Inclusivity in Audiology and LGBTQ+

Ashley Hughes 0:00
Hello everyone and thanks for joining us again this week on This Week in hearing. Today we’re lucky enough to be interviewing Riley DeBacker AuD, PhD. Very excited to have Riley here. We’ve known each other for quite some time and he has lots of information to share. But today we’re going to be focusing on a very important topic LGBTQ+ inclusivity in the audiology profession. Riley, would you mind just briefly introducing yourself to our audience

Riley DeBacker 0:37
sure As Ashley mentioned, my name is Riley DeBacker. I am a research audiologist and postdoctoral fellow at the National Center for rehabilitative Auditory Research, or NCRAR. here in Portland, Oregon, and I do research primarily on the ototoxic effects of different medications. My particular line of research is on drugs used in the treatment and management of HIV. And I found up, Ashley and I worked together a while ago when we were both part of the SAA and B Advisory Committee, and have kept in touch since then. So I’m excited to be chatting with you now. But I also have been working with Ashley a fair bit in the DEI space to do a lot of talks on LGBTQ+ inclusivity and things like that. And so I’m excited to chat some more about that here.

Ashley Hughes 1:32
Awesome. And yeah, we’re really thankful to have you here and especially talking about such an important topic that probably needs to be discussed more. So I’m just going to ask you a few questions so that our audience can better understand kind of our role in this. Can you touch on what some barriers to care are for LGBTQ+ people specific to audiology care?

Riley DeBacker 1:53
Yeah, absolutely. So something that I think, is really good to keep in mind. There are a lot of articles out there. If you go through any kind of Google LGBT barriers to care, for example, you are going to see all kinds of things that will pop up. And a lot of those might sound really familiar. And then a lot of them might not feel quite as familiar. So once they might not as directly relates to our hearing healthcare. At first glance, there are a lot of kind of pieces that show that LGBTQ+ folks are more susceptible to certain kinds of cancer, or have poor access to a lot of kinds of screening method mechanisms, other parts of healthcare, that mean that they tend to have more heart disease and things that way. The auditory physiologist in me would love to do a whole spiel about how if we have a population that’s more likely to have cardiovascular issues, they probably have poorer hearing because of that, because we know that our ears are very greedy for oxygen. And so anytime we’re not circulating that as well, then our hearing is probably worse. But I think the more kind of direct and tangible things that stick out to me when I think about barriers to care for folks in this community are some things that are going to sound really familiar, but just happened to be a lot more pronounced in LGBTQ plus communities than they are in other groups. So for example, LGBTQ+ folks tend to have pretty poor access to health insurance. And while health insurance is a barrier to access for all kinds of audiology services, if folks have poor access to health insurance, their health care costs are already pretty high. And so being able to add on other expensive, non covered services, like audiology are going to be less accessible. And LGBTQ+ folks also tend to have poorer support systems than other folks, especially as they age. So we’re starting to see a growing group of queer elders is is a term that gets used in the community a lot, but LGBTQ+ folks that are either coming out late in life or who are now in an age that we typically think of for our older patients in hearing healthcare, and those folks are less likely to have strong family ties than their straight and cisgender. Colleagues or analogs and that means that a lot of the supports we think about for access to appointments for supporting purchasing devices for kind of counseling, backup support and things that way I, and things that we usually think of four primary communication partners are less likely in this group of folks. So folks may be less likely to have a long term partner that they have that they can rely on, or that can kind of mediate the environment around them. And what that means basically is, for most LGBTQ+ folks, especially as they age, their access to some of the social supports, and the financial supports that we often think of, you know, older adult patients are not there. And that means that they might need more support from us as clinicians in explaining things, having additional appointments to kind of re explain things or checking on how they’re doing might be more important. And also thinking about access. So community resources for folks that don’t have those supports are going to be really significant in supporting this group of group of people.

Ashley Hughes 6:02
Exactly, that, honestly was very eye opening for me to hear that. So I appreciate you sharing this with us, I would imagine that that could impact even things like the impetus to come and make an appointment, the first time is oftentimes a loved one. Or if somebody is losing their dexterity, sometimes their partner or their children will come and help change the batteries once a week. And so there’s a lot to think about with that. Thank you.

Riley DeBacker 6:26
And something else that I would just tack on to that is I knew when I was kind of practicing in like community clinic environments, I’m in the VA now. And so I hear different versions of this. But something that I feel like I often heard from patients was, Oh, I heard about how much hearing aids help so and so when we were doing whatever activity that we did as a community of people of a similar age. And a lot of the time LGBTQ+ folks don’t have access to those same spaces. And so might not be as connected in senior centers in their community or other kinds of community living environments, because they don’t feel welcome there. And that means that things like recognizing signs of hearing loss, or recognizing what to do about those signs, might be harder kind of as a as an initial on ramp to hearing healthcare than they are for other folks

Ashley Hughes 7:24
for sure. That kind of lead. Thank you. You’re leading me nicely to my next question for you. So what can we as clinicians, as researchers, as industry representatives, what can we do to be more inclusive to our LGBTQ+ patients?

Riley DeBacker 7:42
Yeah. So when I think about this, there are a couple things that come to mind right off the bat. And as a as just kind of a general umbrella for everything I’m about to say, I just like to emphasize that you do not practice in a vacuum, right. So any tip that applies to you, as a provider directly, is also going to apply to your other colleagues that are providers is also going to apply to basically everyone that sees a patient as a part of your practice. So whether that’s kind of front desk staff, whether it’s audiology, aides or other assistants you might have working with you. And so just want to throw that out. Because I think a lot of the time, our best efforts as allies can be thwarted, if folks don’t feel comfortable in our practice for other reasons. So all of that said, is kind of that umbrella disclaimer. I am a big fan of tips that I like to call set it and forget it tips. So I have heard so many great talks during during my my time, up to now about oh, this is really quick thing that you can add to your practice. And if you add a quick diabetes screener or you add a quick cardiovascular screener or a stroke screener, or whatever it may be. And by the end of hearing all these really quick things, you can add it it becomes overwhelming to think about, oh my gosh, how am I going to add 35 minutes screeners to

Ashley Hughes 9:22
like shoot, this isn’t that quick anymore. When I add 400 quick things together, it takes up way more time.

Riley DeBacker 9:29
Wild. So until we come up with like the Swiss Army knife of the AI and also general healthcare access. I really like having things that either prompt patients to bring things up to me or that can kind of passively help indicate things to patients. And so one of my favorite tips for inclusivity is having visible signs that this is an inclusive space. So I’m displaying and pride flags like the one that’s hanging out behind me now,

Ashley Hughes 10:03
also the one on your wrist?

Riley DeBacker 10:05
Yes, that is this I got when I started kind of thinking about ways to suddenly indicate to patients that I was a friendly and inclusive provider. And it’s actually why habit. And so when you’re thinking about things like that pins, posters that are up around your office, not just in your booth, but kind of when people are in the waiting room are great ways to indicate to people that are looking for those symbols, oh, hey, this is a space where I can feel slightly more comfortable. And that starts even before someone gets into your clinic. So having kind of indications that you are an inclusive provider, on your website, or in your marketing materials, do you have

Ashley Hughes 10:49
like would asking for pronouns if they have to fill out some online forms ahead of time or having marketing materials that shows people who are part of the LGBTQ+ community?

Riley DeBacker 11:01
Absolutely, yes. So I think that one of the easiest kind of subtle ways to indicate that is having those signs very early on, and it supports that you’ve put in a little bit of work to show that you’re inclusive, you’re not just going to slapping up a poster and then walking away, despite me just saying that that is a good thing. You’ve put in kind of an extra step of effort to look at your marketing materials, and really make sure that you’re representing people that you want to feel comfortable coming to your clinic. And so that’s that’s kind of a an initial step. But to the point of asking for pronouns, something that I think is really important to emphasize is, if you’re gonna do those things, make sure that you’re communicating those things, and then you’re following through on that. So if you asked for pronouns on an intake form, make sure that those are accessible to all of the staff that are going to be working with a patient and that they have a way of accessing those and respecting those pronouns. Because it’s, it can be incredibly disheartening, and almost a worse experience, if someone feels like they’re walking into an inclusive environment, and then they’re misgendered, or then they experience kind of discriminatory behavior. And it doesn’t have to be intentionally discriminatory discriminatory behavior. If I feel like I’ve gone into a practice, something that comes up for me a lot, I go by Riley, I got introduced that way, so but my first name is James, I have always gone by my middle name for whatever reason. And so it’s one of those things where even for me walking into a doctor’s office for the first time, they’ve asked for my preferred name, but when I’m checking in for an appointment, I don’t know if I’m supposed to say, Oh, I’m James DeBacker in here for an appointment, or oh, I’m here for Riley. And so there’s this weird moment of like hesitation, when I’m walking up to the desk, like, I’m going to look like I don’t know what my own name is, when I go to check into an appointment. And I don’t have any kind of trauma associated with the name James, like, there’s no downside, besides the one time that someone came out to call me back for an appointment and kept calling for Jim and I wondered who on earth they were calling. That’s the only traumatic James related experience I’ve ever had. But for folks that have a lot more weight attached to some of those names that might show up in their documentation, but they’ve actively requested you don’t use, it can be a really big deal for you to make what feels like a very innocent mistake, while you’re working on that.

Ashley Hughes 13:31
I mean, that totally makes sense, especially when you bring up the name part of it. Like when there’s no real emotional attachment to it, it’s still like they’re not really paying attention to you as their patient and not seeing you as a person outside of your medical records. And then if you add on top of that, the fact that you’re not seeing them for who they are not addressing them for who they are, but there’s trauma associated with that, or there could be trauma associated with that. It’s going to take that to a heightened state.

Riley DeBacker 14:00
Absolutely. And I think to that, and there’s also something really important about making sure that for inclusive practices, especially we’re not making assumptions about folks lives for them. So just because someone presents a certain way when they’re walking into the clinic, we shouldn’t make assumptions about what that might be. So whether that’s kind of gender or who they might be bringing with them. I always like to highlight this half of my LGBTQ plus inclusivity tips are also just good ones for working with human beings in general. I think every audiologist I’ve ever spoken to has had at least one really awkward interaction, where they assumed that someone that walked into an appointment was romantically involved with someone else or wasn’t. And we’re very wrong about that. So nobody wants to ask the patient’s daughter if she’s their girlfriend. And similarly, we don’t want to assume that just because someone walks in with another person, what the relationship is, so finding ways to make sure that folks are welcome to bring significant people back with them into appointments, and then finding ways to really quickly acknowledged, hey, who did you bring with you today, on a share? We do this in pediatric audiology all the time, we can add that to our adult practice and make it more inclusive, as long as we follow through. Remember, those references there?

Ashley Hughes 15:37
One thing I wanted to share that that made me think of before I asked you, the next question is the term partner, a lot of times, we make assumptions that if somebody uses the term partner, we make an assumption about the gender of their partner. And I feel like that’s an easy one to stop doing. Just when push comes to shove, it’s not really any of our business. And if they want to share, they’re welcome to share and make it a welcome place to share.

Riley DeBacker 16:03
And also remembering then that terminology they’re using and repeating it back to them. So there’s a new resident that just started working with me, and she refers to her partner as her partner all the time. So when I’m asking how he is doing, I ask about her partner, and what he is up to. And so when we’re thinking about those things, it’s a simple sign of respect to use the language that people use to talk about themselves and the people in their lives. That doesn’t really cost us anything besides a little bit of mental effort. And that tends to decline significantly, I was

Ashley Hughes 16:39
just going to say that the more the more you practice, like any other skill, the more you practice it, the more naturally it will come to you.

Riley DeBacker 16:47
And one thing that I just want to tack on before we kind of move away from this is that this not making assumptions doesn’t just apply about people that are in the room, something I really encourage folks to do is not make assumptions about people that aren’t in the room. So if someone mentions their their spouse, or if maybe they haven’t even mentioned it, I used to do a lot of tinnitus counseling or worked at the VA. Lots of folks come in with tinnitus. And rather than asking a veteran Oh, like, Does your wife sleep in the same room as you asking if there’s anyone that sleeps in the same room as you takes the same amount of effort and make sure that we’re not putting anyone in an uncomfortable situation where they have to make a choice of, oh, well, do I correct someone about something, especially in different healthcare environments. If we’re if we’re doing this in a longer version, there’s a there’s a whole thing to be said about coming out being a continuous process. And so every time I see a new healthcare provider, I want a meeting to come up to them at some point, and that’s more or less traumatic, depending on the situation, depending on what I need to talk about. And so giving folks the opportunity to lead those conversations and not making, not forcing folks to correct you and say, Well, my husband sleeps in the same room, but he sleeps like the dead, and so it’s fine. Makes it a more comfortable situation. And we very seldom get the chance to know why people don’t come back to our clinics. And so giving them as few opportunities as possible to feel uncomfortable and not want to come back to see us is going to increase their access to hearing healthcare.

Ashley Hughes 18:41
Awesome. So a similar question that I have for you are, what are things that you can do to make your workplace more inclusive? Obviously, we just talked about to patients, but what about for LGBTQ plus employees and colleagues?

Riley DeBacker 18:55
Absolutely. So a lot of the things that are going to make a clinic more inclusive to patients are going to make it more inclusive to colleagues. So that’s really nice. But something I would just kind of call out in particular is when you’re thinking about kind of ways that your employees interact with your practice. Be those things like dress codes are one of these like great bastions for weirdly gendered language that we institutionalize, right. If somebody comes in and we have different dress codes for men and women, a we’re not including all of our potential employees in that we’re making them make uncomfortable choices about which dress code applies to them. And also I would put forward that’s probably not entirely necessary. So even sis folks might choose to wear slacks or skirts depending on what they want to do, right if that is your kind of practice. And so thinking about the language you’re using Throughout your employee facing materials, how often are you using gender in a way that it doesn’t need to be at all? hair length

Ashley Hughes 20:09
is probably a good example of things that come up a lot. And those I would imagine.

Riley DeBacker 20:14
Absolutely. And it also gives a chance when I was in grad school, not that long ago at all, our university clinic finally eliminated a requirement that all women needed to wear pantyhose. Revisiting gender dress codes gives it gives the chance to potentially update outdated policies anyway, and makes environments a lot more inclusive for folks, for

Ashley Hughes 20:37
sure. And Riley, one thing that I’m kind of hearing as a theme through all of this is having a more inclusive workspace is going to be best for everybody. Regardless of whether or not you identify as part of the LGBTQ plus community, there’s so much research that shows that people are happier and work in the workplace, excuse me, when they can be their true selves. And so really, that’s what you’re doing when you do that. So at least that’s how it feels, to me, I’m not sure if that’s if that’s the same way it feels to you.

Riley DeBacker 21:06
Absolutely. And that’s something I don’t want to diminish work that is made intentionally to make spaces more inclusive, because that by itself is a good goal. And we shouldn’t be doing that. But something I bring up every time we have this conversation is a decent chunk of these tips are useful for all kinds of people that come into your practice, not making assumptions about our patients allows us to learn from them more effectively not kind of intentionally forcing our employees into paths that they don’t ascribe to, allows them to be themselves more authentically at work allows them to be more efficient in their work, because they’re not spending any mental energy, trying to remind themselves that they need to do a certain thing a certain way because of an expectation that has nothing to do with representing their lives. Very sure.

Ashley Hughes 22:00
To the one last question that I want to ask you that I think will kind of sum this up nicely for our audience. And honestly, for me, too, is what can we as your colleagues do to be the best allies to our LGBTQ plus colleagues both inside and outside of work?

Riley DeBacker 22:15
The biggest thing, despite the fact that, obviously Ashley, you and I have shared literally everything that anyone could ever need to know, in the last 20 minutes.

Ashley Hughes 22:27
As usual,

Riley DeBacker 22:29
I often feel that way at the end of our conference is just to like, remember that learning is a continuous process. And we think about this all the time, right? We go to continuing ed, for our day jobs that we do all of the time that we are experts in. So it only makes sense that for things that we’re not experts in, we also need to check in and kind of do some continuing ed to make sure that we’re being good at our day jobs. And so looking for opportunities to stay on top of inclusive practice is the biggest tip that I can give to literally anyone if you forget everything else, I said, Find CEU opportunities, check back in on those almost better than that partner with local queer organizations. So find either LGBTQ plus health care centers in your areas, talk about ways to create referral pipelines on partner with community centers in your area, maybe sponsoring events showing up handing out earplugs at loud events, what a great way to make inroads with with communities. But finding ways to partner with people that will allow you to keep learning both actively and passively is the best thing you can do to make sure that your clinic is going to be inclusive, because the more you understand the community, the easier it’s going to be for you to recognize how to adapt your practice specifically to what’s going to work for people around you specifically. And it also means that you are going to expand your presence in an area people tend to feel more comfortable going to providers that they recognize providers that are more like them. And so the more you can understand a community by showing up at events. By partnering with folks, the more welcomed people are going to feel in your practice because you will be more welcoming without needing to actively put more work into it.

Ashley Hughes 24:33
I love that. Can I ask one more question? That’s just a follow up to that one. And it just came up in my mind when you were talking about ways to get more involved about like getting a booth at a pride parade.

Riley DeBacker 24:45
I think that is a fantastic idea. So I just moved to Portland and so I went to Portland pride for the first time two weeks ago or whatever. It was awesome. And it was something that stood out to me The number of kind of hospitals in the area that had booths there the number of different kinds of practices that I didn’t feel like I’d really seen before in pride contexts. I remember my first time going to I went to college in Columbus, Ohio, and Ohio State’s. And I remember my first time going to Columbus pride, there were a lot of kind of like vendors, there were a lot of people trying to sell me different things. There were maybe some bars that were trying to advertise. But it wasn’t a big like, Ah, this is like, I can go around and do a little health fair here. Whereas I feel like I’ve started to see a bigger shift over the last couple of years in people recognizing that those are spaces to connect with communities, and make those inroads in meaningful ways. And I know a lot of people that will seek out practices that advertise that they are inclusive, there are some check in your area, there might even be kind of like a an LGBTQ inclusive list that you can join to actively indicate to folks Hey, this is a practice that you will be welcome at and that you will be respected at. And when I moved here, that is the kind of list that I looked forward to establish where I was going to go to the dentist and where I was going to go establish primary care and for all kinds of things. Because it was a place where I knew that I could look and I knew I was going to be okay without needing to do a bunch of research on individual websites.

Ashley Hughes 26:34
For sure. Riley as always, I’ve learned so much from you during this conversation and I love that you gave all of our listeners takeaways for things that they can do to make their practice and themselves more inclusive. Again, thank you so much Riley DeBacker for joining us, and hopefully we’ll see you all next week for this week in hearing