Good afternoon, everyone. Thank you for joining today ’s webinar. We will start in 1 minute. <OK it ’s 12pm, let’s get started>
Good afternoon! This is Deana Buck from Virginia ’s Integrated Training Collaborative, and I am joined by Ruth Frierson, Virginia Department of Health, Director of the Virginia Early Hearing Detection and Intervention Program (EHDI) and Christine Evans, Speech/language Pathologist with Evans Family Speech Center. Patty Eitenmiller, EI provider and Infant Development Specialist from the Infant and Toddler Connection of Alexandria, prepared content for today’s webinar but will not be able to join us (or might be able to join us) due to jury duty. Christine Eubanks, Audiologist at VCU Department of Audiology and Beth Tolley, Part C TA Consultant, are available to answer content specific questions during the Q&A portion of the call. Thank you for joining us today. Today ’s webinar has three parts: Ruth will begin by sharing an overview of Virginia’s EHDI program, and she will provide key information pertaining to the link to our EI system. Christine will then provide an overview of the hearing mechanism, ways of testing hearing, and common interventions and supports for children with hearing loss. Patty has prepared content that is especially designed to address key areas of knowledge for the early intervention community about hearing and hearing loss. We will wrap up the webinar with a question and answer period.
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As we transition into the content, Consider these facts: About 20% of babies with genetic hearing loss have a syndrome ” (for example, Down syndrome or Usher syndrome). Infections during pregnancy in the mother, other environmental causes, and complications after birth are responsible for hearing loss among almost 30% of babies with hearing loss. About one in every four children with hearing loss also is born weighing less than 2,500 grams (about 5½ pounds). Nearly one-quarter of children with hearing loss has one or more other developmental disabilities, such as cerebral palsy, intellectual disability, or vision loss. While children with hearing loss is not one of the largest categories of eligibility for early intervention, it is vitally important that we pay attend to the hearing needs of all young children. I am pleased to introduce Ruth Frierson, Director of Virginia ’s Early Hearing Detection and Intervention Program (EHDI) at the Virginia Department of Health. Ruth?
Hello my name is Ruth Frierson… today we are going to talk about Virginia ’s process for identifying infants with hearing loss, and ensuring infants diagnosed with hearing loss receive early intervention services - Early. We will talk about how this process relates to the CDC 1-3-6 goals and Virginia’s Early Hearing Detection and Intervention program, better known as the Newborn Hearing Screening program. The beautiful baby girl in this picture, is sound asleep and having her hearing tested in the hospital, before being discharged to home. All birthing hospitals in Virginia are required, by law, to screen babies and assess their risk for hearing loss before discharging the baby to home. Parents have a right to decline this screening for religious reasons. If a baby does not receive a hearing screening prior to discharge from the hospital, the hospital is responsible for informing the parent of the need for a hearing screening and providing a mechanism by which the screening can be done at no additional cost to the family
As mentioned, Virginia ’s newborn hearing screening program is mandated by the Code of Virginia Section 32.1-64.1, since July 1, 1999. The Virginia Early Hearing Detection and Intervention Program adopted the 1-3-6 CDC Methodology as a means to implement this program and as recommended by the EHDI Advisory Committee. The CDC 1-3-6 Goals are: All babies will have a hearing screening before 1 month of age, Virginia goes further because we require this screening to happen before the infant is discharged, but no later than 1 month of age. For all babies who fail the initial screening, the goal is to have these infants diagnosed before 3 months of age. Infants diagnosed with hearing loss should be enrolled in early intervention service before 6 months of age. The EHDI program has seen great improvements in Goal 1 of the 1-3-6 goals. Since 2004, Virginia has consistently screened over 90% of all infants born in a Virginia hospital. However, Virginia does not have the same success with goals 3 and 6. Although the numbers continue to climb, we do not meet goal 3; diagnosis by 3 months of age, by even 50%. And for those diagnosed, only 30% are enrolled in early intervention by 6 months of age. This data along with a survey recently conducted of several professionals in the early intervention field, indicate we have much work to do to ensure infants receive the services they need at the time they need them.
126 EI Providers responded to the online training survey conducted in February 2011. Of the 126 EI Providers that responded: 5 identified themselves as teachers; 28 as Service Coordinators; 1 as a Physician; 1 as a Nurse; 1 as an Audiologist; 33 as Speech-Language Pathologists; 12 as Physical Therapists; 23 as Early Interventionists; 8 as Occupational Therapists; and 14 as Other. As you can see from the results of the survey; only 6% of early intervention provides are familiar with the 1-3-6 EHDI goals, only 7% use EHDI as a resource when it comes to managing an infant/child with newborn hearing screening issues, and not all are aware of which infants diagnosed with hearing loss qualify for services.
Who are the infants not diagnosed by 3 months of age? Our data indicate that the infants we loose in the follow-up process are more likely born to African-American/Black mothers, with state-sponsored health insurance, and an education of high school diploma or less. If infants are not diagnosed by 3 months of age, it makes it less likely that they are enrolled or receiving early intervention services by 6 months of age. Therefore, EHDI, the Advisory Committee, it ’s partners and stakeholders are increasing our efforts to identify opportunities for collaboration and training, with the emphasis being that we all strive to serve families with services at the time they are needed.
Patty has developed some slides related to the final step in the process which is the month 6
As many of you know, under Part C in Virginia there are various diagnoses that are considered to be automatic qualifiers for Early Intervention services. The Part C office has determined that many localities are unsure to the answer to the question: is a child with a diagnosis of hearing loss automatically eligible for EI services? Please type your answer in the chat box to the right. <Pause for participants to do this>
If you answered YES, you are correct. A diagnosis for hearing loss is an automatic qualifier for EI services. It is important to note here that even though the child may be a young infant who may not yet be showing any developmental delays when fully assessed, the child and family will need support to monitor and assist in the child ’s development, particularly as they relate to the child’s hearing loss from the start. A typically developing baby is exposed to language from the time they are in the womb; a child born with hearing loss, or one that develops a hearing loss, faces more challenges in learning how to communicate which need to be explained to the child family from the beginning. Hearing loss can also impact other areas of development including motor skills, play and socialization with peers.
So what do you, as the EI provider need to do next? First and foremost, gather as much information as you can before the first appointment/therapy session with the family. You might to explain the difference between sensorineural and conductive and maybe even bilateral and unilateral losses. You also need to point out here that it ’s important to know the degree of loss, so that you can explain to families that even though their child has a hearing loss, it does not mean that they are deaf, they do have some residual hearing. They may choose to “use” that hearing to explore amplification options and communication options which will we explore later in this webinar.
<Read above question>. Can ahead and type your responses into the chat box to the right.
Yes, when a parent learns that their child has a diagnosis of hearing loss, one of the first things that they want information about is parent support programs. It ’s important to ensure that the family has a support system in place as they embark on this journey with their child and may want to talk with a family who has gone on a similar journey. The Guide By Your Side program provides trained parent guides of children with hearing loss who offer non-judgemental support, guidance and advice. The Parent to Parent program of Virginia also provides a similar services that helps families learn to empower themselves and draw upon their own strengths to become strong advocates for their children
While programs such as GBYS and Parent to Parent are very beneficial to the emotional support to the family and should definitely be encouraged, they do not replace your role as the professional in the families life. You role as the SC or EI professional will help link them to resources, sort through the various options available regarding communication options, as well as assist in transition planning when the child is ready to transition to Part B services and/or private preschools. The families will need your support and knowledge to be able to eventually become advocates for their child as they continue on their journey. Quote Sass-Lehrer article: &quot;Family -professional relationships that emphasize the parents role as a collaborator and decision maker and reinforce the strengths of individual families and promote self efficacy.&quot;
If the family chooses to explore amplification options and the audiologist has expressed they have these options, there are different choices for the family to explore. <Christine might want to explain the differences between these options (though not too much detail).> Such as: hearing aids can be fitted very early on, and maintained easily through regular appointments with the child ’s audiologist. Cochlear implants often require the usage of hearing aids first to determine the aids are not providing the most benefit for the child. Requires surgery and intensive follow up.
Take a minute to type your answers in the chat box to the left. <Pause>
The communication option that a parent/family chooses is often related to the amplification option that they have chosen. Your are in the position to provide them with a non biased overview of the options available to them. Emphasize that the option will be what works best for the family.
There are various different types of interventions and/or communication options available to the family as they begin to determine how they would like their child with hearing loss to communicate. The early intervention provider working with the family should have a basic knowledge of these various options and also have links and resources in their own community to refer the families to to receive more information, including specific providers who practice these types of thearpy/education.
Auditory Oral or Auditory Verbal therapy a choice for a family who has determined that they would like for their child to be able to orally communicate through learning to listen and maximizing the hearing that they have either through the use of hearing aids, cochlear implants or another amplification device. No sign language or other visual communication devices are used. The participation of parents and caregivers in therapy as critical.
For AV therapy to work, proper fitting of the child ’s amplification device is absolutely essential to ensure that they are receiving the maximum benefit from their device have complete access to spoken language. With the age of Cochlear implants, and advanced technology, children with severe to profound losses as well as children who are deaf can learn to communicate orally. However, since we know that the optimum time to learn language, therapy should begin early. And because there is so much emphasis on listening, the early intervention provider must be aware of the various acoustics in the learning environment. For example, is the tv on? Is the room quiet or are there other distracting and extraneous noises that could be impacting the child’s ability to listen and attend? Considering this in ALL environments that the child is in is important. There are four levels a child goes through when learning to listen. Detection refers to the child demonstrating an awareness of the presence or absence of sound.
Additionally, when thinking about a child learning language through listening, we need to know the steps they go through. First a child detects the presence or absence of sound. The child might react to a door slamming, the lawn mower outside or voices of others. For the child with hearing loss we need to consider the frequency (pitch- high versus low sounds), and intensity (loud versus soft) the child is able to detect. Next the child learns how to discriminate, or demonstrate the ability to tell if two sounds are the same or different. Next, the child learns to identify sounds that they hear, then later demonstrating an ability to comprehend that sounds put together form words that are associated with meaning. Often a therapist will begin assessing a child ’s ability to reach these levels using the Ling 6 Sound test which is comprised of six sounds that represent different frequencies.
Some families of children who are deaf will choose for their child to learn sign language (American Sign Language) as well as learning to read, write and communicate orally with others using spoken English. The use of ASL allows the child to have visual access to language long before they begin to vocalize. There are studies that have shown that children who have a strong foundation in ASL are able to acquire spoken language and English language skills, particularly those children who are not implanted with a cochlear implant until after their first birthday. It is important to note that families who choose this option, but are not fluent signers must be linked to resources to gain access to signing deaf adults, sign language classes, books and videos. And as we know with most typically hearing young infants and toddlers, sign language can decrease frustration by giving the child another means to communicate if they have not yet developed the spoken language they need to convey their thoughts.
Cued speech is another option that families have when exploring how their child will communicate. Often thought as similar to ASL, cued speech is comprised of various hand movements that supplement speech reading. Each hand movement, unlike ASL, represents a speech sound. With ASL each sign or hand movement is representative of a picture or concept. When these “sounds” in the form of hand movements or cues are put together, the word is represented exactly how it is spoken. Cued speech is always used in conjunction with spoken language.
To the right is a chart of the hand movements that comprise cued speech. Cued speech can be viewed as easier to learn that ASL as it is only comprised of a small amount of hand motions and signals. Additionally, it is different from other options as it does not need to be used exclusively. Families can choose cued speech along with learning ASL, total communication or oral programs.
Total communication is built upon the belief that all of the various options we have previously discussed can be used together to help the child learn to communicate as well as develop skills in all other areas of development. As we know each child develops differently and each family has different priorities, this approach allows the family and providers to use different components of several different options that might be most beneficial to the child and family at that time as the child continues to learn and develop. For example, for children with co-occurring disabilities, this approach could be beneficial based on the child ’s skills and abilities in other areas of their development. This approach allows for the flexibility a family or child may need as their skills and needs change over time.
<Read question>. Take a minute to type your answer in the chat box to the right.
As you begin working with a family of a child with hearing loss, it ’s essential to remember that providing unbiased information regarding their options is key. Each family is different with different priorities and resources. A large part of your role as the early intervention provider is to help the family sort and sift through the information that are being provided with to be able to make an informed decision about what is best for their child. Information also needs to be provided in the families native language. Additionally, a child’s hearing loss can affect other areas of their development, including motor, cognitive and social skills particularly with their peers as they grow older. Ultimately we strive for children with hearing loss to be included with their same aged peers in all activities and routines. Important to take advantage of resources that are available to you and families, including the Hearing and Hearing Loss landing pad (www.eipd.vcu.edu) and the soon to be released modules (Hearing 101).
Deana – Thanks, Christine (or Patty). Thanks for your active participation in today ’s webinar. We have a wonderful panel of experts available now and we open the floor to any questions that folks may have about hearing or hearing related services.
Everything You Always Wanted to Know About Hearing But Were Afraid To Ask
Please Call 866-842-5779 Enter Code 463 661 9330# Everything You Always Wanted to Know About Hearing But Were Afraid To Ask Can you name the smallest bones in the body? respond in the chat box—lower right corner
www.cdc.org Did You Know? About 20% of babies with genetic hearing loss have a syndrome ” (for example, Down syndrome or Usher syndrome). Infections during pregnancy in the mother, other environmental causes, and complications after birth are responsible for hearing loss among almost 30% of babies with hearing loss. About one in every four children with hearing loss also is born weighing less than 2,500 grams (about 5½ pounds). Nearly one-quarter of children with hearing loss has one or more other developmental disabilities, such as cerebral palsy, intellectual disability, or vision loss.
1-3-6 Methodology All babies should have a hearing screening test before leaving the hospital, but no later than 1 month of age. Virginia data: 90% If a baby fails the hearing screening—immediately schedule a hearing evaluation with an audiologist for a diagnosis before 3 months of age. Virginia data: less than 50% If a baby is diagnosed with a hearing loss, begin early intervention services before 6 months of age. Virginia data: 30% Centers for Disease Control and Prevention (CDC) and Early Hearing Detection and Intervention (EHDI)
Virginia Early Hearing Detection and Intervention Program (VEHDIP) & Early Intervention Partnership for Infants <ul><li>How familiar are you with the CDC EHDI 1-3-6 goals? </li></ul><ul><li>Very familiar 6% | Somewhat familiar 33% | Not at all familiar 57% | Not sure 3% </li></ul><ul><li>How often do you utilize VEHDIP as a resource for newborn hearing screening follow-up? </li></ul><ul><li>Often 7% | Sometimes 22% | Never 64% | Not sure 7% </li></ul><ul><li>In which of the following cases would an infant/child with hearing loss qualify for early intervention services through Part-C (Infant & Toddler Connection)? </li></ul><ul><li>Severe to Profound in both ears 33% Mild to Moderate in both ears 30% </li></ul><ul><li>Severe to Profound in one ear 31% Mild to Moderate in one ear 26% </li></ul><ul><li>Never 0.8% Variable 9% </li></ul><ul><li>Hearing loss and a developmental delay 34% Diagnosis of hearing loss 84% </li></ul>Early Intervention Survey Results
Infants More Likely to be Lost to Follow-up Characteristic Likelihood Significance Level Race of Mother: Asian Less likely p < 0.0003 Black More likely p < 0.0001 White Less likely p < 0.0001 Ethnicity: Hispanic Status Not significant p = 0.3 Insurance of Mother: Medicaid More likely p < 0.0001 Private Insurance Less likely p < 0.0001 Self pay More likely p < 0.002 Education of Mother: One or more years of college Less likely p < 0.0001 High school diploma or less More likely p < 0.0001
1-3-6 Month 6 Enrollment in Early Intervention
Question <ul><li>Is a child who has a diagnosis of hearing loss automatically eligible for Early Intervention Services in Virginia? </li></ul>Type Your Answer in Chat
Yes! <ul><li>Under Part C in the Commonwealth of Virginia, a child with a diagnosis of hearing loss is automatically eligible for early intervention services. </li></ul><ul><li>Congenital or Acquired </li></ul><ul><li>Bilateral or Unilateral </li></ul>
Gather Information <ul><li>Most recent audiogram (compare to speech banana) </li></ul><ul><li>Report from the Audiologist/ENT </li></ul><ul><li>Determine the type of loss </li></ul><ul><ul><li>Sensorineural? Conductive? </li></ul></ul><ul><ul><li>Bilateral? Unilateral? </li></ul></ul><ul><ul><li>Mild? Moderate? Severe? Profound? </li></ul></ul>
<ul><li>According to research, what is the number one thing parents said they needed when they found out their child had a hearing loss? </li></ul>Can You Guess? Type Your Answer in Chat
Guide By Your Side http://www.vahealth.org/hearing/gbys.htm Parent to Parent http://www.ptpofva.com Link to Support Programs
Family-Professional Relationship <ul><li>Your role is still important as you: </li></ul><ul><ul><ul><li>Link the family to necessary local resources </li></ul></ul></ul><ul><ul><ul><li>Help them sort through their options such as: </li></ul></ul></ul><ul><ul><ul><ul><li>Amplification options </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Communication options </li></ul></ul></ul></ul><ul><ul><ul><li>Assist in transition planning </li></ul></ul></ul><ul><ul><ul><li>Help the family become advocates for their child </li></ul></ul></ul>
AMPLIFICATION OPTIONS Hearing Aids Cochlear Implants FM Systems *most often used in classroom or school settings Amplification Options
When you think about a child with hearing loss, what do you think the options are for them to learn to communicate? Question Type Your Answer in Chat
Communication Options <ul><li>Often related to amplification option family has chosen. </li></ul><ul><li>Need to offer a non biased overview of the options. </li></ul><ul><li>Emphasize what works best for the family. </li></ul>
Communication Options <ul><li>Auditory Oral/ Auditory Verbal </li></ul><ul><li>Sign Language </li></ul><ul><li>ASL & Bilingual Approach </li></ul><ul><li>Cued Speech </li></ul><ul><li>Total Communication </li></ul>
Relies solely on spoken language to listen and orally communicate. Maximizing the hearing the child has to the highest extent for the development of listening skills . No sign language or other visual communication devices are used. Parent/caregiver participation is critical. Auditory Oral/Auditory Verbal
<ul><li>For the child receiving A/V Therapy: </li></ul><ul><ul><ul><li>Proper fitting of the hearing aid and/or CI is essential. </li></ul></ul></ul><ul><ul><ul><li>With this option a deaf child could learn to communicate orally. </li></ul></ul></ul><ul><ul><ul><li>Must start early. </li></ul></ul></ul><ul><ul><ul><li>Focus is on listening, be aware of acoustics. </li></ul></ul></ul>Additional Things to Consider
Hierarchy of Receptive Language <ul><li>Detection </li></ul><ul><li>Discrimination </li></ul><ul><li>Identification </li></ul><ul><li>Comprehension </li></ul>
ASL-English & Bilingual Approach <ul><li>Child will competent both linguistically and academically in both English and ASL. </li></ul><ul><li>Provides a visual access to language prior to learning spoken and written English. </li></ul><ul><li>Support for families is important if they are not fluent signers. </li></ul><ul><li>The use of sign language can decrease frustration. </li></ul>
Cued Speech <ul><li>Hand movements supplement speech reading. </li></ul><ul><li>Unlike ASL, each hand movement represents a speech sound. </li></ul><ul><li>Every sound is cued clearly, showing exactly how to pronounce a word as it is spoken. </li></ul><ul><li>Must watch the mouth and hand movements at the same time. </li></ul><ul><li>Always used in conjunction with spoken language. </li></ul>
Cued Speech Hand Signs Hand movements that comprise cued speech Easy and simple to learn. Do not need to be used exclusively. Retrieved from: www.cuedspeech.org on June 2, 2011.
Total Communication <ul><li>Combines both oral and visual methods of communication. </li></ul><ul><li>Allows for various components of each approach to be used as different times during the child ’s learning. </li></ul><ul><li>Could be optimal for children with co-occuring disabilities. </li></ul><ul><li>Can be adapted as child ’s skills change. </li></ul>
The child should communicate using the methodology the provider is most comfortable with. True or False True or False? ? Type Your Answer in Chat
FINAL THOUGHTS <ul><li>Provide unbiased information. </li></ul><ul><li>Information should be provided in the families native language . </li></ul><ul><li>Keep in mind the other areas of development. </li></ul><ul><li>Take advantaged of resources that are available to you and families. </li></ul>Final Thoughts
Question and Answer Type Your Questions in Chat