June 13, 2024

Jane M. Howard Turner lived with the “noise of the night,” a term she
coined in her youth when a medication caused permanent ringing in her
ears. For decades, Turner watched her mother manage progressive hearing
loss without realizing that the “noise of the night” was a sign that
Turner was in the same situation.

Turner had her hearing tested for the first time at 19 years old,
when doctors told her to sleep with the television on to try to muffle
the constant ringing in her ears. Over 50 years later, Turner finally
received proper hearing health care from the Arizona State University
Speech and Hearing Clinic .

“It was a nighttime noise that I had to deal with,” Turner said.
“When I found out that it wasn’t an outside noise, that it was more in
my ears, I tried to use something to mask it and I’ve done that for all
these years until last year.”

The clinic, part of ASU’s College of Health Solutions, offers
diagnostic care and speech and language therapy for thousands of
patients annually. Patients arriving at the on-campus clinic work with
team members and students to develop a care plan and review their
hearing loss needs.

While open to anyone seeking hearing health, the clinic offers care
for low-income adults 21 or older with an income at or below 150% of the
poverty level, funded through the Hearing Healthcare
Assistance Project, a partnership of the Arizona Commission for the
Deaf and Hard of Hearing with the state’s public universities. Since partnering with ACDHH on the assistance project in 2021, the clinic has provided free care for nearly 80 adults.

Michele Michaels, the hearing health care manager at ACDHH,
recognized that low-income adults who can’t afford private insurance and
don’t have government assistance lack access to hearing health care.
After learning of a hearing aid donation to the ASU Speech and Hearing
Clinic, Michaels pushed for a way to assist those managing hearing loss
or deafness with little funds.

With a grant proposal from the former head of the ASU speech clinic
and 100 extra hearing aids at the ASU clinic, Michaels created the HHAP.

“I surveyed every state to see what they were doing for hearing
health care for low-income adults, and then designed this project, which
is unlike anything else that’s being done in the country,” Michaels

The project offers and covers the cost of a hearing test, hearing
aids, hearing aid fittings, batteries, wax traps, ear molds, and aural
rehabilitation. The cost of such care would typically range from $200 to
$1,500 for hearing aids alone, according to Michaels.

As ASU and ACDHH approached the three-year mark, Michaels and
providers wanted to expand access, particularly after learning that
transportation challenges prevent people from participating in the
project. The commission looked toward the two other state universities
for assistance and announced the involvement of Northern Arizona
University in 2023 and the University of Arizona earlier this year.

“We have clients in our program who have qualified, they can get a
hearing aid, but they have trouble getting here,” said Kate Helms
Tillery, clinical associate professor at Arizona State University’s
College of Health Solutions. “And that was one reason why we expanded
the partnership to include UA so that people who live in more rural
areas of the state don’t have to drive all the way to Phoenix to get
their services.”

While the expansion to northern and southern parts of the state eases
access for many outside of the Phoenix area, ACDHH and providers at ASU
wish to expand further by using trained community care workers and
additional clinics in areas like Yuma.

Those seeking hearing care assistance are welcomed by Christy Abrams,
the hard of hearing specialist at ACDHH, who listens closely to their
needs and guides them toward the best option. If their best option is
the HHAP, Abrams sends them to one of the three universities where they
start the process with four essential appointments.

“We’ve had over 1,000 people who have contacted us since we started
the project and since we started our agreement with ASU, 666 people have
contacted Christy and said, ‘I need help,’” Michaels said.

Just as Turner did, new patients in the HHP receive a hearing test at
their first clinic visit that measures their hearing loss and
determines if they’ll benefit from hearing aids. If they require hearing
aids, they are encouraged to meet with the aural rehabilitation team to
learn how to manage their hearing loss and the emotions they might have
about getting hearing aids. From there, patients return for a fitting
appointment and at least two follow-up appointments with the entire
team, which includes students in the speech language pathology training

Clinical professors at ASU’s Speech and Hearing Clinic allow students
to participate in nearly every step, from diagnosis to aural
rehabilitation. Student participation in clinical care can enable many
of them to lead appointments by the end of the semester without constant
monitoring from professors.

“So there may be other programs that may fit hearing aids, but what
sets us apart is we meet with those individuals again and again, so they
are able to figure out communication solutions,” said Aparna Rao,
clinical professor at ASUs College of Health Solutions.

Tillery said clinics offering aural rehabilitation help those with
hearing loss maximize their ability to communicate and function in daily
life. While there are several factors to this rehabilitation process,
Tillery points out the importance of ensuring that patients are
well-equipped to navigate the sounds and barriers in the world around

There is no copay for HHP services and the program promises in-depth
diagnostic and rehabilitation processes for those without insurance or
those not qualifying for other assistance programs, making this project
unlike any other, according to Michaels.

“Knowing I had to have $400 at least as a copay was just out of my
range,” Turner said. “I could not afford it. And that was another reason
that I was hopeful that the commission could help me … So I was aware
that I have to travel there to be evaluated, but it would be a covered
thing, including the hearing aids and batteries, which I couldn’t ask
for any more.”

Tillery said the project could empower low-income adults with hearing
care needs. For Turner, hearing aids revealed new sounds, like the
static of a computer and the giggles of children at the schools where
she’s volunteered since 2014.

“A client who comes to us is able to go from feeling very isolated
and alone to reconnecting with family and with our community,” said
Tillery. “Sometimes also realizing that they’re not alone in their
hearing loss.”

While Michaels and Abrams have been able to extend assistance to many
low-income adults so far, they hope to see the assistance project
become a permanent program to aid the over 1 million adults with hearing
loss in Arizona.

In the meantime, providers at the clinics want to expand access and
support to communities that don’t have hearing care and need local and
state help to do so.

“Everybody in the community has a role to play,” Rao said.


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