EARLY INTERVENTION FOR CHILDREN WITH HEARING LOSS

Procedures, Outcomes, TherapyAn 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 tool s• 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 TeamAVT team Child & Family Counsellors CI surgeonsAleisha Davis, LSLS Cert AVT Sara Beresford Dr Phillip ChangDonna Sperandio, LSLS Cert AVT Renee Bennett Dr Thomas KerteszTracy Hopkins, LSLS Cert AVT Alison HerseeJenni Harvey, LSLS Cert AVT Anna HuberDanielle Slack, LSLS Cert AVT Michelle Southgate ENT SpecialistsAnne Fulcher, LSLS Cert AVT Dr Nigel BiggsSamantha Arnison, LSLS Cert AVT Research & Assessments Dr Simon GreenbergKristin Bayley, LSLS Lerryn BakerAli Corlette, LSLS Sheila SalunkeJen Crane, LSLSFiona Deeney, LSLSJessica Evers, LSLS Audiology TeamRashmi Hiriyur, LSLS Yetta AbrahamsJoanna McAdam, LSLS Kristin AbelaAmber Monk, LSLS Shellie LaveryLisa Nailand, LSLS Florencia MontesIngrid Steyns, LSLS Katie NealHa Thanh Lam, LSLS

Multi-disciplinary team at TSC

Enrolments 2000 - 2011

Liverpool

Canberra

Wollongong

Roseville

Residential workshop program• Annually > 35 years• Based on intensive residential

program John Tracy Clinic, LA• Week long program • For families from rural and

remote areas to access mutli-disc 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 programSchool ReadinessMother 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 procedures1. 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 processTeam Tasks to be completedLSLS 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

Audiological 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

Child & Family Counseling

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

Medical 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’d5. 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’d9. 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