Captions in Healthcare and Legal Settings
Patients 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:
- Patients with hearing loss to understand the critical information communicated by healthcare professionals.
- Consumers with hearing loss, involved in the legal system, to understand all that is happening so they can make informed decisions.
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 Disability Act (ADA).
Captions provide visual accommodations to supplement the spoken word.
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.
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.
Text can be displayed on a wall, projector screen, computer screen, or on a smartphone. Text can also be embedded in virtual meeting platforms:
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.”
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.
Also many virtual meeting software have the option of automatic captions.
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
- Shirley, T. CART at a medical center. White paper (1 page)
- CART resources
- CART Information (Colorado Division of Deaf, Hard of Hearing and DeafBlind)
- All healthcare webpages (this website)
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)