Eager to get enlightened about the fascinating world of telehealth? Get ready for a compelling conversation with Nell Rosenberg, the National Director of Teleservices at Clarke Schools for Hearing and Speech. We'll be journeying with Nell as she shares her path to becoming a speech-language pathologist and her passion for the prescriptive elements of the craft. Nell also offers a peek into the storied history of Clarke Schools.
Nell helps us navigate the landscape of hearing technology, highlighting how it's enhancing access to sound and fine-tuning listening and spoken language outcomes. In the wake of the pandemic, teleservices have come to the fore, and we'll chat about the acceptance of this technology and Clarke Schools' initiatives to advocate for policy and legislative changes to strengthen its support. As we wrap up, we'll ponder on the urgent need for greater collaboration and unity within the domain of communication sciences and disorders to widen access to speech-language therapy and hearing care services.
Connect with the Hearing Matters Podcast Team
Email: hearingmatterspodcast@gmail.com
Instagram: @hearing_matters_podcast
Twitter: @hearing_mattas
Facebook: Hearing Matters Podcast
Eager to get enlightened about the fascinating world of telehealth? Get ready for a compelling conversation with Nell Rosenberg, the National Director of Teleservices at Clarke Schools for Hearing and Speech. We'll be journeying with Nell as she shares her path to becoming a speech-language pathologist and her passion for the prescriptive elements of the craft. Nell also offers a peek into the storied history of Clarke Schools.
Nell helps us navigate the landscape of hearing technology, highlighting how it's enhancing access to sound and fine-tuning listening and spoken language outcomes. In the wake of the pandemic, teleservices have come to the fore, and we'll chat about the acceptance of this technology and Clarke Schools' initiatives to advocate for policy and legislative changes to strengthen its support. As we wrap up, we'll ponder on the urgent need for greater collaboration and unity within the domain of communication sciences and disorders to widen access to speech-language therapy and hearing care services.
Connect with the Hearing Matters Podcast Team
Email: hearingmatterspodcast@gmail.com
Instagram: @hearing_matters_podcast
Twitter: @hearing_mattas
Facebook: Hearing Matters Podcast
You're tuned in to the Hearing Matters podcast, the show that discusses hearing technology best practices and a growing national epidemic hearing loss. Before we kick this episode off, a special thank you to our partners Sycle, built for the entire hearing care practice. Redux Faster, drier, smarter, verified. Otoset, the modern ear cleaning device. Fader plugs the world's first custom adjustable ear plug. Welcome back to another Hearing Matters podcast episode. I'm your host, Blaise Delfino, and we have an incredibly special guest with us today. We are joined by Nell Rosenberg, who is the national director of teleservices at Clarke schools for hearing and speech. Nell, welcome to the Hearing Matters podcast.
Nell Rosenberg :Thank you so much, Blaise. I'm thrilled to be here.
Blaise M. Delfino, M.S. - HIS:We're so excited to have you, nell. We've been talking about having you on the show for quite some time and super excited that your schedule allowed you to join us today, because we know how super busy you are, but really excited to shine light on the incredible work you and your team are doing at Clarke. Now let's dive in. You are a speech language pathologist. That's where the synergies align here. What inspired you to become a speech language pathologist and pursue a career in communication sciences and disorders?
Nell Rosenberg :Well, I always knew I wanted to work with children from a very young age and I wasn't sure exactly what that would look like. But I pursued my undergraduate in human development and special education and went on to get my master's in education in early childhood and special ed. I loved elements of that. I loved the early intervention. I loved the reading interventions, the small group work. But I realized the classroom setting was not the right fit for me. I was so drawn to the prescriptive elements of what we were doing. I loved collaborating with all of the therapists. I realized my interests were really aligning with the speech language pathologists. I went straight from that master's right into another one to get my master's in science, in communication sciences and disorders. I never looked back. It really felt like I found my calling.
Blaise M. Delfino, M.S. - HIS:But what a great foundation, nell, having both and just your ability to self-audit. We talk to a lot of SLPs, hearing health care professionals, students, to our students tuned in right now who are graduate students, undergrad. Nell is living proof that your career path can change and taking that leap of faith, isn't it so great that the communication, sciences and disorders field the scope is pretty large now?
Nell Rosenberg :Oh very. I actually found it pretty overwhelming when I got to that graduate program because I came in sort of laser focused. I didn't know, I had no idea that being an auditory verbal therapist was even something that existed. But I thought, you know, I know I want to work with young kids.
Nell Rosenberg :And then I got to grad school and, surprise, I needed to learn a lot about adults and about hospital settings and about the brain the brain and speech anatomy and neuroscience and I felt like I had this great foundation that continues to serve me beautifully in understanding child development and the educational system. But I was really in for a shock at the new knowledge I needed to learn and how many directions my career could end up going.
Blaise M. Delfino, M.S. - HIS:Yes, so before joining Clarke for those tuned in communication sciences and disorders you essentially most all programs have an externship. Yes, where did you complete your externship, and was that one of the ways in which you got integrated with Clarke?
Nell Rosenberg :It is. I was really fortunate in grad school. You know you do a different rotation every semester with a different population. And I attended Florida State University and at that time we had an AVT Janet Kahn on staff and I did a rotation with her, a semester where I was working with young children with hearing loss with her, and that's when everything fell into place with me and I thought I found my niche, because I really felt like I hadn't until that point and she suggested that I pursue my externship at Clarke, jacksonville. So I went and I interviewed there and that is where I did my externship Was it Clarke Jax? And I then, after graduating, worked in public schools and private education schools before I ultimately came back to the Clarke family. But it definitely set me up to come back to Clarke at a different campus and now at a national level in the future.
Blaise M. Delfino, M.S. - HIS:Different campus but essentially same culture, right, which is incredible, yes. And then to this. Now you know you've had all of these different experiences. We know that the communication sciences and disorder scope is so vast In your experience. What sets Clarke schools for hearing and speech apart from other institutions or organizations that do provide similar services, essentially on the same mission? And what makes Clarke unique in your experience?
Nell Rosenberg :Yes, I feel really fortunate to have rejoined my Clarke family. I loved all the experiences I had at various schools. Working with different populations and working with children with hearing loss in the public school setting was very valuable for me as well, but Clarke is special. One of the big things that sets Clarke apart is that we are laser focused on children who are deaf or hard of hearing, who are learning to listen and speak using hearing technology, and Clarke has been providing services for over 150 years. Wow, yes, our history goes way back.
Blaise M. Delfino, M.S. - HIS:It's a long time.
Nell Rosenberg :It's a long time. So for over 150 years, clark e has taught children who are deaf and hard of hearing to listen, learn and speak and read alongside their hearing peers in the mainstream setting. It has always been Clarke's mission, from day one, and we have evolved over the centuries, isn't?
Blaise M. Delfino, M.S. - HIS:that cool to say.
Nell Rosenberg :It is. It's incredible, you know it started as a residential program, which is no longer part of our programming whatsoever to now we have five locations along the East Coast, campus-based, as well as mainstream services, permitting services in the natural environment and now tele-services, nationwide and even in other countries. So Clark e has this really rich history of excellence in our field and we have adapted with the time to serve the changing population.
Blaise M. Delfino, M.S. - HIS:The first thing I think of there now, when you say that Clarke has been around for 150 years as humans and we always talk about this in the hearing, health care space, communication sciences and disorders you know what the service delivery model looks like and at the end of the day, as a therapist and as a hearing health care professional, humans are social beings and we thrive on that connection and from an outsider looking in. That has to be that component of why Clarke has been able to successfully help so many people, because they understand that essential component that we as humans are social beings.
Nell Rosenberg :Absolutely so. Our connection with families and our strong belief that social communication, social interaction, is the foundation of all language, carries us through.
Blaise M. Delfino, M.S. - HIS:So you said your connection with families. How does Clarke collaborate with other professionals or organizations in the field of hearing, health care to essentially really ensure comprehensive support for your students?
Nell Rosenberg :Yeah, we work with a lot of different professionals and I could spend all day naming all of them, so I'll focus on the team approach.
Nell Rosenberg :And we really do believe in that family centered or, as children get older, that student centered approach right, and that means we have a whole team around us. So I'll focus on the two biggest players that we interact with, which is audiology teams and then educational districts, educational entities, leas, local educational agencies. So for every child, no matter what department or campus or anything, they are on with Clarke, we are definitely collaborating with their hearing health care team. Even if they receive some audiology services through Clarke, which many do, those are different campus to campus. All of our children have what we call a medical home right, so they have a home base where they're getting their diagnostic testing and so forth. So we've maintained very close relationships with each of our children's audiologists and then many large audiology centers, especially pediatric diagnostic audiology centers, that we interact with very frequently. You know there's some hospitals we get a lot of kids from due to our locations and so forth. So we have very good relationships with those teams and it's very much a back and forth. So they're sending us information, we are sending them information.
Nell Rosenberg :For example, if I have a kid, most of my kids are little right and it's not easy to test them in the booth? Not at all. No, that's an understatement of this entry. So their audiologist may email me and say you know, here's the report, here's the audiogram I got today. I was only able to get SoundField, or I was only able to get up to this. Can you please keep an eye on the high frequencies? I really don't think those are reliable and let me know what you're noticing in listening checks. Or can you do a little work in your sessions on discrimination between these two sounds and let me know what you think? Or I need this kid to move to play audiometry. Can you work on that in your sessions? So we do a lot of that.
Blaise M. Delfino, M.S. - HIS:I love that approach. Number one these children. You're emphasizing the fact that they are in this language-rich environment with their families, with Clarke, essentially they're hearing home right and I love that collaborative approach because we understand and Nell, you more so than I because you're a practicing speech language pathologist you know understanding these language and speech milestones and the carryover from the audiologist to the speech language pathologist. My hope and a lot of hearing care professionals do this really well with maybe their adult patients, primary care physician or ENT. It is that collaborative approach. What you're saying in a report hey, let's look out for this. Maybe the high frequencies. How would you essentially maybe teach an organization to really hone in on that collaborative, streamlined communication, because that really does help the kiddos?
Nell Rosenberg :It does, and it goes back to what you said, that it's all about social connection and we have some institutions are easier to have relationships with than others, and that is often due to constraints that they don't have control over.
Blaise M. Delfino, M.S. - HIS:Sure.
Nell Rosenberg :You know if their teams are really overbooked they don't have any time built into their day for communication. You know that's a real barrier that I respect. But it is about building communications and having point people. So, especially at centers that have roles such as an educational liaison, that's a huge win If a center has that, because I might schedule a call to talk to them about all of our kids who are seeing for two visits at Clarke and kind of run through all of them and say their provider sent me this.
Nell Rosenberg :We would really like to remap the right ear for this kid. So it's establishing those connections and determining who are those people at each practice and it's not always the same. So it's about building relationships and building that mutual respect. And the longer we work with someone, the more we come to respect each other. Right, because they're seeing. Oh, I get really valuable input from the Clarke provider Because their Clarke provider emailed them a week before the kids mapping and said I've noticed in the right CI that they are consistently substituting for ooh. So I want to give you a heads up before mapping and over time that builds trust and we see the value in working with each other more and more.
Blaise M. Delfino, M.S. - HIS:And trust takes time to build, and I just love that collaborative approach Because, again, these kids they are in this language-rich environment, they're working with great professionals like you at Clarke School and these are future leaders of America as well. We want to make sure that they have a chance to really thrive and that's what I love so much about Clarke School obviously doing research about the institution prior to this interview and now. Thank you and your team for all that you're doing for these kiddos. When we talk about emerging technologies, innovation that's really been a buzzword, innovation in emerging technologies Even the past decade in the communication sciences and disorders field, more so, I feel, than even 30, 40, 50 years ago. Of course, I was not around, however, doing research Same, but it seems to me I agree with you.
Blaise M. Delfino, M.S. - HIS:Right. So when we discuss these innovative and emerging technologies, can you discuss them as they relate to speech therapy that have excited you, and what emerging technologies or innovations are you most excited about to implement with your patients?
Nell Rosenberg :So, of course, there's a side of it that I won't get into in detail, that I'll leave to the actual audiologists and industry people that you have on your podcast, but the innovations in hearing technology are simply incredible.
Blaise M. Delfino, M.S. - HIS:It's tremendous.
Nell Rosenberg :It really is, and that is the biggest change, the biggest change we've seen, because with improved access to sound, improved listening and spoken language, outcomes follow, as long as we have appropriate therapies and supports, but the improvements in access have been incredible. For me, what's most exciting is to see the more widespread adoption and acceptance of teleservices across every area of our field. So obviously one of the positive outcomes of COVID was this widespread use of video conferencing and everyone got comfortable with it.
Blaise M. Delfino, M.S. - HIS:It's not weird anymore.
Nell Rosenberg :It's not weird anymore. It's not weird anymore and internet access increased. People's comfort level increased. It's not this crazy thing. I mean, it used to be. We've been doing teleservices since 2011, and it used to be a pretty hard sell. Like, well, you're going to get. We used FaceTime initially and we're going to do therapy like that.
Blaise M. Delfino, M.S. - HIS:Like people were resistant and now Is there evidence behind this? It might be something right, yes, well, and you know what?
Nell Rosenberg :There wasn't, yeah, there wasn't, and now there is. So, what's most exciting to me is to see, now that we have this widespread use, to see innovations that are going to allow for it to become more widespread, and what that is going to require is changes in legislation yes, changes in policy regarding reimbursement and so forth. So what's actually most exciting to me is, now that we have this excellent technology, how can we get the policies and laws needed to support its full use?
Blaise M. Delfino, M.S. - HIS:To dovetail off that, what is Clarke and your colleagues doing to educate elected officials on this very important topic and matter? To kind of give a 10,000-foot view, yeah, at a very high-level view.
Nell Rosenberg :we are working especially within our operating states where we have campuses. Most of our campus directors are very involved on the state level, meeting with advocacy groups, government groups, showing our data, our actual data, as well as these larger studies that are being done. More and more we're seeing large-scale peer-reviewed studies come out and Clarke also has excellent data that we've been keeping on our to-visit students. So we are presenting that, presenting parent testimonials, and really advocating for legislation within our states. And, of course, I am following very closely along on the national level with things such as the ASHA Interstate Compact and all kinds of reciprocity laws that I think will be game changers over the next five years.
Blaise M. Delfino, M.S. - HIS:Absolutely. I think the term reciprocity, when done correctly, can really again open up the floodgates of access to speech-language therapy, to hearing healthcare and again to our speech-language pathologists out there and hearing healthcare professionals. The importance of advocacy cannot stress this enough, because even literally now, putting a block in your calendar of, okay, one day or two days per month, I'm going to make it a point to reach out to my elected officials to establish that relationship, because there's so much policy that how are you top of mind if you're not reaching out? And I feel as though, as a whole communication sciences and disorders, throwing audiology in there, we have to unite because we're small.
Nell Rosenberg :We're small in the grand scheme of things when you look at healthcare overall.
Blaise M. Delfino, M.S. - HIS:Absolutely so. How can we understanding Clarke's history that has been around you've been around for 150 years. Obviously you have a system that works, and collaboration is a part of that. How can we, as an industry, continue to collaborate and spread that message? What does that look like?
Nell Rosenberg :Oh, that's the million dollar question and I'm hoping that we continue to unite the two professions, especially through ASHA, because ASHA is really pushing forward the interstate compact and that requires national coordination as well as state level. And then, how do we collaborate with smaller groups within that? So things like early hearing, detection, like EDEY, within the state level, and many states have their own, you know, sub organizations, special interest groups. How do we get all of the experts we have at these individual places and bring the expertise forward? So we have to unite under certain umbrellas.
Blaise M. Delfino, M.S. - HIS:And again, this really tees us up for next week's episode where we're really going to dive into the nitty gritty of telehealth. But I have to say now I graduated in 2017. So even then, even in 2017, there wasn't much of an emphasis on teleservices.
Nell Rosenberg :Like we even mentioned, I graduated in 2012.
Blaise M. Delfino, M.S. - HIS:So no one had. Even it's not that long ago either, and it's like no.
Nell Rosenberg :I did one of the first tea visits at Clark e as an employee.
Blaise M. Delfino, M.S. - HIS:We are on the ground floor of something that can really revolutionize the industry, but not only revolutionize the industry, because there needs to be a reframe. We need to provide the services these children and kids need to successfully set them up to understand communication, have access to that language, rich environment, and how can we increase greater access? And for many that's telehealth. Before we sign off, I just have one more question. When we talk about the benefits, our listeners tuned in. You need to tune in next week as well, because we're having nail back on to talk really about the benefits of telehealth. But have you personally encountered any surprising or unexpected benefits using telehealth with the hearing impaired?
Nell Rosenberg :Yes, some of it will get into more next week, such as overcoming what we call the zip code lottery.
Blaise M. Delfino, M.S. - HIS:Okay.
Nell Rosenberg :The children who previously it, just wherever they were born, that's, if they had access to services or not and tele-services can completely break that down. It has the potential to to remove massive barriers such as geography, work schedules, so forth. It can remove many of those barriers. But one of the most surprising and incredible benefits to me came from the research that Clarke did.
Nell Rosenberg :We contracted with an outside evaluator to measure the impact of T visits in our birth to three population. We've been doing them since 2011. And they worked with us throughout that time and released a final report in 2022. And here's what's really shocking 95% or more of the caregiver surveyed and was a pretty large number said that T visits were effective or very effective at helping them learn to interact with their child, helping their child progress in their development, increasing their own strategy use to build their children's communication skills and monitoring and tracking their child's progress. And what blew my mind more than anything else was that one of our biggest concerns, one of a lot of people's biggest concerns, is that it will be hard to form a relationship, and in that research conducted by an outside evaluator, 100% of parents surveyed said T visits were effective or very effective at developing and maintaining a relationship with their provider.
Blaise M. Delfino, M.S. - HIS:Wow, so the numbers tell a story there Nell.
Nell Rosenberg :The numbers tell a story and for me personally, working closely with families to break down those access barriers through tele-service has been the greatest joy of my career.
Blaise M. Delfino, M.S. - HIS:I love that. Now, this reminds me during the pandemic okay, so, running a private audiology practice and thank goodness before the pandemic we were implementing tele-audiology but it really during and following the pandemic really became part of the onboarding process of new patients. So during their fitting appointment, their first fitting they would come in, show them how to use the technology, bring them back once more for you know, seven to 10 day follow-up and for the most patients now they all have smartphones or their caregivers do. We would always have that third visit following real ear measurement, because then it's much easier to make the appropriate adjustments with, you know, tele-audiology following real ear measurement.
Blaise M. Delfino, M.S. - HIS:Our patients loved it and, to your point, implementing that into the patient care increased access, decreased barrier. And then they don't have to waste money filling up their gas tank, hitting traffic on one of the major highways. Yes, and they're comfortable in their home.
Nell Rosenberg :It's a huge amount of time and money. We see much improved attendance. You know you don't have to miss an appointment because one child has the common cold in your house. I love the model you're discussing where you have kind of a standard way of doing it. So that they jump in, they feel that connection. You do the things you need to do in person because, especially with audiology, there are some of it that needs to be in person. With speech, they're truly typically isn't, except for certain situations.
Nell Rosenberg :But, I love that you have that set up where you put them right into their third appointment tele-health and the comfort levels they are, regardless of the service delivery model.
Blaise M. Delfino, M.S. - HIS:Especially, you know the asynchronous programming where patient puts in a ticket, essentially, and you make the adjustments and it uploads right to their hearing technology. But now this is super exciting Number one. I so admire your passion. I love what you and Clarke are doing and have been doing for 150 years. Next week we're going to be talking about the benefits of tele-health for hearing health care services. So, nell, thank you so much for joining us on the Hearing Matters podcast and we're going to see you next week.
Nell Rosenberg :My pleasure. I can't wait.
Blaise M. Delfino, M.S. - HIS:You're tuned in to the Hearing Matters podcast. Today we had Nell Rosenberg, who is the national director of tele-services at Clark schools for hearing and speech Tune in next week where Nell talks about the benefits of tele-health for hearing health care services. I'm your host, blaisdell Fino, and until next time, hear life story.