1. 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®

2. A Land Down Under

8. 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

9. The Changing Landscape Early Identification Improved Technology Effective Intervention Evidence based practice

10. 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

11. 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

12. The Changing Landscape Effective Intervention Family Centred Parents as primary clients Ten Principles of Auditory-Verbal Therapy Interdisciplinary services Training of staff

13. The Changing Landscape Evidence Based Practice Assessment Research Lean

14. 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

15. Clinical & Research Team AVT teamChild & Family CounsellorsCI surgeons Aleisha Davis, LSLS Cert AVTSara BeresfordDr Phillip Chang Donna Sperandio, LSLS Cert AVTRenee BennettDr Thomas Kertesz Tracy Hopkins, LSLS Cert AVTAlison Hersee Jenni Harvey, LSLS Cert AVTAnna Huber Danielle Slack, LSLS Cert AVTMichelle SouthgateENT Specialists Anne Fulcher, LSLS Cert AVTDr Nigel Biggs Samantha Arnison, LSLS Cert AVTResearch & AssessmentsDr Simon Greenberg Kristin Bayley, LSLSLerryn Baker Ali Corlette, LSLSSheila Salunke Jen Crane, LSLS Fiona Deeney, LSLS Jessica Evers, LSLSAudiology Team Rashmi Hiriyur, LSLSYetta Abrahams Joanna McAdam, LSLSKristin Abela Amber Monk, LSLSShellie Lavery Lisa Nailand, LSLSFlorencia Montes Ingrid Steyns, LSLSKatie Neal Ha Thanh Lam, LSLS

16. Multi-disciplinary team at TSC

17. Enrolments 2000 - 2011

18. Liverpool

19. Canberra

20. Wollongong

21. Roseville

22. 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)

23. Innovation and Development Hearing Hub School Age Clear Speech Clinic

24. Innovation and Development Kidscape ‘Developing a Listening Landscape Parent playgroup’ Group Programs: Sing and Grow music program School Readiness Mother Goose

25. 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

26. 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

27. A Typical Program-Child Using Cochlear Implant/s All of the above Plus……First Sounds Cochlear Implant Program

28. 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

29. 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

30. Multidisciplinary roles in CI process TeamTasks to be completed LSLS  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

31. 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.

32. CI procedures cont’d 9.Regular sessions at The Shepherd Centre including further programming of the externaldevice 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

33. Outcomes-does it work? Group Results-all graduates

34. Outcomes-does it work? Group Results-Cochlear Implant

35. Outcomes-does it work? Individual Results

36. 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

37. 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

38. 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

39. Proactive Management of Poor Performance

40. 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

41. 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

42. The Changing Landscape Early Identification Improved Technology Effective Intervention Evidence based practice

43. 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