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This very important episode includes a conversation with educational audiologist, Mallorie Evans. We discussed:

• the bias in audiology towards auditory/oral communication, to the exclusion and detriment of language access.

• the need for affective counseling, and the first impressions parents of DHH babies receive from the professionals they interact with.

• the lack of representation of BIPOC clinicians.

• language deprivation
• where parents can get more information, and what is need to become an advocate.

I’d love to hear your thoughts on this episode! Message me on Facebook or Instagram!

And join the upcoming H.E.A.R Retreat !

Related Episodes:

All About Sign Language with Kimberly Sanzo

All About Auditory Verbal Therapy with Elaine Matlow Tal-El

All About Listening and Spoken Language with Dr. Carol Flexer

Do Cochlear Implants Work? with Dr. Lindsay Cockburn

All About Supporting Parents with Dr. Michelle Hu

All About Supporting Your Child Unconditionally with Takniyan Debbie Dachi

All About the Parent-Audiologist Relationship with Janet DeGeorges

All About Educational & Informational Audiological Counseling with Dr. Sarah Sparks

All About Educational Audiology with Dr. Tina Childress

Next episode:

All About Collaborating with Speech Language Pathologists – Episode 74- with Dr. Leah Beekman

Transcript:

Dr. Lilach Saperstein:

Welcome back to the All About Audiology podcast. I am your host, Dr. Lilach Saperstein and this is the show where we talk about audiology and how it actually matters to you and your family. Whether you are a professional, a student or a parent, or a family member, this is the place for really important conversations about the impact and all the other topics that come around audiology. So today is a very exciting episode. I’m really looking forward to speaking with Mallorie Evans, an educational audiologist in California, and we’re going to be talking about bias, and some of the things you didn’t learn in audiology school or in grad school or in your studies; some of the things that may have been skipped over. 

So we’re going to try and fill in some of those gaps and get a sense of what’s going on. So buckle up, here we go. We’re getting ready. Welcome, Mallorie. Thank you for coming on the show. 

Mallorie Evans:

Thank you so much for having me. 

LS:

I’m so excited about this conversation, mostly because I think it’s one of those conversations that people are afraid to have, and they’re doing it behind your back on Instagram DMs. Like [higher pitch] is this right? Should I do this? Everyone says one thing, da da da da da. [regular pitch] There’s a little bit of that energy. So let’s bring it out in the open and have some of the hard questions today.

Here’s the thing. You know, many of the listeners on the show have been listening for many, many episodes already. Two and a half years or over 70 episodes. You can actually, as you listen through the show, you can actually hear me changing, learning, growing throughout the topics we’re talking about today, which is the idea of, quote-unquote communication mode. Are we using sign language? Is auditory-verbal therapy the way to go? It’s like the signed versus spoken as if this is like two battling it out in the boxing ring. Even that duality is part of the problem. So let’s back up here and, first get an introduction on you, a little bit of your background, and what brings you to this work and this conversation.

ME:

I have been an audiologist for 19 years. Just saying that out loud is crazy to me. But I have primarily been in the educational setting. I do a little private practice work just in my off times in the summer, just to get my hands on the clinical world but I also, in being an educational audiologist, I made a conscious decision to really understand education better and how audiology has a huge impact on education. And because I work in the schools, I decided that it was important for me to understand the students that I was working with, and so I took a two-year training in ASL English bilingual methodology, just so I could try to see how I could fit into that mold. 

Instead of trying to get the students to kind of fit into my perceptions and my preconceived ideas, I needed to fit into their world. So I did that, and that opened up a lot of avenues for me in terms of how I perceived the work that I was doing. Some of it, in some ways, potentially harmful, even if it was unintentionally, but really examining myself and examining things that I believed, and the things that I was taught, and seeing how I could turn those things into something more empowering and uplifting and meaningful for my students. And it really came down to what was meaningful in everyday life for my students because what was the point of me working with them if it was something they were just going to toss aside the second they were out the door? Kind of how I have evolved myself over the years. You know, I came in thinking I knew stuff [Lilach laughs] and then realized I didn’t know anything at all. [Mallorie laughs]

LS:

Yeah, we talk about that. There’s a process of education that is actually learning how much you don’t know, how much there is to know. Dunning and Kruger were these two psychologist researchers who figured out that more people will rate themselves average and above average, and that’s impossible. You need, so a statistical thing here where some people are below average and things and they found that the people who were most educated were likely to say I don’t know or you know, underrate them, and people who were the least educated or knowledgeable about a subject were the most certain that they knew what was up. And I think we have seen this in many fields and public spheres in the last few years. [laughs] I mean, and all of humanity. What should I say, I’m a little philosophical today, I don’t know. 

ME:

That’s alright, I am too. Don’t worry, I’m right there with you, we’re vibing. [Lilach laughs]

LS:

Okay, cool. Okay, so let’s just one more time, back up to what is an educational audiologist and how does it differ if you’re working in a deaf education setting versus a mainstream setting. And where have you worked?

ME:

An educational audiologist is an audiologist who works in a school system. It could be a school district, it could be what we call here SELPAs which are special education local plan areas, meaning like, a group of districts kind of coming together to pool resources to provide services to students in special ed, or you could work through your county office of education. There’s a lot of different ways but whatever your local education agency is, an educational audiologist works those settings, and so they’re working with students. Could be from birth all the way through age 22, and that service looks different depending on the area, depending on the organization you’re working for. I personally have done a little bit of everything.

My first school district that I worked for for four years, I was the SELPA audiologist, so I was responsible for seven school districts, and I had on my caseload, students who were mainstreamed, we call them the itinerant students, so they were in general education classes. They might be the only student in their school with a hearing loss but still needed some support. So I had a caseload of students like that, but I also had special day programs for deaf students as well. So I had a balance of a little bit of everything. 

In addition to those students who are already identified as deaf or hard of hearing, we were also tasked with testing students who didn’t pass their school screenings. So, at least in California, we have mandated hearing screenings for students: kindergarten, second, fifth, once in middle school, and then high school, if a student is new to the school district. It’s a lot. Those mandated screenings are not done by the audiologist. They’re either done, depending on where you are, either by school nurses or by a trained audiometrist, depending. But if the students don’t pass those screenings, then they’re referred to the educational audiologist for a full diagnostic evaluation, so we’re also a search and serve service, where we are also still identifying students with hearing loss. 

So, there’s a lot to it. There’s a great deal to it and it’s a little different now, in the post AUD era in California, at least, I can only speak for California. Before the AUD became the entry-level degree, and everything was still masters level, our state universities offered audiology graduate programs but they also offered credential programs, because you need to have a credential to work in the schools. And so that credential program required additional coursework in order to be an educational audiologist. So some basic stuff, just introduction to special ed law, a little bit on language development. My particular program required ASL one and ASL two. So those things were all a part of going into educational audiology, but once those programs left our state universities, those credential programs went away. 

So now to be an educational audiologist, you just need your state license and your state license gets you your credential. And it’s a problem, and I know people don’t always think it’s a problem, but it really is, because one of the things audiologists get blamed for is making educational decisions when they’re not qualified to do it. And if you haven’t been through any program that focuses on the educational system about child development and academic development, we really shouldn’t be giving educational advice or opinions, including placement. You know, oh, this child’s got this level of hearing they should be in this program. That’s one of my biggest pet peeves. [Lilach laughs]

Yeah, it’s super frustrating because in education, when we’re evaluating kids for special ed in general, it’s not actually legal to use one assessment to make determinations about anything, and we will base placement and language decisions on a single assessment and that doesn’t even begin to give you the whole picture of a child. So if we’re reducing children to audiograms and making decisions about their lives based on that, it’s no wonder we have a lot of kids who are not thriving and not succeeding. It’s because we’re not looking at them holistically. We’re looking at them by their ears and what’s on an audiogram and that’s just not the way to go. 

LS:

And that is so frustrating and upsetting and even worse is that you’re saying audiogram. 

We’ve seen it for the pure tone average, just one little number. [chuckles] If you’re past 60 or if you’re past 70, BOOM. It’s a one-off number and if you have a whole audiogram, at least you have some information about degree, configuration, type, and even that is certainly not enough to say, hey, this is a child, and what their language access is, what the resources at home are, what the languages spoken around them are. The rest of their medical case history like what else? 

ME:

So much. So yeah, so that in a nutshell is educational audiology. I think California is one of the states that employs the most educational audiologists as hired directly by the schools. I think a lot of other places, you see a lot of consults like there are audiology companies that will consult with school districts and provide those services, but they’re not actually employed by the schools. That’s different too, and what that looks like the level of interaction varies as well, but when you’re part of the school system, you are an educator and you are part of the IEP team, which is an important responsibility, you’re a part of a lot and I think there’s a lot to be said for working from the inside to understand the system.

LS:

Finishing a four-year very intensive program with a full year of residency, it’s not an easy degree to just pick up. However, there’s still some kind of spots that are being overlooked. I don’t want to say blind spots. That sounds ablest.

ME:

Falling on deaf ears. Yeah, no, these are all the things that we always kind of took for granted but words matter. Language matters. And it’s good to be reminded of it. 

LS:

Let’s take a tangent for a second. Let’s say my personal life with people I know, I’ll say something like that. I’ll say something and then I’ll unsay it and be like I don’t know, maybe that wasn’t the right thing to say. And they’ll say, [deeper pitch] Oh, what? Are you listening to all those people that are gonna tell you how to speak and da da da da da? [normal pitch] So I wonder if you have a good kind of comeback. [laughs] Well, what is wrong with being a little extra-sensitive? What is the problem? Is it so hard? But I can’t do that.

ME:

You bring up an interesting point. It’s hard when in your personal life, you get pushback from the people you care about. We’re so conditioned to just the way things are, that if we ever stopped to think, I say this all the time. Just because something has gone on for a long time doesn’t make it right. There’s a lot of things that have gone on for centuries that are just dead wrong. 

Okay, so they’ve been going on and that’s the way things have been. Doesn’t mean it’s good and doesn’t mean that we shouldn’t work to change it. And I think when it comes to language that is ablest that we’re only just realizing and recognizing it is problematic. I think my go-to thing is I’m not listening to them, I’m listening to the people this affects and I want them to understand that I’m valuing what they have to say. That’s kind of, yeah, where I come from. The them I’m listening to the people who are directly impacted by it, so I’m okay with that. 

And I think that people are just uncomfortable when they feel called out and it’s not even a call out, you’re not really going at them about it. They’re feeling a little bit defensive like, is there something that I’ve been saying all my life that you’re saying is no longer acceptable? Like, yeah, that happens. That’s happened since before we existed. Things change over time. The way people identify themselves has changed over time. 

In the United States, it was normal and acceptable to call black people negros. But that’s not acceptable anymore. I don’t see a big pushback on that. But now, as we’re in the moment of things changing, I’m realizing this is probably exactly what happened all those years ago when this change was happening. And so, I think if we recognize that we’re in the midst of the change we will understand. Okay, this is part of the process. Change is always going to be met with resistance and it’s not intentional all the time. It’s just that people have difficulty confronting what they thought was okay and are now realizing that they’re on the wrong side of an issue. 

I try as much as I can to have grace and empathy, even when it’s something that’s deeply personal to me. I think all of us want to react really quickly. And I do, but I don’t do it to the person in the moment. I will rant and rave like a lunatic about something that’s making me crazy. Somebody has said something or done something. I’m just like, blah. I get it all out and then when I go back to the person I’m like, so... I get it all out of my system, personally, confront myself, and then when it’s time for me to go to the person, I can do it with a lot more grace, compassion, and lack of accusation. 

And I think that’s a skill that takes a long time to hone because I am still working on it. I think I will always be a work in progress with that but I’m making the effort so it applies to everything. It applies to audiology and the discussions that we’re having. Discussions that are actually really old but seem new because in the context of what’s going on around us, it’s just kind of repackaged but it’s the same old argument that’s been going on for a long long time. 

LS:

Yes. Okay, so can you tell me a little bit about how you see recent or new audiology graduates that are coming out with the Doctorate of Audiology. What is missing from education?

ME:

Well, I think what’s missing from our graduate programs in audiology, is really the most basic foundation in language development. And not just language development. I know when I was in school, I had a language development class. I had a class. We all know how that goes. You can have one class in something. It doesn’t make you an expert in it.

I think that we hold language separate from what we do, and it’s a thing. I can only speak from my time. Audiology and speech-language pathology were together in the undergrad, and then we split off in grad, and all the audiology students when I was in school, we were like yeah, we don’t mess with that speech stuff. That speech-language stuff is for the touchy-feely people. We’re like the science people. And I think we’ve separated language from what we do so much that we have developed this wall and we haven’t been able to penetrate it. But simultaneously, believing that we’re experts, and it’s a really weird disconnect. 

But if we really examine our grad programs, you’re not going to see a great deal on language development. You’re not going to see a great deal on the education system. Even if you’re not going to be an educational audiologist, you have to understand the education system because if you’re a pediatric audiologist and you’re working in a pediatric setting, everything you do impacts that child’s education. Just because you don’t work in the school doesn’t mean you’re not responsible for the knowledge and as pediatric audiologists, parents cling to what you say. They do.

I know we try to act like well, I’m just doing my part. I’m staying in my lane, doing my thing. But there’s so much power embedded in our position and in our roles, especially when you’re working in a pediatric center. Like, if you’re in a children’s hospital or if you’re in a larger pediatric facility in a metropolitan area, there’s so much weight and prestige behind that that parents don’t know anything but to cling to the words that we use and the things that we say and to try to deny that is really doing a disservice to us as professionals and to the families that we’re serving.

 And so we need to really recognize that and I think our university programs need to do a better job of incorporating language development, including the education system, and including Affective Counseling. We learn how to give information. We’re champs at informational counseling. We can explain anything we do, any technology, like, we’ve got that down, but we don’t understand the basics of counseling in terms of, if you’ve just told a parent that their newborn or their young child is deaf, that wall has just come up and no matter what you’re saying to the parent, no matter how nice or how easy you’re explaining it, they’re not taking it in. They’re not in a headspace to receive that information.

And so I know a lot of audiologists get frustrated when they think over time that parents still don’t understand their child’s hearing and it’s like from the audiologist’s perspective, I have gone out of my way to explain. You know, I’ve done this, I’ve done that, I’ve provided these materials, these resources, but think about it from the parent’s perspective, the parent is overwhelmed. We bombard them with information and because clinical settings don’t give you the space or the time to be able to have multiple sessions – you’ve got 30 minutes, you’ve got a 45 minute or if you’re lucky, you’ve got an hour – you get in there, you get all the information, you get out. You don’t have a chance to really foster that back and forth. Which, by the way, I think is a real benefit of educational audiologists. 

We have that opportunity because we’re part of that system and it’s not BOOM BOOM BOOM all the time. We have more flexibility. The audiologists who work with the families in our early start – the zero to three population – that’s totally their jam. They have that ongoing relationship and can explain what the parents got from the clinical audiologist and break it down over time. So I think that the Affective Counseling is something that has to be included in our graduate programs because what we’re doing is not working.

LS:

This is exactly the gap that I identified early on, from being a new young grad being like wait, these people need something else from me, which I maybe have personally, as an empathetic person. It’s like my personable skills, being like, this is great news, take off your audiology adage to be a person, so I was just kind of doing that naturally and then the settings were like no, no, we don’t have time for this.

ME:

It’s true though, right? We’re not set up for that. Our clinics, our whole model isn’t really set up for that. And that’s a problem.

LS:

Then you’re gonna have people who say, but, what do you want us to be? Mental health counselors? That’s a whole other expertise. I just like pretending to be the peanut gallery over here. [both laugh]

ME:

And I’m, in no way am I advocating that we take on full responsibility for counseling, but we also have to recognize when we need to make those referrals and you have to identify, right? You have to be able to identify those families that are going to need that additional support and you have to be able to make appropriate referrals. And that I think in counseling, and any coursework that we would take, that would be the biggest takeaway. 

I think it’s just the basics. I don’t think that we need to have counseling backgrounds or counseling degrees or have a whole rotation in counseling. I’m not even saying that. We don’t even have the basics. What I was taught, how to explain an audiogram, how to do all this stuff, nobody ever said to me the parents are not going to take any of this in because they’re going to be in such shock. Like, they taught us the five stages of grief. We learned what they were. We didn’t learn what they looked like. We didn’t learn how all those stages can affect the information that we’re trying to give parents. There’s more that needs to be there, without us fully going into mental health. It’s true we have to learn how to say this is not my area of expertise, but I’d like to guide you to somebody who is and make those appropriate referrals.

LS:

We had one excellent counseling class and it was taught by a mental health professional who came in and that was incredible, however, it was taught in our first semester before we knew anything. So, it was like, let me tell you how to do counseling and really, counseling about what? We don’t know how to explain this at all. 

One of the big takeaways I do have from that was that he taught to start, pretty much, start every session and continually throughout the session, ask questions. To start with, what do you know, what do you expect, does this make sense to you, can you explain it back to me? He’s like, you’re asking them to talk. Talk less and ask questions for them to talk and that was powerful. So listen, as a podcaster, an interviewer, I’m very good at asking questions. [both laugh] That’s where this came in for me. But, right, that’s what it’s all about. It’s like how I remember a case. I’m gonna take a little storytime. Short. 

A family was doing the ABR and they had other children who were cochlear implant recipients, profoundly deaf. So this was like maybe their fifth or sixth child. And so, when they came in for that ABR, they were like, ‘nu, just give us the paper. Because we already know. We have our surgeon, we have our hospital, and we know how to do this. We just need the paperwork.’

Everyone’s like, [whispers] oh baby. [regular voice] There’s kind of this hush round with the colleagues, like, look, there’s no responses and the parents are just sitting there like, are you guys done? Can you imagine sitting with them and starting a whole conversation? This is the result of, like, this is a totally different case, but if you hadn’t talked to them or asked a question, then you wouldn’t know. 

ME:

That’s actually a really great story because it brings up another thing that we have to address about us as audiologists. And it’s that everything in our body language, everything and how we’re trying to tiptoe around, it just sets alarms off in a parent. And I don’t know if there are programs out there that address this. I would love to know because I’m not going to say that this is not happening anywhere, but I’m going to say, from my own experience and from the people I’ve worked with throughout the years, I don’t think that people coming out of these programs know or consider the impact of the newborn hearing screening process has on mother-child bonding. When you start off the relationship with an I’m sorry kind of a mentality, it really does affect the mother-child bonding, because now you don’t just have this beautiful newborn, you’ve got this beautiful newborn who isn’t perfect, air quotes, and we don’t know how each parent is going to respond to that. 

Some respond better than others and they don’t even realize that it’s impacting their bonding. A lot of parents go into a fix-it mode, and they’re so concerned on fixing whatever’s going on that they’re not really taking time to appreciate the baby right in front of them. And so even though we are audiologists and we’re all about the ears and all that stuff is great and I’m an audiologist. I am not gonna lie, I’m all about the ears, like, I get it. That’s my comfort zone. That’s my wheelhouse. But we have to consider, we’re not working in isolation. That our professional actions have consequences. And with, these are the discussions that we need to start having, as, as a profession, as a community of people who want to be better professionals. 

We need to acknowledge that a lot of the things we have been doing, even though we intended for them to be good, in the long run, we’re now seeing a lot of potential harm coming from them. And that’s where I really want to sit and I want to sit with people and talk about the things that we’ve done that we always thought were this is good. But now looking back and speaking to adults who have been through this and said, yeah, you know, this really messed up my parents or this really messed me up. Or, you know, talking to parents who’ve been through it, we need to listen to their stories. Not every story is good and I’m not saying every story is bad and see, that’s where these dichotomy things come in. When we are highlighting the people who had bad experiences, there’s always somebody who’s going to come in and say, oh, but, you know, so and so had a great experience or, you know, all the kids I’ve worked with have had great experiences and it’s like, okay, those two things can exist together. 

LS:

Hashtag not all men [laughs]

ME:

Right. Let’s not do the what-about-isms when it comes to this stuff because listen, we got what-about-isms everywhere in society right now. We’ve gotta knock it off because it’s just another way of using people as a shield and using scenarios as a shield to not deal with the things that are unpleasant and life is unpleasant and sometimes we get stuff wrong. 

I’m a professional. I’m an audiologist. I have gotten things wrong and it was never intentional, but how am I supposed to be a better professional, a better audiologist? 

LS:

If you double down, ooh. 

ME:

Right. if you can’t acknowledge where, in retrospect, oh that might not have been the best way to handle that. Or, oh, that perspective wasn’t what I thought it was. Self-reflection is a tough thing if you’re not willing to do the work and I think audiology needs a big mirror held up to it because audiology as a profession has a lot of self-reflection to do. Like, a great deal of self-reflection to do and I haven’t seen a space yet where we’ve been able to do that and I’m dying for it. I really am.

LS:

Let me ask you this, what would you say about how the average AUD student comes out of a four-year program having never once met a deaf adult? Do you think that that’s fair to say that that’s what’s going on? I mean that was my experience in my cohort.

ME:

Yeah, absolutely. 

LS:

You think that’s part of the problem?

ME:

I have this discussion with my deaf education colleagues a lot because it’s all a matter of perspective. Well, there’s a lot of reasons and I’m not speaking on behalf of the deaf community. There’s this prevailing feeling in the community and in the educational community that it’s really upsetting that audiologists don’t know how to sign and communicate effectively with their students, their patients, whatever setting you’re in. And they keep saying, well, how can they get into a profession that benefits off of us and they don’t even try to learn our language? 

And I had to tell them, you’re looking at it from the small percentage. If you think about the typical audiologist, 99% of the time, they’re not dealing with the deaf community. They’re not dealing with ASL or whatever country’s sign language. They’re not dealing with that community; that community is not the majority that you see in private practice and clinical settings. So it’s not quite fair to say that all audiologists are trash because they don’t take the time to learn. I mean, that’s not exactly how they say it, but that’s kind of the idea.

But it is fair to say, particularly when we’re talking about pediatric audiologists, I really don’t see a justification for not having some kind of interaction with the deaf community, because you don’t know when that baby is born what the future is going to hold and you don’t know what language is going to be most accessible. And at some point, you’re going to be dealing with children who are visual language learners and so it doesn’t make sense to pretend like it’s not important for you to have some background in that or some experience in that because it also lends itself to the bias that we keep perpetuating in audiology and that’s a big one. 

I know I talk about bias a lot and I talk specifically about language bias and modality bias because it’s baked into what we do. It’s part and parcel of what we do. And so it’s something that we have to consciously and actively correct in ourselves, myself included. To answer that, I think the majority of people who come out of AUD programs probably have little to no contact with deaf adults and it’s not ideal. Just the fact that you’re in a profession where you could come into contact with an entire community, I think merits our programs addressing it. It doesn’t have to be a huge chunk of the program, but how many of our programs even have one course on the deaf community, or deaf culture, or ASL? There are a few programs that do have them. Obviously, Gallaudet. I don’t know every program well enough to say what they have but I would say your typical average program doesn’t include any information about deaf people.

LS:

Audiology became a profession after World War Two, with the veterans. That’s when it all began. Like before, I don’t know. What happened? How do people deal with differences of hearing? Nope, it just started at the day that we turned on an audiometer. [sarcastic]

ME:

Exactly. Exactly. And people forget that. It’s like, this whole profession was born out of World War Two and the after-effects of all those soldiers coming back with major hearing loss from explosives and all kinds of heinous things. But prior to that, the world was getting along just fine without audiologists and the deaf world was getting along just fine without audiologists, you know?

LS:

I mean once you start learning about the history of Alexander Graham Bell and the whole eugenics situation, you’re like, wait, So can you tell us more about bias and the work you’re doing to help change the tide around biases in audiology?

ME:

When I talk about implicit bias in audiology, I always start off telling people to breathe because it’s a difficult topic. People feel instantly attacked as if bias is malicious. But we really have to just take a moment and think about what bias really means. Implicit bias is not intentional, but even though it’s not intentional, it still has an impact on how anybody that is on the receiving end of that bias. We all have biases. We’re humans. Nobody’s saying that there are people out there who are bias-free, but it’s what you do with that bias and how you allow that bias to impact your professional decisions that is important. 

And so, in audiology, we have a couple different things. Let’s start with the easy stuff and I’m saying easy because it’s relative. If you look at audiology from a racial standpoint, it is an overwhelmingly white and female profession and it always has been. I went to a national audiology convention several years ago. It’s been a while now. I was waiting for a friend, and I was up over the expo hall where all the vendors are, kind of just getting a little bird’s eye view. And out of nowhere, it struck me as I looked across the sea of people down there, [sighs] I don’t see anybody that looks like me in this whole place. There were thousands of people there. 

I think out of thousands of people, there might have been two or three of us, at most, and I thought, wow, that’s really bad. Why is that? And I’m saying bad not because the people there had anything to do with it. It made me think, what is happening that bipoc people don’t see audiology as a viable career? Why?

LS:

For our podcast listeners and for the sake of a transcript, can you please tell people what you look like? [laughs]

ME:

That’s a great question. I am black. [both laugh] I am black. I am actually Afro-Caribbean. I come from Jamaican parents, but yes, I am black, so there are not a lot of black audiologists out there. I happen to be very lucky that in my current work setting, there are three of us. Three out of 17, which is actually pretty representative proportionally, compared to the population. So, actually maybe even more, we might be a little more represented, which is amazing, but in audiology in general, there are not that many of us. And it’s not a blame game, but it does lead me to examine why. 

And I think about career fairs in high school and what careers are targeted toward specific groups. And I can tell you I’ve been invited to career fairs in many schools. I’ve never been invited to a career fair in a predominantly black or Latino school. And so I think it starts there.

LS:

Interesting.

ME:

And that’s just one tiny little sliver. I mean, career fairs aren’t where most people end up going into their profession, but just the idea that this is not a career that is even known or discussed in certain communities. There’s a lot of questions there and I don’t have the answers. I’m definitely not your girl when it comes to answers. I just have a lot of questions. I’m hoping that I can find those answers or somebody can work with me to find those answers, but it’s a big deal. So the reason I brought that up is because we filter everything in audiology through the lens of the majority and that can lead to socioeconomic bias in the ways that we have expectations. Racial implicit bias can influence our expectations around a family commitment. 

We may say oh this white, affluent family is going to have the resources to be able to do all these things for the child and that child’s gonna thrive but this Latino family, immigrant family might not have the resources so their child might not do as well. So where am I going to invest more of my time? And not that you’re always thinking like that, but these things are already planted in our heads, and that’s why they’re implicit biases. They can also influence microaggressions between provider and family. Things that you don’t realize are microaggressions are still microaggressions. And also the potential for successfully acquiring language and educational outcomes. 

So, the expectations that we have around our bipoc students, we make assumptions or predictions about their educational outcomes and their educational success, and again, none of this is intentional. It’s just baked into us as a society. So these are all things that we have to think about. As far as the bigger bias that I’m concerned about, it’s language bias. That’s where I feel like audiology really has to hold up a mirror and start reflecting. We really do value listening and speaking above anything else. Not that listening and speaking isn’t important, of course, it is.

But, in almost everything that we say, we show how much we value it. There is a very famous screenshot that I took of a very well respected, and I respect this particular audiologist, but this graphic and the message was that ears are the doorway to the brain. Not a doorway, the doorway. And there was a graphic that went with it, with all these little representations of different sounds in the environment. Then there’s the ears and then there’s the door. The doors are open and the brain is being stimulated, which implies that if those doors are closed those ears aren’t working, the brain is not being stimulated. 

Whether intentional or unintentional, it’s such a dangerous thing to say to a parent of a deaf child. You’re implying that because their ears are closed, quote, or aren’t working, that if you don’t get those things to work, their brains are not going to be stimulated properly and they are going to therefore have less intelligence, less access to the world around them. 

I missed the part in school where we only have one sense, I thought we had five. We have five senses. Our brain receives information about the world around us through our eyes, through our hands. We’ve got touch, we’ve got smell, we’ve got taste. We’ve got all these five senses, but saying that the ears are the pathway or the doorway, that we have made a hierarchy of our senses, and we have placed hearing at the top of the hierarchy. That’s not how the brain is organized. That right there is a huge bias in audiology that we relentlessly perpetuate and it causes so much damage in the fact that there are a lot of deaf children who just, no matter how much support you give, they just are not going to be those auditory kids, are just not going to be able to thrive through their auditory channel. 

And so while we’re so busy pumping them full of auditory stimulation, we’re neglecting their other intact senses and we are lessening the opportunity for them to have full language proficiency. And the ramifications of that are quite frankly unforgivable and really just need to confront this and deal with it as a profession.

LS:

And I think there’s also this ticking time, urgency that’s put into it. That is, like, first 12 months, zero to three. We have this, like, let’s go, let’s go, early, early, early, and then, at the exact same time as, like, being obsessed with implanting early or putting hearing aids early, we’re not using that same logic for critical language acquisition. So, throughout those first few months, language access is still a thing, even if it isn’t auditory, but there’s no guidance or information about how to provide language access through other means. [deep inhale] That one really hurts me because it’s like yeah, they got implanted at 11 months. It was even before a year, we got them. And it’s like, what about the first 11 months? What do you think that baby is getting? Like, they were obviously taking in information but what was the quality of that?

ME:

I would love to see that same level of urgency applied to language, the critical language window. Because that Critical Language window is not exclusive to spoken language. It’s all language, so including ASL. So the whole tired trope of, well, let’s pump them full of spoken language first and if that doesn’t work out, they can always learn ASL later. No, [laughs in disbelief] like, yeah, they might learn it later, but they’re never going to learn it at the proficiency level that they could have had they have been given it during the critical language period. That critical period is for any language, and any modality of language because the brain does not care the modality that it receives a language. It just needs the language. 

They’re not doing well because you waited so long to allow them to have an accessible language that they’re going to be playing catch up for the rest of their lives. So we create the systems that we then go back and blame people for. We’ve created this. We, for generations, have withheld accessible language, because we’re all about this overwhelming prioritizing of the auditory channel and then we turn around and say, now look how badly these kids are doing over here. It’s because they’re using ASL or because of whatever. No, it’s because we withheld accessible language to them in the most critical year and now they’re starting from the beginning, but by that age, they’re way behind where they should be.

Now, we’ve got a language deprivation situation and that’s another thing. Language deprivation versus auditory deprivation is a big issue with me. You can have auditory deprivation, but the bigger problem is language deprivation. Auditory deprivation, in and of itself, doesn’t have the long-term effects that people want to believe it does. Let’s just think about that. There are deaf people who have never had any auditory stimulation, whatsoever, who have PhDs. They’ve got all kinds of things. Perfectly wonderful, successful, normal lives. Auditory deprivation didn’t prevent anything to do with their cognitive development because they had language.

And if we’re talking about language, language is not for communication. Language is for cognition. Language is for cognitive development. If you don’t have language, your cognitive development is going to be delayed. It’s all intertwined and the idea that we want to withhold accessible language to deaf children, it just blows my mind. Somebody’s going to have to make me understand because I’m not seeing why we think that’s working. It’s not working. We have plenty of kids to show that that’s, that’s not working. [laughs] It’s not. It works for some. It’s great that there’s always going to be exceptions to the rule. And this is where I have a problem. People are always going to point to the exceptions, and try to make them the rule, but that’s not the case.

LS:

Not only are they going to point to them, they’re going to make documentaries about them. They’re going to put that as the spokespeople for the manufacturer company. We definitely point to the success cases and those are the ones that we really noticed. But in the data, even in, I mentioned this in a recent class I did with Language First of Kimberley Sanzo. Big fan. Everyone check it out. We talked about device failure rates and how the device failure rate of a biomedical device needs to be reported and the company has those statistics. 

However, what’s not included are people whose devices are not broken and work just fine, but they’re not using it because they never got what they wanted out of it or didn’t develop auditory, you know, perception, the way they expected or other influences of their life. And then, we’re not, we’re not using it, so we’re not actually having the stats on use rate. It’s an important statistic that they’re providing but it’s definitely only one piece of four possible outcomes there are. So, what would you say about this idea that people are getting a very dichotomous choice? Like this or that, black or white, you’re with us or against us.

ME:

I think that the dichotomy serves the majority. And what I mean by that is, the majority of the world hears and speaks. That’s a fact, statistically, and every other way that matters when you make things into a dichotomy, you are forced into a this or that. And if we’re talking about influencing parents, parents are going to go with what they know. They don’t know anything about anything else. It’s our job to educate them that there is something else, but I have a problem with the concept of parent choice, not because I’m trying to take anything away from a parent. I’m a parent. But the concept of parent choice has been weaponized and it’s been used, in a way, as a way to deflect any counterargument to why a listening and spoken language only approach might not always be the best. 

I actually have had this discussion recently with some colleagues that I feel like in our early start programs or zero to three programs, there really shouldn’t even be a discussion about choice, air quotes. We’re asking it at the beginning. That’s the wrong place. How can you make a choice about something when you haven’t given everything? I feel like in the beginning, why aren’t we giving everything? We don’t know. We can’t predict how a child is going to do with technology because it’s technology. It’s not a cure. It’s not a magic bullet. We have no idea. 

So instead of providing a child with everything and seeing where they might go with it, we’re telling parents: make a decision now. And now parents are paralyzed by fear. What if I make the wrong choice? But I’ve committed to this choice. I have to see it through. It’s a really bad place to put parents, quite frankly and an even worse place to put their child. You don’t have information. You have a hypothetical. Making a choice based on hypotheticals is crazy. It really is making a choice based on pure speculation is not an informed decision. 

I don’t think that you should even be deciding the type of educational program a child goes into until at least kindergarten, because from zero to five, you’re getting children ready for school. In order to get them ready for school, you have to give them everything. You have to give them all the tools and all the resources and everything so that when they show up in school, they are ready to learn. But how are they going to be ready to learn if they don’t have accessible language and how do we know what’s accessible to them if we haven’t tried multiple modalities? 

It’s all very backward to me. We’re asking parents to make a choice at the beginning when there’s no information. By definition, it can’t be an informed choice. It can’t be an informed decision. So the dichotomy is meant to really serve [pause] people who prioritize and value listening and spoken language because they know that nine times out of 10 that’s where families are going to go. It’s a baked-in bias. I don’t actually think that there are individuals out there who are this calculating and saying, this is what I’m gonna do; this is my plan. I don’t feel that way, but it’s in the system and I see it and I’m just putting it out there, hoping that people will start to examine it in themselves. 

Because I just think we’re going about this totally backward and the idea of choice is not real. It’s an illusion and it’s a weapon, and I think we need to just stop. Right now, we need to be providing opportunities for accessible language, full stop. We don’t make hearing children work hard to acquire their language. Why are we requiring our deaf children to work hard to acquire language? I don’t understand it.

LS:

The other thing that is happening is that these conversations are generally happening in medical centers. You mentioned at the beginning, a hospital is a respected place. You have respect and authority there. And then, that isn’t the end of the conversation at all. That’s the beginning. It’s like here’s one piece. Here’s where you take us. But if they were at a cardiac specialist, a GI doctor, or any other specialists, then they would just kind of do what the doctor says. You need a surgery, you do the surgery. You need medicine, you do the medicine. That’s kind of the medicalized modern world that we’re in. Except this is not that. There’s more nuance and I think that’s the problem.

ME:

I think that’s a big problem and even though my current work assignment, I’m not working with zero to three, I’m still deeply invested in the whole EHDI system, Early Hearing Detection and Intervention. I’m still very invested in it because I get the students at age three who’ve just come out of that program and I see a lot of room for improvement. I see a lot of gaps. I see a lot of holes. Not from the individuals who are working with these students, but from the system itself. We have to ask ourselves, in a medical setting, we can’t have it both ways. We want to be considered professionals, quote, medical professionals, but we also want to be educational professionals. We want to give professional recommendations about things that have nothing to do with a medical model. 

So we kind of try to play all sides, and we are not doing a good job of it. I think that one of the things that we need to do in the EHDI system, we need to have deaf people in it. And I’m not just talking about ASL using deaf people. Deaf people are different. They’re just as diverse as any other group out there. We’ve got very successful, happy, well-adjusted deaf adults who use listening and spoken language. Parents need to see that. Parents also need to see the deaf adult who is perfectly happy, well-adjusted, successful, who uses ASL or whatever your country’s sign language is. They need to see what can be. 

Again, we keep expecting parents to make decisions based off of abstract and based off of theory and we’re not actually giving parents everything. Why we have a system that’s set up to identify babies and provide services that has no investment in including deaf professionals is beyond me. It’s beyond me. I don’t understand it, and the only reason I can come up with is, there is bias, and it doesn’t fit in with what the profession or the model wants to perpetuate. And unfortunately, that is a harmful practice. I mean it’s not like there aren’t deaf people in the medical profession, you know? There are deaf doctors. There are deaf medical professionals. There are deaf social workers. There are deaf psychologists. There’s all of that. Why are we not including them as a part of this system? That right there is where we need to start.

LS:

That’s a very good suggestion. I think they should take you up on that. [both laugh] So what would be your advice to new parents who kind of are maybe finding this podcast and be like, wait, I didn’t know this stuff, what do we do now? Depending on what age your child is but like, is it possible to have a new approach that changed your mind or who should you believe now if I kind of feel like, you know, you’re like in The Matrix? Oh my gosh.

ME:

I’m glad you asked me that because one of the hardest things I ever had to hear was from a few parents of former students of mine. I had their children when they were already in high school so I wasn’t there in their early years. One of the parents said, why didn’t anybody ever tell me that these things were out here? Why didn’t and why didn’t anybody tell me when my child was younger, that if I wasn’t giving him this access that I was really doing him more harm than good? It was tough to hear that. 

I think that it’s never too late. Wherever parents are in their journey, we all learn and we all grow as parents. I mean, like I said, I’m a parent and I get stuff wrong all the time and I look back and think, why? Why did I do that thing that I did or why was my mindset this way? I’m now talking to my kids. I’m being honest. I’m being open and I’m talking to them about mistakes that I made and making sure to tell them, they weren’t the mistakes. It was me, as a parent, not understanding in the moment what I was doing and what potential harm I was causing. 

But it’s not too late to address it and go forward trying to do better. And I think that same kind of thing applies in this case. It isn’t too late. Parents are always going to want to do what is best for their children. We want our children to have every opportunity in life to be successful. That is pretty universal. I don’t even want this framed as you’re not a good parent if you don’t do X, Y, & Z. That’s not about that. Parenting is so complicated and every family dynamic is different. 

There should never be a feeling on a parent of a deaf child that they are at fault for whatever outcome or lack of outcome is happening with their child. They only know what they know. In that moment and as they learn, they may change. They may not, but whatever it is, it doesn’t come down to you as a parent failed your child because you didn’t have the information. It’s not about that. But once you get the information, what you do with it is entirely up to you. 

So I would say to parents, if you’re starting to have doubts or you have questions or you have anything that’s giving you some uneasiness, I would reach out to… I think it’s really important for parents to connect with other parents, parent organizations. Parents and parent organizations are critical because you have parents who are at every possible stage of the journey. You’ve got the new parents, you’ve got the mid-range parents, and you’ve got the parents whose kids are all grown up that have so much wisdom to impart and I don’t think there’s anything more powerful. 

There’s no professional that can match a parent who has been there, done that, so parents and parent support is really important. And looking for organizations that do value the voices of deaf adults and again, it doesn’t have to always be about sign language. There are plenty of really healthy deaf role models out there but the point is, listen to deaf people. They know. They know this life more than any of us can. It doesn’t matter how many degrees we have or how much experience we have, we’ll never know it like they know it. Start seeking out those, those voices. It’s really important. So I think parents, parents’ support, and seeking out deaf adults would be the two best things that parents can do.

LS:

Thank you so much for all that advice and all those ideas. This amazing conversation. My key takeaway that I hope people take and think about is that whenever you’re faced with, with, with anyone who’s saying it has to be like this or it isn’t right or it has to be like that or it isn’t right, that’s a red flag. 

ME:

Definite red flag.

LS:

And even in the decision of language access, it can change. Like, you do something for the first six months and then that program isn’t right for you and your family. Okay, let’s do the next idea. You don’t connect with one professional, second opinions are very valid thing. 

Thank you so much for the conversation, Mallorie. Where can people find you if they want to learn more about your work or connect with you?

ME:

I don’t have my own personal website but I’m on all the social media, so again, I’m Mallorie Evans on Facebook. If you want to follow me on Instagram, I’m actually @bambino_mum. [both laugh] It’s a weird, weird story behind that. Bambino Mum. B A M B I N O M U M.

LS:

I will find you on Instagram, that’s awesome. 

ME:

And then Twitter, it’s @malbeckford. When you search me, it’ll come up as excessively black Mallorie. It’s a joke. [laughs] I’m there. I’m there if you search for Mallorie, you’re gonna find me on any of the social media platforms.

LS:

I do think that there’s a change in the tide and the young, young professionals, and then include myself in that, on this one, are noticing and more aware and I and because I agree we’re connected and I think social media is a big part in that. So, let’s connect.

ME:

 I agree. Much more open, much more open in our young audiologist which gives me a lot of hope for our profession. So it’s a good change that I’m seeing and I’m excited to see it continue.

LS:

Okay, thanks a lot. Thank you for being a listener to the All About Audiology podcast. If you’d like to support the show, please head over to patreon.com/allaboutaudiology. That is so so appreciated. And I’d love to hear your takeaways or any questions you have over on Instagram @allaboutaudiologypodcast. See you soon, Bye.