1. An Audiological Management Manual for UNHS Referrals Antonia Brancia Maxon, Ph.D. Karen Ditty, M.S. Kathleen Watts, M.A. Diane Sabo, Ph.D. Karen Munoz, M.A. NCHAM Technical Assistance Network

2. NCHAM Goals of EHDI Identify infants with hearing loss by one month Diagnose hearing loss by three months Enroll infants in early intervention by six months These goals can be met only if professionals are prepared to meet the needs of infants with hearing loss and their families.

3. NCHAM Initial Step Infants who do not pass UNHS are referred for a diagnostic audiological evaluation All audiologists have expertise in audiological assessment, HOWEVER Not all audiologists are able to evaluate young infants Infants must be referred to a qualified pediatric audiologist

4. NCHAM Pediatric Audiologists Selection of pediatric audiologists should be based on: –the population they generally serve –the type of equipment they have available –their familiarity with appropriate and necessary pediatric techniques –their experience with specialized pediatric testing

5. NCHAM Through NCHAM a manual was developed Audiological Management After Referral from Universal Newborn Hearing Screening Written by Antonia Brancia Maxon, Ph.D., Karen M. Ditty, M.S. and Kathleen Watts, M.A. Editorial assistance from Diane Sabo, Ph.D. and Karen Munoz, M.A., Karen Clark, M.A.

6. NCHAM Purpose of Manual To provide information about: types of tests and follow-up procedures used for infants referred from newborn screening personnel involved in EHDI process timelines for completing the process

7. NCHAM Purpose of Manual Written for: –parents –primary care physicians –ear, nose, throat physicians –rehabilitative audiologists –early intervention providers –teachers of the hearing impaired –family service coordinators

8. The remainder of the presentation summarizes the sections of the manual

9. NCHAM Table of Contents I. Introduction II. Types of Hearing Loss Conductive Sensorineural Mixed III. Audiological Diagnostic Evaluation Initial Diagnosis Case History ABR ASSR OAEs Tympanometry The Audiogram Use of residual hearing

10. NCHAM Table of Contents IV. Sensory devices Hearing Aids FM Systems Cochlear Implants V. Early Intervention Family Issues Routine Audiological Test Battery Visual Reinforcement Audiometry Amplification selection, fitting and validation Communication Choices Individual Family Service Plans Medical Intervention Third party payers

11. NCHAM Table of Contents VI. The Team Pediatric Audiologist Primary Care Physician (PCP) Ear, Nose and Throat Physician (ENT) Early Interventionist Geneticist/Genetic Counselor Other Professionals VII. Appendices References Resources

12. NCHAM Referral to Pediatric Audiologist The primary care physician should be contacted so he/she can be involved in the referral process Statewide centralized tracking systems are beneficial –Reduce lost to follow-up numbers –With input from pediatric audiologists - maintain record of the hearing status of all infants referred Pediatric audiologist needs a connection to Part C programs to reduce time to intervention

13. NCHAM Professional Team Pediatric Audiologist - Diagnosis –Training and equipment for infant evaluation –Interpret test results type degree configuration –Complete diagnosis quickly –Establish follow-up sessions –Provide written information

14. NCHAM Professional Team Pediatric Audiologist – Hearing Aids –Training and equipment for infant procedures loaner hearing aids available earmold fabrication available –Establish follow-up sessions to determine appropriate selection and fitting –Able to provide training about hearing aids to parents –Provide written information

15. NCHAM Professional Team Pediatric Audiologist – Habilitation –Training and experience in typical development –Able to work with families Provide information about language stimulation Provide information about listening training –Able to provide parent education Establish appropriate goals and expectations –Able to provide direct service to infant/toddler Speech, language and listening training

16. NCHAM Professional Team Primary Care Physician –Establishes medical home General medical care Ongoing monitoring and treatment of MED Part of IFSP team Refer for genetic follow up Ear, Nose, Throat Physician –Treat medical conditions –Provide medical clearance for hearing aid fitting

17. NCHAM Professional Team Early Interventionist –teacher of the hearing impaired, speech-language pathologist, rehabilitative audiologist, parent-infant specialist –provide listening, speech, language, communication services Geneticist/Genetic Counselor –physician conducts medical tests –helps family determine possible genetic factors –makes appropriate referrals

18. NCHAM Professional Team Other professionals –To address any other conditions occurring with the hearing loss Physical therapist Occupational therapist Developmental therapist Ophthalmologist The whole team makes rapid decisions The whole team responds to needs of the family

19. NCHAM Audiological Diagnostic Evaluation Initial Evaluation –Occurs within 2 weeks of referral from screening –Pediatric audiologist determines the type, degree and configuration of the loss Hearing loss is determined –Degree of hearing loss –Type of hearing loss –Configuration of hearing loss

20. NCHAM Early Intervention Diagnosis results in immediate referral for early intervention services. IDEA, Part C. Individual Family Service Plan (IFSP) is developed. –focus on residual hearing –amplification use –speech and language development –consider communication modality

21. NCHAM Early Intervention Family Issues –services provided in natural environment –family configuration is accommodated Use of residual hearing –hearing aids/other sensory devices provided –listening expected –hearing levels regularly monitored –routine audiological test battery Communication mode selected –family choice

22. NCHAM The IFSP Early intervention team and family develops IFSP Covers all aspects of EI services needed by child and family –Goals and objectives with timelines Regular assessments to monitor progress toward goals Transition plan –moving from Part C to LEA services

23. NCHAM Medical Intervention Medical clearance for hearing aids Monitoring for middle ear disease PCP part of EI team General development Vision assessment

24. NCHAM Summary In addition to the material previously summarized the manual contains: –References –Websites and other resources –Glossary –Materials that can be used for dissemination Written Graphics