EARLY INTERVENTION FOR
CHILDREN WITH HEARING LOSS
Procedures, Outcomes, Therapy
An Australian Model
Donna Sperandio Principal Listening and Spoken Language Specialist, Dip TOD, MEd, LSLS Cert AVT ®
Yetta Abrahams Principal Audiologist , MClinAud, MAudSA (CCP)
Aleisha Davis Director of Clinical Programs, LSLS Cert AVT®
A Land Down Under
A Land Down Under
A Land Down Under
A Land Down Under
A Land Down Under
A Land Down Under
Today’s Presentation
• The Changing Landscape
• What is possible for a child with hearing loss
in 2012
• The Shepherd Centre
• What we do and how we do it
• Does it work??
• The First Sounds Program
• What we do and how we do it
The Changing Landscape
• Early Identification
• Improved Technology
• Effective Intervention
• Evidence based practice
The Changing Landscape
• Early Identification
• Newborn hearing screening
• Skilled testing of infants
• Testing of infants’ functional access to
sound
• Use of appropriate tools
• H.E.A.R
• Auditory Learning Guide
The Changing Landscape
• Improved Technology
• All children should have access to the
speech string bean
• Liaison with audiological agencies
• First Sounds Cochlear Implant
Program
• The importance of functional access to
sound=therapist – audiologist liaison
The Changing Landscape
• Effective Intervention
• Family Centred
• Parents as primary clients
• Ten Principles of Auditory-Verbal
Therapy
• Interdisciplinary services
• Training of staff
The Changing Landscape
• Evidence Based Practice
• Assessment
• Research
• Lean
The Shepherd Centre
• Early Intervention focussing on Listening and
Spoken Language (Auditory-Verbal Therapy)
• Programs at 5 centres: 3 in Sydney; 1 >
100km; 1 > 300km
• Since 1970, > 1,500 children and families have
been supported
• Currently providing services to >350 families
• All levels of hearing from mild and unilateral
through to profound and total
• All devices including CI, HA, BC, Baha, a small
number unaided
Clinical & Research Team
AVT team
Aleisha Davis, LSLS Cert AVT
Donna Sperandio, LSLS Cert AVT
Tracy Hopkins, LSLS Cert AVT
Jenni Harvey, LSLS Cert AVT
Danielle Slack, LSLS Cert AVT
Anne Fulcher, LSLS Cert AVT
Samantha Arnison, LSLS Cert AVT
Kristin Bayley, LSLS
Ali Corlette, LSLS
Jen Crane, LSLS
Fiona Deeney, LSLS
Jessica Evers, LSLS
Rashmi Hiriyur, LSLS
Joanna McAdam, LSLS
Amber Monk, LSLS
Lisa Nailand, LSLS
Ingrid Steyns, LSLS
Ha Thanh Lam, LSLS
Child & Family Counsellors
Sara Beresford
Renee Bennett
Alison Hersee
Anna Huber
Michelle Southgate
Research & Assessments
Lerryn Baker
Sheila Salunke
Audiology Team
Yetta Abrahams
Kristin Abela
Shellie Lavery
Florencia Montes
Katie Neal
CI surgeons
Dr Phillip Chang
Dr Thomas Kertesz
ENT Specialists
Dr Nigel Biggs
Dr Simon Greenberg
Multi-disciplinary team at TSC
Enrolments 2000 - 2011
Liverpool
Canberra
Wollongong
Roseville
Residential workshop program
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Annually > 35 years
Based on intensive residential
program John Tracy Clinic, LA
Week long program
For families from rural and
remote areas to access mutlidisc team of internal and
external professionals
Includes individual and group
sessions, workshops, seminars
Extended in 2011 due to
additional corporate grants to
add 3x 3day workshops around
NSW (Lower and mid central
coast, south coast)
Innovation and Development
•
Hearing Hub
•
School Age Clear Speech Clinic
Innovation and Development
•
Kidscape ‘Developing a Listening Landscape Parent
playgroup’
•
Group Programs:
Sing and Grow music program
School Readiness
Mother Goose
A Typical Program-Child Using
Hearing Aids
• Individual one-to one auditory-verbal therapy
sessions – typically fortnightly
• Monitoring of functional access to sound
• Monitoring of child’s progress
• Coaching of parents
• Audiological support as needed
• Additional testing, management
• Liaison with Australian Hearing
• Enrolment in First Sounds as needed
A Typical Program-Child Using
Hearing Aids
• Child and family counselling
• Little Listeners Program
• On needs basis
• Group Programs
• Kidscape
• Includes parent education program
• Music program
• School readiness
• Reverse integration preschools
• Assessment
• Informal
• Formal
A Typical Program-Child Using
Cochlear Implant/s
• All of the above
• Plus……First Sounds Cochlear Implant Program
First Sounds Cochlear Implant Program
• Established in 2001
• In collaboration with The Sydney Children’s Hospital
• Small number of publicly funded per year including
bilateral, others private health insurance
• Young paediatric focus, 210 CIs today
CI procedures
1. Initial Enquiry (from family or LSLS) to Senior Clinical Team
2. Internal case discussion meeting with Principal Audiologist and
members of team working with child/family.
3. Initial CI meeting arranged covering basic set of information topics
4. During the next 6-8 weeks the necessary LSLS, audiological, CFC and
medical aspects must be addressed (and additional may be required)
THERAPY CONTINUES
Multidisciplinary roles in CI process
Team
Tasks to be completed
LSLS
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Audiological
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Child
&
Family
Counseling
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Medical
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Confirm access to sound, separate ear and binaurally over 2+ sessions
Discuss the child’s listening, speech and language skills with any relevant
professionals e.g. Department of Education support staff
Confirm that this matches information understood by whole team
Gather/review/perform audiological testing to determine aided and unaided
access to sound, separate ear and binaurally over 2+ sessions
Confirm that this matches information understood by whole team
Notify Australian Hearing, confirm current devices are optimized
Show device, confirm family’s choice of colours
Discuss unilateral vs. bilateral implantation
Discuss expectations & risk vs. benefit
Monitor hearing aid compliance
Discuss how the family is feeling about the process of cochlear implant evaluation
Discuss any relevant concerns the family has
Confirm that the family’s expectations and understanding matches the information
provided by the whole team
Initial consultation with ENT specialist to discuss medical appropriateness for
surgery and likely outcomes
MRI/CT scan arranged to confirm presence of auditory structures
Final consultation with ENT specialist immediately prior to surgery to discuss risks
of surgery and likely benefits
CI procedures cont’d
5. Final meeting to present CI Recommendations and confirm surgery
date
6. Surgery - TSC Paediatric Audiologist attends surgery to perform
Neural Response Telemetry
(NRT) testing
7. Approximately one week after surgery, ENT specialist check’s the
child’s wound.
8. Equipment session with child and family TSC to become familiar
with the external speech processor and equipment, device taken home
for practice
9. Initial activation scheduled as early as one week after surgery.
Relevant organizations who work with the child notified.
CI procedures cont’d
9. Regular sessions at The Shepherd Centre including further
programming of the external device and sessions focusing on listening,
speech and language development continue, typically weekly.
Recommended frequency of sessions change over time.
10. One month after initial activation, a review appointment scheduled,
including:
- Review of equipment, including process for repairs, replacement parts,
loaner devices and regular maintenance and operation of speech processor
- A review of listening progress and expectations
- Scheduling of future appointments
- Recommendation for any medical concerns e.g. middle ear infection
Outcomes-does it work?
Group Results-all graduates
Outcomes-does it work?
Group Results-Cochlear Implant
Outcomes-does it work?
Individual Results
The Importance of Focusing on the Individual
Our key aim is to guide clinical practice
Dramatic increases in this group were due to:
• More consistent access to sound
• Increased exposure to the test language
• Proactive clinical management of poor performance
The Importance of Focusing on the Individual
Our key aim is to guide clinical practice
Declines in performance in this group were due to:
• Introduction of a second CI
• Significant change of learning environments
• Impact of increased language demands
Proactive Monitoring of
Performance
• Robust assessment process
– Formal assessment by TSC Assessment team
– Ongoing informal diagnostic assessment (the AV
approach)
– LSLS receiving ongoing training
• Weekly Clinical Team Meetings
• Database to automatically flag situations
eg. non-attendance
• Three monthly case reviews
Proactive Management of Poor
Performance
Proactive Management of Poor
Performance
• Increased session frequency
• Increased contact with external services
(eg. termly visits increased to monthly)
• Increased audiological service
• Increased child and family counselling
support
• Senior input within TSC
Language Outcomes by Age of CI
Clear evidence that
the best chance of
language results in
the typical range is
with earlier age at
implantation
The Changing Landscape
• Early Identification
• Improved Technology
• Effective Intervention
• Evidence based practice
Today’s Presentation
• The Changing Landscape
• What it means to have child with hearing
loss in 2012
• The Shepherd Centre
• What we do and how we do it
• Does it work??
• The First Sounds Program
• What we do and how we do it