Telehealth and Telework Accessibility in a Pandemic-Induced Virtual World

Telehealth and Telework Accessibility discussion. Zoom conference with Zainab Alkebsi, Blake Reid, Christian Vogler and two sign language interpreters.

The COVID-19 pandemic has many ramifications for telehealth and telework accessibility. Blake Reid, Zainab Alkebsi and RERC Director Christian Vogler examine technical and legal angles in a Colorado Law Review essay, as well as a virtual roundtable hosted by Silicon Flatirons.

The essay and the event address disability law’s COVID-related “frailty”: how the pandemic has undermined equal access to employment and healthcare for Americans who are deaf, hard of hearing or DeafBlind as healthcare and employment migrate toward telehealth and telework activities. They touch on some of the difficult legal and technical issues we have encountered in healthcare and workplace accessibility for Americans who are deaf, hard of hearing or DeafBlind in the pandemic-induced virtual world.

DHH-RERC and Deaf/Hard of Hearing Consumer Groups Provide Remote Workplace Guidance

Deaf, hard of hearing, and DeafBlind people working remotely during the COVID-19 crisis may encounter significant barriers to communication. We have collaborated with consumer advocacy groups and subject matter experts to provide guidance on making remote workplaces accessible:

The following organizations and subject matter experts have contributed:

(*consumer advocacy groups that advocate for the rights of deaf, hard of hearing, and DeafBlind people)

DHH-RERC Provides Guidelines for Virtual Meetings with Deaf and Hard of Hearing Participants

The DHH-RERC has posted time-tested guidelines for running virtual meetings with people who are deaf or hard of hearing. That includes meetings where everyone signs. We also cover meetings with a mix of signers and non-signers.

Virtual meeting with six deaf and hard of hearing participants; four women and two men. Two of the participants are signing, while the others are watching. A chat pane shows a web URL under discussion.

People who are deaf or hard of hearing face many barriers with access to virtual meetings. These barriers now have to be addressed with renewed urgency because of the COVID-19 pandemic. Fortunately, there are some relatively simple changes that we can make to the way we run meetings. By implementing them, we can make an immediate difference for our deaf and hard of hearing coworkers.

Overall, consider these guiding principles:

  • Keep meetings as small as possible
  • Have well-defined roles in running the meeting, especially for larger ones (e.g., chair, turn-taking manager, note-taker)
  • Have well-defined communication rules
  • Turn-taking management is critical
  • In larger meetings, default to video off except for chairs, interpreters, turn-taking manager, and people who have the floor
  • Get a second screen, if at all possible
  • Run Ethernet cables instead of WiFi, if at all possible

Check out our detailed guidelines for more information. Also check out Catharine McNally’s related accessibility tips, and Jo Wootten’s tips for British Sign Language.

The RERC will update these guidelines to cover additional scenarios in the near future. So, check back often, and drop us a line at

N-CHATT Trainer Empowering People with Hearing Loss Through Her Work

Shelley Gladden is a Grant Coordinator at Oklahoma ABLE Tech, the state’s Assistive Technology Act Program funded by the Administration for Community Living at the U.S. Department of Health and Human Services. While her primary role is the financial loan program for consumers to purchaShelley Gladden: Woman with short dark brown hair and glasses in a grasslands environmentse hearing assistive technology (HAT), Shelley assists in numerous aspects of ABLE Tech, including the demonstration and loan program, fire safety grant, state department of education contract, and is a hearing support specialist to consumers, teachers, and professionals. Shelley also serves as a statewide trainer for the Network of Consumer Hearing Assistive Technology Trainers (N-CHATT), the volunteer train-the-trainer program supporting the successful integration of HAT at home, work, school, and in the community.

  1. What drew you to a career helping people with hearing loss?

    “Hearing loss is hereditary in my family; my aunt has two cochlear implants. The day I learned of my early onset of hearing loss, I became a knowledge-seeker and an advocate to take away the stigma of hearing loss. My proactive approach persuaded my mom and my older sister to seek hearing assistance, and they too are both now wearing hearing aids.  Being proactive plays a significant role in my career as I assist other individuals to gain information, resources, and overcome fears of embracing the technology to help them gain – or maintain – independence with hearing loss.”

  2. The theme for National Disability Employment Awareness Month in October this year was “America’s Workforce: Empowering All” – how do you think N-CHATT helps support a more inclusive workforce?

    “N-CHATT helps educate and inform consumers and peers with hearing loss on HAT that can assist them gaining, or maintaining, independence in their desired environment, including the workforce.”

  3. Through your work, you’ve likely participated in or are familiar with many training programs. What makes N-CHATT unique?

    “N-CHATT is unique because it allows for the application of the trainer’s personal connection and experience using HAT. When you can give real-life experiences and examples, along with practical education and solutions, as well as demonstrate how easily HAT can level the playing field, it has a much greater impact.”

  4. Have you had any standout experiences in training consumers and professionals who work with consumers with hearing loss?

    “At Oklahoma ABLE Tech, we are charged with improving access to and acquisition of assistive technology for individuals with disabilities. This includes training across the large spectrum of children, adults, and seniors in improving access to and knowledge of assistive technology and its uses. A large part of our contract services include training the State Department of Education on assistive technology in the classroom and beyond. We are reaching great numbers of special education professionals and helping them prepare their students with a variety of disabilities to be successful in their future endeavors with the use of assistive technology—whether that is continuing their educational pursuits, employment, or other community involved activities.”

  5. What are the benefits of HAT from the working individual’s perspective?

    “HAT is a game-changer and absolutely necessary to stay in an active and competitive work environment. From all aspects of daily function – telecommunications, meetings, professional development, peer relations – to a larger scale of being on equal levels for job enhancement and career growth. I absolutely could not do what I am doing today without the use of both hearing aids and related assistive technology to improve my daily communications.”

  6. What types of HAT are most in demand in the workforce setting?

    “I see the continuous need for HAT assistance with telephone use, team meetings, continuing education (hearing in the large conference/classroom environment), and computer accessibility as it relates to video conferencing, virtual meetings, webinars, captioning, etc.”

Flowchart: Navigating the Labyrinth of the FCC’s IP Captioning Rules

Captioning rules for TV are straightforward. Unfortunately, the same cannot be said for Internet captioning, due to a plethora of special cases and exemptions that have been carved out. Prerecorded programming, live programming, and clips are all treated differently; it also matters when a video was first posted on the Internet, and when it last was shown on TV.

The Federal Communications Commission (FCC) is the agency responsible for enforcing the rules for Internet captioning. This process is primarily driven by consumer complaints. If you see a captioning problem, the first step is to figure out whether it is covered under the law and/or rules. The RERC has developed a flowchart to assist you in determining the legal situation. This flowchart was initially distributed in April 2016, under the Development of a Consumer Model for a Technology-Focused Train-the-Trainer Program. It has been updated to take the most recent captioning deadlines into account. We wish to thank Dr. Gregg Vanderheiden for his assistance in producing an accessible version.

View the flowchart:

Cochlear Implant Skills Review Tool

Cochlear Implant Skills Review (CISR) is a new assessment measure developed by Enhanced Aural Rehabilitation for Adult Cochlear Implant Users via Telerehab Technology investigators Bernstein and Brewer, in collaboration with Hume and Presley, to be used clinically to evaluate a patient’s demonstrated skill and knowledge with their cochlear implant. The CISR was modeled on the Practical Hearing Aid Skills Test-Revised (PHAST-R) developed by Desjardins & Doherty (2012). The CISR can be used as a key assessment tool to help clinicians better evaluate the cochlear implant (CI) user’s understanding and demonstrated skills in using their technology. This, in turn, can serve as a guide for training, counseling, and rehabilitation with the CI user so that they can achieve maximum benefit from their CI.

Benefits of the CISR

For the CI user, the CISR can aid in the development and mastery of these skills which is central to confidence and success with technology. Training in areas where skills or knowledge are needed improve self-confidence and skills to manage the use of their implant and facilitate self-efficacy. In all, it can serve to help optimize the benefits from the CI.

For clinical professionals, the CISR will be an excellent pre and post assessment measure and guide not only for CI Audiologists, but also Speech Language Pathologists who work with CI users, as well as doctoral students to guide their counseling and rehabilitation work with patients, and Audiologists who do not work with CIs regularly. It can be used in its entirety or in modular format since it is comprised of 6 sub categories which address basic skills.

Future Research Needs for the CISR

While the CISR is available for immediate clinical use, we are still refining the measure and it will require a full validation study before it receives widespread clinical use. The test-retest reliability of the CISR needs to be assessed with a large n of at least 50 adults with cochlear implants for publication of this assessment measure. It is currently in use, however, as part of our assessment protocol in our telerehabilitation study at the following clinical sites: Columbia University Medical Center, University of Maryland College Park, University of Kentucky College of Health Sciences, Gallaudet University, and the Cleveland Clinic.

View the tool and related resources:

Voice Telecommunications Access Survey

The Rehabilitation Engineering Research Center (RERC) on Telecommunications Access at Gallaudet University conducted a survey to learn about the experiences of adults who are hard of hearing, deaf or have hearing loss, in their use of voice telecommunications technology. The goal was to better understand how such adults use current voice telecommunications technology, what barriers they face using it and what needs they have for improved accessibility.

This survey has been analyzed with support from the Deaf/Hard of Hearing Technology RERC, and selected results were made available to the Institute of Medicine’s Committee on Accessible and Affordable Hearing Health Care for Adults in December 2015.

View the survey results:

  • Telecommunications Access Survey description (PDF)
  • Telecommunications Access Survey results (PDF)

Achieving Cell Phone Hearing Aid Compatibility

Ever since the Federal Communications Commission (FCC) partially modified the original exemption for wireless (cell) phones from hearing aid compatibility (HAC) requirements, consumer organizations for individuals with hearing loss have worked, through advocacy, toward the goal that all cell phones would become accessible to and usable by hearing device users. Over the last eight months, there have been both policy activity at the FCC and consensus building work between consumer organizations and the wireless industry that may achieve this goal. 

In November 2015, consumer and industry stakeholders jointly submitted a letter to the FCC outlining the terms of a consensus proposal, which included:

  • Enhanced benchmarks for HAC cell phones,
  • A task force process for assessing the achievability of 100% HAC compliance for cell phones, and
  • A means for enabling innovation to achieve HAC in cell phones.

Currently, the FCC is considering comments provided in response to its notice of proposed rulemaking  on this proposal and other matters. The Deaf/Hard of Hearing Technology Rehabilitation Engineering Research Center (DHH-RERC) provided technical advising to consumer organizations throughout the consensus building effort and signed onto comments to the FCC in support of the consumer’s goal. It’s expected the FCC will establish rules based on the consensus proposal by year’s end.

Cell Phone HAC Standards

The C63.19 standard provides the method for measuring the compatibility between cell phones and hearing aids. The American National Standards Institute-Accredited Standards Committee-C63® (ANSI-ASC-C63) is the United States standards development organization for this type of electromagnetic compatibility engineering work. The most recent (and fourth) revision of the standard occurred in 2011.

The work for this fifth revision of the standard got underway at the May 2016 meeting of ANSI-ASC-C63. The DHH-RERC is participating in the working group addressing the revision. Volunteer participation in the working group is open and free, and volunteers are expected to attend meetings and actively participate in the work effort.