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Well, I want to welcome everybody to today's webinar, which is entitled, Build on Your Previous Experience and Training with Evidence-Based Hearing Screening.

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Uh, for children birthed through the school age. My name is Will Iserman, and I'm the affiliate Associate Director of the National Center for Hearing Assessment and Management, known as NSAM at Utah State University. And NCAM is housed within the Institute for Disability Research.

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policy and practice at Utah State, which is a federally funded university center for excellence in Developmental Disabilities. With a critical nationwide focus.

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Since 2001, I've also served as the director of the Early Childhood Hearing Outreach Initiative, which is known as the ECHO Initiative, and for 20 years after that, the ECHO initiative served as.

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a national resource center on early hearing detection and intervention.

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With a focus first. on supporting early Head Start, and then Head Start program staff in implementing evidence-based hearing screening and follow-up practices. And that just has continued to evolve over the years, um, to include, um.

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providing training and support and resources to a variety of early care and education programs, and those in educational settings who can put our resources and trainings to use.

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Including those in early intervention programs, healthcare settings, private practices.

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and schools. Now, I'm joined today by my good friend and colleague.

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Dr. Terry Faust. Terry is a pediatric audiologist and a speech-language pathologist.

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who has served as a consultant and a trainer with the ECHO Initiative since its very beginning, so thank you, Terry, for being with me yet again.

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Yeah, thank you, William. You know, as you mentioned, um, you know, William and I have, along with other ECHO team staff.

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As well as local collaborators, we've really provided in-person training in nearly every state, and I say in-person because I'm used to saying we've provided training in nearly every state, but really thinking about the reach of our webinars, we've really provided training in every state.

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And we're so grateful for the continued interest. Um, we've, um, you know, trained thousands of staff from all types of early childhood and childhood programs, from Early Head Start, Head Start, American Indian, and Alaska Native.

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programs, Migrant Head Start, and other early care and childhood programs in schools over these years that we've been.

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involved.

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Yep, thank you, Terry. So today's webinar is primarily intended for those of you.

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who have already had some experience implementing evidence-based hearing screening for children either in the birth to 3 age range, in the 3 to 5 age range, or even in older populations in school-based training screenings.

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a number of you have submitted questions to us in advance, and our responses to those have been, at least we've tried to incorporate those into what we've planned to share with you today. And we should have ample time to take additional questions if.

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others come up during our presentation, but hopefully we've. We will be addressing a lot of your questions as a part of the flow of our presentation.

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We did notice that some of the questions we received were from folks for whom evidence-based hearing screening is new.

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And if you are a newcomer, by all means, you are welcome to hang out with us during today's webinar, but we also want to alert you to the fact that tomorrow, February.

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uh, 26th? Did I get that wrong? On the slide.

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make it, yep.

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Now, to the 25th, tomorrow. Good morning. Um, we're in. We have an introductory webinar that will present the topic of evidence-based hearing screening throughout the age ranges, starting at the very beginning.

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So, if you're a newcomer, or if you know of anybody who.

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is new to this content area, that's the webinar that you want to have them or yourself attend. So the information is on the screen right there. It's also going to be posted in the chat here in a moment, um, so that you can copy that information down and register for tomorrow.

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it will also be recorded, so anybody who needs that. That orientation to this content area can.

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can get it, uh, either live or in our recorded sessions. So, we're going to organize our time today largely around many of the questions that you've submitted.

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We're going to present information about each of these topics, and we're going to start with a brief.

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review for our newcomers to evidence-based hearing screening practices.

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On the purpose of hearing screening and what the recommended methods are. And.

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One of the reasons why we think it's worth taking a few minutes to do that is because even if that is not new to you.

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Being able to explain the big picture to other people.

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your colleagues, to parents. decision makers.

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is an important skill set and information base in and of itself. So we're going to give you a quick walkthrough of that and show you some resources that might support you in creating.

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more support for the work that you do related to hearing screening.

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We're then going to review the screening and follow-up protocol that applies to whether you're using OAE or PureTone screening, no matter what age child you're screening.

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We're then gonna turn our attention, uh, to a review of.

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of issues pertaining specifically to pure-tone audiometry.

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And then we're going to move on to issues pertaining to how to do otoacoustic emission screening and some helpful hints for screening.

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particularly when you encounter children that may be difficult to screen. We've received a number of questions about that, which is, only natural, you're not the only one that has those occasional children that are tough.

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So we're going to talk about some tricks that we've learned over time.

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And then we're gonna wrap up our conversation with making sure you're aware of other technical assistance resources that are available to you. Um, so.

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let's just dive in and get started. So, big picture.

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You know, I'm gonna turn my video off now so you don't have to be distracted by.

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my mug. Alright. So, the work of the ECHO initiative, the Early Childhood Hearing Outreach Initiative, has been based on the recognition.

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that every day, there are children who are deaf or hard of hearing, being served in various.

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early childhood, school, and healthcare settings. often without their hearing-related needs being known.

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the question is, you know, how can we identify which children have normal hearing.

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And which may not. You know, hearing loss is often referred to.

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as the invisible condition. So, how exactly do we identify children.

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who have normal hearing. Compared to those that don't.

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And you know, the short answer to that question, William, is that early care and education providers, um, just like most of us here today, we can be trained to conduct evidence-based hearing screening, just like you see depicted in these photos right here.

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The ultimate outcome of a hearing screening program is that we can identify children who are deaf or hard of hearing, who have not been identified previously, like newborn screening.

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You'll recognize the procedure on the left as being otoacoustic emissions, or OAE hearing screening.

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And again, that's the recommended method for children birthed to 3 years of age, and increasingly recommended for children 3 to 5 years of age as well.

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And then, if you go over to the right, you'll see the procedure pure tone audiometry hearing screening.

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which has historically been the most commonly used screening method for children 3 years of age and older, which you'll still see many early care and education providers using.

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Now, as Willie mentioned, we're going to talk about both of these methods today, but keep in mind that hearing screening pros. The hearing screening process does not diagnose a hearing loss, but it.

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does identify children who need further follow-up evaluation, either by healthcare provider.

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are an audiologist with that ultimate aim of diagnosing hearing loss if, in fact, that exists. And then, connecting those children with the intervention services that they need.

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So, your screening process is really the first important step in the bigger process.

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So, some of you have asked us. how do we more effectively encourage parents to follow up.

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when a child hasn't passed a screening. I mean, that's a. That is one of the.

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points in this whole process. That is both so critical and also where the process can break down.

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And one way is to share information about the prevalence or incidence of.

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of hearing loss. And the fact that a child's hearing ability, like vision as well.

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can change at any time without us even recognizing.

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You know, it's often called an invisible condition. About 3 children in a thousand.

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are born with a permanent hearing loss, death, or hard of hearing.

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mild all the way to severe or profound hearing loss.

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Most newborns in the U.S. Are now screened for hearing loss using evidence-based evidence-based methods. Oae screening is, in fact, one of those that is used in the hospital, and they often get that screening before.

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Even leaving the hospital. But, you know, screening at the newborn period isn't enough.

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And the reason it isn't enough. is because the research has shown.

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that the incidence of permanent hearing loss actually doubles between birth and school age. From that 3 in 1,000 at birth to about 6 in a thousand.

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By the time children enter school.

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And that incidence only continues to increase during the school years.

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up to about 50 in 1,000. During the school year. So.

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wow, right? That is a dramatic change.

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And how are we going to know that those children are developing those hearing losses?

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So, the answer to that is clear. You know, they need to be seen. They need to be identified.

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But this really shows us that we can't only screen for hearing loss at birth, or even just one time after that. We really need to screen throughout childhood because hearing loss can occur at any time. It can occur as the result of illness.

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um, physical trauma. Or environmental or genetic factors.

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And this is. This type of hearing loss that comes later is often referred to as late-onset hearing loss, and that just simply means that it's acquired after the newborn period.

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Again, very similar division. You can have subtle changes in vision that can occur for any of us.

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So a child can also experience a change in hearing ability that we want to identify so that they have full access to language and all of the information they're being exposed to as they learn and grow.

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Um, and just on a personal note, I have a grandchild who's just experienced at 9 years of age a pretty significant change or drop in her hearing. So.

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Um, it really, really does happen. Now, this information is on our website, um, as is a letter for parents that you're welcome to use.

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Because being able to fluently discuss this with parents and your colleagues can help strengthen that overall support that you need for your screening and follow-up efforts.

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You know, any conversation that we have about screening and follow-up should always begin with a reminder that screening methods aren't perfect.

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And that whenever a parent or a caregiver expresses a concern.

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about language or hearing, children should be referred for a more thorough evaluation, and that's true even if the child passes the hearing screening.

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And that's true even with the highly reliable hearing screening methods that we're talking about today.

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And we also want to acknowledge right up front that for any number of reasons, there's going to be that occasional child that you just can't manage to screen.

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So, after you've tried everything you can do, and you've had a colleague try as well, if possible, um.

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you're gonna be faced with the dilemma of what to do with this particular child. So here's our recommendation about that question.

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that I know most. Many of you have had. If you aren't successful in screening a child through multiple attempts, having somebody else.

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Refer the child to someone who can, and often that's going to be a pediatric audiologist.

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Just keep in mind that sometimes the children, you may actually have the most difficult, um, screening that may be the most difficult to screen, may be the very ones who have a hearing loss. So, we really don't want to skip them and then, you know, just try again next year, for example.

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Yeah.

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Yeah, and this isn't a criticism, but something. we do kind of cringe about, right, Terry? That when we hear people struggling and they say, well, we just say we're gonna screen them, we're gonna try again next year.

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we don't really want to ever see that. want to see them referred, and have somebody, an audiologist, really, be the one.

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to determine, um. they're hearing status.

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So, we just mentioned a pediatric audiologist being in the picture. Now, a pediatric audiologist, which.

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Terry is, um, is a, if you don't know, is a professional who specializes in the diagnosis and non-medical treatment of hearing-related and other disorders associated with the ear or the auditory system.

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a pediatric audiologist specializes in.

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As you'd guess, children. So, having access to a local pediatric audiologist can really be helpful.

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Even though we'll acknowledge there aren't a lot of them. Um.

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they can help with things like equipment questions you might have, they can consult with you about specific children who.

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aren't passing your screenings.

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And importantly, maybe one of those valuable resources when you do, in fact, need to refer a child.

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for further evaluation. Now, how do you find a pediatric audiologist?

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Well, one way is through our website on kidsHearing.org.

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You'll find a. And I'll show you this all, um, later on, but on our website, you'll find a tab that.

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says, find an audiologist, and you'll find several different directories there that might help you guide yourself to local pediatric audiologists.

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Now, one question that is a perfect question for a pediatric audiologist, and which some of you have submitted questions about, is whether they should screen children. Now, we're going into the weeds a little bit here, so.

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Come along with me. You've asked the question. Should we screen children that we know have PE tubes? So, let's just answer that question right now. Terry, you're the pediatric audiologist here.

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What do you say to that question?

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Yeah, so yes, you absolutely can and should screen children who you know have PE tubes. It's actually one way to find out if the tubes are doing the job that they've been put in to do.

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Children with PE tubes should pass hearing screenings if the rest of their auditory system is functioning normally.

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So, for those of you that are using the, um, autoacoustic emissions, or OAE method.

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You'll want to look at your equipment manual, because you want to be. You want to see if you have to do an extra button push or so to adjust the setting for screening an ear that has PE tubes.

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Some equipment requires the adjustment, others does not. So be sure to check that out. Um.

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And for those doing pure tone, you'll complete the screening just as you would for any other child. So, yes, you can and should screen children with PE tubes.

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Okay, so we have the two screening methods we want to talk about today. By way of big picture.

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If you're responsible for children who are under the age of 3, the only recommended evidence-based method is OAE screening, which you see on the left here.

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If you're responsible for screening children 3 years of age or older.

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Historically, pure tone audiometry has been considered the, quote, recommended method for this age group.

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This is the headset screening where the child raises a hand or performs another task each time.

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They hear a sound that's presented into the earphone. And you see this method on the right.

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Now, several of you have asked about why some programs.

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are no longer using pure-tone audiometry with a 3-5 population, or even those older, and have switched primarily to ode acoustic emissions, or OAEs.

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And that's because there's growing recognition that although the PureTone method has been the most widely used.

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um, used method historically, it may not always be the most feasible method to use with some of these younger children.

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Research has shown that about 20-25% of children in that 3-5 age group can't be screened with this methodology.

223
00:19:56.476 --> 00:19:59.468


224
00:19:59.488 --> 00:20:05.458
Um, because they just aren't developmentally able to follow the directions reliably or respond reliably.

225
00:20:05.478 --> 00:20:06.470


226
00:20:06.490 --> 00:20:12.460
And that's been, um. That's really been our experience as well. So in those instances, OAE screening is the preferred method for these children.

227
00:20:12.480 --> 00:20:15.471


228
00:20:15.491 --> 00:20:21.461
Um, as we emphasized a moment ago, we want to be sure we screen every child, even the ones we find challenging to screen, right?

229
00:20:21.481 --> 00:20:22.473


230
00:20:22.493 --> 00:20:27.474
So, what this means. is, at a minimum.

231
00:20:27.494 --> 00:20:33.464
If you're using, um, and doing 3- to 5 year olds or olders, and you're using the PureTone method.

232
00:20:33.484 --> 00:20:36.476


233
00:20:36.496 --> 00:20:42.466
You'll need to have a plan, a backup plan, for those that you just can't successfully screen that way. And.

234
00:20:42.486 --> 00:20:44.477


235
00:20:44.497 --> 00:20:50.467
The best plan would be to have OAEs, uh, an autoacoustic emissions device that you've been trained on to use with all of those children that you can't successfully screen with Puritone.

236
00:20:50.487 --> 00:20:58.480


237
00:20:58.500 --> 00:21:03.481
The only other alternative to being able to do OAEs yourself.

238
00:21:03.501 --> 00:21:09.471
is that you have a mechanism for referring all those children to an audiologist who can perform the screening, which.

239
00:21:09.491 --> 00:21:12.483


240
00:21:12.503 --> 00:21:18.473
frankly. would be pretty challenging to implement in its own right if you're referring, like 20.

241
00:21:18.493 --> 00:21:20.485


242
00:21:20.505 --> 00:21:26.486
percent of your children to an audiologist just for a screening.

243
00:21:26.506 --> 00:21:32.476
So really, to simplify things, more and more of us, um, audiologists are recommending the use of OAEs uniformly with all children 3 years of age and older.

244
00:21:32.496 --> 00:21:37.488


245
00:21:37.508 --> 00:21:42.489
It's because it's quicker than pure-tone screening, both to learn to do and to actually implement.

246
00:21:42.509 --> 00:21:48.479
But really, it's far more likely to be a method that'll work across the board with all children in that 3 to 5 age group and older that you'll be screening, and it's equally as effective.

247
00:21:48.499 --> 00:21:52.492


248
00:21:52.512 --> 00:21:58.482
If you or your program are grappling with this question of method, um, for use of.

249
00:21:58.502 --> 00:22:00.493


250
00:22:00.513 --> 00:22:05.494
particularly for the 3 years of age and older.

251
00:22:05.514 --> 00:22:08.495
We want to encourage you to look at a document that we've.

252
00:22:08.515 --> 00:22:14.485
developed that's on our website at kidsHearing.org, and I'll show you where to find it, that compares OAE screening and pure tone screening.

253
00:22:14.505 --> 00:22:17.497


254
00:22:17.517 --> 00:22:23.487
Now, here's an important point, though. Some states have regulations about the specific methods that are to be used.

255
00:22:23.507 --> 00:22:28.499


256
00:22:28.519 --> 00:22:34.489
Based on age, requiring PureTone, for example, for children 3 years of age and older.

257
00:22:34.509 --> 00:22:35.500


258
00:22:35.520 --> 00:22:41.490
at least as the primary or first method that is used. So, you do need to check with your state if you're considering OAEs for this 3- to 5-year-old age group.

259
00:22:41.510 --> 00:22:48.503


260
00:22:48.523 --> 00:22:54.493
And you can do that by contacting your state's newborn hearing screening program, which you can find a link to on our website.

261
00:22:54.513 --> 00:22:57.505


262
00:22:57.525 --> 00:23:03.495
No, you just need to know that. Sometimes those regulations haven't even been looked at or updated since the 1990s.

263
00:23:03.515 --> 00:23:10.508


264
00:23:10.528 --> 00:23:16.498
before OAEs were really a viable consideration. So, um, the reason why they're still in there is not because of an enduring evidence that Puritone is better, it's just that the regulations haven't been updated.

265
00:23:16.518 --> 00:23:29.512


266
00:23:29.532 --> 00:23:35.502
On another note, we have a question about whether there are any other recommended evidence-based methods other than OAE or PureTone that could or should be considered. So, Terry, wanted to give the definitive answer on that.

267
00:23:35.522 --> 00:23:47.515


268
00:23:47.535 --> 00:23:53.517
There's only one answer, William, and it's no. There are no other recommended evidence-based.

269
00:23:53.537 --> 00:23:59.507
methods for the populations that you're screening. You can augment these methods with parent questionnaires or questions, and your observations of a child.

270
00:23:59.527 --> 00:24:03.519


271
00:24:03.539 --> 00:24:09.509
Um, those things are absolutely important to note, but they do not and can't stand alone as hearing screenings.

272
00:24:09.529 --> 00:24:10.520


273
00:24:10.540 --> 00:24:16.510
Yeah, so what you're saying, Terry, is that, yeah, by all means, get parents' input.

274
00:24:16.530 --> 00:24:19.522


275
00:24:19.542 --> 00:24:25.512
do your own observations, and listen to that. In fact, and we said earlier, even if a child passes and there are serious questions.

276
00:24:25.532 --> 00:24:28.524


277
00:24:28.544 --> 00:24:34.525
about a child's language development or hearing, then you should still.

278
00:24:34.545 --> 00:24:40.526
recommend and refer those children for a complete audiological evaluation.

279
00:24:40.546 --> 00:24:41.527
Yep, absolutely.

280
00:24:41.547 --> 00:24:46.528
Okay, so we have our evidence-based methods, which are key.

281
00:24:46.548 --> 00:24:51.529
to fulfilling the purpose of the hearing screening effort.

282
00:24:51.549 --> 00:24:57.530
But, you know, our best screening efforts, efforts are only worthwhile.

283
00:24:57.550 --> 00:25:03.520
If we follow up effectively. And a lot of you have expressed frustration in making sure that.

284
00:25:03.540 --> 00:25:06.532


285
00:25:06.552 --> 00:25:12.522
There is follow-up, and you know, you can only do so much, and then you're dependent on parent follow-up, or others who are designated to play a role in that, so.

286
00:25:12.542 --> 00:25:18.534


287
00:25:18.554 --> 00:25:24.524
Before we get into how to strengthen those follow-up activities, let's take a good look at what the recommended follow-up protocol is.

288
00:25:24.544 --> 00:25:30.537


289
00:25:30.557 --> 00:25:34.538
and see if there are any questions about that.

290
00:25:34.558 --> 00:25:40.528
I just want to say, um, before we do that, one of the good things to remember is that the steps of the follow-up protocol, they're going to be the same, regardless of the screening method you're using or, um, the child's age.

291
00:25:40.548 --> 00:25:46.540


292
00:25:46.560 --> 00:25:52.541
Okay, so regardless, Terry, of whether we're talking about OAE or pure tone screening.

293
00:25:52.561 --> 00:25:58.543
The follow-up protocols. protocol is identical.

294
00:25:58.563 --> 00:26:03.544
And also, regardless of what the age of the child is.

295
00:26:03.564 --> 00:26:04.544
All right, all right, very good. So, there's one main rule to remember.

296
00:26:04.564 --> 00:26:07.544
Absolutely, yep.

297
00:26:07.564 --> 00:26:10.545
about your screening and follow-up process.

298
00:26:10.565 --> 00:26:16.535
And that is this. It's complete. When either the child passes the screening on both ears.

299
00:26:16.555 --> 00:26:18.547


300
00:26:18.567 --> 00:26:24.537
That's pretty obvious. or the child receives an evaluation from an audiologist, and you've obtained the results.

301
00:26:24.557 --> 00:26:27.549


302
00:26:27.569 --> 00:26:33.539
Any other referrals, like to a healthcare provider, to manage a middle ear dysfunction or an ear infection, any of that other stuff is not a complete screening process. In fact.

303
00:26:33.559 --> 00:26:41.551


304
00:26:41.571 --> 00:26:47.541
It's only when they fast on both ears. or a referral to an audiologist had been made, and you've gotten the results. So, here is how the screening and follow-up process unfolds.

305
00:26:47.561 --> 00:26:54.554


306
00:26:54.574 --> 00:26:59.555
Keep in mind, again, we're talking about screening both ears.

307
00:26:59.575 --> 00:27:05.556
And that they each need to fulfill the past criteria in order for the child to pass.

308
00:27:05.576 --> 00:27:11.546
So, if an ear passes the screening right off the bat.

309
00:27:11.566 --> 00:27:12.558


310
00:27:12.578 --> 00:27:16.559
then the process is complete for that year. Simple enough.

311
00:27:16.579 --> 00:27:22.549
Now, if the ear doesn't pass. we can't be absolutely sure why.

312
00:27:22.569 --> 00:27:24.560


313
00:27:24.580 --> 00:27:30.562
Yeah, sometimes an air may not pass due to screener error, or.

314
00:27:30.582 --> 00:27:36.552
a temporary condition, like a head cold. So it wouldn't usually be practical for every child who doesn't pass this first initial screening to be referred to a healthcare provider or, um, an audiologist. So, in the birth to 3 age group, we.

315
00:27:36.572 --> 00:27:45.565


316
00:27:45.585 --> 00:27:51.555
We have seen that up to 20 to 25% of children that we screen with OAEs, they don't pass on at least one year the first time we screen them.

317
00:27:51.575 --> 00:27:54.567


318
00:27:54.587 --> 00:28:00.557
So several of you have asked about how a head cold or congestion, um, can affect screening outcomes. And this is right where we might see that.

319
00:28:00.577 --> 00:28:04.569


320
00:28:04.589 --> 00:28:05.569
Um, and. Yeah.

321
00:28:05.589 --> 00:28:11.570
And Terry, Terry, even though it's probably not as high as $20 to 25%.

322
00:28:11.590 --> 00:28:17.560
The 3- to 5 year old age group and even older children, there's going to be a percentage that don't pass that initial screening, probably for the same sorts of reasons, right?

323
00:28:17.580 --> 00:28:23.573


324
00:28:23.593 --> 00:28:29.574
Oh, exactly. In fact, many of my colleagues who, um, who work in the school system.

325
00:28:29.594 --> 00:28:35.564
just. Just try to stay away from cold and flu season when they're doing screening. But what that tells you is, yeah, absolutely, those same kind of factors, um, affect, uh, children of all those ages.

326
00:28:35.584 --> 00:28:42.577


327
00:28:42.597 --> 00:28:48.567
So, if an ear doesn't pass that first screening, instead of making an immediate referral.

328
00:28:48.587 --> 00:28:49.578


329
00:28:49.598 --> 00:28:55.579
We wait a couple of weeks, two weeks. If you want a solid guideline.

330
00:28:55.599 --> 00:28:56.580
And then we screen again.

331
00:28:56.600 --> 00:28:59.580
mhm.

332
00:28:59.600 --> 00:29:05.570
And that screening, that waiting period allows for, you know, the cold to go away, the fluid to dissipate, even the earwax to wiggle its way out of the ear.

333
00:29:05.590 --> 00:29:10.582


334
00:29:10.602 --> 00:29:16.584
And by the way, if one ear passes the first screening, and the other doesn't.

335
00:29:16.604 --> 00:29:22.574
You don't need to re-screen the ear that passed again. Just focus now on the one that didn't already pass. That first one met the past criteria.

336
00:29:22.594 --> 00:29:27.586


337
00:29:27.606 --> 00:29:33.576
If the ear then passes that second screening. This screening is then considered complete for that ear.

338
00:29:33.596 --> 00:29:36.588


339
00:29:36.608 --> 00:29:42.578
If, however, the ear still doesn't pass the screening. Now, it's not passed twice.

340
00:29:42.598 --> 00:29:44.589


341
00:29:44.609 --> 00:29:49.591
This is the point at which further evaluation is needed.

342
00:29:49.611 --> 00:29:54.592
We expect from our data, at least for those younger children.

343
00:29:54.612 --> 00:30:00.582
It goes down to about 8%. that still don't pass the second screening.

344
00:30:00.602 --> 00:30:01.593


345
00:30:01.613 --> 00:30:07.583
And those are the ones that will need to have their ears evaluated by a healthcare provider using a method called tympanometry.

346
00:30:07.603 --> 00:30:10.595


347
00:30:10.615 --> 00:30:15.596
or pneumatic otoscopy.

348
00:30:15.616 --> 00:30:21.597
Yeah, this is such a key thing. You've gone from 20% to 25% down to 8%, so.

349
00:30:21.617 --> 00:30:27.598
8 out of 100 children or fewer will be the ones that, um, that we refer.

350
00:30:27.618 --> 00:30:32.599
And, um, you know, it's not uncommon that a wax blockage.

351
00:30:32.619 --> 00:30:38.589
or fluid or inflammation in the middle ear, was what prevented the screening of the inner ear from being completed, and that could have caused that non-passing result.

352
00:30:38.609 --> 00:30:42.602


353
00:30:42.622 --> 00:30:43.602
You know, Terry, let me just introduce something. What. You just said something really important.

354
00:30:43.622 --> 00:30:48.603
So, oh, go ahead.

355
00:30:48.623 --> 00:30:54.604
It's that that fluid, or the wax blockage, prevented the screening.

356
00:30:54.624 --> 00:31:00.594
of the inner ear from being completed. Which is the focus, the target of what we are screening.

357
00:31:00.614 --> 00:31:08.607


358
00:31:08.627 --> 00:31:09.607
Exactly.

359
00:31:09.627 --> 00:31:15.597
In hearing screening. It's the inner ear. So if there's something that is in the way of screening the inner ear, we've got to first get that addressed so that we can really do the screening.

360
00:31:15.617 --> 00:31:17.609


361
00:31:17.629 --> 00:31:22.610
of the target area, which is that inner ear.

362
00:31:22.630 --> 00:31:28.600
Yeah, exactly. That's the target. So now, at this point, then, you're going to want to intensify your monitoring of the child's follow-up. So.

363
00:31:28.620 --> 00:31:31.612


364
00:31:31.632 --> 00:31:37.602
They've referred twice, we've referred them on, and so now we want to consult with that healthcare provider to find out the results of the middle ear evaluation and any treatment that's being provided.

365
00:31:37.622 --> 00:31:42.614


366
00:31:42.634 --> 00:31:48.615
So always document the results of the middle air evaluation. And keep in mind that since the ear.

367
00:31:48.635 --> 00:31:54.605
actually hasn't yet passed the screening, because we're wanting to know if the inner ear of the cochlea is functioning properly. Um, that hasn't been done. Most healthcare providers do not have hearing screening equipment, and therefore cannot complete that screening process.

368
00:31:54.625 --> 00:32:04.619


369
00:32:04.639 --> 00:32:09.620
So we'll need to confer with a healthcare provider about when that ear should be rescreened.

370
00:32:09.640 --> 00:32:15.621
This right here is probably from our experience and data collection.

371
00:32:15.641 --> 00:32:21.611
The single most significant breakdown in the follow-up process, where a referral to a healthcare provider is made.

372
00:32:21.631 --> 00:32:23.622


373
00:32:23.642 --> 00:32:27.623
And there's a mistaken assumption.

374
00:32:27.643 --> 00:32:32.624
that this child has now been passed on to the healthcare provider,

375
00:32:32.644 --> 00:32:38.626
to complete the whole screening process. But they're really not going to complete it in most cases.

376
00:32:38.646 --> 00:32:43.627
like Terry just said, they don't do hearing screening usually.

377
00:32:43.647 --> 00:32:49.628
in healthcare providers' offices. So that's why, after the screening,

378
00:32:49.648 --> 00:32:52.628
After the middle ear consultation,

379
00:32:52.648 --> 00:32:54.629
We need to do the re-screen.

380
00:32:54.649 --> 00:33:00.630
But keep in mind, you know, I know this sounds like, wow, I'm screening, and then I'm screening again.

381
00:33:00.650 --> 00:33:06.631
This is only a small fraction of the total number of children you're screening, so…

382
00:33:06.651 --> 00:33:12.621
Even in the younger population, which has the highest rates of referral, we're talking about

383
00:33:12.641 --> 00:33:13.633


384
00:33:13.653 --> 00:33:15.633
Around 8 out of a…

385
00:33:15.653 --> 00:33:21.623
100 children who will need these follow-up steps, but these are essential steps, so you

386
00:33:21.643 --> 00:33:24.635


387
00:33:24.655 --> 00:33:29.636
rescreen them after they've been to the healthcare provider.

388
00:33:29.656 --> 00:33:34.637
And what would you suspect happens at this point?

389
00:33:34.657 --> 00:33:38.638
they pass. Most of them will pass at this point.

390
00:33:38.658 --> 00:33:43.639
The most common reason for a child to not pass those two times before?

391
00:33:43.659 --> 00:33:46.640
was because they, in fact, did have

392
00:33:46.660 --> 00:33:52.630
a middle ear condition. But we haven't really screened that inner ear until this point.

393
00:33:52.650 --> 00:33:54.641


394
00:33:54.661 --> 00:33:57.642
And now, you know, so if they pass,

395
00:33:57.662 --> 00:34:01.643
they're complete. But if they don't pass…

396
00:34:01.663 --> 00:34:04.643
After all of these steps,

397
00:34:04.663 --> 00:34:10.633
This is when the child should be referred to a pediatric audiologist for an evaluation. And it's really important that when you make that referral to the healthcare provider,

398
00:34:10.653 --> 00:34:16.646


399
00:34:16.666 --> 00:34:18.646
for that middle ear consultation.

400
00:34:18.666 --> 00:34:24.636
that you inform them of your protocol, and that you are going to rescreen them.

401
00:34:24.656 --> 00:34:25.648


402
00:34:25.668 --> 00:34:28.648
After you get medical clearance from them,

403
00:34:28.668 --> 00:34:34.638
And that you may, in fact, need a referral from them for an audiologist. We have a letter on our website that explains, um, to the healthcare provider your protocol.

404
00:34:34.658 --> 00:34:40.651


405
00:34:40.671 --> 00:34:45.652
So, Terry, wrap this up in a bow here.

406
00:34:45.672 --> 00:34:51.642
Yeah, yeah, so really, if the air still does not pass, that child needs to be referred to a pediatric audiologist for evaluation. And again, this is when our level of concern is heightened, because now they've repeatedly not passed, and we really don't think there's a middle ear condition now.

407
00:34:51.662 --> 00:35:02.655


408
00:35:02.675 --> 00:35:08.645
To explain why that child's not passing, like William said, because that's what typically gets addressed or ruled out by that middle ear consultation.

409
00:35:08.665 --> 00:35:10.657


410
00:35:10.677 --> 00:35:16.647
it's really less than 1% who will typically go this far in your protocol follow-up and be referred to an audiologist.

411
00:35:16.667 --> 00:35:19.659


412
00:35:19.679 --> 00:35:23.660
But what an important one percent that is.

413
00:35:23.680 --> 00:35:29.650
When you make, again, when you make that initial referral for the healthcare provider, uh, for the middle-year evaluation,

414
00:35:29.670 --> 00:35:31.661


415
00:35:31.681 --> 00:35:37.651
convey to them what will be a potential follow-up to this, which is your rescreening,

416
00:35:37.671 --> 00:35:40.663


417
00:35:40.683 --> 00:35:46.653
And the need for a referral if they still don't pass. So, we'll show you when we look at our website where to find those letters to help you with this, um,

418
00:35:46.673 --> 00:35:50.665


419
00:35:50.685 --> 00:35:53.666
part of the follow-up process. So,

420
00:35:53.686 --> 00:35:59.656
That gives you an overview of the complete screening and follow-up protocol from start to completion.

421
00:35:59.676 --> 00:36:02.668


422
00:36:02.688 --> 00:36:08.658
Keeping in mind that overriding rule that the screening and follow-up process is complete,

423
00:36:08.678 --> 00:36:09.669


424
00:36:09.689 --> 00:36:12.670
When either A

425
00:36:12.690 --> 00:36:15.671
The child passes the screening on both ears,

426
00:36:15.691 --> 00:36:18.671
That's pretty obvious. Or B…

427
00:36:18.691 --> 00:36:24.661
The child receives an evaluation from an audiologist, and you've gotten the results.

428
00:36:24.681 --> 00:36:25.673


429
00:36:25.693 --> 00:36:31.663
And any other referral along the way is just simply a little detour, but it's not the end destination. Remember,

430
00:36:31.683 --> 00:36:34.675


431
00:36:34.695 --> 00:36:40.665
Although screening can lead to the identification of the most common types of permanent hearing loss.

432
00:36:40.685 --> 00:36:42.676


433
00:36:42.696 --> 00:36:47.677
What we're doing here is only a screening.

434
00:36:47.697 --> 00:36:53.667
Anytime a parent, caregiver, or a teacher, or even yourself,

435
00:36:53.687 --> 00:36:55.679


436
00:36:55.699 --> 00:36:58.680
has a concern about a child's hearing,

437
00:36:58.700 --> 00:37:04.681
or language development, even if the child passes the screening,

438
00:37:04.701 --> 00:37:09.682
A referral for an audiological evaluation is warranted.

439
00:37:09.702 --> 00:37:14.683
So I really want to make that clear.

440
00:37:14.703 --> 00:37:20.673
We know that a number of you have had questions about how to move this process along once referrals are made.

441
00:37:20.693 --> 00:37:24.685


442
00:37:24.705 --> 00:37:30.675
You've asked both about how to support parents in the follow-up, as well as what to do when healthcare providers don't

443
00:37:30.695 --> 00:37:33.687


444
00:37:33.707 --> 00:37:35.687
appear to support,

445
00:37:35.707 --> 00:37:40.688
the ongoing follow-up steps. Terry, you have…

446
00:37:40.708 --> 00:37:45.689
decades of experience dealing with this.

447
00:37:45.709 --> 00:37:49.690
You want to take a minute or two and talk about, first,

448
00:37:49.710 --> 00:37:52.691
How to encourage parents about the…

449
00:37:52.711 --> 00:37:58.681
importance of follow-up, and then what else we can do to make sure that healthcare providers…

450
00:37:58.701 --> 00:37:59.692


451
00:37:59.712 --> 00:38:02.693
are aligned with our…

452
00:38:02.713 --> 00:38:07.694
hearing screening and follow-up efforts and protocol?

453
00:38:07.714 --> 00:38:13.684
Yeah, thank you, William. You know, one of the things that's been most helpful is, you know, really helping parents to understand how hearing is really similar to other other disorders, and especially with vision.

454
00:38:13.704 --> 00:38:23.697


455
00:38:23.717 --> 00:38:29.687
Because hearing can be not only the invisible condition that William talked about, but it can be kind of tricking because it's very much like vision. Rarely are children completely deaf or completely blind, but there's a range.

456
00:38:29.707 --> 00:38:42.701


457
00:38:42.721 --> 00:38:48.691
of hearing ability, just like a range of ability to see. And when we talk about the importance of.

458
00:38:48.711 --> 00:38:52.703


459
00:38:52.723 --> 00:38:58.693
communication development, as well as academic achievement, the ability to hear across the frequency range, all of the sounds from lows to highs is important. It's important for speech development and for academic performance, just the same way as vision is. So we often walk them right through that process. We'll give them some.

460
00:38:58.713 --> 00:39:17.708


461
00:39:17.728 --> 00:39:23.698
examples of how sounds are hard to hear with background noise for kids that are hearing impaired, just like certain things are not clearly in focus for vision.

462
00:39:23.718 --> 00:39:29.711


463
00:39:29.731 --> 00:39:31.711
And what about… Terry, you're gonna say this, but what about, like, just how…

464
00:39:31.731 --> 00:39:35.712
The other thing… oh, go ahead.

465
00:39:35.732 --> 00:39:41.702
Easily, children can kind of fool us, because they might be following the examples of their peers that makes it look like they've heard the instruction that was just given.

466
00:39:41.722 --> 00:39:49.715


467
00:39:49.735 --> 00:39:51.715
But they're really just…

468
00:39:51.735 --> 00:39:53.716
following the leader, if you will,

469
00:39:53.736 --> 00:39:55.716
And…

470
00:39:55.736 --> 00:40:01.706
They get very skilled at reading context and using contextual cues. Sometimes I have used something where some kind of the old typewriter.

471
00:40:01.726 --> 00:40:10.719


472
00:40:10.739 --> 00:40:16.709
test where you have some letters that don't work, and when you read them, most of us are able to fill in and guess or figure out what the word is. It's kind of similar with sound. They can get the contextual cues.

473
00:40:16.729 --> 00:40:26.723


474
00:40:26.743 --> 00:40:32.713
Of the conversation. They may not hear the word clearly, but they guess and try to, um… fill that information in, but it's taxing and takes a toll, and it's not always accurate for them. And so… but there are ways that we try to help educate parents to understand the impact of the hearing loss.

475
00:40:32.733 --> 00:40:49.727


476
00:40:49.747 --> 00:40:55.717
And that, um, can help motivate them for follow-up. We also try to make the referral process as easy as we can, and part of that is the relationships that we build with other providers to.

477
00:40:55.737 --> 00:41:04.731


478
00:41:04.751 --> 00:41:10.721
make an easy handoff for that. And so, we sure appreciate all the efforts that, um, you put into follow-up with each of these kids.

479
00:41:10.741 --> 00:41:11.732


480
00:41:11.752 --> 00:41:16.733
You know, another really important concern that…

481
00:41:16.753 --> 00:41:19.734
warrants a thorough…

482
00:41:19.754 --> 00:41:22.734
conversation has to do with…

483
00:41:22.754 --> 00:41:24.735
The tendency that…

484
00:41:24.755 --> 00:41:27.735
I think a lot of folks can make,

485
00:41:27.755 --> 00:41:33.725
To assume that, certainly, somewhere along the way, somebody would have already identified a hearing loss, particularly, like, if a child was already getting speech therapy?

486
00:41:33.745 --> 00:41:40.738


487
00:41:40.758 --> 00:41:42.738
Certainly, somebody has…

488
00:41:42.758 --> 00:41:45.739
evaluated their hearing. Now,

489
00:41:45.759 --> 00:41:50.740
That's a fair enough assumption, but it's not a good assumption.

490
00:41:50.760 --> 00:41:56.741
In that, not all children who are getting speech therapy have, in fact,

491
00:41:56.761 --> 00:42:00.742
had their hearing evaluated. So,

492
00:42:00.762 --> 00:42:05.743
When you find yourself, or you hear somebody making an assumption,

493
00:42:05.763 --> 00:42:07.744
that hearing had been evaluated,

494
00:42:07.764 --> 00:42:11.744
Dig into that, find out, well, where are the results?

495
00:42:11.764 --> 00:42:17.746
I want to see those results. Is it one of these evidence-based methods? Did follow-up

496
00:42:17.766 --> 00:42:21.747
And a complete evaluation occur,

497
00:42:21.767 --> 00:42:23.747
If the child didn't pass,

498
00:42:23.767 --> 00:42:26.748
We found, early on,

499
00:42:26.768 --> 00:42:29.748
In our work with Head Start,

500
00:42:29.768 --> 00:42:33.749
And this is not an indictment of Head Start at all.

501
00:42:33.769 --> 00:42:39.750
Awesome. But there were a number of children who were receiving early intervention,

502
00:42:39.770 --> 00:42:45.740
Speech and language-related intervention and therapies that had not had their hearing evaluated.

503
00:42:45.760 --> 00:42:47.752


504
00:42:47.772 --> 00:42:52.753
And so assumptions were made that that was, in fact, done when it wasn't.

505
00:42:52.773 --> 00:42:58.743
or the assumption that it was happening as a part of well-child visits with healthcare provider.

506
00:42:58.763 --> 00:42:59.754


507
00:42:59.774 --> 00:43:05.756
healthcare providers, and it didn't happen there either. It rarely does. So…

508
00:43:05.776 --> 00:43:10.757
Really, you know, engaging the family in those assumptions and saying,

509
00:43:10.777 --> 00:43:16.747
Let's just be sure, and let's not assume that there isn't a mild or moderate hearing loss that may

510
00:43:16.767 --> 00:43:19.759


511
00:43:19.779 --> 00:43:25.749
help to… if we help to explain any of the challenges a child may be having,

512
00:43:25.769 --> 00:43:27.760


513
00:43:27.780 --> 00:43:33.750
or may start to have in the future. So, those are some initial thoughts about how to…

514
00:43:33.770 --> 00:43:34.762


515
00:43:34.782 --> 00:43:40.752
improve the follow-up process. So, let's take a look at our website, because I've referred to some resources for you. And so this is kidshearing.org, and if you look in this first group of resources that are called

516
00:43:40.772 --> 00:43:50.765


517
00:43:50.785 --> 00:43:56.755
planning resources, you'll find information first under that header, Big Picture Resources. You'll find some of this information that will help

518
00:43:56.775 --> 00:44:01.767


519
00:44:01.787 --> 00:44:07.757
Um, communicate to families what you're doing, to your colleagues, um, explaining why hearing screening is really central to achieving the mission of schools, and…

520
00:44:07.777 --> 00:44:14.770


521
00:44:14.790 --> 00:44:20.760
Early childhood development, um, you'll… you'll see that second bullet, find an audiologist. That's where you can go to find some directories of local pediatric audiologists. Underneath that, information about screening equipment.

522
00:44:20.780 --> 00:44:31.774


523
00:44:31.794 --> 00:44:36.775
So you can look, um, for that. In the next group,

524
00:44:36.795 --> 00:44:40.775
If you or any of your colleagues are needing

525
00:44:40.795 --> 00:44:46.777
Real thorough, standardized training in either OAE or Pure Tone.

526
00:44:46.797 --> 00:44:52.767
Um, audiometry screening. It's available right there, and you can do it whenever you need it. Everybody will get exactly the same training.

527
00:44:52.787 --> 00:44:57.779


528
00:44:57.799 --> 00:45:03.769
Um, and if you're looking for CE credits, continuing education credits, those are now available through, um, those online training courses as well.

529
00:45:03.789 --> 00:45:10.782


530
00:45:10.802 --> 00:45:16.772
Then, screening resources. Lots of practical tools here about how to get ready to screen, checklists, a review of the protocol that we just went over,

531
00:45:16.792 --> 00:45:22.784


532
00:45:22.804 --> 00:45:28.774
um, documentation forms that we'll be showing you in a minute here are available there. Um, letters to send to parents or to healthcare providers

533
00:45:28.794 --> 00:45:33.786


534
00:45:33.806 --> 00:45:39.776
are beneath that, and then, um, whoops, and then, uh, follow-up resources, including a tracking tool to stay on top of

535
00:45:39.796 --> 00:45:43.788


536
00:45:43.808 --> 00:45:48.790
on the status of each child's follow-up steps. So,

537
00:45:48.810 --> 00:45:53.791
As I said at the beginning, have a look at kidshearing.org and the

538
00:45:53.811 --> 00:45:57.791
resources that are available there.

539
00:45:57.811 --> 00:46:03.781
almost every resource you see there was developed in collaboration, or maybe even primarily, by people just like yourselves, who shared them with us.

540
00:46:03.801 --> 00:46:08.794


541
00:46:08.814 --> 00:46:14.784
And we tried to format them in ways that, um, others could pick up, adapt, and use as well. So, have a good look at those things.

542
00:46:14.804 --> 00:46:19.796


543
00:46:19.816 --> 00:46:25.786
Okay, so we appreciated a lot of various questions that we received from you in advance.

544
00:46:25.806 --> 00:46:28.798


545
00:46:28.818 --> 00:46:34.788
asking us, could you just go over the screening methods again, walk us through the screening processes,

546
00:46:34.808 --> 00:46:37.800


547
00:46:37.820 --> 00:46:43.801
and the documentation of results, just so that we're sure we're really abiding by what is

548
00:46:43.821 --> 00:46:48.802
recommended evidence-based practices.

549
00:46:48.822 --> 00:46:52.803
I'm going to take a little sip of water here.

550
00:46:52.823 --> 00:46:58.793
excuse me, okay. So, let's start with Pure Tone Audiometry, keeping in mind that while the two methods, pure tone and OAE, are different,

551
00:46:58.813 --> 00:47:02.805


552
00:47:02.825 --> 00:47:08.795
They follow many of the same steps, and they do that because they're following the same overall protocol.

553
00:47:08.815 --> 00:47:12.807


554
00:47:12.827 --> 00:47:18.797
So, as I just showed you, there are a number of tools on our website for our screening efforts. So, for each method, we have a screening skills checklist, which is on that tracking tools, um,

555
00:47:18.817 --> 00:47:28.810


556
00:47:28.830 --> 00:47:31.811
Here, I'll go back and show you where that is.

557
00:47:31.831 --> 00:47:37.812
I kind of skimmed past it.

558
00:47:37.832 --> 00:47:43.813
Where are we here? Yeah, at the bottom there. OAE screening skills checklist.

559
00:47:43.833 --> 00:47:48.814
Um, that's where you'll see the OAE and Pure Tone Checklists.

560
00:47:48.834 --> 00:47:53.815
that are really helpful in making sure that you've adhered to them. So,

561
00:47:53.835 --> 00:47:57.816
Um…

562
00:47:57.836 --> 00:48:03.806
This is what the checklist looks like, and it helps with a step-by-step guide for conducting any screening on a child.

563
00:48:03.826 --> 00:48:07.818


564
00:48:07.838 --> 00:48:13.808
And not only can it be useful in reviewing as you prepare and complete a screening, it can also be used for monitoring the quality of your screening. If you need to evaluate the quality of yours or someone else's screening practice.

565
00:48:13.828 --> 00:48:23.822


566
00:48:23.842 --> 00:48:29.812
So, this checklist can be a helpful tool. Now, keep in mind that we also have documentation forms that directly correspond with the recommended screening and follow-up protocol. And these are the forms that you see right here for the pure tone method,

567
00:48:29.832 --> 00:48:42.826


568
00:48:42.846 --> 00:48:48.816
In which, after recording the identification information of the child being screened, you document the screening results of the first screening.

569
00:48:48.836 --> 00:48:55.828


570
00:48:55.848 --> 00:49:01.818
In most cases, children will pass on both ears at the first screening,

571
00:49:01.838 --> 00:49:02.830


572
00:49:02.850 --> 00:49:08.820
This first portion of the form is all you'll need to use in those cases. But in cases where the child doesn't pass on one or both ears, the form includes fields to record subsequent results.

573
00:49:08.840 --> 00:49:17.833


574
00:49:17.853 --> 00:49:21.834
And we also have a second form,

575
00:49:21.854 --> 00:49:27.824
Um, which is when the child is referred for a middle ear consultation and subsequent steps in the protocol. Together, these two forms include space to indicate the results

576
00:49:27.844 --> 00:49:34.836


577
00:49:34.856 --> 00:49:38.837
for completing the entire possible protocol

578
00:49:38.857 --> 00:49:40.838
for a given child.

579
00:49:40.858 --> 00:49:44.839
Having good documentation like this

580
00:49:44.859 --> 00:49:48.839
is really useful in knowing where a child is,

581
00:49:48.859 --> 00:49:50.840
In the follow-up process,

582
00:49:50.860 --> 00:49:56.830
As well as for overall program fidelity. If you were to show any reviewer of your screening practices,

583
00:49:56.850 --> 00:49:58.841


584
00:49:58.861 --> 00:50:01.842
This documentation strategy.

585
00:50:01.862 --> 00:50:04.843
It would really, um…

586
00:50:04.863 --> 00:50:10.833
show them that you are implementing evidence-based practice. So let me walk you through how you might put these

587
00:50:10.853 --> 00:50:11.844


588
00:50:11.864 --> 00:50:13.845
to use.

589
00:50:13.865 --> 00:50:19.835
So, as you prepare to screen, the screening skills checklist reminds you of the steps for

590
00:50:19.855 --> 00:50:21.846


591
00:50:21.866 --> 00:50:27.836
Um, your complete screening process, from setting up the environment, the whole process, the listening check,

592
00:50:27.856 --> 00:50:30.848


593
00:50:30.868 --> 00:50:33.849
All of it is right there.

594
00:50:33.869 --> 00:50:35.849
So,

595
00:50:35.869 --> 00:50:41.850
The first step for any screening is to document

596
00:50:41.870 --> 00:50:43.851
who you're screening.

597
00:50:43.871 --> 00:50:49.841
And then to do a visual inspection of the ear. Terry, what are we looking for in a visual inspection of the ear that might tell us whether to continue or not?

598
00:50:49.861 --> 00:51:00.854


599
00:51:00.874 --> 00:51:06.844
Yeah, what we're wanting to do is to take a look at the air to make sure that there's no visible sign of infection or blockage. You know, anything that would indicate that we don't want to proceed with the hearing screening, then if the ear appears normal, which will be most of the time, then we'll proceed with the next step.

600
00:51:06.864 --> 00:51:19.858


601
00:51:19.878 --> 00:51:25.848
Now, that next step is to prepare the child for screening by doing what we call conditioning the child. And this means teaching the child the process

602
00:51:25.868 --> 00:51:29.860


603
00:51:29.880 --> 00:51:32.861
Whereby the, um…

604
00:51:32.881 --> 00:51:38.862
Child learns the behavioral response each time they hear a sound.

605
00:51:38.882 --> 00:51:44.852
Yeah, exactly. This is where you, as the screener, instruct or condition, as William said, the child in how to listen for a tone, and then respond. They respond by raising a hand or placing a toy in a bucket. You do this by presenting tones at the 60 and then the 40 decibel levels.

606
00:51:44.872 --> 00:51:59.867


607
00:51:59.887 --> 00:52:05.857
And while you're conditioning the child, you're usually facing them, making sure that you're carefully assessing whether they're understanding your instructions or not. And when you think that they understand, then you turn them around so they can no longer see you to see if they continue to respond just like you instructed. Once you've observed that the child reliably responds to the sounds that are presented, just like.

608
00:52:05.877 --> 00:52:24.872


609
00:52:24.892 --> 00:52:26.872
you instructed them, that's when the actual screening can get started.

610
00:52:26.892 --> 00:52:32.862
So, let me interject, Terry. We have received some questions about how long should that conditioning process take?

611
00:52:32.882 --> 00:52:36.874


612
00:52:36.894 --> 00:52:42.864
Yeah, let me answer that. The conditioning process, that conditioning should not take much more than 5 minutes, hopefully less. Children who are going to be successfully screened using this pure tone method, they ought to be able to be screened in 10 to 15 minutes max, including that conditioning step that we just talked about. If you can't condition a child in 5 minutes or less.

613
00:52:42.884 --> 00:52:58.879


614
00:52:58.899 --> 00:53:04.869
Then we need to consider using your backup plan, which is either to do the OAE, hopefully right then while you have the child there. You could also try on another day, if you have the flexibility to do that. Just remember, um, that if you can't screen the child.

615
00:53:04.889 --> 00:53:14.882


616
00:53:14.902 --> 00:53:20.872
You'll need to either do an OAE or refer the child as someone who will be able to successfully screen them, which in most cases will be a pediatric audiologist. And then, as I mentioned earlier in our discussion, just remember that some children who have hearing loss.

617
00:53:20.892 --> 00:53:31.886


618
00:53:31.906 --> 00:53:37.876
could be the very ones who are most difficult to condition to do the screening. So, one way or another, we want to get every child screened. I know we've said it over and over, but it's just not acceptable to conclude that if a child can't be screened, we'll just wait till next year. Again, these might be the very kids that have hearing loss.

619
00:53:37.896 --> 00:53:54.890


620
00:53:54.910 --> 00:54:00.880
Okay, so then, during this screening process, this listen and respond game is repeated at least twice at three different pitches on each ear, noting the child's response or their lack of response after each tone is presented.

621
00:54:00.900 --> 00:54:09.894


622
00:54:09.914 --> 00:54:15.884
If the child responds appropriately and consistently to the range of tones presented each year, the child passes the screening.

623
00:54:15.904 --> 00:54:18.895


624
00:54:18.915 --> 00:54:24.885
Now, assuming that the child is successfully conditioned, they understand the task, the screening process begins. Note that the form here provides space to record the results for each ear.

625
00:54:24.905 --> 00:54:32.898


626
00:54:32.918 --> 00:54:38.888
Begin with the right ear by repeating the conditioning tone one more time, and noting that the child responded as desired.

627
00:54:38.908 --> 00:54:41.900


628
00:54:41.920 --> 00:54:47.890
Now, the actual screening then starts up to 4 presentations of the tone can be made for each frequency level, starting at 2000, then 4000, and finally 1000Hz.

629
00:54:47.910 --> 00:54:55.903


630
00:54:55.923 --> 00:55:01.893
Two responses are needed for the ear to pass for a given tone. Once you've completed the presentations across all three frequency levels, then the form will remind you how to determine if the child passes for that ear.

631
00:55:01.913 --> 00:55:11.906


632
00:55:11.926 --> 00:55:17.896
The child needs to have at least 2 successful responses out of no more than 4 attempts at each frequency level in order to have an overall ear pass. Once that's recorded, then the left ear is screened in the same way.

633
00:55:17.916 --> 00:55:26.909


634
00:55:26.929 --> 00:55:32.899
Recording each presentation result as you go. Now, if the child responds at at least 2 times at each frequency level on both ears, they pass the screening. Sometimes you'll have an ear or even both ears, though, that don't meet the criteria for passing.

635
00:55:32.919 --> 00:55:42.913


636
00:55:42.933 --> 00:55:45.913
Like we see in this example here for the right ear.

637
00:55:45.933 --> 00:55:51.903
That little red box. See how the child only responded successfully? 1 out of four attempts at the 2,000 Hertz level. If one or more ears do not meet that pass criteria, such as you see here, then a second screening of a previously non-passing air is conducted.

638
00:55:51.923 --> 00:56:04.917


639
00:56:04.937 --> 00:56:09.918
Just like with OAE, in approximately 2 weeks, like the form indicates.

640
00:56:09.938 --> 00:56:15.908
You'll do a second screening two weeks later on the ear or ears that didn't pass that first time.

641
00:56:15.928 --> 00:56:18.920


642
00:56:18.940 --> 00:56:23.921
In this case, you'll only need to re-screen the right ear,

643
00:56:23.941 --> 00:56:29.911
If the child passes at this point, the screening is complete, because you've re… you've received passing results.

644
00:56:29.931 --> 00:56:31.923


645
00:56:31.943 --> 00:56:35.924
on both ears, across your two screening sessions.

646
00:56:35.944 --> 00:56:41.914
But if that previously non-passing ear still doesn't pass, as we see here,

647
00:56:41.934 --> 00:56:43.925


648
00:56:43.945 --> 00:56:49.915
then you'll need to have, uh, you'll need to record that, and the form points you to the next step, which is a middle ear consultation from the healthcare provider. And that's what this form is for here.

649
00:56:49.935 --> 00:56:59.929


650
00:56:59.949 --> 00:57:05.919
Yes, yeah, for any child that's referred for a middle ear consultation from a healthcare provider, you'll want to use this diagnostic follow-up form, on which you'll now document the remaining steps in this child's screening and diagnostic process, starting with the results of the middle ear consultation.

651
00:57:05.939 --> 00:57:17.933


652
00:57:17.953 --> 00:57:23.923
Since the child was referred to the healthcare provider to see if there's any middle ear health-related problem that may have prevented the child from passing the screening on either ear during your first 2 screening sessions, you're going to want to find out what the results of this consultation are and record them here.

653
00:57:23.943 --> 00:57:37.937


654
00:57:37.957 --> 00:57:43.927
Then, once the healthcare provider indicates that the ears are healthy and clear, that's when we'll re-screen the child's ear or their ears that have not yet passed.

655
00:57:43.947 --> 00:57:48.939


656
00:57:48.959 --> 00:57:54.929
So all children that have been referred for middle ear evaluation must receive the rescreen on any ear that did not previously pass. And then we'll document the rescreening results back on the screening form that we started with.

657
00:57:54.949 --> 00:58:04.942


658
00:58:04.962 --> 00:58:08.943
If the air passes now, then the screening is complete.

659
00:58:08.963 --> 00:58:14.933
If at this point there's still an air that is not yet passed, that's when the child is referred for a complete audiological evaluation.

660
00:58:14.953 --> 00:58:16.945


661
00:58:16.965 --> 00:58:22.935
And this is where we'll want to support the family in completing this important step, and be sure to get the results and document them on this form.

662
00:58:22.955 --> 00:58:25.947


663
00:58:25.967 --> 00:58:31.937
We'll also want to collect any supporting additional supporting documentation from that audiological evaluation, especially if a permanent hearing loss is identified. And in most cases, this will include additional referrals for intervention services that you'll want to be aware of and that so that you can help support the family in obtaining those services.

664
00:58:31.957 --> 00:58:48.951


665
00:58:48.971 --> 00:58:54.953
Upon getting all of the results, that's when we'll consider the child's screening and follow-up process complete.

666
00:58:54.973 --> 00:58:56.953
So, that gives you an overview.

667
00:58:56.973 --> 00:59:02.943
of the complete screening and follow-up protocol from start to completion, keeping in mind the overriding rule.

668
00:59:02.963 --> 00:59:05.955


669
00:59:05.975 --> 00:59:11.945
that the screening and follow-up process is complete. When the child passes the screening on both ears,

670
00:59:11.965 --> 00:59:12.956


671
00:59:12.976 --> 00:59:18.946
or the child receives an evaluation from an audiologist, and you've obtained those results.

672
00:59:18.966 --> 00:59:19.958


673
00:59:19.978 --> 00:59:25.948
And remember, although screening can lead to the identification of the most common types of

674
00:59:25.968 --> 00:59:26.959


675
00:59:26.979 --> 00:59:28.960
permanent hearing loss.

676
00:59:28.980 --> 00:59:32.961
It is, even with all of that, only a screening.

677
00:59:32.981 --> 00:59:38.951
So, anytime you, a parent, a caregiver, or a teacher, has concerns about a child's hearing,

678
00:59:38.971 --> 00:59:40.962


679
00:59:40.982 --> 00:59:42.963
or language development,

680
00:59:42.983 --> 00:59:47.964
referral to an audiological evaluation is warranted. Now,

681
00:59:47.984 --> 00:59:49.964
Just in presenting that,

682
00:59:49.984 --> 00:59:52.965
I know that was overwhelming. Remember,

683
00:59:52.985 --> 00:59:54.965
This webinar is being recorded, and you can go review that again.

684
00:59:54.985 --> 00:59:58.966
Yeah.

685
00:59:58.986 --> 01:00:00.966
It's also…

686
01:00:00.986 --> 01:00:02.967
reviewed in depth.

687
01:00:02.987 --> 01:00:06.968
In the courses that you can take online,

688
01:00:06.988 --> 01:00:10.968
As well as some of the other supportive

689
01:00:10.988 --> 01:00:16.970
resources that are on kidshearing.org. But those steps

690
01:00:16.990 --> 01:00:22.960
that are articulated in the use of that form that correspond directly to the recommended protocol.

691
01:00:22.980 --> 01:00:23.971


692
01:00:23.991 --> 01:00:29.961
really are what makes evidence-based practice evidence-based. It's not just using

693
01:00:29.981 --> 01:00:32.973


694
01:00:32.993 --> 01:00:35.974
the right equipment.

695
01:00:35.994 --> 01:00:41.964
So, that's the screening process there. Terry, I'm going to jump forward in the interest of time, to otoacoustic emission screening now.

696
01:00:41.984 --> 01:00:47.976


697
01:00:47.996 --> 01:00:53.966
And let's go through some of the information that we've gotten about that. And, you know,

698
01:00:53.986 --> 01:00:54.978


699
01:00:54.998 --> 01:01:00.968
It's precisely all of those manual steps that are required by pure tone screening.

700
01:01:00.988 --> 01:01:02.979


701
01:01:02.999 --> 01:01:08.969
that is driving why so many people are saying, can we just do OAE screening with all of the kids?

702
01:01:08.989 --> 01:01:10.981


703
01:01:11.001 --> 01:01:15.982
Because it isn't as complicated as what we just saw.

704
01:01:16.002 --> 01:01:21.972
So, let's shift gears over here and look at OAE screening, and remind us, Terry, how does the OAE screening process unfold?

705
01:01:21.992 --> 01:01:27.984


706
01:01:28.004 --> 01:01:33.974
Okay, so exactly the same way as we started with pure tone. To conduct an OAE screening, we're first going to take a thorough look at that outer part of the ear, again, to make sure that there's no visible sign of infection or blockage. Then, if the ear appears to be normal and healthy.

707
01:01:33.994 --> 01:01:43.988


708
01:01:44.008 --> 01:01:49.978
Then we're going to place a small probe in which we've put a disposable cover on. We're going to place that and insert that into the ear canal.

709
01:01:49.998 --> 01:01:55.990


710
01:01:56.010 --> 01:02:01.980
And then we push a button on our equipment. It's pushed to start the automated screening process. That probe, which sits independently in the ear, delivers a low-volume sound stimulus into the ear, and a cochlea, or that inner snail-shaped portion of the ear.

711
01:02:02.000 --> 01:02:12.994


712
01:02:13.014 --> 01:02:18.984
A cochlea that's functioning normally will respond to this sound by sending the signal to the brain, while also at the same time producing an acoustic emission. This emission is analyzed by the screening unit, and in approximately 30 seconds or so.

713
01:02:19.004 --> 01:02:29.997


714
01:02:30.017 --> 01:02:34.998
A result will appear as either a pass or a refer.

715
01:02:35.018 --> 01:02:39.999
And every normal, healthy inner ear produces an emission that can be recorded in this way.

716
01:02:40.019 --> 01:02:45.989
So, just like we showed you with pure tone screening, we have a screening skills checklist for OAE screening that can be used to make sure that you're going through all of the steps that are, um, required in order to be evidence-based

717
01:02:46.009 --> 01:02:57.003


718
01:02:57.023 --> 01:03:02.993
Now, one of the things to highlight is that in addition to these steps, you also want to make sure you have all of your supplies in advance. You want to be sure to test your equipment and, um, go through all of the items that are on this checklist. So,

719
01:03:03.013 --> 01:03:14.006


720
01:03:14.026 --> 01:03:19.996
Have a look at that as a sort of self-evaluation. Am I really following all of the steps required?

721
01:03:20.016 --> 01:03:24.008


722
01:03:24.028 --> 01:03:29.998
Now, Terry, some… some people have asked us how to prepare children for screening. Do you want to say a few words about that?

723
01:03:30.018 --> 01:03:35.011


724
01:03:35.031 --> 01:03:41.001
Yeah, really, our main recommendation up front is just to keep it fun, regardless of which method you're using. Um, there's a lot of little things, like, other than, like, rather than referring to the activity as a screening or a hearing test, we'll call it a listening game. And you can engage teachers or parents in some activities that include things like.

725
01:03:41.021 --> 01:03:55.015


726
01:03:55.035 --> 01:04:01.005
Maybe noticing the child's body parts, eyes, nose, ears, or we can expound on the idea of what animals have ears too.

727
01:04:01.025 --> 01:04:06.017


728
01:04:06.037 --> 01:04:07.017
Things like that.

729
01:04:07.037 --> 01:04:13.007
Yeah, we have a little video that you can find on our website that is fun for kids to see, um, so you might want to check that out. It's called Listen Up.

730
01:04:13.027 --> 01:04:15.019


731
01:04:15.039 --> 01:04:21.009
So, you see here our screening form that is also corresponds with, um, the

732
01:04:21.029 --> 01:04:23.021


733
01:04:23.041 --> 01:04:29.022
the, um, protocol, just like we have with, um,

734
01:04:29.042 --> 01:04:35.012
OAE screening with pure tone screening. Let's just take a quick look at that form. Um, these are much simpler to follow than the pure tone forms, because, frankly, the process is easier to follow, because it's automated, allowing you to just record the outcome for each screening. Now, these forms

735
01:04:35.032 --> 01:04:50.026


736
01:04:50.046 --> 01:04:56.016
correspond directly with the protocol. Um, you can record the results of the first screening.

737
01:04:56.036 --> 01:04:58.028


738
01:04:58.048 --> 01:05:03.029
And then if there's needed a second screening, if the child didn't pass the first time.

739
01:05:03.049 --> 01:05:08.030
And then if needed, if they still don't pass, you can record the results

740
01:05:08.050 --> 01:05:14.020
of the middle ear consultation, just like we saw with Pure Tone.

741
01:05:14.040 --> 01:05:15.032


742
01:05:15.052 --> 01:05:21.033
then a follow-up screening is done after the middle ear consultation.

743
01:05:21.053 --> 01:05:27.023
And if they don't pass and need to be screened, uh, and need to be referred to an audiologist, the results from the audiologist are reported there. So, on these two forms, again, you have all of the steps of the recommended protocol,

744
01:05:27.043 --> 01:05:40.037


745
01:05:40.057 --> 01:05:44.038
Um, documented.

746
01:05:44.058 --> 01:05:48.038
So, one of the things you'll notice…

747
01:05:48.058 --> 01:05:54.028
is that OAE screening can be conducted in a wide variety of environments.

748
01:05:54.048 --> 01:05:56.040


749
01:05:56.060 --> 01:06:02.030
As you see here, you know, it can be done. You don't have to be pulling children into unusual places that they don't normally spend time. You can go to where they are, and um…

750
01:06:02.050 --> 01:06:09.043


751
01:06:09.063 --> 01:06:13.044
And so, we hope that you're aware that

752
01:06:13.064 --> 01:06:19.045
you could… you know, any decent piece of OAE equipment will allow you to screen.

753
01:06:19.065 --> 01:06:23.046
in these kinds of settings.

754
01:06:23.066 --> 01:06:29.036
Yeah, I just love all these pictures. These are real experiences that we've had with these screeners and have taken these pictures. In fact, you know, the screening works best when children are familiar and they're comfortable with the adult that's doing the screening.

755
01:06:29.056 --> 01:06:39.049


756
01:06:39.069 --> 01:06:45.039
And where they can play with a toy, they can be held, or even sleep while the screening is being conducted. So we have a lot of options to work with. Now, some equipment is more effective than others when attempting to screen in these natural environments, but most of them can work just fine under these conditions.

757
01:06:45.059 --> 01:06:57.053


758
01:06:57.073 --> 01:07:02.054
There are several keys to successful screening, though, to keep in mind.

759
01:07:02.074 --> 01:07:08.044
Um, and these four right here are really important. We need to get a good probe fit in the ear. We want to minimize movement, the child's movement, and we want to minimize internal noise as well as the external noise in the nearby environment.

760
01:07:08.064 --> 01:07:17.057


761
01:07:17.077 --> 01:07:23.047
You know, Terry, a number of people have asked us about the various error messages they get on their OAE devices, and

762
01:07:23.067 --> 01:07:27.059


763
01:07:27.079 --> 01:07:33.049
what to do, and do they do something different depending on which error message they get? It really is just comes back to these four keys, right?

764
01:07:33.069 --> 01:07:39.061


765
01:07:39.081 --> 01:07:45.051
Absolutely. In fact, you know, the error messages can vary in what they say, but what we do to get to, um… have better success screening are these four things, no matter what the error message says. So, um, if you don't get a passing result, um, we're gonna… we're gonna try these things. We're gonna try to reposition the probe. We're gonna try to…

766
01:07:45.071 --> 01:08:05.067


767
01:08:05.087 --> 01:08:11.057
screen in a quieter environment, reduce that external noise. You want to check your probe, look at it. Did we, by putting it in the air, did we pull out some wax and we need to clean the probe, or replace it with a new cover? Internal noise really refers to quieting and reducing the movement of the child itself.

768
01:08:11.077 --> 01:08:25.071


769
01:08:25.091 --> 01:08:31.061
Um, and we can do that by trying to use unique and quiet toys to distract the child. Um, we… it's always helpful if we can elicit the help of another adult or screener.

770
01:08:31.081 --> 01:08:37.073


771
01:08:37.093 --> 01:08:43.063
Now, with probe placement, the goal for proper probe placement is that we have a really snug fit. Um, what that does is it seals out all of the background noise from the environment, but what that means is that we need to select as large a possible probe cover.

772
01:08:43.083 --> 01:08:57.078


773
01:08:57.098 --> 01:09:03.068
So that when we insert that probe into the child's ear, you can totally let go of it. It should be self-seeding and stay in place. In fact, you need to let go of it, because if you hold onto it, your touch can loosen it as they move, it can allow more noise to get in, and it can disrupt the screening process. They're actually designed that we don't hold them in the ear.

774
01:09:03.088 --> 01:09:19.082


775
01:09:19.102 --> 01:09:25.072
So, as you select probe covers, always aim for the biggest ones that'll fit in that child's ear canal. There's no great secret, aside from experience, in being able to make that good probe cover choice selection. You will get good at it.

776
01:09:25.092 --> 01:09:32.085


777
01:09:32.105 --> 01:09:38.075
What about that clip you see on the boy's collar there? That's an important one too, right?

778
01:09:38.095 --> 01:09:39.086


779
01:09:39.106 --> 01:09:45.076
It really is. It takes the weight of the cord off of the probe. And so you don't have that weight pulling the probe and helping it to get loose or to fall out. So we always recommend that you… we clip it up out of the way of the child's hands and take the weight off that probe.

780
01:09:45.096 --> 01:09:55.090


781
01:09:55.110 --> 01:09:58.090
We're going to continue to talk through some

782
01:09:58.110 --> 01:10:04.080
Various strategies. There's an endless number of them. But while we do that, why don't we open up the chat field as well, so that

783
01:10:04.100 --> 01:10:10.093


784
01:10:10.113 --> 01:10:16.083
If you have some questions that we haven't addressed yet, we'll have a chance to do that. So, Gunner, if you could do that, and then I also want to let you know that when we end up at the bottom of the hour today, um, we're going to ask you to open up a quick link to evaluate us,

785
01:10:16.103 --> 01:10:30.097


786
01:10:30.117 --> 01:10:36.087
And once that… you've answered the four questions that are there, it will generate a certificate of attendance for you today, so you can document that you did attend this webinar. Alright, so let's just look at a few strategies here.

787
01:10:36.107 --> 01:10:48.101


788
01:10:48.121 --> 01:10:54.091
One of them is about what you said before, Terry, right? About having a fun feeling, like,

789
01:10:54.111 --> 01:10:55.102


790
01:10:55.122 --> 01:10:58.103
Using words that are encouraging and…

791
01:10:58.123 --> 01:11:04.093
Uh, doing things like telling children they have to wait their turn, rather than it, they have to go do this now.

792
01:11:04.113 --> 01:11:07.105


793
01:11:07.125 --> 01:11:13.095
By just using the right wording, it's not your turn yet, it creates a different kind of vibe around it. What would you add to that, Terry, about

794
01:11:13.115 --> 01:11:18.107


795
01:11:18.127 --> 01:11:23.108
creating a fun feeling.

796
01:11:23.128 --> 01:11:29.098
Yeah, it, um, this is really an important one. Like, first thing that comes to mind is, as William talked about, careful wording. We never want to clue them that it's going to be unpleasant in any way. We don't say, this won't hurt, or, um, we're going to test your ears. We actually want to keep it really positive. We ask, for example, we'll ask what.

797
01:11:29.118 --> 01:11:45.112


798
01:11:45.132 --> 01:11:51.102
Um, the classroom or those that were working with the children, who's the most likely to, um, engage with us so we can set this kind of fun example for all the rest of the kids? We've done that before, where they're actually lined up, wanting… wanting their turn.

799
01:11:51.122 --> 01:12:02.116


800
01:12:02.136 --> 01:12:08.106
And so we want to tell them what we're going to do rather than ask. We don't want to give them the opportunity to say no. We want you to direct the screening. And we want to use terms that describe the activity as fun and interesting, and uh… because.

801
01:12:08.126 --> 01:12:20.120


802
01:12:20.140 --> 01:12:24.121
If we don't, we might get a response that we don't want.

803
01:12:24.141 --> 01:12:30.111
Terry, what about, um, any suggestions on, uh, Jenny asked the question about

804
01:12:30.131 --> 01:12:31.122


805
01:12:31.142 --> 01:12:37.112
Screening children who are in special education that don't easily tolerate things in their ears, any thoughts about

806
01:12:37.132 --> 01:12:41.124


807
01:12:41.144 --> 01:12:46.125
creating less sensitivity.

808
01:12:46.145 --> 01:12:52.115
Yeah, that's really a great question, and it's really a valid concern or a challenge in screening. So William mentioned earlier, we have our little listen up video, and we've had programs that will spend a couple weeks playing the song, touching ears.

809
01:12:52.135 --> 01:13:03.129


810
01:13:03.149 --> 01:13:09.119
Using the ears of stuffed animals and other things, just to try to socialize that concept. We've, um, brought the machine in, and we've had the.

811
01:13:09.139 --> 01:13:14.131


812
01:13:14.151 --> 01:13:20.121
Um, the probes, and we've danced it up their arm and up to their ear, and just touched their ear. We don't try to put it in, and we do that over the course of several days, and then one day we slip that probe in the ear, and we try to get the test. We also look at other ways of testing the child. Some of these.

813
01:13:20.141 --> 01:13:34.135


814
01:13:34.155 --> 01:13:40.125
things, um, you know, the toys and the distractors and rewards are really important because we, um, for example, I love toys where I can get several different types of reinforcement out of it, so maybe.

815
01:13:40.145 --> 01:13:49.138


816
01:13:49.158 --> 01:13:55.128
the toy lights up, and we… we use the light as a distractor, and then the toy will, if we hold the button down more, the toy actually moves, and then maybe it vibrates. So, um, you'll learn to find great toys and distractors, um, that you can use when you need the child's cooperation.

817
01:13:55.148 --> 01:14:07.142


818
01:14:07.162 --> 01:14:13.132
Also, I've been pretty successful with screening during sleep. I had parents who have driven in, their child's fallen asleep on the ride in, and so I've gotten in the car and they continue to drive around the block while I've done the screening. So nap times, um, we can try to keep them a little sleep deprived and then try to get them during sleep.

819
01:14:13.152 --> 01:14:32.147


820
01:14:32.167 --> 01:14:38.148
It's challenging, and so you'll have to pull out your full repertoire of things in order to try to get that screening complete.

821
01:14:38.168 --> 01:14:43.149
Terry, we have a few people talking about the challenges associated with

822
01:14:43.169 --> 01:14:48.150
Keeping the probe in the ear, you know, having it fall out.

823
01:14:48.170 --> 01:14:54.140
Um, what's the key to getting a good seal and probe placement?

824
01:14:54.160 --> 01:14:57.152


825
01:14:57.172 --> 01:15:03.142
Yeah, that is the key to getting a good screening completed. So I'm going to just review, you know, the bigger the probe cover, um, that will… the biggest probe cover that'll fit in that ear is important.

826
01:15:03.162 --> 01:15:12.155


827
01:15:12.175 --> 01:15:18.145
And when we talk about that, in our experience, or my experience, it found that the compressible foam covers tend to work better for more children than the harder, more silicone-based or rubber type tips. They, uh, we compress them down, we put in, they expand, and I feel like we get a better seal and stability of the probe with that. We clip the probe up, but we want the.

828
01:15:18.165 --> 01:15:37.161


829
01:15:37.181 --> 01:15:43.151
chord really clipped maybe at the back of their collar so that that cord's not in front for an easy grab to pull it out. We want to keep both hands occupied. This is where, if you've got a screening assistant, they can put a fun toy into those hands, they can grab those hands and clap, various little things like that.

830
01:15:43.171 --> 01:15:57.165


831
01:15:57.185 --> 01:16:03.155
We want to keep those hands busy. In some instances, um, sucking on a bottle or chewing, we can still get the screening complete, even though those things contribute to movement.

832
01:16:03.175 --> 01:16:13.168


833
01:16:13.188 --> 01:16:19.158
When the child pauses in the sucking, for example, on a pacifier, when they pause, that test will run, and we can often get the test completed.

834
01:16:19.178 --> 01:16:26.171


835
01:16:26.191 --> 01:16:27.171
Yeah.

836
01:16:27.191 --> 01:16:33.172
Caveat there is that if you get a passing result while the child is sucking or chewing, that's great. You can consider that complete.

837
01:16:33.192 --> 01:16:36.173
But if you get a non-passing result,

838
01:16:36.193 --> 01:16:42.163
You'll need to redo the screening without the sucking or chewing going on, as it may be the reason why you got a non-passing result.

839
01:16:42.183 --> 01:16:46.175


840
01:16:46.195 --> 01:16:52.165
Terry, we also have several people talking about their frustrations with their equipment being

841
01:16:52.185 --> 01:16:53.176


842
01:16:53.196 --> 01:16:57.177
too sensitive to be able to screen.

843
01:16:57.197 --> 01:17:00.178
Um, because of noise in the environment.

844
01:17:00.198 --> 01:17:05.179
And we know that not all OAE equipment is the same.

845
01:17:05.199 --> 01:17:11.169
Some equipment really is a lot better at screening in regular

846
01:17:11.189 --> 01:17:12.180


847
01:17:12.200 --> 01:17:18.182
Not overly noisy, but moderately noisy active environment.

848
01:17:18.202 --> 01:17:23.183
Um, on the screen right here, you see some of the equipment that's available.

849
01:17:23.203 --> 01:17:29.173
Um, we know that some of these are particularly suited. Um, we've…

850
01:17:29.193 --> 01:17:31.184


851
01:17:31.204 --> 01:17:36.185
I mean, we're not gonna recommend a particular device here.

852
01:17:36.205 --> 01:17:42.187
But I will tell you that the devices that are in columns A and B

853
01:17:42.207 --> 01:17:46.187
We know work well in, um,

854
01:17:46.207 --> 01:17:49.188
early childhood environments,

855
01:17:49.208 --> 01:17:53.189
Uh, would you… would you agree with that, Terry?

856
01:17:53.209 --> 01:17:59.179
You do? Yeah. So we've had good experience with those in those 2 columns. And those are actually probably the pieces of equipment that we used in the photos of those natural environments that you saw on our earlier slides.

857
01:17:59.199 --> 01:18:07.192


858
01:18:07.212 --> 01:18:09.192
Yeah.

859
01:18:09.212 --> 01:18:15.182
Yeah, I don't want to, um, downplay how difficult it can be with a wiggly toddler. It takes some patience, some skill, and you may not be successful on one day, but we want to keep… we want to keep trying.

860
01:18:15.202 --> 01:18:24.195


861
01:18:24.215 --> 01:18:25.195
Um…

862
01:18:25.215 --> 01:18:31.185
We also want to make sure that, you know, when you talk about probe placement, that goes hand-in-hand, right, with your perceptions of it being a noisy room, or the equipment being

863
01:18:31.205 --> 01:18:37.198


864
01:18:37.218 --> 01:18:40.199
to sensitive, um,

865
01:18:40.219 --> 01:18:46.189
A good probe placement should be able to offset some of the noise of the environment.

866
01:18:46.209 --> 01:18:48.200


867
01:18:48.220 --> 01:18:52.201
Um, so you want to always make sure that

868
01:18:52.221 --> 01:18:58.191
You know, many… many shy screeners who are new will be, oh, they don't want it to be too…

869
01:18:58.211 --> 01:19:01.203


870
01:19:01.223 --> 01:19:07.193
far in, or they don't want it to feel too tight, but actually, that's what

871
01:19:07.213 --> 01:19:08.204


872
01:19:08.224 --> 01:19:14.194
creates the condition that we need.

873
01:19:14.214 --> 01:19:15.206


874
01:19:15.226 --> 01:19:21.196
Yeah, and, um, you know, just one comment there, William, you know, the… these probes are designed and have been standardized to fit in those ears, so, um, you know, we won't, we won't hurt them. But I also, you know, on the positive side, have seen that this is the one area that the more kids you screen.

875
01:19:21.216 --> 01:19:35.210


876
01:19:35.230 --> 01:19:40.211
You rapidly grow more comfortable with probe placement the more you do it.

877
01:19:40.231 --> 01:19:42.211
For those of you who are, um…

878
01:19:42.231 --> 01:19:45.212
Struggling with this,

879
01:19:45.232 --> 01:19:47.213
you know, um…

880
01:19:47.233 --> 01:19:53.214
We would encourage a couple of things. And again, we don't want to minimize how

881
01:19:53.234 --> 01:19:59.204
Frustrating that is, when you can't satisfactorily get your screenings done.

882
01:19:59.224 --> 01:20:00.215


883
01:20:00.235 --> 01:20:06.205
And so we do want to make sure that, one, you've had adequate training, and

884
01:20:06.225 --> 01:20:07.217


885
01:20:07.237 --> 01:20:13.207
A couple of you have asked about where can we get that? And this, on our website, is where you can go to get

886
01:20:13.227 --> 01:20:14.218


887
01:20:14.238 --> 01:20:20.208
training that walks you through these different strategies. I mean, we're… you can tell, we're talking pretty fast here. Um, so…

888
01:20:20.228 --> 01:20:23.220


889
01:20:23.240 --> 01:20:29.221
Make sure that you are getting the training you need. A really good part of training.

890
01:20:29.241 --> 01:20:32.222
is if you have an experienced screener,

891
01:20:32.242 --> 01:20:38.223
or a pediatric audiologist who can come and not only, you know,

892
01:20:38.243 --> 01:20:44.213
you not only do this training, but then after you do, they can go screen a few children with you.

893
01:20:44.233 --> 01:20:46.225


894
01:20:46.245 --> 01:20:52.215
And, you know, look at the way you're getting the probe in. Make sure that you don't have too much tension on that cord, that you've clipped the cord to the child's shirt.

895
01:20:52.235 --> 01:20:58.227


896
01:20:58.247 --> 01:21:04.217
Um, and allowing that probe to stay, um, sealed and placed in the ear.

897
01:21:04.237 --> 01:21:05.229


898
01:21:05.249 --> 01:21:11.219
Getting that kind of input can be really a game changer in your completion rates.

899
01:21:11.239 --> 01:21:15.231


900
01:21:15.251 --> 01:21:21.232
Anything that add there, Terry?

901
01:21:21.252 --> 01:21:22.232
I think that was great.

902
01:21:22.252 --> 01:21:27.233
You know, some of you have talked about sensory deficits.

903
01:21:27.253 --> 01:21:30.234
And that you're… you're…

904
01:21:30.254 --> 01:21:34.235
inclined to think, well, gosh, you know, this child is so sensitive to

905
01:21:34.255 --> 01:21:37.235
The probe in the ear,

906
01:21:37.255 --> 01:21:42.236
Um, maybe this suggests something more about what might be going on

907
01:21:42.256 --> 01:21:44.237
with this child that they…

908
01:21:44.257 --> 01:21:50.238
might have a sensory disorder, or even be on the spectrum, possibly.

909
01:21:50.258 --> 01:21:55.239
You know, children, uh, we want to make sure that children don't get misdiagnosed.

910
01:21:55.259 --> 01:22:01.240
And so, figuring out a way to adequately screen them, but it is true.

911
01:22:01.260 --> 01:22:07.230
that some children, especially those that have had ear infections, or other ear-related, um,

912
01:22:07.250 --> 01:22:09.242


913
01:22:09.262 --> 01:22:15.232
conditions, um, may be hypersensitive to getting a screening done, and you may need to desensitize them to this. Terry, can you talk a little bit about what desensitization

914
01:22:15.252 --> 01:22:23.245


915
01:22:23.265 --> 01:22:29.235
might be before you even try to do a hearing screening with some of these kinds of children.

916
01:22:29.255 --> 01:22:30.246


917
01:22:30.266 --> 01:22:36.236
Well, I think that's… it's mostly centered around some of those strategies that we've mentioned before, where we, um… We spend time with the probe, we touch it, we try to screen, you know, we can screen toy animals, other things. But it takes time and patience, and I acknowledge the…

918
01:22:36.256 --> 01:22:54.251


919
01:22:54.271 --> 01:22:55.252
Challenge.

920
01:22:55.272 --> 01:23:00.253
Yeah, so showing them, you know, what the probe… like you see in the image here,

921
01:23:00.273 --> 01:23:03.253
This… this woman is…

922
01:23:03.273 --> 01:23:09.243
putting the probe on the child's fingers, letting them squeeze it, maybe touching their face with it. And maybe that's all they do that day.

923
01:23:09.263 --> 01:23:15.256


924
01:23:15.276 --> 01:23:16.256
They don't try to put it in the child's ear that day. They might…

925
01:23:16.276 --> 01:23:19.257
Right.

926
01:23:19.277 --> 01:23:23.257
put it in the ear of their stuffed animal.

927
01:23:23.277 --> 01:23:29.259
or their parent, or the caregiver, but they don't do it with the child.

928
01:23:29.279 --> 01:23:35.260
right that first time. I know that requires the luxury of time.

929
01:23:35.280 --> 01:23:37.260
Um, but that is…

930
01:23:37.280 --> 01:23:43.261
kind of what it takes sometimes with those exceptions of children that

931
01:23:43.281 --> 01:23:45.262
Um, have… have…

932
01:23:45.282 --> 01:23:51.252
struggled with that. Let's see if there are any other questions before we go on.

933
01:23:51.272 --> 01:23:53.264


934
01:23:53.284 --> 01:23:58.265
It looks like some people have some good suggestions themselves about…

935
01:23:58.285 --> 01:24:01.265
Um…

936
01:24:01.285 --> 01:24:03.266
Oh, right. So…

937
01:24:03.286 --> 01:24:05.266
Before we end here…

938
01:24:05.286 --> 01:24:09.267
Um, I want to remind you of a couple of things.

939
01:24:09.287 --> 01:24:15.257
One is, again, to take a look at the website kidshearing.org for the various resources that we have there, not only for accessing

940
01:24:15.277 --> 01:24:20.269


941
01:24:20.289 --> 01:24:26.259
Training, but for the practical tools associated with screening and documentation, and our tracking tools that are there. This webinar has been recorded, so you know that you can go back and look at this again, along with our other resources.

942
01:24:26.279 --> 01:24:38.273


943
01:24:38.293 --> 01:24:43.274
Tomorrow, we're doing an introductory webinar, so…

944
01:24:43.294 --> 01:24:49.264
If that would be helpful to you or anyone else that you are aware of that could benefit from an introduction,

945
01:24:49.284 --> 01:24:51.276


946
01:24:51.296 --> 01:24:54.276
to evidence-based practice.

947
01:24:54.296 --> 01:24:57.277
Um, come join us tomorrow!

948
01:24:57.297 --> 01:25:03.267
And, uh, you can register for that webinar at this place right here. It's

949
01:25:03.287 --> 01:25:04.278


950
01:25:04.298 --> 01:25:08.279
also, um, posted earlier in the chat.

951
01:25:08.299 --> 01:25:12.280
And then, before we go, um,

952
01:25:12.300 --> 01:25:18.270
Uh, Connor… or Gunnar, how do you want to go about giving people the website for…

953
01:25:18.290 --> 01:25:19.281


954
01:25:19.301 --> 01:25:21.282
um… are…

955
01:25:21.302 --> 01:25:27.272
our evaluation and certificate of attendance today. Should we just put it in the…

956
01:25:27.292 --> 01:25:29.283


957
01:25:29.303 --> 01:25:31.284
Um, chat?

958
01:25:31.304 --> 01:25:34.285
Yeah, I mean, you can show it on the screen, and I can put it in the chat.

959
01:25:34.305 --> 01:25:40.275
Okay, alright, and then… so that would be here.

960
01:25:40.295 --> 01:25:41.286


961
01:25:41.306 --> 01:25:47.276
So, thank you to everybody. We know we covered a lot of information that can be overwhelming.

962
01:25:47.296 --> 01:25:49.288


963
01:25:49.308 --> 01:25:52.288
Um, but…

964
01:25:52.308 --> 01:25:57.289
Hearing screening doesn't need to stay overwhelming. If you've had the proper, um,

965
01:25:57.309 --> 01:26:03.279
guidance in selecting equipment. If you're using the appropriate equipment for the developmental level and age of the children you're screening.

966
01:26:03.299 --> 01:26:08.292


967
01:26:08.312 --> 01:26:14.282
that you have the appropriate follow-up or backup for when a child can't be screened with the initial recommended method,

968
01:26:14.302 --> 01:26:17.293


969
01:26:17.313 --> 01:26:22.294
Whether that's going from pure tone to using OAEs,

970
01:26:22.314 --> 01:26:28.284
Or if you can't screen a child to refer them to a pediatric audiologist.

971
01:26:28.304 --> 01:26:29.296


972
01:26:29.316 --> 01:26:35.297
To make sure that you have a documentation strategy, not only for the initial screening,

973
01:26:35.317 --> 01:26:38.298
But for all of the other steps.

974
01:26:38.318 --> 01:26:43.299
And that, together, you're able to report on

975
01:26:43.319 --> 01:26:46.299
Not only the numbers of children that you screened,

976
01:26:46.319 --> 01:26:52.289
But those that pass, those that didn't, those that needed follow-up, and what that follow-up was,

977
01:26:52.309 --> 01:26:54.301


978
01:26:54.321 --> 01:26:59.302
And then, most importantly, those that were identified with…

979
01:26:59.322 --> 01:27:02.303
some kind of hearing health-related condition,

980
01:27:02.323 --> 01:27:05.303
And the intervention that they were provided,

981
01:27:05.323 --> 01:27:11.305
And the number of children ultimately identified with a permanent hearing loss.

982
01:27:11.325 --> 01:27:16.306
All of that is what sets up children to have success in school.

983
01:27:16.326 --> 01:27:22.307
To not be misdiagnosed with other conditions that are actually impacted

984
01:27:22.327 --> 01:27:28.308
by a mild, moderate, or significant hearing loss.

985
01:27:28.328 --> 01:27:33.309
So, you can change the lives of kids by playing this role.

986
01:27:33.329 --> 01:27:35.310
And, um…

987
01:27:35.330 --> 01:27:41.300
we just… really, our hats are off to you for all the different things you do in your current positions.

988
01:27:41.320 --> 01:27:43.311


989
01:27:43.331 --> 01:27:49.301
And the impact that you can make on children's lives by, um, getting this part right.

990
01:27:49.321 --> 01:27:51.313


991
01:27:51.333 --> 01:27:57.303
Um, Terry, any closing thoughts?

992
01:27:57.323 --> 01:27:58.314


993
01:27:58.334 --> 01:28:04.304
Whopp, I can't hear you.

994
01:28:04.324 --> 01:28:07.316


995
01:28:07.336 --> 01:28:09.317
Nope, I don't need you.

996
01:28:09.337 --> 01:28:14.318
It looks like Terry has a… He said his power might go out. So.

997
01:28:14.338 --> 01:28:20.319
Oh, okay, very good. Well, thank you, everybody. Remember to go check out kidshearing.org,

998
01:28:20.339 --> 01:28:26.309
As well as learn toscreen.org if you're looking for training.

999
01:28:26.329 --> 01:28:27.320


1000
01:28:27.340 --> 01:28:33.310
Thanks, Gunnar.

1001
01:28:33.330 --> 01:28:41.323


1002
01:28:41.343 --> 01:28:47.313
Thanks for all the applause, too, that's cool. I've never seen that before.

1003
01:28:47.333 --> 01:28:48.325


1004
01:28:48.345 --> 01:28:30.825
Thanks, everybody.