JCPSLP Vol 21 No 1 2019

The role of speech-language pathologists in the justice system

Hearing loss and services available for people in the justice system Samantha Harkus

I am going to tell you a story about a woman whose name is not, in actual fact, Christine. I would like to acknowledge and pay respect to the real woman behind the name. Knowing and working with her briefly was personally touching, professionally transformative and very memorable. In the late 1990s I was regularly visiting an urban Aboriginal medical service providing rehabilitative hearing services through Australian Hearing’s outreach program: hearing and communication evaluation, hearing aid fitting and communication support. The visits ran concurrent to a visiting ear nose and throat (ENT) clinic. At the time, a GP from the medical service was providing services to Aboriginal women at a nearby women’s prison. During one of the hearing clinics, a prisoner was brought in to see the visiting ENT specialist, an unusual event. The woman, Christine, had large, almost total, perforations in both ear drums, suggesting that she had experienced chronic ear disease at some time in her life. Early onset, chronic ear disease and conductive hearing loss continue to be much more prevalent for Aboriginal and Torres Strait Islander people than for non-Indigenous Australians. The disparity is largely socially determined (Kong & Coates, 2009). According to self-report data, one in eight Aboriginal or Torres Strait Islander Australians report middle ear disease or hearing loss (Australian Bureau of Statistics, 2013); however, self-report is thought to underestimate actual prevalence rates as both ear disease and hearing trouble are often normalised (Burns & Thomson, 2013). Prevalence of hearing loss varies significantly, by remoteness and socioeconomic status (Australian Institute for Health and Welfare, 2017; Simpson, Enticott, & Douglas, 2017). Christine’s hearing results showed a flat, moderately severe mixed hearing loss in both ears: the maximum possible level of conductive hearing loss with an additional component of sensorineural hearing loss, likely to relate to cochlear damage caused by bacterial toxins that diffuse through the round window membrane (Kolo, Salisu, Yaro, & Nwaorgu, 2011). At 36 years of age, this was the first time she had been referred for both ENT consultation and hearing evaluation. With such a degree of loss, it was highly likely that most speech sounds were inaudible to Christine, yet her communication skills were very good: conversation was fluent, with few clarifications or repeats. Observing her, it was clear she was working hard to use all visual and auditory resources to achieve this: she was leaning forward, sitting at the front edge of her chair, straining to hear and

watching me so intently that she was frowning. Cognitively, she would have been using knowledge of context and language to supplement gaps in the auditory signal. When it is difficult to hear speech for any reason, because of hearing loss, environmental noise or the speaker’s voice is soft or unclear, the centres of the brain not normally engaged in the process of hearing and decoding language must come to the assistance of the centres whose role it is. When this happens, performance on these non-hearing related activities decreases. For example, verbal working memory performance decreases as level of listening difficulty increases. As listening difficulty increases, cognitive activity increases – to a certain point. Once it becomes too difficult, cognitive activity drops off sharply (Peelle, 2014). We know that for children in the classroom, it is important to hear easily, to have good acoustics and amplification when needed, so that students can spend more time thinking about what they are learning rather than trying to decode what it is they are hearing. Despite the listening effort required for daily communication, Christine was able to communicate well, indicating she was motivated to understand and communicate. Christine agreed to join the waiting list for surgical repair of one ear drum, and her GP approached the prison to request funding for one hearing aid. As for many adult prisoners, any eligibility Christine may have had for the Australian government’s Hearing Services program prior to imprisonment was likely to have been lost upon incarceration. For most adult prisoners, responsibility for funding services relating to hearing and ear health, including hearing devices, transfers to state and territory- based corrections health services. Currently, adults with age-based eligibility, for example, adolescents and young adults aged 25 years or younger and Aboriginal or Torres Strait Islander adults aged over 50 years, retain access to the Hearing Services program, provided that they were in receipt of services at the time of incarceration. Adults with a current Hearing Services Voucher may continue to receive services until it expires. When prison services are deciding whether to fund a hearing aid for a prisoner, factors such as severity and impact of hearing loss and length of time still to serve are often considered. Christine had significant hearing loss and one year remaining on her non-parole period, and one hearing aid was approved. I saw her at the prison to find out more about her hearing and communication needs and discuss amplification options with her. During the appointment, she told me more about herself. Christine

THIS IS AN INVITED ARTICLE

Samantha Harkus

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JCPSLP Volume 21, Number 1 2019

Journal of Clinical Practice in Speech-Language Pathology