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Universal Design for Hearing: Considerations for Examining Hearing Demands and Developing Hearing Friendly Workplaces

Universal Design for Hearing: Considerations for Examining Hearing Demands and Developing Hearing Friendly Workplaces
Mary Beth Jennings, PhD
March 1, 2010
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Editor's Note: This article is an edited transcript of the course presented live on AudiologyOnline on November 4, 2009. To view the original presentation, register here .

Introduction

This presentation will discuss work that we have been doing in the area of Universal Design for Hearing and its application to workplaces, especially considering adults who acquire a hearing loss during their working life and who are not working in industrial settings. I will give you some background information about our research team and how we came to this problem, and discuss some existing approaches that are used to support workplace accessibility. I'll discuss an occupational perspective to support workplace changes and how we have used that perspective to look at Universal Design principles and their application to hearing.

The purpose of today's presentation is to describe an interdisciplinary approach taken by researchers to examine the applicability of Universal Design principles to hearing accessibility and usability. Universal Design principles will be introduced, as well as the guidelines that we have developed for Universal Design for Hearing. I will also discuss the implications of Universal Design for Hearing principles for examining hearing demands and for developing more hearing friendly workplaces.

Background Information

This work brought together an interdisciplinary team of researchers and consumers to critically analyze the literature on accessibility and to develop a guideline for creating and evaluating hearing accessible spaces based on principles of Universal Design.

Our team includes persons from hearing science and audiology: myself, Mary Beth Jennings, Ph.D;Margaret F. Cheesman, Ph.D;Michael Prangley, MCISc;and Laya Proost-Foroosh Bataghva, MCISc, Ph.D. (candidate). Three of us have been trained as clinical audiologists and have worked clinically. Our team includes complement expertise from occupational science, occupational therapy, ergonomics and human factors: Lynn Shaw, Ph.D;Lisa Klinger, MSc;Daniel Fok, MEng, Ph.D. (candidate);Heather Hodgins, MSc;and Ashley Kuchar, MSc. We were fortunate that hearing science and audiology is housed in the same building as the occupational therapy program, and this brought us together to share and complement each other in this project. One of the members of the group, Mr. Daniel Fok, is an engineer whose area is ergonomics and human factors and he has made a major contribution to this project.

Overview of the Problem

As you are well aware, hearing loss is the most prevalent and fastest growing sensory related chronic disability in North America. My presentation today will focus on what is happening in Canada and I encourage you to think about what is happening in the areas where you live. In Canada, the average age at which adults self report a hearing loss is about age 51 (Canadian Hearing Society, 2002). In three Canadian provinces there is legislation against mandatory retirement at the age of 65 (Government of Ontario, 2006;MacGregor, 2006). In 2001, which is the most recent year in which we have labor force statistics prior to the abolition of mandatory retirement, about 12% of our population ages 65 to 69 were active in the labor force (Statistics Canada, 2001). I have no doubt that that percentage is growing. We have seen many stories in the news lately about persons over the age of 65 who, because of the current financial situation, are not able to retire. There are also those people of retirement age who would just prefer to be out working.

In many workplaces, especially in the knowledge and the service sectors, hearing loss remains hidden. As we know, there can be a lack of recognition of hearing loss when it happens gradually, as well as denial and lack of disclosure of hearing loss. Because of lack of disclosure and lack of recognition of hearing loss, and because jobs are growing in the knowledge and service sectors, this became our research area of interest. Age discrimination can limit a worker's mobility. Aging workers are thought to experience greater difficulties adapting to changes in technology. They are also thought to have greater difficulty learning new tasks and to generally have more health problems than younger workers. Aging workers with hearing loss therefore may have discrimination related to the combination of both advanced age and hearing loss. This certainly increases the complexity of hearing loss disclosure for some older workers. Given the growing number of older adults that we have, the abolishment of mandatory retirement, and the potential cost savings for workplaces who choose to keep their older workers we believe that more efforts are needed to assist employers and workers to create environments that support/safe and productive work performance. We also believe that proactive planning for workplace changes relevant to older workers needs to be initiated in workplaces.


Existing Approaches to Support Workplace Accessibility

Barrier-Free Design Ideology

Existing approaches to support workplace accessibility include Barrier Free design and Universal Design ideologies. Traditionally, designs for persons with disabilities in the built environment have focused on removing physical barriers through Barrier Free design. Within Barrier Free design ideology, a barrier is defined as anything that prevents a person with a disability from fully participating in all aspects of society because of his or her disability, including physical, architectural, informational, communication, attitudinal, and technological barriers, policies or practices (Accessibility for Ontarians with Disabilities Act, 2005). Barrier-Free means a building or its facilities can be approached, entered and used by persons with physical and sensory disabilities (Toronto Ministry of Municipal Affairs & Housing, 2006). The greatest focus in Canada has been on physical barriers, and to a lesser extent, visual barriers. Barrier-Free design usually means that accessibility is achieved through a specialized design or adaptation that is specific to the disability of concern.

The government of Canada has a Canadian Standards Association Accessible Design for the Built Environment document (2004) that is considered to be our most stringent technical standard on accessibility. This document is heavily focused on access for persons with physical and visual disabilities but provides only limited information on hearing access and violations are seldom enforced.

The Canadian Standards Association put out a document in 2008 called the Canadian Standards Association: Inclusive Design for an Aging Population (B659-08). This group states that aging presents diverse needs and complex challenges. To quote the document:

"They may be as minor, for example, as sight or hearing impairments that can be overcome with reading glasses or a standard hearing aid. Or they may be more profound such as blindness or deafness. Even minor limitations, when combined (as is often in the case in late aging) can present a significant barrier to independence and a high quality of life."
It is good that they recognize that the combination of one or more difficulties has a significant impact. However, the part of the quote that is of concern is where it refers to hearing impairment as a minor challenge that could be overcome with a standard hearing aid.

The province of Ontario is just now in the process of developing accessibility standards for the Accessibility for Ontarians with Disabilities Act. There is a Proposed Employment Accessibility Standard (EA-SDC File #:N168) as part of this act, and it is also heavily focused on barriers and Barrier Free design, as evidenced by some of the verbiage in the proposed standard. It states that we need to have, "Policies, procedures and requirements for the identification, removal and prevention of barriers across all stages of the employment life cycle for persons with disabilities (p. 2)." It further states that this "Requires employers to engage in the proactive identification, removal and prevention of barriers that hinder the full participation of persons with disabilities. Where barriers cannot be removed up front, the development and implementation of accommodation practices is integral to the recruitment, retention and promotion of qualified persons with disabilities (p. 4)."

Barrier Free Design ideology takes an individualized approach to accommodating needs. The solutions are targeted at the person rather than the work environment. Current technological approaches to enable hearing in workplaces focus on personal hearing devices, for example, the use of hearing aids, FM systems, visual alerting devices, and the provision of amplified telephones. This approach does not consistently or comprehensively consider the realm of occupations conducted in workplaces. While individual solutions are vital, a more comprehensive approach to address the hearing needs of workers across the spectrum of what they do on a daily basis is lacking.

Universal Design Ideology

According to Mace (1998) Universal Design ideology can be defined as the design of products and environments to be usable by all people to the greatest extent possible without the need for adaptation or specialized design. It seeks to create products and environments that are usable by the broadest spectrum of the population, regardless of age or physical differences. Ronald L. Mace was an architect, designer and an educator. He contracted polio at the age of nine which caused him to use a wheelchair for most of his life. In 1989, he established The Center for Universal Design at North Carolina State University. This center is a leader in research and information on Universal Design in housing products and the built environment. The Universal Design movement has inspired professionals to think beyond the boundaries of Barrier Free design. While no design can be truly universal, the principles of Universal Design have had a tremendous impact, especially in housing and product design, and these principles have fostered considerations for the design of built environments and products for people with a wide range of abilities. Its Web site, www.design.ncsu.edu/cud/, has a wealth of information.

The Center for Universal Design's Seven Universal Design Principles

The Center for Universal Design established seven principles of Universal Design (The Center for Universal Design, 1997). These are: equitable use;flexibility in use;simple and intuitive use;perceptible information;tolerance for error;low physical effort;size and space for approach and use. I'm going to review each of these principles with some comments and examples of how they may apply to hearing, and I encourage you to consider other applications of these principles to hearing.

Principle one: Equitable use

The first principle is equitable use. Equitable use means that designs need to be useful and marketable to people with diverse abilities. The design needs to provide the same means of use for all users, identical when possible, and equivalent when not. It should avoid segregating or stigmatizing users. For example, having to sit in one of the front rows of a place of worship to use a hard-wired headset would be segregating users;or, for persons who would feel uncomfortable being seen wearing a headset, that would be stigmatizing for those users. The design needs to make provisions for privacy, security and safety equally available to all users. For example, does the person who is not using hearing assistive technology have the same level of privacy, security and safety as someone who is using an FM system or an infrared system in an environment? Finally, the design needs to be appealing to all users.

I remember when they first started building ramps at entry ways so that persons with mobility issues, such as those who use wheel chairs, could have access to public places. Think of an alternate design for an entry way at street level (i.e. no ramp required), where electronic doors open at your approach. This particular design is an example of equitable use in that it provides equal access for someone who has mobility issues as well as someone who does not, without using a specialized ramp.

Principle two: Flexible use

The second Universal Design Principle is flexibility in use. The design needs to accommodate a wide range of individual preferences and abilities. There should be a choice of methods of use. For example, an individual should be able to gain information through both an auditory announcement and a visual display. Or, an individual should be able to choose between using a kiosk to check-in and ticket at an airline counter or using a customer service desk. Also, flexibility in use accommodates right or left handed access and use, such as scissors that are designed to be used by both right-handed and left-handed persons. The design should also facilitate the user's accuracy and precision and provide adaptability to the user's pace.

Principle three: Simple and intuitive use

Simple and intuitive use means that the design needs to be easy to understand regardless of the user's experience, knowledge, language skills or current concentration level. Unnecessary complexity needs to be eliminated. For example, an automatic telecoil may be easier to use and less complex than a manual telecoil. The design needs to be consistent with the user's expectations and intuition, accommodate a wide range of literacy and language skills, and arrange for information consistent with its importance. In addition, the design should provide effective prompting and feedback during and after task completion, such as when a person can hear a beep to confirm the changing of hearing aid programs.

Principle four: Perceptible information

The fourth Universal Design principle is perceptible information. The design needs to communicate necessary information effectively to the user regardless of ambient conditions or the user's sensory abilities. Different modes can be used for redundant essential information, such as the combined use of an auditory announcement with a visual display. Designs should maximize legibility of essential information. It needs to differentiate elements in ways that can be described, therefore making it easy to give instructions and directions. For example, when someone is using a personal FM system he or she needs to inform or show others how to use that transmitter and microphone versus having an FM system that is directly connected to an existing PA system that does not require such instructions. Also, designs need to provide compatibility with a variety of techniques or devices used by people with sensory limitations. In terms of hearing assistive technology, this may mean a design that can be used with or without a hearing aid, with or without a telecoil, and potentially with Bluetooth.

Principle five: Tolerance for error

Tolerance for error refers to a design that minimizes hazards and the adverse consequences of accidental or unintended actions. Elements need to be arranged to minimize hazards and errors. Elements that are most used should be most accessible and hazardous elements should be eliminated, isolated or shielded. In terms of hearing, think about when someone is using an FM system and the talker has the mic turned off and forgets to turn it back on. The design also needs to provide warnings of hazard or errors. For example, a low battery signal in a hearing aid would be such a warning. It should also provide fail safe features and discourage unconscious actions in tasks that require vigilance.

Principle six: Low physical effort

The sixth Universal Design principle is low physical effort. The design should be used efficiently and comfortably with a minimum of fatigue. It should allow the user to maintain a neutral body position, use reasonable operating forces, minimize repetitive actions, and minimize sustained physical effort. An example of such a design might be controls that are easy to use on a hearing aid or other hearing assistive technology. Another example may be the use of a hearing aid with an integrated FM instead of using an FM with a neckloop or via direct audio input which adds extra bulk to the system for that person.

Principle seven: Size and space for approach and use

This principle refers to an appropriate size and space provided for the person to approach, reach, manipulate and use the product or environment regardless of his or her body size, posture or mobility. It would be necessary to provide a clear line of sight to important elements for any seated or standing user, to accommodate variations in hand and grip size, and to provide adequate space for the use of assistive devices or personal assistance. An example for a person with hearing loss, may be that he or she should be able to get close to the talker or sound source in order to speechread and to listen.

Universal Design and Hearing - Literature

Universal Design concepts and their application have largely remained restricted to the physical and the visual domains. Little work has been done to expand these for tasks that require hearing although they have been applied to hearing assistive technologies. Research related to Universal Design and hearing includes some projects that looked at electronic materials and distance education for persons who are hard of hearing or Deaf (e.g. Berent, 1996;Erath & Larkin, 2004;Obrenovic, Abascal & Starcevic, 2007), and one study by Danford (2003) on access within a model of a Universal Design building.

In the Danforth (2003) study, participants with vision, mobility and hearing impairments were asked to complete tasks within a model Universal Design building. The tasks included locating the building and its entrance, getting information (getting to the information desk), locating a telephone and a restroom, and using a drinking fountain. The study's authors did not elaborate on communication demands that may take place between the information desk clerk and the participant, and therefore the results unsurprisingly suggested that there was little impact for the persons that had hearing loss.

The Canadian Hard of Hearing Association, which is the Canadian equivalent of the Hearing Loss Association of America, developed a document called Universal Design and Barrier Free Access (2008). They theorized six Universal Design principles which included good acoustics and noise control, appropriate visual conditions, built in alerting systems, augmented telecommunication systems, provision of assistive communication technologies, and an awareness of design elements. This document provided appropriate technical and solutions-based approaches. It provided an overview of acoustic and visual conditions as well as a reliance on traditional assistive listening devices. The greatest emphasis in this document, however, is still on Barrier Free design rather than Universal Design. The guidelines and principles offer excellent technical and solutions-based resources but do not provide a comprehensive approach to bring to light the what, how, where and with whom people conduct activities that require hearing.

Gaps in Enabling Workplace Change

If we look at the literature on managing transitions of older workers with hearing loss, there still seems to be an individualized approach to accommodating needs. The hearing demands and requirements related to the entire workplace have not been adequately investigated or addressed. They have not looked at how workers with a hearing loss communicate with others in the workplace and how the workplace context impacts competent work performance.

We propose a more comprehensive approach that integrates concepts and perspectives from occupational science, to complement and build on current knowledge. Such an approach would allow management and workers to prepare for and support transitions for older workers as they acquire a hearing loss during their working life.

An Occupational Perspective to Support Workplace Changes

An occupational perspective to support workplace change is the focus on and study of what people do, what they need to do and what they want to do in community and public environments, and what constrains participation in occupations. It considers the complexity of interactions between the person, environment, occupation and objects (Hocking, 1994;Law et al., 1996). In an occupational approach, occupation is defined as engagement or participation in a recognizable life endeavor and work is a sub category describing paid endeavors. Occupation, therefore, refers to activities or the things that people do. Work tasks are negotiated in a complex relationship with people and the environmental context in which they take place. Using an occupational approach involves making a detailed description of the activity or the occupation, its requirements and demands, and the available resources to support individuals or groups, and the workplace itself. Barriers and facilitators within the immediate context, the community and the societal context are examined to fully assess the quality and degree of occupational participation as well as opportunities for change.

An occupational approach can provide a foundation for critically examining how environments support or hinder hearing accessibility and usability for persons in the community.

An Occupational Approach (Fok, Shaw, Jennings & Cheesman, 2007)

Preparing physically and socially for older workers with hearing loss to remain productive and safe at work requires an occupational approach. In the knowledge and service sectors, hearing demands that are placed on workers occur in multiple and complex environments. Work tasks may involve communication and interactions between various individuals or groups;for example, with co workers, with clients or with customers.

An in-depth understanding of the work context and available resources for change is required. The contexts that underscore work productivity for persons with diverse abilities include micro level, meso level and macro level contexts. The micro level refers to the level of the individual. This is the level at which most audiologists work;it refers to the places and the physical spaces where work occurs. The meso level refers to the characteristics or nature of the work and includes procedures, team-oriented workplace cultures, safety and security issues, deadline pressures, as well as exposure to unanticipated emotional, confrontational, or situational distractions that may or may not be conducive to change. The macro level refers to the governance, policy, legislation, unionization and economics that undermine occupations and organizational productivity, plus the availability of financial resources to support design and redesign of work contexts. At this level, participation of older workers with hearing loss in health and safety committees is one approach that might be used to help socialize the workplace to be more sensitive and responsive to the needs of older workers.

Using an Occupational Perspective to Promote Universal Design Concept for Hearing: Universal Design for Hearing

How have we used this occupational perspective to promote hearing access? We have applied this perspective in order to look at the principles of Universal Design and to develop guidelines for a Universal Design for Hearing. These guidelines are not a cook book list of technologies and environmental adaptations, and they are not meant to provide specific solutions. Rather, they are intended to allow employers a better appreciation of productivity and safety concerns as they relate to occupations requiring hearing. We also hope that they will be useful for health practitioners in highlighting desirable outcomes, and for others who wish to develop guidelines for creating better hearing environments using an occupational perspective. In addition, the guidelines were established to highlight the potential for integrating an occupational perspective towards a more comprehensive approach to addressing the hearing needs of older workers.

Design usability is affected by hearing, whether or not there is hearing loss. Consider these hearing situations: determining where a siren is coming from while driving with the radio on;listening to directions from someone across a busy street;following verbal instructions while listening to music through headphones;or using a cell phone where there is background noise and/or when transmission quality is variable, such as in a shopping mall or airport. In these situations, design usability is affected by hearing both for those who do not have a hearing loss as well as for those who do but are not currently using hearing technology.

As mentioned, Universal Design principles have been applied to the design of some recent hearing assistive technologies. We believe they may also be contextualized to optimize hearing environments in the workplace.

Some of the Universal Design principles are particularly relevant for activities that involve hearing. These include that the design should not segregate or stigmatize users, that there should be a choice in methods used, and that we should discourage unconscious action that requires vigilance within the sensory task of hearing. An additional principle that we developed is that designs should be able to be used across multiple contexts.

Preliminary Universal Design for Hearing Themes (Fok, Shaw, Jennings & Cheesman, 2007)

Our group developed five Universal Design considerations for hearing which complement the Universal Design principles.

The five preliminary Universal Design for Hearing themes that we identified were: to design hearing environments that maximize the capabilities of a person to hear with or without a hearing device or with their current hearing device;to optimize object person interactions for hearing;to consider designs that require low cognitive and physical effort;to allow for a choice of interaction;and to design environments that support single function or multi functions to allow for a range of planned or unplanned occupations that involve hearing.

Universal Design for Hearing Principles

From these themes we developed five principles. Our team has visited numerous public environments;for example, bus stations, airports, coffee shops, coffee shop drive thrus, etc. and we have used these principles as a basis for describing hearing access within those environments.

UDH I: Optimizing the hearing environment for all.

The first Universal Design for Hearing principle is optimizing the hearing environment for all. This is related to the Universal Design principle of equitable use. Equitable use is related to the micro context, the level of the person, the individual and the environment. Regarding hearing, we must consider who will be using a particular workspace. The design of the environment needs to consider the presence of hearing loss and the use of hearing assistive technologies. However, the onus should not be on the worker with hearing loss to rely on those technologies to engage in work tasks in a given environment.

As we know, workers may or may not disclose their hearing loss. They may also be unaware of the presence of hearing loss or choose not to use hearing assistive technologies.

The design of the environment should benefit most, if not all, individuals to hear better regardless of their hearing abilities. Things to consider may be designs for optimal reverberation times and reverberation characteristics, minimizing background noise levels and maximizing intelligibility.

UDH II: Optimizing interactions between persons and objects to promote better hearing in an environment.

The second principle is optimizing interactions between persons and objects to promote better hearing in the environment. At the micro level, we need to consider what is in the space and what people need to do in this space. At the meso level, we need to consider how people conduct work within the constraints of the environment, of the workplace culture and established procedures. At the macro level, we need to consider the factors within the social and emotional aspects of the environment that may or may not be conducive to change.

Within a given workspace, objects may generate both desired sounds and undesired noise. An evaluation of how these objects interact to shape an environment that is or is not suitable for hearing activities is warranted. We need to consider the positioning and maintenance of objects that generate unwanted noise and we need to consider the relative distance between the person and desired sound sources.

UDH III: Consider the need of people to have multiple choices of interactions with one another.

The third principle is to consider the need of people to have multiple choices of interactions with one another. We need to consider the many forms of interpersonal interactions within an environment. For example, in a meeting room interactions include but are not limited to one to one communication, one-to-many communication, and many-to-one communication. An environment that is designed for hearing that considers the various types of interpersonal interactions may not only benefit individuals with hearing loss but may also benefit others who have no hearing loss or those who have hearing loss and are not using any technologies.

We need to consider the dynamic and sometimes fast-paced nature in what occurs in various environments and again, we need to consider the micro, meso and macro level contexts.

UDH IV: Consider the need for different activities to be performed in and across environments.

The fourth principle is to consider the need for different activities to be performed in and across environments. A particular space may be used primarily for a specific activity or for multiple activities. We need to consider whether an environment is meant to support single hearing activities, such as only talking on the telephone, or multiple hearing activities such as talking on the telephone, transcribing meeting notes from audio to text, communicating face to face with a customer, and maybe the space is also used as an impromptu meeting area.

The design or redesign of spaces needs to consider the different configurations of an area to allow for a variety of desired and expected occupations to be performed. We need to consider the micro, meso, and macro level contexts.

UDH V: Enable use of the environment without extra steps for hearing access;and enable safe, private and secure use of the environment.

The fifth design principle has two parts. The first is to enable use of the environment without extra steps for hearing access, during preparatory, use and/or after use phases. The second part is to enable safe, private and secure use of the environment while minimizing distractions/interference or cognitive loading. We need to consider the effort on the part of the individual to interact with the design or the redesign of the environment. This includes the original Universal Design principles of simple and intuitive use, tolerance for error, and low physical effort. An individual should be able to walk into an environment and access the necessary information right away without having to expend considerable, or ideally any, cognitive or physical efforts before, during and after the occupation that involves hearing. Designs of spaces need to become more seamless. There is a potential here for the integration of both emerging and existing technologies.

A design or a redesign should address any inequity in access and usability between persons with and without hearing loss. For example, using a personal FM system to listen to a presentation in a conference room requires significantly greater time, set up and effort when compared to using a listening system that might already be installed in a room. The extra effort required may discourage an individual from using a personal device. Solutions need to be relatively easy to use and transparent.

The explicit mention of the need to consider the cognitive efforts of a redesign is especially relevant for an older worker with hearing loss. The combination of aging and hearing loss may require greater concentration and the use of more cognitive resources to conduct tasks, especially if the individual chooses not to disclose the hearing loss.

In the area of safety, one should not expect a worker with hearing loss to be continually vigilant to emergency signals such as fire alarms or public announcement systems. The use of high quality auditory signals at the source, along with other visual indicators, should be in place using redundant information that was also mentioned in the Universal Design principles. This may also apply to non-emergency situations. For example, providing a printed copy of a presentation to supplement a verbal presentation.

Using an Occupational Perspective to Promote Universal Design Principles for Hearing - Example

Jane Smith is attending a meeting. She enters the room, sets her laptop down on the table, plugs it in, powers it up, and gets it running. She also uses a personal FM system. Next, she has to get the FM set up with the conference microphone in the meeting room. She then gets some coffee and has some incidental chat with two or three other people in the room. The meeting itself begins and includes three others who are all sitting at one end of a large boardroom table. Jane has to follow the conversation around the table, contribute to the discussion, ask questions, take notes, and keep an eye on new e-mail as it pops up on her computer screen. There is noise from her computer, from the heating and cooling system, and from the hallway, even though the door is closed. There is a knock at the door and someone enters the room. The person asks a question, someone in the meeting answers the question and then the meeting resumes.

I think you will agree that this is a highly complex hearing environment, and also a fairly typical environment for many people who work. As a clinical audiologist, when we have patients who are working we may ask basic questions such as, "Do you attend meetings?" or "Do you use the telephone/cell phone?". We then consider solutions such as FM systems, amplified telephones, etc. In general, I do not think that most of us think in great detail about the complexity of the environments that people are in on a day in, day out basis, like the one in this example.

Following the five Universal Design for Hearing principles can provide us with a much more comprehensive picture of the hearing accessibility issues in the environment.

Summary

Existing approaches to support workplace accessibility and manage transitions of older workers with hearing loss include Barrier-Free design and Universal Design ideologies. Using an occupational perspective to promote Universal Design concepts for hearing, five Universal Design for Hearing guidelines have been established.

Knowledge from occupational science can complement the hearing sciences and the accessibility and usability literature to present a more comprehensive approach to assist management in collaboration with workers to support productive and safe work tasks involving hearing.

Within a Universal Design for Hearing approach, there is a global consideration of hearing in the workplace environment. This is essential for the promotion of a hearing environment that is suitable for most people, including workers, customers and clients, as well as to complement the transitions faced by older workers with a hearing loss.

On the part of employers and professionals who are involved with vocational assessment, there is a need to better understand the hearing abilities of workers as they age, along with the associated issues such as awareness of hearing loss and disclosure of hearing loss.

We hope that this knowledge will assist in identifying barriers and challenges for workers in performing work tasks involving hearing in a safe, productive manner within the work context.

With this knowledge, management and workers need to identify and be mindful of barriers and resistance to change that may impede successful transitions for older workers with hearing loss, such as the work culture's attitude towards aging and hearing loss as well as tolerance and acceptance of diversity by other co workers.

These considerations can then assist management and workers to carefully navigate towards identifying potential opportunities and resources to change the micro and meso work contexts. This can be done through a combination of hearing assistive technologies, Barrier- Free solutions and Universal Design for Hearing. Macro level facilitators such as accessibility legislation, availability of unions, and involvement of older workers with hearing loss on health and safety committees may also help to break down some resistance to change.

We believe there is a great potential for the enactment of more inclusive and more innovative workplaces by considering the hearing needs of most people in the workplace. Opportunities to change the work context to meet the transitional needs of older workers with hearing loss may also feed back to benefit other workers, customers and clients. This may benefit business through a more productive and safe workforce, and it may attract a larger total addressable market of customers and clients. Such a broad scheme for improving hearing in the workplace may shift the practice away from an individualized approach to access as has been taken in the past.

We hope that this work offers management and workers new insights into strategies to achieve compliance with disability and human rights guidelines and standards developed to protect the rights of those aging and those with hearing loss in public and private service and knowledge sectors.

Future Directions

We are currently developing a rating scale for use with the Universal Design for Hearing guidelines and will undergo validity and reliability testing of the rating scale in 2010. We then hope to develop and disseminate educational resources related to the guidelines and the rating scale, and to work with our Ontarians with Disabilities Act committees as they look at compliance over the next few years.

Acknowledgements

Our work is supported by the Ontario Research Fund, the Canada Foundation for Innovation, and Dominion General Life Insurance Company.

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mary beth jennings

Mary Beth Jennings, PhD

Assistant Professor, National Centre for Audiology and Communication Sciences and Disorders, Faculty of Health Sciences

Dr. Mary Beth Jennings worked clinically at The Canadian Hearing Society for 12 years where she developed and implemented individual and group aural rehabilitation (AR) programs (the Hearing Help Class curriculum) for adults. She began her academic career in 2004 and teaches courses and seminars on Counseling and AR and supervises students who facilitate group AR programs. Her areas of research include the assessment of group AR outcomes, the use of Goal Attainment Scaling, the impact of self-efficacy on rehabilitation outcomes, barriers and facilitators to the use of hearing assistive technologies for older adults, stigma of hearing loss, assessing workplace accessibility for older workers with hearing loss, and Universal Design for Hearing. Past projects have included program development and outcome measurement in homes-for-the-aged and in community-based settings, as well as a hearing accessibility audit of university classrooms.



Related Courses

The Connection Between Hearing and Overall Health
Presented by Jack Scott, PhD
Recorded Webinar
Course: #35243Level: Introductory1 Hour
Research has linked physical health to the prevalence of hearing loss, and the prevalence of hearing loss to cognitive health. As hearing healthcare professionals, it is important to understand these relationships from the aspect of counseling patients on the impact of lifestyle on hearing and the benefit of hearing aids on listening lifestyle and satisfaction.

Medical/Surgical Options for Conductive and Mixed Hearing Losses
Presented by Jill Messina, AuD, CCC-A, Robert A. Battista, MD, F.A.C.S
Recorded Webinar
Course: #21174Level: Intermediate1 Hour
This will be a slide presentation describing the causes of, and the treatment options for, conductive/mixed hearing loss. The presentation will include brief videos of the mechanics of ossicular reconstruction and surgical reconstruction of the ossicles including stapedectomy.

Deafness with Autism: An Occupational Therapy Perspective
Presented by Erin Harvey, OTD, OTR/L
Recorded Webinar
Course: #23775Level: Intermediate1 Hour
When deafness coexists with autism, sensory seeking behaviors may be present and interdisciplinary interventions will be necessary for success. Learn the normal development of sensory, attention, and play skills, understand vestibular processing and how to create and manage interventions that are sensitive and responsive to sensory issues.

Please note: You may earn ABA Tier 1 credits for this course if you complete it as part of course 24657, "Deafness with Autism." Course 24657 contains recordings of four events from this series presented by Advanced Bionics. ABA Tier 1 CEUs can be earned only when all modules are completed as part of course 24657.

Deafness with Autism: An Early Communication Perspective
Presented by Wendy Deters, MS, CCC-SLP, LSLS Cert. AVEd.
Recorded Webinar
Course: #23776Level: Intermediate1 Hour
Deafness and autism both affect communication; but deafness is frequently identified before autism. Learn to identify the differences in communication development when a dual diagnosis may exist, proper referral channels, and intervention strategies to promote early listening and communication skills.

Please note: You may earn ABA Tier 1 credits for this course if you complete it as part of course 24657, "Deafness with Autism." Course 24657 contains recordings of four events from this series presented by Advanced Bionics. ABA Tier 1 CEUs can be earned only when all modules are completed as part of course 24657.

CBD and Essential Oils for Hearing Loss, Tinnitus and Balance Disorders
Presented by Robert DiSogra, AuD
Recorded Webinar
Course: #34543Level: Intermediate1 Hour
This course addresses the increased interest in cannabidiol (CBD) oil for hearing loss, tinnitus and balance disorders in addition to addressing the use of essential oils for the same auditory/vestibular issues. Patient counseling strategies are discussed.