Captions for People with Hearing Loss
Captions are invaluable for people with hearing loss. Captions provide visual accommodations to supplement the spoken word.
- Professional, human generated captions at high stakes meetings, such as legal settings and healthcare.
- Automatic captions during lower stakes meetings such as virtual meetings (Zoom, WebEx) and one-on-one
Consumers with hearing loss can be hesitant to ask for accommodations, and these accommodations are rarely offered without requests. It is imperative that staff realize the high prevalence of hearing loss in all populations and proactively offer services that enable people with hearing loss to understand the information.
- Telehealth
- Captions can be integrated into telehealth.
- Telehealth platforms are required to have captions by the end of 2026, under the “interoperable video conferencing” section in the FCC.
Below are some captioning solutions for communicating effectively with people with hearing loss. These provide “auxiliary aids and services” under Effective Communication with the Americans with Disabilities Act (ADA).
Live, Human-Generated Captions
(Institution provided)
CART (Communication Access Realtime Translation). CART is an accurate, verbatim, near-instantaneous conversion of the spoken language into text by a stenographer using a stenotype machine, a laptop, and software to produce the text. In addition to capturing the speaker’s communication, CART providers also include environmental cues and are sensitive to the consumer’s needs.
CART provides equal access.
For technical accuracy, CART is preferred over automatic captions for medical or legal appointments as well as court proceedings.
- In-person CART professional: usually preferable to have the best access to sound.
- Remote CART professional: has improved immeasurably. Remember to prioritize how the mic(s) are used effectively.
- Providers need to maintain a list of CART providers.
- It’s ok for anyone, including the CART provider, to say, “Hold up – words matter, and _(insert name)_ deserves every one of them.”
Text can be displayed on a wall, projector screen, computer screen, or on a smartphone. Text can also be embedded in virtual meeting platforms (see below for links).
Computer-Generated Captions
(Institution provided or patient provided). See handout below.
Computer-generated captions are also called “automatic captions,” “AI captions,” “speech-to-text apps,” or ASR (Automatic Speech Recognition). Smartphones, devices, and computers have apps to convert speech to text. Accuracy depends on keeping the microphone close to each speaker, how clearly people speak, background noises, and people speaking over one another.
Automatic captions are better for shorter interactions, where accuracy isn’t as important – such as patient check-ins. Usually automatic
- Windows 11, for Windows and Mac, is a good option if the telehealth platform doesn’t have built-in captions. The transcription is done locally on the device, meaning audio isn’t sent to the cloud (unless configured otherwise), and thus meets HIPAA compliance.
- Ava captioning is HIPAA compliant.
- Communication Matters/Tina Childress, AuD My Favorite Captioning Apps for iOS and Android. Note, not all are HIPAA compliant.
Tools
Resources
- Watson T. and K. Odiwe, Esq. (February 2026) A federal settlement for self-determination and the mandate for professional CART (3 pages, pdf) Watson v. Anti-Recidivism Coalition TheJCR.com pages 24-26
- Shirley, T. CART at a medical center. White paper (1 page)
- CART resources
- Real-time captioning Minnesota Deaf, DeafBlind and Hard of Hearing State Services (webpage)
- CART Information (Colorado Division of Deaf, Hard of Hearing and DeafBlind)
- Requesting captioning. Template for Town Halls and Meeting Events (Google doc) Download and customize.
- Captioning symbols (this website)
- All healthcare webpages (this website)
Virtual Conferencing Resources
- Teams: CART Teams and ASR Teams
- Zoom: CART Zoom and ASR Zoom
- WebEx: CART WebEx and ASR WebEx
Professional Organizations and Resources
- National Court Reporters Association (NCRA)
- CART Consumer Bill of Rights
- CART flyer (1 page)
- CART in the Court: Setting a Standard
- The CART Captioner’s Manual (16 pg)
- CART Code of Ethics
- Captioning Matters (further resources)
- Global Alliance of Speech-to-Text Captioning
Please email the Center for Hearing Access with photos, videos, corrections, ideas, or additional products. Contact us (this website)
CART Videos
These videos show how CART can be used in other settings.
Live Captioning (CART) on Any Device for your Accessible Event
Source: Inclusive Communication Services (35 seconds)
Employment Solution Showcase: CART.
Source: AskJAN (3:27)
Follow along with the lyrics in real time, with CART closed captioning services
Source: Rochester Public Music (0:39)
Sample of CART (Communication Access Real-time Translation) services during statistics class at University of Delaware (1:55)
CART Assists the Deaf and Hard-of-Hearing in Joining the Conversation (4:27)
CART Services for Deaf and Hard-of-Hearing People
Source: Washington State DOITCenter (7:34)