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A Few Minutes With Clarion Mendes and Amanda Lawrence on Non-Essential Care during COVID-19 Crisis

Vince Lara of the communications office of the College of Applied Health Sciences at the University of Illinois speaks with Clarion Mendes, clinical assistant professor and director of Clinical Education in the Department of Speech and Hearing Science, and Amanda Lawrence, clinical assistant professor in SHS, about the impact of COVID-19 on so-called non-essential health issues such as speech-language pathology and audiology and how those patients are treated.

Click here to see the full transcript.

VINCE LARA: Hi. And welcome to another edition of A Few Minutes With, the podcast that showcases Illinois College of Applied Health Sciences. I'm Vince Lara. And today I'm speaking with Clarion Mendes and Amanda Lawrence from the speech and hearing science department to talk about how the SHS clinics are impacted by the coronavirus crisis. I know Speech and Hearing Science operates the Speech-Language Pathology Clinic and the audiology clinics. And are those still open?

CLARION MENDES: So that's a great question. The physical location of the clinic is currently closed for the safety of our clients, our patients, our families, and our students and staff. So we're following CDC recommendations as far as that's concerned. However, like most of the rest of the world, we are diving deep into the world of telepractice, tele-interaction. So from the speech-language pathology standpoint, we have started to introduce telepractice for our patients and clients, and their families.

For audiology, it's a little bit more complicated because of the types of equipment that are often used for audiological assessment and intervention. So what we're doing currently for audiology patients is working with them to make sure that their hearing aids are up and running appropriately and making sure that their equipment is running smoothly. So repairs are still up and running for audiology.

VINCE LARA: How do you get hearing aids repaired without having that kind of face-to-face interaction?

AMANDA LAWRENCE: So there's a couple things. So if a hearing aid's malfunctioning, everything from-- sometimes we can talk them through it. Because there's a handful of things you just do to start, like, say, diagnosing what the issue is. And sometimes that fixes the issue. So that can be everything from just talking them through appropriate cleaning, just making sure there's not wax that's the problem or a microphone that's blocked to that extent.

So once we've worked through that, if need be-- current pandemic-- one of the things that we can do is, if a patient were to-- most of what I need to know in trying to assess or diagnosis is what their problems or the difficulties are, what's happening with the actual instrument.

They could bring it in without-- either drop it-- I mean, set it on a bench or a t-- outside the clinic. I would be there at the same time, pick it up, go in the clinic, diagnose it. I mean, figure out what's happening-- does it need to be sent in? Is it something I can replace or fix in the clinic?

Once I verify that it's functioning properly, I can clean it back off and disinfect it, and set it back somewhere for the patient to come back and pick up. I mean, it would be sitting there in the meantime, so not just sitting out for somebody to just come by and pick it up. So that can be done.

And most the time, the same thing can even happen even if they need-- if it's a sound-- like if I need programming adjustments, those kind of things. Usually, most, vast majority, 90% or better, I can do without the patient sitting there at all.

The only issue I would have is sometimes the problem is actually wax in the patient's ear. And I cannot do anything about that without seeing or touching the patient, though medical offices are open. So primary care or somebody could do that. But most things I can assess or take care of just by their feedback. It works.

VINCE LARA: You raise a good point, though. What are some of the complications for getting care for what people might deem as non-essential care during this time? And I think you know you bring up one of them. If a patient has an ear wax issue that's going to affect their hearing aid, I don't know, is that considered essential care? Is that something they could go to get care for?

AMANDA LAWRENCE: I don't know how they're doing it. Do we know how the system is set up here? So this I can tell you, just because I've had a friend who's had to go in Florida, who's in the same kind of stay-at-home.

So what they were doing was, well patients, not, say, for a primary care, they were doing those all in the morning. And if anyone-- ill or sick, then they were separating them out and seeing them in the afternoon so that they disinfect in between. So I can tell you there. I haven't tried to go to the doctor here, so I don't know what that means here.

I don't know if Christi and Carl are not seeing any well patients at all, if a patient or somebody called and said, I cannot hear at all, and this is the reason, like if somebody said they could not hear, if it would actually be considered a medical emergency. And if it ended up just being earwax, that would be a great day for their PCP. I mean, because that's something they can actually fix.

VINCE LARA: And Clarion, for someone with a speech-language issue, how would that be handled? And is that considered essential care or not?

CLARION MENDES: That's a great question. So it's going to depend quite a bit on the particular type of diagnosis that we're dealing with. So for instance, one of the specialties of speech-language pathologists is dysphagia, or difficulty eating and swallowing. And dysphagia is often frequently coupled with respiratory issues.

So for speech-language pathologists that are working in a acute care setting or an ICU, they're going to be pretty busy right now. And those services are kept up and considered essential. And of course, it's going to vary on a case-by-case basis from medical facility to medical facility. Something that we've been seeing a lot right now is, for individuals that have acquired neurogenic language or cognitive issues, having SLPs who can communicate with individuals to explain what COVID is and what their limitations are currently. That's something that has also been popping up in their speech-language pathology community quite a bit.

VINCE LARA: Clarion, I'm directing this toward you only because I know you've worked with geriatric populations a lot. And in fact, I think you've said in the past it's your favorite population to work with. Since they're most at risk at this time, what extra steps, if any, would you have to take to ensure their health?

CLARION MENDES: So that is incredibly difficult right now, both from the that they're staying healthy, because they are at the highest level of risk of contracting the virus, but the other challenge is-- I don't mean to stereotype, but they're not digital natives. And so currently, the way that the world is going with managing all aspects of health care in this current state is to do everything as digitally as possible. And so because they're not digital natives, this has been very, very problematic.

I can speak for-- I think I speak about my grandmother a lot when I'm interviewed by you, Vince. She's currently 89 at home. And she's talking with my parents on the phone, but she's excluded from the family Zoom meetings and all that kind of thing. So I wish I had a great answer for you, but currently I don't.

VINCE LARA: And Amanda would you-- how about from an audiology side of things?

AMANDA LAWRENCE: It's the same. That's [INAUDIBLE]. It's how tech savvy they are or have interest in being. So some, it's just frightening all the way around. And there is no interest, little interest, more just out of the anxiety of it or misunderstanding of it. And then some are interested, if you can help them work through it and how well you can do that via telepractice, or just some really does depend on auditory skills. I mean, there is something about telepractice that does depend on the institution.

And the other issue with hearing aids and the older population is, when we have declining visual acuity, hearing aids are very small. Everything about them is very small. So sometimes that alone is one of the things that they need more support with or something they miss clinic when the clinic is an open, because I'm asking them to look for something or wax in an area that's about the size of the head of a pin. And if your visual acuity is not there-- it's not because they're not trying. It's because they can't see it, so the same issues.

But we have a lot of-- I mean, the older population around here a in Champaign-Urbana is definitely a little bit of a sliver or a slice of just a very unique group in that many tend to be retired professors. And so they sometimes have an interest, or at least more inclination, into things that are different, and a lot of times, I would say above average willingness to try. Something that's a little bit different, particularly in my hearing aid population, which can certainly be helpful. But that doesn't change their visual acuity or the dexterity issues that can come with managing hearing aids.

VINCE LARA: We've touched on telehealth a little bit. But I'm wondering, in general, how has the buy-in been from patients with calling them about issues?

CLARION MENDES: So I'll get started with that. This is Clarion. I have jumped in, maybe cart before the horse, with telepractice with many of my voice clients. And I was tentative. I was nervous.

But surprisingly, the buy-in has been pretty good. And I think the reason is, one, I have found overall everybody is in this mood of, we're all in this together. We're collaborating together. We're all figuring out those unknown territories together. And so people have been extraordinarily gracious and understanding that this is something we're all working through.

And I'll say, as far as my client population, a lot of folks are stuck at home. And so people are just happy to have a piece of normalcy, even if it's delivered in an alternate model. And so, so far it's been it's been very positive.

And we're starting to work with this with children as well. And there's some great evidence that suggests that telepractice works very nicely with kids. And to be honest, I think parents are grateful to have somebody else be educating their children and supporting their communication needs right now during this complicated time.

VINCE LARA: That's well put. How about you, Amanda? Are you finding the same thing?

AMANDA LAWRENCE: Yeah. So in audiology and telepractice, you are more limited to being able to give some type of verbal instruction with a device. Otherwise, a lot of what we do is diagnostics, which, it does not lend. Because we have so much equipment. It does not lend to telepractice as well. But making the contact, or to know that somebody can be there via-- even if that is just phone, but if it needs to be talked through, that kind of thing, that there is an availability there. But in general, large swaths of what we do, if it's diagnostic in nature, the equipment just isn't available to be supported through telehealth practices, telepractice.

VINCE LARA: And I think that works well with what my final question is, is that, what are students doing to replace internships, replacing what have to be in-person internships? Clarion, do you want to start with that?

CLARION MENDES: That's a very interesting question. So I have been e-mailing and calling my certifying body, the American Speech-Language Hearing Association, the Council on Academic Accreditation, the Illinois Department of Federal and Professional Regulation, the Illinois Board of Higher Education, and many other entities. Because currently, students are not allowed to participate in telepractice and count it for their certification in the state of Illinois for speech-language pathology and audiology.

As of this recording, every other state permits it for speech-language pathologists. But Illinois is an isolate. So we have been working pretty around the clock to try to get our Practice Act updated so that students can participate in this important aspect of care that I imagine is going to be just becoming more and more common in our current state of affairs.

So that's something we've been working towards. And we check the updates daily, sometimes hourly, for changes in telehealth rules, regulations, and certification. So this has been keeping me up day and night. I have not gotten much sleep recently, to tell you the truth.

CLARION MENDES: I am overjoyed to share this update with you since you interviewed Dr. Lawrence and me on Friday, April 3, 2020. The Illinois Practice Act for Audiology & Speech-Language Pathology has been revised. Effective today, April 6, 2020, the Illinois Department of Financial and Professional Regulation, is allowing, through 7/31/2020, students of speech-language pathology and audiology, to provide their services via telepractice, provided that, per best practice, there is a licensed and certified clinician overseeing all services in real time. This variance is congruent with current best practice for speech-language pathology and audiology, and allows our students to successfully continue a high quality, clinical education while meeting the communication needs of our community during a pivotal time in health care. We are excited to step up and offer this medium of service delivery to our current and future clients. This opportunity, for our energized and dedicated students to offer services with the supervision of experts, allows us to maintain and enhance our standing as a highly-ranked program in audiology and speech-language pathology.

VINCE LARA: Well, I appreciate you both being on today to talk about these really important issues. And I hope that we can see a return to campus and to normalcy very soon. My thanks to Clarion and Amanda.

For more podcasts on Illinois College of Applied Health Sciences, search A Few Minutes With on iTunes, Spotify, iHeartRadio, radio.com, and other places you get your podcast fix. Thanks for listening, and see you next time.

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