NHS Newborn Hearing Screening Programme
The Early Support Monitoring Protocol:
used to support positive multimultidisciplinary working with families
Mary Kean
UCL Symposium, 9th November 2011
hearing.screening.nhs.uk
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NHS Newborn Hearing Screening Programme
Objectives
• To examine how the collective involvement in the use of the
Early Support (ES) Monitoring Protocol can support families
and practitioners working with them to follow “the same path
to achieve a common goal” (DfES, 2006, p.4)
• “Families need to be able to draw on the skills, knowledge
and understanding of early years practitioners with a detailed
knowledge of childhood development and the impact of
hearing loss as they use it.” (DfE, 2011)
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NHS Newborn Hearing Screening Programme
Your questions
• How can we increase the likelihood of professional agencies
sharing information generated by the Monitoring protocol?
• How can we support parents in their full understanding of the
Monitoring protocol and encourage them to share the
information with all agencies involved with the child?
• How can we ensure that all agencies involved with the child
and their family are conversant with all the Early Support
materials?
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NHS Newborn Hearing Screening Programme
What families want to know
• Where is my child?
• Are the hearing aids making a difference?
• What will he/she do next?
• How can I help?
• Is everything else all right?
“I want to know what I am up against and what I can do to help”
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NHS Newborn Hearing Screening Programme
Co-ordination of support and joint planning
Family File
Background
Information
File
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NHS Newborn Hearing Screening Programme
The Monitoring Protocol for deaf babies
• A way of describing and evaluating the progress of deaf
babies 0-3 years
• Supports the gathering and sharing of information between
parents and professionals
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NHS Newborn Hearing Screening Programme
Monitoring Protocol: the elements
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NHS Newborn Hearing Screening Programme
Underpinning Philosophy
•
Parents are the natural word of the child
•
By placing parents at the centre we hope to support and provide value
added components
•
Parents are the ones who make choices: amplification, method of
communication, education
•
Parents have specific outcomes that may not match professionals’
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NHS Newborn Hearing Screening Programme
Main Principles
• Family led – monitoring folder is held by families
• Comprehensive – allows for monitoring at different levels
• Should identify progress, enable any difficulties or concerns to be
identified and responded to early
• Whole child orientated – sets the hearing loss within the context of
‘normal’ development and compares development in different areas
• Particular detail in areas that we need to ‘check up’ on
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NHS Newborn Hearing Screening Programme
Early Support Monitoring Protocol
• Not done to the family rather in
partnership
• Informs proper planning for
practitioners
• Informing audiologists
• Look at the different domains
• Gives a good overall picture of
how the baby/child is doing
across the domains
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NHS Newborn Hearing Screening Programme
OK if families complete all or some of the monitoring protocol on
an ongoing basis – with or without support from professionals
working with them
OK if families ask (or give permission to) professionals to
complete it on their behalf, but with them
OK if professionals fill it in because families have indicated this is
what they want to happen
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NHS Newborn Hearing Screening Programme
What families said that they needed?
• Information – about options, about their baby’s deafness, about how
their child is doing and the sort of things that will help him/her to
move on
• Services – resources, access to professionals and to expertise
• Confidence – in themselves, their child and the professionals
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NHS Newborn Hearing Screening Programme
What is included in the protocol
Individual strands on:
• Communication
• Listening
• Vocalisation
• Play
• social and emotional development,
• general development including physical and cognitive milestones
Summary sheet
Record sheet or profile
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NHS Newborn Hearing Screening Programme
Individual strands will enable
•
A child’s progress and developmental level to be plotted
• Judgements to be made about whether enough progress has been
made
• Suggest what the child will go on to do next and some of the
strategies that will support this
• Identifies what needs to be investigated further and suggest routes if
an area of development gives rise to concern
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NHS Newborn Hearing Screening Programme
Contents
•
Developmental profiles
•
Section 1: Communication Baby stages 1-11
•
Section 2: Attending, listening and vocalisation B1-B11
•
Section 3: Social-emotional development B1-B11
•
Section 4: Other developmental milestones B1-B11
•
Section 5: Development of play B1-B11
•
Summary records
•
Glossary
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NHS Newborn Hearing Screening Programme
Ages and stages (overlapping, guidelines)
Stage
Age of child/timescale after identification
B1
0-2 months (approx)
B2
2-4 months (approx)
B3
4-6 months (approx)
B4
6-9 months (approx)
B5
9-12 months (approx)
B6
12-15 months (approx)
B7
15-18 months (approx)
B8
18-21months (approx)
B9
21-24 months (approx)
B10
24-30 months (approx)
B11
30-36 months (approx)
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NHS Newborn Hearing Screening Programme
Baby Stages 1-11
1
Developmental monitoring of:1.Communication and language
(spoken and signed)
2.Attending listening and
vocalisation
3.Play
4.Social and emotional
5.General developmental steps
Age 0-3 years
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NHS Newborn Hearing Screening Programme
The summary sheets
Summary sheets:
• Record where a child is up to in all areas of development on one
sheet
• Make it easier to compare development across more than one area
• Family completes, with the support of their key worker/teacher of the
deaf
• Intervals for completion are recommended in the ‘How to use’ guide.
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NHS Newborn Hearing Screening Programme
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NHS Newborn Hearing Screening Programme
How does it work in practice?
• Most families fill in the monitoring protocol on an ongoing basis
• Key service staff contribute, at least, to the pre review of family
service plan or at 2-3 month intervals
• On recognising progress, most families then ‘look forward’ to
what should consolidate or emerge in next few months
• Discussion around activities that promote development
• If there is an area ‘lagging behind’ this is discussed, and ‘what
will now happen’ is shared
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NHS Newborn Hearing Screening Programme
The summary sheets
•
Record where a child is up to in all areas of
development on one sheet
•
Make it easier to compare development across
more than one area
•
Family completes, with the support of their key
worker/teacher of the deaf
•
Intervals for completion are recommended in the
‘How to use’ guide.
Every 2 months until end B3
Every 3 months until end B9
6 monthly after that
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NHS Newborn Hearing Screening Programme
Once the protocol is completed
• There is clearly allocated time for discussing where the child ‘is’
and what they need now to go on to do
• This includes using the ‘fridge cards’ for suggestions as to what
helps children to move forward
• Families have copies of all contributions to the monitoring
protocol and keep it (professionals will need to ask if they can
photocopy it or will need to fill in their own copy)
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NHS Newborn Hearing Screening Programme
Example of Attending, vocalisation and listening for a child just moved into
communication B3 (4(4-6 months)
• Sarah uses prolonged vowel like sounds; occasionally /h/ or /m/
intrudes
• She vocalises more when directly ‘talking’ with an adult and her
voice tends to be louder then
• She gets upset when she hears her brother crying and excited
when she hears him coming; she loves to hear mum singing and
searches for mum when she is talking on entering a room
• Her mum is uncertain what Sarah hears
• Sarah is very interested in faces and fills a space left for her in
conversation with a sound or movement
• Sarah uses her voice to make contact with people
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NHS Newborn Hearing Screening Programme
Next steps for target setting
• Sarah to use more consonants in her vocalisation
• Her vocalisation to become more tuneful and more syllabic
• She will communicate with more purpose
• She will show preference for speech/sign directed to her
• Sarah’s hearing status will be further clarified, particularly her
response to mid and high frequencies when aided
• In 2-3 months time there should be some B4 (6-9 months) and
more B3 (4-6 months) behaviours
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NHS Newborn Hearing Screening Programme
Implementation – How?
• The family will continue to play the sort of games with Sarah that
are exemplified on the fridge cards B3 and B4 and continue to
surround Sarah with narrative about what she is doing,
responding to Sarah’s own communication including
vocalisations with encouragement
• Support services and audiology will re-evaluate hearing aids to
clarify further what Sarah hears with her hearing aids
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NHS Newborn Hearing Screening Programme
Summary
• Family engagement
• Sends a message to families – we value their views
• Increased contributions from families
• Observations are enhanced/more focused
• ‘Real picture’ of where the child is at
• Celebration of achievements – ‘can dos’
• Practical ‘real life’ ideas from the fridge cards
• Families lead more on questions
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NHS Newborn Hearing Screening Programme
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NHS Newborn Hearing Screening Programme
The ‘fridge cards’
• Provide suggestions for how to
support and encourage
development at each stage
• Outline potentially useful
activities and strategies
• Organised and colour coded in
line with the sections of the
monitoring protocol.
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NHS Newborn Hearing Screening Programme
Example: Listening and Vocalising
• Separate column to track this for hearing aid evaluation as well as
for general assessment purpose
• There is another layer underneath it to allow sounds and listening to
be linked into hearing aid fitting and help to confirm/ challenge
appropriateness of hearing aid fitting at this point
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NHS Newborn Hearing Screening Programme
Parents’ Experiences using the Monitoring Protocol
• Parents reports feeling more powerful when talking to
professionals
• They are able to seek help/reassurance earlier
• They have a better understanding of their child’s
development
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NHS Newborn Hearing Screening Programme
Level 2 materials
• Provide reassurance
• Enable parents to have a detailed understanding of their
child’s development
• Support development where concerns arise
• Ensure that any hidden needs are identified early and
appropriately managed
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NHS Newborn Hearing Screening Programme
Level 2 materials
• Provide more detail
• Least important where development is following
expected pattern
• Most useful when lack of development in a
particular area gives cause for concern
• Prime users will be professionals but some
families may wish to use, alongside the
monitoring protocol
• Recommended for all end B5, B8, B9 and B11.
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NHS Newborn Hearing Screening Programme
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NHS Newborn Hearing Screening Programme
Level 2 materials structure:
Generally:
3 tables for each aspect to be completed at:
•
12 months
•
24 months
•
36 months
* Take account of “listening age”
Grammar has two checks; words tend not to be combined until
approximately 2 yrs
Interaction covers stages B1-5, B5-9, B10-11
Vocalisation has 3 tables at each stage covering consonants, vowels and
diphthongs
Can also plot sounds against frequencies
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NHS Newborn Hearing Screening Programme
Range of aspects looked at:
Covers:
• Pragmatics (Tables C1, 2 & 3)
• Early words and meanings (Tables W1, 2 & 3)
• Early grammatical development (Tables G1 to G3)
• Parent-child interaction (Tables PC1, 2 & 3)
• Further procedures (Other assessments)
• Attending, Listening and Vocalisation – focus on vocalisation and
support for listening (Tables L1, 2 & 3)
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NHS Newborn Hearing Screening Programme
Level 2 checks from B5(9-12 months) onwards
Pragmatics (communicative intentions)
C1
(at end of B5) 12 months following identification
C2
(at end of B8) 21 months following identification
C3
Between B9-11 months, i.e. between 2 – 3 years following identification
Early words and meanings
W1
(at end of B5) 12 months following identification
W2
(at end of B8) 21 months following identification
W3
Between B9-11 months. This table may be useful beyond B11
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NHS Newborn Hearing Screening Programme
What are we looking for? Increasing range of vocalisations
• Completion of monitoring protocol to overview progress,
identify any concerns
• Level 2 looks in detail at the development of a child’s own
sound system
• It links development of a child’s phoneme inventory to
acoustic phonetics
• It considers factors that may affect development and
places these and development within a context of early
audiological management.
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NHS Newborn Hearing Screening Programme
Information provided
•
Basic tests that will have been done
•
Articulatory information
•
Acoustic information
•
Consonants, vowels, voicing, formants
•
Why development may be delayed
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NHS Newborn Hearing Screening Programme
Attending, listening and vocalisation
•
•
To inform hearing aid fitting,
verification and validation
Daily
Management
experience
Audiological
Assessment
To identify child’s developing use
of amplification, listening and
attending
Babble,
speech sounds
words
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NHS Newborn Hearing Screening Programme
Mapping emerging sounds
Kind of
sound
Lips
Lips and
teeth
Teeth
Ridge
behind teeth
Palate
Soft palate
(Velar)
Babble
stage
(Bilabial)
Nasal air
comes down
the nose
m man
Stop
p pea
(Labiodental)
(Alveolar)
(Dental)
(Palatal)
Ŋ song
n no
k cup
t toe
A short
sound
g go
b bat
d daddy
Fricative a
long sound
f feet
ſ thing
s sun
ñ that
z zip
v van
Approximant
Gliding
ʒ measure
l lorry
w wet
ʃ ship
j yes
r red
sound
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Frequency of consonants
NHS Newborn Hearing Screening Programme
150-250 250-500
5001000
10002000
30004000
b bat
300-400
>6000
20002500
t tea
2500
d dog
300-400
3500
25003000
k king
20002500
300
1500
2500
m me
250-350
10001500
2500
3000
n no
250-350
2000
3000
z
40006000
15002000
p pan
g go
20003000
200
200
300
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40005000
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NHS Newborn Hearing Screening Programme
What parents have said
I give the fridge
cards to the nursery
staff, his nanna and
the babysitter. They
help them to know
what to do.
Good discussion
document. It makes
support all about
sharing .
At first I found it a
bit daunting but
your teacher talks
it through and it
gave me such
confidence.
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When you see your child
making progress, going
up the ladder its just
wonderful.
You know you are
making a difference and
it gives you hope.
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NHS Newborn Hearing Screening Programme
What practitioners say
• “It is really supporting our work and our work together; the summary
sheets help us to be clear as to the all round progress the child is
making”
• “It takes away the need for lots of other assessments – if the child is
making progress on this, we don’t need to carry them out”
• “There is a real sharing of information”
• “If the child is not moving forward we have had to agree protocols as
to what we then do”
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NHS Newborn Hearing Screening Programme
Useful pages/references in Level 2 materials
•
P24 Factors that affect development (joint attention, environment)
•
P56 explanation to parents re hearing tests & effects of OME
•
P57 Listening & vocalisation tables
•
P64 How do we know if the hearing aiids are loud enough?
•
P69 useful summary
•
P70 Getting the amplification right
•
P72 Further ways of looking at listening skills
•
P73-77ning Parents behaviours that support
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NHS Newborn Hearing Screening Programme
Summary
• Family engagement
• Sends a message to families – we value their views
• Increased contributions from families
• Observations are enhanced/more focused
• ‘Real picture’ of where the child is at
• Celebration of achievements – ‘can dos’
• Practical ‘real life’ ideas from the fridge cards
• Families lead more on questions
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NHS Newborn Hearing Screening Programme
How we share information
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NHS Newborn Hearing Screening Programme
Feedback to Hearing Aid Review Clinic using the Monitoring Protocol
Child’s listening skills development
Name:
DOB:
Evidence of child’s levels from Monitoring Protocol
H.A. Review Date:
Skill demonstrated by child
Child’s chronological age at review:
•
Enjoys singing and rhyme games B4
Child’s age when fitted with hearing aid (s):
•
Beginning to practice own sounds for fun B4
Right Ear
Left Ear
•
Turns to own name B4
Make:
Make:
•
Will ignore sounds if they come when he is concentrating –
listening selectively B4
Model:
Model:
Child’s vocal/verbal development
Use of hearing aids (frequency/consistency);
Evidence of child’s level from Monitoring Protocol
Management issues:
Skill demonstrated by child
Fit and management of earmoulds:
•
Will shout to attract attention, listen, then shout againB4
•
Voice is beginning to be tuneful…B4
•
Using some (limited) range of consonants with some vowels
B3-4
•
Waiting for ____ to string his sounds together B3-4
Comments
Compiled by:
Date:
In discussion with:
Agreed action:
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NHS Newborn Hearing Screening Programme
Child’s listening skills development
Evidence of child’s levels from Early Support Monitoring
Protocol skill demonstrated by child
Level
Enjoys singing and rhyme games
B4
Beginning to practice own sounds for fun
B4
Turns to own name…
B4
Will ignore sounds if they come when he is concentrating – listening
selectively
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B4
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NHS Newborn Hearing Screening Programme
Child’s vocal/verbal development
Evidence of the child’s level from the Early Support Monitoring Protocol
Skill demonstrated by child
Level
Will shout to attract attention, listen,
then shout again
B4
Voice is beginning to be tuneful…
B4
Using some (limited) range of
consonants with some vowels
B3-4
Waiting for ____ to string his sounds
together
B3-4
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NHS Newborn Hearing Screening Programme
•
Families choose their level of
engagement with the materials
•
Families and those working with them
to share what they know about their
child
•
Jointly owned and standard across all
agencies working with a family
•
Improves everyone’s understanding of
early childhood development
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NHS Newborn Hearing Screening Programme
References:
http://www.direct.gov.uk/en/CaringForSomeone/CaringForADisabledChild/DG_10027494
http://www.education.gov.uk/search/results?q=Monitoring+protocol+for+deaf+babies
Key government initiatives related to Early Support
•
Together from the Start: Practical guidance for professionals working with disabled children (birth to third birthday)
and their families.
•
Removing Barriers to Achievement: the Government’s strategy for SEN.
•
Children Act 2004.
•
Every Child Matters and Every Child Matters: Change for Children.
•
The National Service Framework for Children, Young People and Maternity Services.
•
Choice for parents, the best start for children: a ten year strategy for childcare.
•
Aiming high for disabled children: better support for families
•
Child Health Promotion Programme
•
Early Years Outcomes Duty
•
Early Years Foundation Stage
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