Connecting with Appropriate Early Intervention Programs

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Connecting with Appropriate Early Intervention
Programs

• Antonia Brancia Maxon, Ph.D
• New England Center for Hearing Rehabilitation

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Birth to Three Mission

• To strengthen the capacity of families to meet
  the developmental and health-related needs of
  their infants and toddlers who have delays or
  disabilities.
• Connecticut Birth to Three

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Service Provision

• Families will have equal access to a coordinated
  program of comprehensive services that
• foster collaborative partnerships
• are family centered
• occur in natural settings
• recognize best practice in early intervention
• are built on mutual respect and choice

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Pediatric Audiologist Criteria

• can evaluate a childs hearing within a short
  time after being contacted for an appointment
• specializes in working with infants and young
  children- worked with large numbers of them
• provides hearing aids child in a timely manner

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Pediatric Audiologist Criteria

• makes earmold impressions
• dispenses hearing aids
• has loaner hearing aids available
• provides hearing aids on a trial basis

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Pediatric Audiologist Criteria

• has resources to repair hearing aids quickly
• has worked with the Birth to Three System
• is familiar with the procedures of the Birth to
  Three System including IFSP development and
  procedures for acquiring hearing aids or
  assistive technology

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Pediatric Audiologist Criteria

• will review the results of the audiogram with the
  family at the time of the evaluation
• will provide a comprehensive written report, with
  a copy of the audiogram in a timely manner

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Enrollment

• Establish guidelines
• Eligible child
• automatic enrollment criteria - diagnosed
  condition
• significant developmental delay
• Selecting a program

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Enrollment

• Develop Individualized Family Service Plan (IFSP)
• All services
• speech and language development
• auditory development
• assistive technology
• Goals and objectives
• Timelines

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Principles of Intervention for Infants and
Toddlers with Hearing Loss

• 1. Early identification and diagnosis is
  essential.
• 2. Ongoing audiological assessment and
• management must be conducted by staff
• trained to work with infants and young
• children.

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Principles of Intervention for Infants and
Toddlers with Hearing Loss

• 3. The intervention team should assist the
• family in learning about the nature of their
• childs hearing loss.

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Principles of Intervention for Infants and
Toddlers with Hearing Loss

• 4.Intervention requires a team approach. The
  family is the most important member of this team.
  The mission of the Birth to Three System is to
  support, assist and advise families on how to
  best meet their childs unique needs. This
  should include access to a wide variety of
  information that is shared in an unbiased manner.

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Principles of Intervention for Infants and
Toddlers with Hearing Loss

• 5.Parents and children are partners in
  communication. Parents and children must develop
  a communication system in order for a language
  system to develop.
• 6.Language development begins as soon as a child
  is born and develops through interactions with
  the family in daily routines.

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Principles of Intervention for Infants and
Toddlers with Hearing Loss

• 7.Parents need to understand and mange the
  hearing aids and/or auditory equipment for their
  child. A program must help the family learn how
  to maintain any hearing aids or equipment.
• 8.Parents are advocates for their children who
  are deaf or hard of hearing. EI should help
  parents understand their legal rights.

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Pediatric amplification fitting

• Initiate amplification process immediately after
  diagnosis
• Select, fit and validate amplification within
  first few months
• Does not require exhaustive audiological data
• Conduct real-ear measures
• Use functional measures of benefit
• Scheduling flexibility

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Basic Audiological Information Used to Fit
Amplification

• Hearing Sensitivity
• ABR click low frequency pulse tones
• Target audiogram 500, 1000, 4000 Hz
• Individual ear measures insert phones,
  localization
• Middle Ear Status
• Tympanometry
• Tolerance
• Stapedial reflexes

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Prescriptive Approach to Hearing Aid Fitting

• Desired Sensation Level - DSL
  (Seewald, et al, 1996)
• Uses minimal audiometric data
• Real ear measures
• Adjustments for pediatric ears
• Used to determine target gain and output settings

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DSL Goal

• Provide optimal gain across maximum frequency
  range
• Infant acquiring language has access to speech of
  others
• Infant acquiring language has access to own speech

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Accessing the Speech Signal

• Primary purpose of amplification
• Maximal exposure to speech spectrum
• Develop auditory feedback loop
• Speech must be well above detection within an
  appropriate dynamic range

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Hearing Aid Fitting/Validation

• Ongoing process with flexible instrument
• Clinical measures
• More audiological data - setting adjustment
• Observe behaviors, communication, environment
• Audiologist
• Family
• Service providers

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Pediatric Audiologists Responsibility

• Must be able to schedule evaluations, earmolds,
  etc immediately
• Must be able to make a decisions rapidly
• Must be able to provide amplification rapidly
• Must be aggressive about amplification
• Immediate response to parents needs
• Immediate response to infants needs

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Benefits of Early Amplification

• When diagnosis and hearing aid fitting occur in
  first six months of life and early habilitation
  is initiated, infants with hearing loss will
  perform at levels superior to those who do not
  have early appropriate diagnosis and habilitation
  (Yoshinago-Itano, 1997).
• Infants with severe-profound hearing loss who use
  hearing aids by six months of age acquire
  language and vocal communication at ages
  equivalent to infants with normal hearing
  (Robinshaw, 1995).

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Aural Habilitation Programming

• Use of residual hearing
• detection to discrimination
• Integrated approach
• speech perception/production
• language/communication
• Parent education
• amplification
• listening environment
• facilitating language acquisition

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Communication Modality

• Spoken language options
• oral/aural
• cued speech
• total communication
• Signing Exact English
• Seeing Essential English
• American Sign Language (ASL)

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Professional Issues Pediatric Audiologists

• Present number of pediatric audiologists
• Guidelines for pediatric audiology
• Credentialing pediatric audiologist
• development of standards
• overseeing agency
• Establishing link from diagnostics to fitting

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Professional Issues Pediatric Aural Habilitation

• Pediatric aural rehabilitationist
• expertise in
• infant development
• infant auditory development
• infant speech and language acquisition
• experience working with infants and their
  families
• flexibility in scheduling

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Professional Issues Pediatric Aural Habilitation

• Present number of pediatric aural rehabilitation
  providers
• Guidelines for pediatric aural rehabilitation
  providers
• Credentialing pediatric aural rehabilitation
  providers
• development of standards
• overseeing agency
• Establishing link from fitting to aural
  rehabilitation

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Professional Issues Audiological Guidelines

• Must establish
• Maximum time until diagnosis made
• Minimal audiological information for
  amplification fitting
• Maximum time until amplification fitting
• Maximum time until enrollment in management
  program
• Age-appropriate diagnosis and management

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Medical Intervention

• Hearing aid fitting is dependent on medical
  status of auditory system
• Middle ear effusion has a significant impact on
  infants with sensorineural hearing loss
• immediate access to medical intervention
• ongoing medical management
• Cochlear implant candidacy

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Professional Issues Medical Intervention

• Pediatricians and ENTs with expertise in
• infant hearing loss and otologic conditions
• amplification for infants
• pediatric cochlear implant candidacy
• Physician experience working with early
  intervention agencies and personnel
• facilitating referral and implementation of
  programming
• Accommodation of families
• flexible scheduling
• time for counseling

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Early Intervention Benchmarks

• Infants enrolled in family-centered EI by 6
  months old
• Infants enrolled in family-centered EI program
  with professionals knowledgeable about
  communication needs of infants with hearing loss
• Amplification use begins within one month of
  diagnosis when appropriate and agreed on by
  family

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Early Intervention Benchmarks

• Infants with hearing loss have ongoing
  audiological management - not to exceed 3 month
  intervals
• Language development in familys chosen
  communication modality and commensurate with
  developmental level and similar to that for
  hearing peers of a comparable developmental age.
• Families participate in and express satisfaction
  with self-advocacy.