Audiogram Done… Now What? Counseling and the HAE

1. Audiogram Done…Now What?Counseling and the HAE Nikolas Klakow, Au.D. Customer Trainer Jessica Zellmer, Au.D. Customer Trainer Phonak U 2008 Audiogram done; now what?

2. Topics • Textbook to Clinic • Demo: What NOT to do! • A Patient Centered Approach • Model of Hearing Aid Appointment Phonak U 2008 Audiogram done; now what?

3. From Textbook to Clinic! Phonak U 2008 Audiogram done; now what?

4. The (bad) Explanation Dear Mrs. Jones, let me tell you about the results of your audiogram. On this graph you will see a series of blue exes and red circles which correspond to the hearing thresholds of your left and right ear, respectively. The responses indicate that you have a hearing loss in the right ear sloping from 25dB at 250Hz, which is a low pitch, to 85dB at 8000Hz, which was the very high tone that you heard. The left side ranges from 30dB at 250Hz to 75 at 8000Hz. That would be considered a sloping mild to moderately-severe loss, and the bone conduction scores, obtained with that uncomfortable headband that kept slipping off your mastoid, supports the findings of a sensori-neural loss, counter-indicating the chance of surgery being able to fix your hearing loss. Any questions? Phonak U 2008 Audiogram done; now what?

5. …continued So as you can see from the audiogram the hearing loss cuts right through the speech banana, reducing your ability to comprehend most of the high frequency consonants. And as you can see from the configuration of the slope of the loss, it moves from the mild into the moderate range around the 2000Hz mark, where the normal resonance of your ear canal should be doing most of its work, in order to enhance certain speech signals. From your intake questionnaire I can see that you feel like this loss is not really affecting your day to day ability to hear, but your audiogram shows me differently. Let me tell you a little about the hearing aid technology that will work for you. Phonak U 2008 Audiogram done; now what?

6. …and continued In order to reduce the background noise you need a hearing aid system that has VoiceZoom and NoiseBlock algorithms. With the twenty channels of processing and compression you should be comfortable. Did I tell you that it also has SoundRelax and WhistleStop? They come in all model sizes. You like the small ones? They seems to have more problems. I find that the BTEs are my favorites. They are much easier to work with. They come with a two year warranty for repairs but only a one year warranty for loss and damage, which can only be applied once and would also require a replacement fee. Here, let me put one on you so you can listen to it. Phonak U 2008 Audiogram done; now what?

7. …to the (bad) demo “So… How does my voice sound to you?” “How about your own voice?” “ Uh… OK, I guess?” “ Uh… kind of funny; hollow; not normal!” Phonak U 2008 Audiogram done; now what?

8. …continued • “Plugged up? Let’s see what I can do to adjust that.” • “Better?….No?” • “Any better now?…No?” • “How about now?… No?” • “Well that isn’t the actual earmold that you will have, and this foam tip tends to make your voice sound somewhat plugged up. But that won’t be that way with a custom made mold with a ventilation channel. Let me tell you about the nature of occlusion…” Phonak U 2008 Audiogram done; now what?

9. …to the cost question “So how much will this cost me?” “Uh… that’s more than I was thinking of paying. I can’t afford that right now” “Well, this model with SoundRelax, WhistleBlock, VoiceZoom and the 20 channels etc. will be $$$.” “Yeah; I couldn’t afford that either!” Phonak U 2008 Audiogram done; now what?

10. … and on “Well I have another model that is less expensive.” “Well… it has 16 channels and AudioZoom instead of VoiceZoom etc… OK?” “What does it do?” “I think that would be better for me!” Phonak U 2008 Audiogram done; now what?

11. “It seems like he just wanted to sell me the expensive model! Why didn’t he tell me about this one right away?” … and on “Well… Yes it is also good and it would probably work for you.” Phonak U 2008 Audiogram done; now what?

12. … quick, change the subject! “ So…What color would you want that to be? We have a choice of eight colors!” “Here, take the brochure so you can read about all of the great features!” “I will need to think this over. Thank you very much for your time.” Phonak U 2008 Audiogram done; now what?

13. So what went wrong? • This actually happens! • Who did all of the talking? • What information was the recommendation based on? • Do you want a do-over? Phonak U 2008 Audiogram done; now what?

14. Information Retention Information provided early in process is usually not retained because clients affect is still very high. Luterman, 2008 Use time to build a trusting relationship Phonak U 2008 Audiogram done; now what?

15. Trust • Caring • Consistency • Credibility Phonak U 2008 Audiogram done; now what?

16. The better Model: • The Demo • The Connection & Explanation • The Audiogram • Needs Assessment • The Recommendation • Gaining Commitment • The Wrap-up • The Conclusion Phonak U 2008 Audiogram done; now what?

17. The Demo You have finished the audiogram… Connect BTEs with Slim-Tubes or tubing and Comply tips Ask the following question: Phonak U 2008 Audiogram done; now what?

18. The Demo “I am speaking in a normal conversational tone …My voice should be comfortable for listening in this room. Is that correct?” If “no”, make the necessary adjustments; If “yes”, then move on! Phonak U 2008 Audiogram done; now what?

19. The better Model: • The Demo • The Connection & Explanation • The Audiogram • Needs Assessment • The Recommendation • Gaining Commitment • The Wrap-up • The Conclusion Phonak U 2008 Audiogram done; now what?

20. The Connection & Explanation Now that she can hear you better, ask: “Ms. Jones, how do you think you did on that test?” Validate or correct (tactfully) their answers Phonak U 2008 Audiogram done; now what?

21. The Connection & Explanation “What you noticed during the test is correct. You do have a hearing loss in both ears.” “Would you like me to explain the details of the test?” Or “What would you like to know?” Phonak U 2008 Audiogram done; now what?

22. The better Model: • The Demo • The Connection & Explanation • The Audiogram • Needs Assessment • The Recommendation • Gaining Commitment • The Wrap-up • The Conclusion Phonak U 2008 Audiogram done; now what?

23. The Audiogram Now the audiogram can make an appearance! Explain away! She has given you permission to educate her and will accept your information. Phonak U 2008 Audiogram done; now what?

24. The better Model: • The Demo • The Connection & Explanation • The Audiogram • Needs Assessment • The Recommendation • Gaining Commitment • The Wrap-up • The Conclusion Phonak U 2008 Audiogram done; now what?

25. Needs Assessment • Arguably the most important step! • Elaborate on intake form/COSI • Find the Needs Phonak U 2008 Audiogram done; now what?

26. Needs Assessment • Ask open ended questions • Match needs to features • Discuss features as they relate to the patient’s lifestyle Phonak U 2008 Audiogram done; now what?

27. Needs Assessment Present information like this: Need – Trouble Hearing while out with friends Feature –Directional Microphones and Echoblock Benefit – Reduce noise and reverb to help patient hear better in restaurants Reaction Question – How would that make spending time with friends more enjoyable for you? Phonak U 2008 Audiogram done; now what?

28. The better Model: • The Demo • The Connection & Explanation • The Audiogram • Needs Assessment • The Recommendation • Gaining Commitment • The Wrap-up • The Conclusion Phonak U 2008 Audiogram done; now what?

29. Active Lifestyle • Focus on communication needs and lifestyle issues with the patient • Re-iterate what you have uncovered during discussions with the patient – i.e. frequently goes out to dinner, involved in meetings at work, plays golf, socially active, uses cell phone, etc • Make your recommendation for product (Exelia, Audéo YES or Savia Art) based on these agreed upon needs • After reviewing the benefits of these products for the patient’s lifestyle, communication needs and hearing loss • If the patient responds favorably – STOP! • Do not continue to move forward through the brochure once you’ve chosen a product / level of technology Phonak U 2008 Audiogram done; now what?

30. Mr. Smith • “Mr. Smith, you told me that you frequently go out to dinner, participate in meetings at work and are an active person in your community.   • “In my experience in fitting hearing instruments, consumers that purchase hearing instruments that have technology capable of meeting their lifestyle needs and situations are the happiest with their hearing instruments. • “Based on your communication needs in these situations, and your desire for something stylish, I believe that Audeo YES IX is the hearing instrument best suited to your needs and desires.  It will automatically adjust in every listening environment so you will hear optimally in background noise and difficult listening environments. • “The Audéo YES IX has a great, sleek design and is virtually invisible on the ear. • “How does that sound to you?” Phonak U 2008 Audiogram done; now what?

31. The better Model: • The Demo • The Connection & Explanation • The Audiogram • Needs Assessment • The Recommendation • Gaining Commitment • The Wrap-up • The Conclusion Phonak U 2008 Audiogram done; now what?

32. Gaining Commitment What will be the next question? “So, how much is that going to cost me?” or, “That is probably the top of the line product? Phonak U 2008 Audiogram done; now what?

33. Gaining Commitment “So, how much is that going to cost me?” *Reiterate Features and quote price: “In order to have a hearing aid meeting your needs of x, y and z, your investment will be $” “Would you like to go ahead with the process?” Phonak U 2008 Audiogram done; now what?

34. Gaining Commitment You will get one of three answers: • Yes • Stall – “I think I need to think about it” • Objection – “The price is too high” Phonak U 2008 Audiogram done; now what?

35. The Objection An objection will be a clear statement, which can be directly addressed. • Question to completely understand it, • Question to identify potential solutions, • Summarize objection in your words, • Provide solution with clear benefits, • And ask for commitment. Phonak U 2008 Audiogram done; now what?

36. Gaining Commitment…Objection to cost • If Mid-Level Technology can meet most of the patients needs…. Phonak U 2008 Audiogram done; now what?

37. Moderately Active Lifestyle • If price objections are raised by the patient, then move to the mid-level technology • Make appropriate recommendation (Versata or Audéo YES V) based on communication needs, lifestyle and hearing loss • Be sure to point out the “grayed out” pictures and counsel on what features are lost with this level of technology – places value on the high-end products Phonak U 2008 Audiogram done; now what?

38. Gaining Commitment Now is the time to listen. You just asked a question. Wait for an answer! Phonak U 2008 Audiogram done; now what?

39. Gaining Commitment….Objection to Price….again • If Basic technology will not meet their needs…..Tell them!! • You are the professional, they expect you to guide them in the correct direction Phonak U 2008 Audiogram done; now what?

40. The Stall:I need to think about it…. Do not challenge a stall, be diplomatic: “I understand. It is a big decision.” • Restate the features that they liked: You mentioned that you want to hear better at work and with friends and cost is a concern. • Add a feature you kept undisclosed earlier: We do offer a free year supply of batteries • Tie it to a benefit for the client: That will help you keep the cost down. • Ask the reaction question: How does that sound? • Ask for the commitment: Would you like to go ahead? Phonak U 2008 Audiogram done; now what?

41. The better Model: • The Demo • The Connection & Explanation • The Audiogram • Needs Assessment • The Recommendation • Gaining Commitment • The Wrap-up • The Conclusion Phonak U 2008 Audiogram done; now what?

42. The Wrap-up Explain the ordering and fitting process: • Impressions/Measurements • Trial period • Warranty information • Fitting appointment process • Color choice Phonak U 2008 Audiogram done; now what?

43. The better Model: • The Demo • The Connection & Explanation • The Audiogram • Needs Assessment • The Recommendation • Gaining Commitment • The Wrap-up • The Conclusion Phonak U 2008 Audiogram done; now what?

44. The Conclusion • Reassure their decision to buy the hearing aids from you. • Thank them • Explain the next step so they can focus on that, rather than the money they just spent. • Brochure, card and set follow up Phonak U 2008 Audiogram done; now what?

45. Disclaimer This process will work for most of your adult hearing aid appointments. However, there may be times when a greater amount of counseling will be necessary. Please become comfortable with dealing with grief and denial, because you will come across those emotions. Pediatric hearing aid appointments also take on a different form, with significantly greater emphasis required on the counseling process. Phonak U 2008 Audiogram done; now what?

46. Resources • Counseling Persons With Communication Disorders and Their Families - David M. Luterman; • Counseling Strategies For Hearing Aid Fittings - Robert Sweetow • Counseling in Audiologic Practice – John Greer Clark, Kristina English • Changing for Good – James Prochaska, John Norcross, Carlo Diclemente • Interviewing and Counseling in Communicative Disorders – Kenneth Shipley, Celeste Roseberry-McKibbin • Negotiating behavior change in medical settings: The development of brief motivational interviewing – Stephen Rollnick, Nick Heather, Alison Bell. Journal of Mental Health (1992) 1, 25-37 • Get ready for the next Big Thing in Audiologic Counseling – Kris English; Page Ten, The Hearing Journal, July 2005, Vol. 58; No. 7 • Integrating new counseling skills into existing audiology practices. K. English; [Online] http://www.audiologyonline.com [2001, January 4] Phonak U 2008 Audiogram done; now what?

47. Recap • Make the focus of the appointment the discovery of needs and how the features of the hearing aids can benefit the client. • Know when to listen and when to disclose facts. • A proper hearing aid demonstration will move the process forward. • You are the professional- control the situation • Be comfortable with counseling. Phonak U 2008 Audiogram done; now what?