Transcript Connecting with Appropriate Early Intervention Programs Antonia Brancia Maxon, Ph.D

Connecting with Appropriate Early
Intervention Programs
Antonia Brancia Maxon, Ph.D
New England Center for Hearing Rehabilitation
Birth to Three Mission
To strengthen the capacity of families to
meet the developmental and healthrelated needs of their infants and
toddlers who have delays or disabilities.
Connecticut Birth to Three
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
CT Birth to Three Guidelines
Pediatric Audiologist Criteria
• can evaluate a child’s 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
Service Guideline 5, CT Birth to Three
(October, 1999)
Pediatric Audiologist Criteria
• makes earmold impressions
• dispenses hearing aids
• has loaner hearing aids available
• provides hearing aids on a trial basis
Service Guideline 5, CT Birth to Three
(October, 1999)
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
Service Guideline 5, CT Birth to Three
(October, 1999)
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
Service Guideline 5, CT Birth to Three
(October, 1999)
Enrollment
• Establish guidelines
• Eligible child
– automatic enrollment criteria - diagnosed condition
– significant developmental delay
• Selecting a program
CT Birth to Three Guidelines
Enrollment
• Develop Individualized Family Service Plan (IFSP)
– All services
• speech and language development
• auditory development
• assistive technology
– Goals and objectives
– Timelines
CT Birth to Three Guidelines
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.
CT Birth to Three Guidelines
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
child’s hearing loss.
CT Birth to Three Guidelines
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 child’s
unique needs. This should include access to
a wide variety of information that is shared in
an unbiased manner.
CT Birth to Three Guidelines
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.
CT Birth to Three Guidelines
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.
CT Birth to Three Guidelines
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
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
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
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
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
Hearing Aid Fitting/Validation
• Ongoing process with flexible instrument
• Clinical measures
– More audiological data - setting adjustment
• Observe behaviors, communication, environment
– Audiologist
– Family
– Service providers
Pediatric Audiologist’s 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 infant’s needs
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).
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
Communication Modality
• Spoken language options
– oral/aural
– cued speech
– total communication
• Signing Exact English
• Seeing Essential English
• American Sign Language (ASL)
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
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
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
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
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
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
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
JCIH, 2000
Early Intervention Benchmarks
• Infants with hearing loss have ongoing audiological
management - not to exceed 3 month intervals
• Language development in family’s 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.
JCIH, 2000