr-Lawler M. Thinking Outside the Booth: Three Overlapping Categories of University Audiology Outreach. Hearing Review. 2016;23(10):36.?

Other Articles in This Special Edition about Interventional Audiology Services:

Introduction: Interventional Audiology Services: Meeting the Demands of Today’s Consumer, by Brian Taylor, AuD, Guest Editor

What Hearing Care Professionals Need to Know About Today’s Healthcare Economics, By John Bakke, MD, MBA

Intervening in the Care of More Patients: Beyond Clinic-based Testing and Fitting, by Brian Taylor, AuD

Incorporating Health Literacy into Your Hearing Care Practice, by Jennifer Gilligan, AuD, and Barbara E. Weinstein, PhD

Patient Engagement Through Interventional Counseling and Physician Outreach, by Robert Tysoe

Patient Complexity and Professional Time: Improving Efficiencies in the Service Model, by Dan Quall, MS, and Brian Taylor

Thinking Outside the Booth: Three Overlapping Categories of University Audiology Outreach, By Melanie Buhr-Lawler, AuD