An Advocate for Self-Assessment: Barbara Weinstein This article is third in a series highlighting the work of master clinicians in audiologic/aural rehabilitation contributed by Special Interest Division 7, Aural Rehabilitation and Its Instrumentation. In this interview, Barbara Weinstein, professor and executive officer for the City University of New York (CUNY) clinical doctoral programs, discusses the evolution ... Features
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Features  |   October 01, 2007
An Advocate for Self-Assessment: Barbara Weinstein
Author Notes
  • Joseph Montano, EdD, CCC-A, is director of audiology and speech-language pathology at New York Presbyterian Hospital-Weill Cornell Medical Center. Montano’s clinical expertise is audiologic rehabilitation with a particular interest in adjustment to adult-onset hearing loss, hearing assistive technology systems, and hearing aids. Contact him at jjm2003@med.cornell.edu.
    Joseph Montano, EdD, CCC-A, is director of audiology and speech-language pathology at New York Presbyterian Hospital-Weill Cornell Medical Center. Montano’s clinical expertise is audiologic rehabilitation with a particular interest in adjustment to adult-onset hearing loss, hearing assistive technology systems, and hearing aids. Contact him at jjm2003@med.cornell.edu.×
Article Information
Hearing Disorders / Audiologic / Aural Rehabilitation / Special Populations / Cultural & Linguistic Diversity / Older Adults & Aging / Professional Issues & Training / Features
Features   |   October 01, 2007
An Advocate for Self-Assessment: Barbara Weinstein
The ASHA Leader, October 2007, Vol. 12, 5-29. doi:10.1044/leader.FTR1.12142007.5
The ASHA Leader, October 2007, Vol. 12, 5-29. doi:10.1044/leader.FTR1.12142007.5
This article is third in a series highlighting the work of master clinicians in audiologic/aural rehabilitation contributed by Special Interest Division 7, Aural Rehabilitation and Its Instrumentation. In this interview, Barbara Weinstein, professor and executive officer for the City University of New York (CUNY) clinical doctoral programs, discusses the evolution of the Hearing Handicap Inventory for the Elderly (HHIE-S), a self-assessment inventory she co-authored with the late Ira Ventry 25 years ago. Weinstein is best known for her work in geriatric and rehabilitative audiology.
—Joseph Montano, Division 7 coordinator
Q: It has been 25 years since the original publication of the HHIE. What impact do you think this scale has had on rehabilitative audiology?
he HHIE has been translated into Mandarin, Hebrew, Spanish, German, Russian, French, Portuguese, Arabic, and Italian, speaking to its domestic and global impact. This is quite humbling. The evolution of the HHIE and its many applications speaks to my evolution as a clinician and researcher and dovetails with the changing face of our profession as it has moved from a focus on rehabilitation to diagnostics and back to rehabilitation. The current emphasis on evidence-based practice, health promotion, disease prevention, new reimbursement protocols, and the ICIDH-2 classification systems have elevated the role of self-assessment tools. The incorporation of reliable and valid instruments into the armamentarium of new AuDs and practitioners is vital to our growth and stature as a credible profession concerned primarily with the welfare of patients.
Self-assessment scales such as the HHIE are at the heart of effective health care and health care decision-making, as they provide clinicians with a patient’s perspective on quality care. In short, the HHIE is a tool of proven validity in documenting outcomes and one of the few tools proven effective for clinical outcomes research. This type of research, which helps clinicians understand the end results of hearing health care interventions, quantifies the patients’ experiences and what they care about, while documenting changes in function attributable to the work we do as audiologists (Outcomes Research: Fact Sheet, 2000). By linking the care people get to the outcomes they experience, outcomes research has become the key to developing better ways to monitor and improve the quality of care (Outcomes Research: Fact Sheet, 2000).
Q: While a number of self-assessment tools are available for audiologists, why do you think that most do not include this measurement in their diagnostic procedures?
I would like to see self-assessment become a standard part of the audiological evaluation on par with pure tones and speech recognition. The Guidelines for the Audiologic Management of Adult Hearing Impairment (Valente et al., Audiology Today, Vol. 18:5, 2006) clearly recommend that an auditory assessment to determine magnitude of hearing loss and need for treatment, including candidacy for amplification, should include the following:
  • Formal self-assessment prior to fitting to establish communication needs, functions, and goals

  • Post-fitting administration of self-assessment instruments to validate benefits/satisfaction from amplification

The guidelines also recommend assessment of non-auditory factors that may impact the communication deficit, including personality characteristics, expectations, and motivation, all of which can be assessed only by a self-report questionnaire. Their systematic review of the literature revealed considerable empirical support for the use of self-assessment in the process of audiologic management.
The ASHA Preferred Practice Patterns for the Profession of Audiology include self-report measures as part of the clinical process for audiologic rehabilitation (AR) evaluation and while not specifically part of the clinical process in audiological evaluation, are included as other measurements that can be considered supplemental to the basic assessment, a short-sighting if I say so myself.
I continue to be surprised and dismayed at the tendency on the part of most clinicians to ignore the evidenced-based literature supporting the value of self-assessment. Clinicians contend that self-assessment measures are too time-consuming and therefore cannot realistically be incorporated into their clinical routines.
This contention is very disheartening and I believe does not bode well for the profession of audiology, which comprises individuals who consider themselves to be in a field designed to promote quality of life through enhancement and maximization of communication skills.
Q: You have recently been named executive director of the CUNY clinical doctoral programs. How is AR incorporated into your AuD curriculum?
The AuD program at the CUNY graduate center is within a program distinct from the hearing sciences PhD program, as it is considered a clinical doctorate. We offer a number of courses under the umbrella term AR, if one considers AR in the broadest sense—as the delivery of services designed to minimize communications difficulties, activity limitations, and participation restrictions that ensue from untreated hearing impairment of varying levels of severity.
Further, provision of hearing aids, hearing assistive technologies, cochlear implants, BAHA units, and tactile aids in a context that includes strategies and techniques for maximizing and optimizing communication is also embedded in my definition of AR. Using this operational definition, I can state unequivocally that we offer a minimum of seven courses in AR, and this number excludes the course we offer in pediatric audiology, geriatric audiology, and central auditory processing. This translates into at least 55% of our course offerings, I am proud to report.
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October 2007
Volume 12, Issue 14