Captions for People with Hearing Loss
Overview
Captions are invaluable for people with hearing loss. Captions provide visual accommodations to supplement the spoken word. There are two categories of captions, and both are covered on this webpage.
- 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
- Both CART and speech-to-text captions can be integrated into telehealth platforms, or can be shown on a second device (more complex for the patient)
- 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 when there is technical information, such as medical, legal appointments, and 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).
Find providers through NCRA, state agencies, and searching for CART provider small businesses.
For medical settings: HIPAA compliance. CART providers will need to sign a business associate agreement with the covered entities that they provide services for.
Computer-Generated Captions
(Institution provided or consumer provided). See handout below.
Automatic captions are better for shorter interactions, where accuracy isn’t as important – such as patient check-ins, some meetings, emergency situations when CART is not available, etc.
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.
Presentations
- Windows 11, for Windows and Mac
- PowerPoint captions
Apps
- Communication Matters/Tina Childress, AuD My Favorite Captioning Apps for iOS and Android. Note, not all are HIPAA compliant.
HIPAA-compliant, speech-to-text. Links go to webpages that explain the company’s privacy. These companies are willing to sign a BAA (Business Associate Agreement) with a healthcare clinic subject to HIPAA, or because of their data privacy/data design, there is no need.
- Ava captioning. Desktop and app solutions for in-person or online needs.
- Caption Companion. A self-contained single-purpose standalone hardware device that works completely offline without internet.
- 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.
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
- State Relay Programs. NASRA and the specific page showing each state and its relay administrator.
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)