Written by Melissa Karp, Au.D., Novant Health Audiology, Mecklenburg County
Pediatric audiologists are the professionals who diagnose, evaluate and treat hearing loss in children. It sounds simple when stated like that, but the process encompasses coordinating care with other medical specialists and early interventionists, managing technology, and – most importantly – working with families to accept a diagnosis and determine what their goals are for their child. It is a process that has potential for families to receive conflicting and confusing information. Professionals working with children and families have a responsibility to communicate effectively and help them come to a place of acceptance about their child’s diagnosis.
Here are six things that early interventionists and families should know when working with an audiologist:
- We want to hear from you! We truly value your eyes and experience. Tell us what you see in the home. Is the child responding to certain sounds, but consistently missing others? Is the family overwhelmed and unable to manage hearing aids as part of the daily routine? Do you see great progress since we made programming changes? Has the child’s responses to sounds changed significantly? We take ALL of that into account when managing hearing loss. We are often available by phone or email, and providers are always welcome to attend appointments with families when necessary to provide support. Even meeting with families before their appointments can help them understand how to communicate with their audiologists over the longer relationship that they may have together after their child transitions from early intervention.
- You can empower families. Encourage parents to research options for adapting their home environment and requesting accommodations in the child’s preschool or child care setting. The audiologist can be contacted with questions or concerns. All of this helps caregivers to be active collaborators in addressing their child’s needs, and this allows them to focus on the things that will have an impact on their quality of life. For example, if we are contacted by a professional and asked for an FM system for a child whose family does not see a need for it, the technology will likely sit in a drawer instead of becoming the useful tool as it was intended. If a parent contacts us and says, “We really want to be able to talk in the car,” or “We need to be able to get our child’s attention on the playground,” then they are ready to embrace additional technology because it is tied to a practical goal. This is a great opportunity for writing new IFSP outcomes or activities – these fall into some specific routines, and it’s great when the family hones in on how they would like additional support. Furthermore, coaching the parent on how to advocate for their children’s needs will carry over in their ability to request accommodations when transitioning from Infant-Toddler Program services and as their child continues in their educational career.
- We want to incorporate your suggestions into our treatment plans. We’ve had calls from frantic parents because the specific brand or device recommended by another provider was inappropriate for their needs, was no longer on the market, or was technologically inferior to what they were using. For example, technology changes constantly, along with the criteria, for cochlear implants in children. Over time, the child’s hearing may fluctuate or becomes worse. Teams can use these opportunities to communicate with the audiologist before making a recommendation that may be inappropriate for the family they serve and set parents up for disappointment. As you are discussing options with the family and audiologist, be sure that you are also talking with the family’s service coordinator – assistive technology supports may be warranted, especially if there are outcomes supporting the need for technology within daily routines. States have different processes for this, so check into your local policies for more information and support.
- You can offer reassurances that are genuine and knowledge-based. There are some wonderful tools providers can use when families have questions to assess the listening abilities of our patients and identify areas that need to be strengthened. Tools such as the Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS) and the Early Listening Function (ELF) can guide and monitor progress. This is another great teaming opportunity to utilize everyone’s expertise, both within early intervention services and with outside available resources. It is better to say, “I don’t know, but I can help you find out,” than offer a false reassurance that may complicate the acceptance process. It’s very tempting to swoop in and save the day, but in the end, we want the families to be the heroes of their own stories.
- You should consider hearing loss in daily routine planning and setting goals. We know that, throughout the day, we are taking in lots of information just by listening. Our ability to hear can impact everything we do, so we want to be thinking about ways to incorporate this need into IFSPs. If you are writing a goal around getting dressed in the morning, add checking and putting in the hearing aids to that routine. Maybe the family’s priority is embedded in walking an older child to the bus stop every morning – there are lots of ways to focus on how the child is engaging with others, staying safe, and transitioning out of and into the home. As you are looking at activities, be sure that you’re giving suggestions that can be easily put into routines that exist or that the family wants to start using, as opposed to adding things that aren’t connected to the rest of their day.
- Remember that hearing loss is not just about the ears, it is about the brain. The ears are a gateway to get information to the brain and to develop neural pathways necessary for learning. When hearing aids are not being properly used, the brain can’t develop to its full potential. There are lots of ways to describe this to families to help answer their questions, and it may not make sense to them for a while. We can want so many things for parents and caregivers, but we need to start where they are and support what they are willing to do. Building a strong rapport is key, as well as ensuring that we are on their side and making their priorities our focus.
Collaborating as a team is the best way to support children and families, and audiologists are an important part of that process. When we work together to incorporate information and resources into IFSP outcomes to support families’ priorities, we are able to really give families a good foundation to help set them up for success. Here in North Carolina, we also work with two great programs specifically tailored to this population – for children under 3 years of age, The Early Intervention Program for Children who are Deaf or Hard of Hearing is a beneficial connection and service for the family. When children are first diagnosed with hearing loss, they are also referred automatically to another program called Beginnings – as children begin transitioning out of the Infant-Toddler Program, we want to include Beginnings in the transition plan if the family would like to do so. The group effort between families, EI professionals, and community providers can make a big difference in the successes of day-to-day life and beyond.