Q1: EHDI

Question 1

What counseling approach will be used to communicate with Matthew’s parents?

Answer 1

• Personal adjustment

- Informational

Question 2

What is personal adjustment counseling?

Answer 2

 Personal adjustment counseling helps guide the patient and family in dealing with the emotional impact of the situation.
• This form of counseling can help Matthew’s parents get beyond their grief and move forward with appropriate intervention once they acknowledge the problem.
• Matthew’s parents can express an emotion and it is the role of the audiologist to let them know that their emotions are acknowledged and validated.

Question 3

What are the three steps involved in facilitating personal adjustment counseling?

Answer 3

o Help Matthew’s parents tell their “story”
o Help them “clarify” their problems
o Help Matthew’s parents take responsibility for their son’s communication problems

Question 4

What is informational counseling?

Answer 4

 Information counseling is another approach that is often used in the medical model.
 While it provides individuals with the relevant information, it can be dismissive of patient’s emotions.
• Patients and their family only retain approximately 50% of the information provided. Only half of the provided information is remembered correctly by the patients and their family.
• Often times in this counseling approach results in one-way communication where the professional does most of the talking.

Question 5

Why will both personal adjustment and informational counseling be used?

Answer 5

o Both forms of counseling will be used to communicate with Matthew’s parents.
o The informational counseling will help convey the important information and the personal adjustment counseling will help establish a relationship between the audiologist and Matthew’s parents.
 The purpose of incorporating personal adjustment counseling is to establish a therapeutic alliance between the audiologist and Matthew’s parents.
 The therapeutic alliance promotes collaborate problem solving, accountability, and alignment of purpose when proceeding with Matthew’s treatment plan.

Question 6

What is the treatment plan recommended for Matthew?

Answer 6

 Matthew’s parents need to be presented with a range of communication options for their son in a nonbiased manner.
• If Matthew’s parents elect amplification, then Matthew should be fit with bilateral hearing aids within 1 month of diagnosis (JCIH, 2007)
o The recommended style is the behind-the-ear (BTE) hearing aids due to expected changes in pinna and ear canal size (AAA, 2013).
o BTEs are coupled to custom earmolds, which are frequently replaced as children grow.
o Safely considerations when fitting bilateral hearing aids:
 Use tamper resistant battery door to prevent battery consumption
 Deactivate volume control to ensure consistent and appropriate amplification
o Verify the fitting with real-ear measurements, either with Speechmapping or real-ear to coupler difference (RECD)

Question 7

What should happen following the initial fitting of Matthew’s hearing aids?

Answer 7

 Following the initial fitting, Matthew and his family should be followed up with audiological evaluation and adjustment of hearing aid programming settings. The verification process should be repeated to ensure appropriate amplification to meet the patient’s auditory needs.
• Any follow-up should ensure that Matthew’s parents are able to independently care for and manage the hearing aids.
 Following the fitting of hearing aid, audiological assessment should occur every 3 to 6 months to monitor auditory development and use of amplification.
o Matthew’s parents need to be referred to early intervention services to supplement the auditory habilitation treatment method.

Question 8

What referrals to other professions should be made?

Answer 8

o A multidisciplinary team approach to working with Matthew and his family is necessary.

• Otologic and medical evaluations
• Speech-language pathology for speech-language intervention services
• Opthalmology for visual examination (JCIH, 2007)

Question 9

Referral 1: otologic and medical evaluations

Answer 9

 The goal of otologic and medical evaluations is to determine the etiology of the hearing loss, identify other physical conditions, provide recommendations for medical and surgical treatment, and make referrals to appropriate services (JCIH, 2007)
 Every child identified with a permanent hearing loss should be evaluated by an otolaryngologist who is knowledgeable about pediatric hearing loss.
 These health care professionals may refer Matthew to genetic testing.
• Matthew’s parents are not required to pursue genetic testing, but the opportunity should be offered to them.

Question 10

Referral 2: speech-language pathology

Answer 10

 A complete language evaluation should be performed at regular intervals to assess a child’s language development.
 Language intervention will not only support Matthew’s language development, but help foster communication between Matthew and his family.
 A speech-language pathologist can provide Matthew’s family with information pertaining to language development and access to peer and language models.

Question 11

Referral 3: opthalmology

Answer 11

 A vision exam determines vision acuity and can rule out late-onset vision disorders, such as Usher syndrome.

Question 12

What different recommendations should be made?

Answer 12

• Home

- School setting

Question 13

Recommendation 1: home

Answer 13

 Matthew’s parents need to provide an auditory rich environment to promote speech and language development.
 Matthew’s parents should engage their son, and other children, in activities that facilitate language development.

Question 14

Recommendation 2: school

Answer 14

 Matthew’s parents should work with the educational audiologist and Matthew’s preschool teacher to determine his classroom needs.
• It is necessary to determine the educational placement that will promote Matthew’s academic success.

Question 15

What accommodations or modifications should Matthew receive?

Answer 15

• Determine any accommodations or modifications that Matthew may need.
o Accommodations are provisions in how a student accesses information and demonstrates leaning. They do not substantially change the instructional level, contact, and/or performance criteria.
o Modifications are substantial changes in what a student is expected to learn and demonstrate. These changes are made to provide a student the opportunity to participate meaningfully and productively in learning experiences and environments.
 Classroom modifications for children with hearing loss include:
• Environmental modifications
• Seating arrangements
• Peer assistance
• Alerting techniques
• Teaching strategies

Question 16

What else should be implemented in Matthew’s classroom setting?

Answer 16

 Implement the use of assistive technology, such as an FM system, in the classroom setting.
 The educational audiologist, Matthew’s preschool teacher, and other educational professionals can help determine if Matthew is eligible for an Individualized Education Plan (IEP) or a 504 plan.
• The IEP and 504 plans are written, legally binding documents that define the content and parameters of appropriate educational services for each student.

Question 17

What is the role of the medical home?

Answer 17

o The role of the medical home is to identify infants and toddlers with developmental disorders and provide timely and appropriate referrals to early intervention services.
o The Early Hearing Detection and Intervention (EHDI) program states that all infants should have a hearing screening at no later than 1 month, receive audiologic and medical evaluations no later than 3 months, and children identified with permanent hearing loss should receive early intervention services no later than 6 months (JCIH, 2007)
 When infants do not pass the newborn hearing screening, parents are not always effectively referred to an audiologist for diagnostic hearing assessments (Larsen, Muñoz, DesGeorges, Nelson, & Kennedy, 2008).
 Various familiar factors contribute to the lack of effective referrals to audiologists (Liu, Farrell, MacNeil, Stone, & Barfield, 2008):
• Distance families live from testing facility
• Type and severity of hearing loss
• Whether the hearing loss is unilateral or bilateral

Question 18

What is a critical aspect of the EHDI program?

Answer 18

Communication
 The birth hospital and the state EHDI coordinator need to ensure that the hearing-screening results are communicated to the parents and the medical home (JCIH, 2007).
 Additionally, parents of children identified with permanent hearing loss should be provided with follow-up and resource information. Hospitals should ensure that each infant is linked to a medical home.
 All hearing-screening, audiologic, and habilitation information should be communicated to the medical home and the state EDHI coordinator.
 In Matthew’s situation, there was an obvious lack of communication of the hearing screening results.
• The hospital did not report the screening results to Matthew’s parents, Matthew’s medical home, and the state EDHI coordinator.
• The lack of communication prevented Matthew from receiving diagnostic audiological evaluation and early intervention services.

Question 19

What must happen once a hearing loss is identified?

Answer 19

o Federal guidelines mandate that once a hearing loss is identified, a referral to early intervention programs must occur within two days of the documented hearing loss.

Question 20

Why is a medical home needed in family-centered early intervention?

Answer 20

o The medical home is a process of care for children that involves pediatricians and family physicians who collaborate with parents and other health care professionals.

Question 21

What is the child’s pediatrician responsible for?

Answer 21

o The pediatrician is responsible for monitoring the health and overall development of the child.
 According to the American Academy of Pediatrics (AAP), the medical home is the provision of care to children that is accessible, family-centered, comprehensive, coordinated, compassionate, and culturally effective (Moeller, White, & Shisler, 2006).
 The medical home is at the center of a child’s development and well-being.
 In the medical home, children with permanent hearing loss should receive continued assessment of communication development.
o While PCP’s are critical to facilitating effective care for children with hearing loss, the majority of pediatricians do not know what to do when babies fail their newborn hearing screening (Moeller, White, & Shisler, 2006).
 Additional training is needed so that PCPs can make appropriate recommendations to audiologists so children with hearing loss can be identified and treated in time.