staff in implementing evidence-based hearing screening
and follow-up practices, and we also reached out to many other
early care and educational settings and those who work in those
settings to develop their hearing screening and follow-up practices
as well, such as programs like Part C or, um, Community Health
Centers.
So, we had quite a diverse set of people who have registered for
today's webinar from all of those contexts, and we're really
delighted to have you all with us today, so that we can continue to
share the information that we have that you may be able to put to use
use.
Before I go any further, I want to let you all know a couple of
logistics.
Today's webinar is being recorded and, so, what that means
is that, within the next couple days, if you go to kidshearing.org,
you'll be able to stream this video, um, and be able to just go to
whatever portion you want to listen to again.
It also allows you to share this webinar with people who aren't
attending live with us today, so, keep that in mind as we progress.
We're going to, um, present our information for you today and,
then, we'll open up the floor for questions, and we'll open up a Q &
A box, um, at that point.
We won't be monitoring and interacting with questions
throughout, we'll save them till the end and, hopefully, we'll
anticipate some of your questions, so you won't even to ask us.
That's always our goal.
I also want to give a shout-out to our interpreters and our
captioner today for your time and talents and helping us make this
webinar as accessible as possible.
To Gunnar, who is our tech person in the background and,
um, to all of you for taking the time out to think about these
important issues related to communication with, um, young
children that we're all serving.
We're joined today, um, by Terry Foust, who is a pediatric
audiologist and speech-language pathologist, who has served as a
con consultant and a trainer with the ECHO Initiative since its very
beginning and, so, Terry, welcome.>>: Thank you, William and,
um, it's a pleasure to be with all of you this afternoon afternoon.
As William mentioned, he and I, along with many other ECHO team
staff, as well as local collaborators, we've provided
training on nearly every state.
It's really, literally, been, I think, thousands of staff from
Early Head Start, Head Start, American Indian alatchinga Native
and Migrant Head Start, as well as other education programs over the
almost 20 years that William mentioned, but the important thing
is that we're always encouraged, just like we are today, with a huge
amount of interest that there is in establishing and improving
evidence-based hearing screening programs, really so that children
with hearing-related needs can be identified and served.>>: We
always like to start out with, kinds kind of, addressing the
question of why.
The work of the ECHO Initiative is based on the recognition that,
each day, young children who are deaf or hard of hearing are being
served in early childhood education and healthcare centers
without their hearing-related needs even being known known.
Hearing loss is an invisible condition.
So, how can we reliably identify which children have normal hearing
and which may not?
>>: Well, the short answer to that question, William, is that early
care and education providers can successfully be trained to conduct
evidence-based hearing screening, just like you see here in the
photos on your screen, and the ultimate out outcome of a hearing
screening program is that we can identify children who are deaf or
hard of hearing, who have not yet been identified previously.
So, if you look at your screen, the procedure on the left is called
otoacoustic emissions, or OAE hear hearing screening, which is the
recommended method for children birth to 3 years of age and
increasingly recommended for children 3 to 5 years of age as
well.
Now, on the right-hand side, you'll see the procedure called
pure tone audiometry hearing screening, and that's historically
been the most commonly used screening method for children 3
years of age and older, which you'll still see in many early care
and education settings and providers using, and we're going to
be talking about both of these methods today.>>: So, let me give
you, um, an overview of what we're going to cover today.
While this presentation is not a training per se, our goal is to
provide an overview of the big picture of what is involved in
implementing evidence-based hearing screening for children across the
age spectrum birth to 5 years of age, and we're going to start off
by giving you an overview of the auditory system, or hearing system,
which will help lay a foundation for understanding how the hearing
screening methods we'll be talking about actually work.
Then, we're going to talk about why we screen for hear hearing loss,
what even makes it possible for us to seriously be engaged in
systematic screening for hearing with young children.
We're going to talk about the two methods Terry just mentioned,
OAE and pure tone audiometry, starting with an over overview of
OAE screening and followed by an overview of the pure tone
audiometry screening process.
Next, we're going to address the important question, what do we do
next, when a child doesn't pass a screening?
We'll summarize the follow-up steps that are undertaken when a
child doesn't pass a hearing screening on one or both ears ears,
so you have a big picture of not only how to screen, but that
important follow-up part of the process.
We'll wrap-up by showing you some of the resources that are
available to help you develop your evidence-based screening program,
how to get training and, um, and, then, answer whatever questions you
might have, okay?
So, that's where we're headed, and you can follow the progression
of these topics by referring to the left side of your screen and,
since this is a recorded webinar, this left side menu can be helpful,
if you return to this webinar and in the recorded format and want to
navigate to a specific portion of your our presentation to review
again or to share with others.
So, before we launch into our content, I want to make sure you
all know where to go after today's webinar to get additional resources,
information, and access to training.
You know, before I do that, one of the things that you're going to
hear us say several times today is that we really want to make sure
that you all understand that implementing evidence-based hearing
screening practices is more than using a designated piece of
equipment or a specific method.
Would you agree with that,
Terry?
>>: Yes, absolutely.
We want to really identify those children that are at risk for
hearing loss and, um, and, then, provide for their follow-up.>>: So,
to implement evidence-based practices, the recommended
equipment or methods we'll be talking about today must be used
according to a prescribed set of steps under carefully controlled
conditions, each step of which is carefully documented in detail,
and this is true whether you're using OAE screening or pure tone
audiometry screening.
Over the years, the ECHO Initiative developed a wide range
of resources to help you achieve this goal, and our goal today is
primarily to help you find all of that information and the resources
that you need.
So, let's take a look at this website, kidshearing.org.
You'll find, um, if you go here, you'll find a variety of
implementation tools and, certainly, before you sit down to develop
something or to write a letter to parents about your screening
efforts or a referral letter or to create a form for documenting your
results, please check out what's already -- audio out -- many of
the resources you'll find here are the result of various examples,
early childhood programs shared with us.
So, you can be assured that others have used the language and
the format of many of these resources to achieve the same goals
that you have.
We also know that many of you want to know about how to access
train training.
So, be assured that we can direct you to a specific location where
you can get the training you need, um, and, so, let me just show you a
few of these, but, again, take some time to, after the webinar, to
get acquainted with these, um, re resources you'll find on our
website.
So, this is the landing page for kidshearing.
kidshearing.org, which provides that, a variety of practical
resources.
The first part of the page, um, places early childhood screening
into the larger context of identifying children who are deaf
or hard of hearing, expanding the traditional focus on newborn
screening to include a focus on identifying hearing loss throughout
early childhood.
Now, if we scroll down, this is where you'll find all of the
practical re resources most relevant to early childhood
screening, starting with planning resource resources.
Then, you'll see the area where to, um, access training and, um,
you know know, which is, um, one of the most important pieces, but you
always want to do your planning first.
As we said, for nearly 20 years, the ECHO Initiative was funded to
provide in-person and virtual comprehensive training and
evidence-based screening, and we worked with thousands of people in
various, um, Early Head Start and Head Start and other early care
and education programs, and that complete training process is now
available anytime you or your staff need it.
So, we encourage you to check out that.
We know that many of you are needing to know how to get training,
so, check out what we have there for, both, OAE and pure tone
screening.
The website, um um, is where you can access the comprehensive
training and, you know, some of you may have a group of staff who need
training at the same time, while some of you may find that your
staff entering your program are coming in at different times and
are need needing training throughout the year.
So, having an online training option available that can be done
anytime and at any pace can serve a lot of different peoples' needs.
So, um, we encourage you to check that out.
Yep?
>>: Can I just interject on training that, um, the training
William's referencing is really different than the training that,
um, your equipment manufacturer or the, um, vendor that you buy your
equipment from, they will be very technically proficient in how to
operate the equipment and to turn it on, but the training that comes
with with screening children, um, children handling probe fit issues,
all of those things to get a successful screening, as well as
program management, are really crucial and key key, and that's
what William is really referencing here in under the training.>>:
Thanks, Terry.
The next part of our website has to do with screening resources,
and these are all sorts of good resources to help you prepare for
screening, the protocol guides and forms, which we'll be referencing
today, how to share results with others, documenting your screening,
um, outcomes, all of those things are found there and, then, um, the
next thing you'll find on the website are follow-up resource
resources, how to track a group of children through the complete
screening and follow-up process and some tools to help you do that,
as well as monitoring your program, um, over time for quality.
So, again, kidshearing.org is where you want to go to look for
those things.
So, make a note of that, kidshearing.org.
So, let's put all these resources into context, and we're
going to start by giving you a quick overview of the auditory or
the hearing system.
Terry, you want to take us through this?
>>: Yes.
So, um, as many of you, um, may remember from school, there are
three main parts to the auditory system.
There's the outer ear, the middle ear, and the inner ear, or what we
call the cochlea.
So, when sound enters the outer ear, it causes the ear drum to
vibrate, which then moves three small bones in the middle ear, and
this movement stimulates thousands of tiny, sensitive hair cells in
that snail-shape portion of the ear that you see there called the
cochlea.
From the inner ear, the sound signal is carried along special
nerves to the hearing centers of the brain and, then, the
individual experiences, then, the sensation that we call sound.
You can see it just moving through right there.
Okay, so, while this is how the auditory system typically
functions, we can have some exceptions.
There can be some temporary issues, like a wax blockage, um, or
fluid in the middle ear caused by ear infections that we may
discover and get addressed during hearing screening process, but it's
key to remember the primary target condition of the hearing screen is
the functioning of the inner ear, or cochlea, that snail-shape
portion of the ear.
Now, in some instances, the sound travels through the outer and
middle ear, but when it reaches the cochlea, the signal is not
transmitted to the brain, and that results, then, in what we would
call a sensorineural hearing loss, and this condition is usually
permanent, and this is the primary condition for which we are
screening in mass screening efforts, such as we're talking
about today.
Now, this might come as a surprise to you, but it is, um,
it's an important fact for us to all know, that sensorineural
hearing loss is the most common birth defect in the United
States.>>: Yeah.
In fact, about three children in a thousand are born with a hearing
loss, deaf or hard of hearing.
Most newborns in the U.S.
are now screened for hearing loss using evidence-based methods, most
before even leaving the hospital,, but screening at the newborn
period isn't enough.
Research suggests that the incidence of newborn hearing loss
doubles between birth and school age, from about 3 in a thousand at
birth, as you see here, to about 6 in a thousand by the time children
enter school.>>: And hearing loss can occur, um, anytime as the
result of, um, infection or, um, trauma.
There can be genetics.
So, as you can see here, illness, physical trauma, environmental
factors, um, and genetics and, so, that's why we want to keep
screening screening, because this is typically called late onset
hearing loss.>>: And that means, simply, that it's acquired after
the newborn period.
You know, it's commonly understood that language
development is at the heart of cognitive and social emotional
development and school readiness.
Those things drive many of the practices that we see in early
childhood settings.
Think about how much emphasis is always being placed on early
language development; counting the words children can produce, etc.
It's also important, though, to note that hearing health is at the
heart of typical language development and that, if we're
going to be conscientious about promoting language development as
apart of our commitment to school readiness, we should be equally
conscious conscientious about monitoring the status of hearing
throughout this early childhood period.
If hearing is compromised, then typical language development will
ultimately be compromised as well, and we don't want to wait for a
language delay to develop in order to discover that a child has a
hearing loss, even if it's a minor hearing loss.>>: This is why we
see so much emphasis being placed on monitoring the status of
hearing in young children, so programs like Head Start, which,
for years, have served as mods models of comprehensive health and
educational programs for young children and their families,
they've required hearing screenings for all of their children, even
before we have the, um, excellent methods that we now have to do
this.>>: You know, sometimes, we use the term screening and we
neglect to make sure that everyone really understands what we really
mean by that.
So, as an audiologist, Terry, how do you describe what screening
is?
Or, in this case, hearing screening.>>: I think it's easy to
think of screening, so, think of it as, kind of, a sorting process,
helping us to separate the children who are at risk of having a
condition from those who are far less likely to have the condition.
So, those in that first at at-risk group are then followed
with additional steps implemented by pediatric audiologists and
healthcare providers to continue to refine the sorting process until
we've definitively identified or identified that small group of
children that ac actually have hearing loss and, I guess, to be
blunt, we screen, because we simply cannot provide a comprehensive
audiological evaluation on each and every child.>>: Yeah, so, try not
to get too hung up by the term, screening, especially for those of
you who are working in, um, early intervention settings, like Part C.
I know you don't typically use the word screening as much as you
use the word e evaluation, but the step is the same.
That first step in trying to determine whether a child has
typical hearing or not are these measures, these methods that we're
going to be talking about today.
Screening, or evaluation, followed by appropriate
audiological assessment and intervention can dramatically
improve options and outdomscome outcomes for children who are deaf
or hard of hearing.
When hearing loss is identified early, we can make sure a child has
access to language and, as a result, children who are deaf or hard of
hearing are thriving in ways that used to be rare.
By providing hearing screening, you can be apart of creating these
amazing, life- life-changing outcomes.
So, let's take a look at several examples of children with severe
to profound hearing loss, who have had the benefit of early
intervention and quality, or early identification and quality
intervention.
These children are learn learning, they're thriving, and
communicating.
So, let's just take a quick look.
Those two girls are deaf.
They both have hearing aids, they're bilat sensorily deaf and,
because of early intervention and the support of technology, they're
communicating pretty darn well with one another.
Let's take a look at another example.
These, um, kids are using American Sign Language as their
mode of communication, which their parents chose.
They're also proficient communicators.
So So, let's have a look.
See, the idea here is to make sure that children have access to
language one way or another.
This last example is of two boys who are also deaf, and they'll
tell you, um, what technology is supporting their ability to
communicate.
So, the point here is to be reminded of children like them,
that they are our goal.
We want to make sure that all children have access to language
one way or another, regardless of whether they have a hearing loss,
and the way to achieve that is to be fully committed to quality
periodic hearing screening.
Terry, are you up with me now
now?
Are you able to continue?
>>: I think so, William.>>: Okay.>>: So, um, let's talk about
these two hearing methods that are used during early childhood.
So, if you're responsible for children who are under 3 years of
age, then the recommended method is OAE screening, that you'll see
on the left here, but if you're responsible for children, if you're
responsible for screening children 3 years of age or older, then,
historically, as I mentioned earlier, pure tone screening has
been considered the recommended method for this age group, and this
is the headset screening, where the child raises the hand or
performs another task every time they hear a sound that is
presented into the ear phone, and you see this method, again, being
used on the right.
Now, there's growing, um, recognition, I was just going to
mention, William, that for a variety of reasons, as common as
the pure tone method has been, it may not always be the most feasible
method to use with some of these younger children.
Research has showed that about 20 to 25 percent of children in that
3 to 5 age group, um, can't be screened with this methodology,
because they just aren't developmentally able to follow the
directions reliably, and that's really been our experience as
well.
So, in those instances, OAE screenings are the preferred
method for those children.
William, I'm off again here.>>: Yeah, I am too, Terry.
So, one of the things we want to make sure, and we know a lot of
people have questions about is whether, um, there are other
methods.
You may have heard or seen other methods in the past, which are
subjective, like ringing a bell behind a child's head or depending
solely on a caregiver's perceptions of a child's hearing.
Now, don't get me wrong, observations of a child's response
to sound, especially a lack of response can be helpful, and we
should pay attention to how children do or do not respond to
their environment, but these sorts of observations, um, do not
constitute a hearing screening, because they're far too crude and
unreliable and, frankly, we can do so much more than that because of
our current technologies.
We also want to make sure that we're aware that, um, healthcare
providers have, um, even though that they have incorporated, um,
evidence- evidence-based hearing screening into well-child visits,
this is not yet a standardized practice, especially for children
less than 4 years of age.
Some parents, Terry, did you have something to say?
>>: I was just going to chime in, saying that, um, and you're
probably going this same direction, but some parents, um, they report
with a lot of certainty that their healthcare provider actually did
perform a hearing screening, but I think it's really important to
understand, um, and I really can't emphasize this enough as an
audiologist myself, that routine examinations of ears by healthcare
providers should not be mistaken as hearing screenings, and I know
that may come as a disappointment to you, as it does to, you know,
many of us, um, and parents who are really hoping this is being taken
care of during well-child visits to healthcare providers, but it's
precisely because it isn't yet happening in that context that
programs like your yours are adopting hearing screening
practices, because of that increased recognition of the
importance of monitoring hearing, and it's just now so feasible to do
it.>>: Yeah, and, so, unless a healthcare provider and the medical
records that you've gotten from them include documentation of
ear-specific hearing screening results and the screening method
that was used, we really should never assume a hearing screening
was completed.>>: Yeah, and another important point to remember
is this, is that, well, OAE and pure tone screening highly reliable
screening methods, but they're still not perfect, so that means
there may be some rare conditions that are not identified through
these screenings.
So, whenever a parent express expresses concern about a child's
hearing or language development, even if they've received and passed
a hearing screening using one of these methods, that child should
still be referred for an evaluation from an audiologist.>>: So,
before we go on, let me say one more thing about newborn hearing
screening results, because many of the children that you will see will
have had newborn screen screenings.
When children enter your program or system, during that first year
of life, always be sure to collect their newborn hearing screen
newborn hearing screening result.
If the results are anything other than a pass on both ears, you
want to make sure that follow-up evaluations have occurred.
If you don't see any evidence of that follow-up follow-up, you'll
want to help circle the family back to their healthcare provider to
get that accomplished.
If you're in a program that requires an annual hearing screen
screening, you can go ahead and use the newborn hearing screening
result for that first year of life, but you'd want to re-screen after
that, because hearing screening is only an indication of that child's,
um, abilities at that point in time and, as we said earlier, that can
change.
Okay, so, now, lets let's talk about the two screening methods
that are responsible for early childhood.
If you're responsible for children who are under 3 years of
age, the recommended method is OAE screening, which you see here on
the left, and there really is no other evidence-based method that
you'll find out there as an option to that for this birth to 3
population.
If you're responsible for screening children 3 years of age
or older, historically, pure tone audiometry has been considered the
recommended method for this age group.
This is the headset screening where the child raises a hand or
performs another task each time they hear a sound that's presented
into an ear phone, and you see this method on, um, on the right.>>:
And just, um, a reminder, what I mentioned a little earlier, that,
um, as common as the pure tone method has been, um, again,
remember, it may not be the most feasible method to use with some of
these younger children due to that 20 to 25 to 25 percent of those
kids in the 3 to 5 age group that can't be screened with that
methodology because they just aren't developmentally able to
follow the directions re reliably.
So, again, in that case, OAE screening is the preferred method
for these children.>>: So, at a minimum, what Terry's saying is if
you're establishing evidence-based practices for 3 to 5 year olds, and
if you're considering using pure tone screening, you'll also need
to be equipped and prepared to do OAEs on that 20 to 25 percent who
can't be screened with pure tones, or, alternatively, you'll need to
have a means for systematically referring all of those, you know,
that 20 to 25 percent to an audiologist who can perform the
screening and, frankly, that can be pretty challenging to accomplish,
because audiologists are hard to get into, and screening is not, um,
usually the thing they, um, want to make time for.>>: And, maybe,
William, to simplify things, um, a little bit, more and more, um,
audiologists are recommending the use of OAEs uniformly with children
3 years of age and older, and it's because it's quicker than pure tone
screening, both to learn and to do, to actually implement, and 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 that you'd be screening,
and it's equally as effective.>>: If you or your program are still
undecided or you're asking this question again about which method
to use primarily for children ages 3 and older, we encourage you to
carefully review a document we have on our website that compares OAE
screening and pure tone screening for this population.
So, take a look at that, it's under the very first heading on
our website, and I'll come back and show you that in a little bit
where you'll find that.
Terry, let's dive into OAEs.>>: Thank you.
So, as William said, let's start with otoacoustic emissions, or OAE
screening, and as we said, it's the recommended hearing screening
method for children birth to 3.
It's the evidence-based method recommended by the American Academy
of Audiology and the American speech language hearing association,
known as ASHAler.>>: So, OAE screening is the most appropriate
method to identify young children at risk for permanent hearing loss,
because it's accurate, um, it's quick and easy.
Most children can be screened in just a minute or two.
Sometimes, in as little as 30 seconds per ear.
It's a flexible thal tool that can be used in a variety of
environments, including classrooms, homes, or healthcare settings.>>:
And most important of all, it's effective.
It's effective in identifying children who may have a child
hearing loss or loss in just one ear, as well as those that have a
severe bilateral hearing loss.
In addition, it can be, um, helpful in drawing attention to a
broader range of hearing health conditions that may need further
medical attention.
So, OAE screening, it can also help to identify children who have
a temporary hearing loss as a result of middle ear infections and,
again, as we mentioned earlier, although this isn't the primary
goal of OAE, excuse me, of OAE hearing screening, it's definitely
an added benefit of screening with this method.
O OAE screening clearly meets the World Health Organization's, um,
principles of screen screening.>>: So, let's take a look at these
pictures for a second.
These children you see here are all being screened using the OAE
method, and what do you notice about where they're being
screened?
They aren't being pulled out into an environment that's foreign or
strange to them.
We can go to them, they are being screened in every day educational,
home, or healthcare settings, where the children are already, hopefully,
happily spending their time, and those that are doing the screening
are, often, people they already know.
They're teachers, they're home visitors, health specialist
specialists at the program, people they know.>>: In insidious hearing
screening works best when children are familiar and they're
comfortable with the adult doing the screening and where they can
play with a toy, they can be held, or even sleep while the screening
is being conducted.>>: And, that's right, you heard it, they can sleep
while they're being screened, which is a real added benefit for
some of those kids in that, you know, 6 months to to 18 months or
20 months age range that could be, kind of, difficult to screen.
So, Terry, walk us through the OAE screening procedure, would you?
>>: Yeah, yeah.
Thank you, William.
So, to conduct an OAE screening, we're, first, going to take a
thorough look at the outer part of the ear to make sure that there's
no visible sign of infection or blockage.
After we've done that, a small probe on which we've placed a
disposable cover is then inserted into the ear canal, and that probe
is in the ear canal delivers a low-volume sound stimulus into the
ear.
Now, a cochlea, or that inner snail-shaped portion of the ear, a
cochlea that is functioning normally will respond to this sound
by sending the signal to the brain while also producing an acoustic
emission, and this emission is analyzed by the screening unit in
approximately and, in approximately 30 seconds or so, the
result will appear as either a pass or a refer.
Now, every normal, excuse me, every normal, healthy inner ear
produces an e emission that can be recorded in this way.
So, let's look at a video of an actual realtime screening, just so
you can see how it can go under ideal conditions.>>: Yeah, so, the
woman on the right is going to be pointing the probe in this little
guy's ear.
She has the added benefit of a partner adult who's going to help
manage this child's behavior.
Now, a little boy this age may not really need the help of that
other adult, but if he was a year younger, it would really be
valuable to have that person there to help his hands be busy and not
reach up and get interest interested in the probe going in
the ear.
So, let's take a look.
This is a realtime screening, no editing.
So, that means they got their results already.
It was a pass or refer, we don't know.
They celebrate either way when they get a result.
There, you see the device.
Then another result.
So, like many skillful tasks, competent screeners can make it
look so easy, and it, often, can be easy, once you've been trained and
have had a little practice.
To assist screeners in developing all of the different steps of the
screening process and developing that as a habit, um, we have, as
apart of our training, a skills checklist for OAE screening, and
that's available on kidshearing.org, and that checklist
guides a screener through the OAE screening process, and it's
helpful, whether you're a screener or an experienced screener need
needing a refresher, or if you're a manager, it can be used as a
competency-based observation tool for those that you're supersing
supervising.
So, that's what you see here on your screen.
So, we'll show you where you can find those on our, um, website.
As we've emphasized, evidence-based screening is more
than just using a designated piece of equipment.
We have to be trained to use that equipment and have a screening and
follow-up process built around that equipment, but you do need to have
appropriate equipment.
So, let's talk about this for just a minute.
You should be aware that OA OAE equipment is available from several
different companies and in models designed specifically for
screening by lay individuals, um, such as most of you who are
participating with us today.
These are the simpler and less expensive models, basic OAE
equipment is what you're looking for and, currently, that costs, and
I know you're not going to like this, but it's about $3,800 for the
device.
Now, there are also other equipment models intended for the
use of audiologists, like Terry, that are designed for diagnostic
purposes, and those are more complicated and more expensive,
but they may come by the same name.
So, you don't need or want those expensive or complicated models, so,
as non-audiologists, be careful to ask for the simplest version they
have as a non-diagnostic model.
Now, in addition to the cost of the equipment, each time you screen,
um, you have to have a disposable cover that goes over the probe,
that needs to be inserted snuggly into the ear canal and would come
in a variety of sizes to ensure a really snug fit.
You'll need a good selection of those and, again, they have a cost
of about $1 to $1.50 each.
Now, I just want to interject here, you know we're not selling
equipment.
That's not us.
We're just try trying to help you use this equipment.
We know all too well the burden of the cost of this, but it is
part of what it takes to use this recommended method.
Now, since you'll not always select the proper size on the very
first try, especially when you're learning, you could end up using
several probe covers for each child you're attempting to screen.
So, we always recommend purchasing at least twice as many
probe covers as you have a total number of children to be screened.
Now, you'll also need some adult size probe covers as well, because
during your learning process, as well as, really, on a regular basis,
you'll be testing the equipment out on your own ears and on
another adult, to make sure it's functioning properly before
screening.
In fact, when you're being trained, before you even try to
screen children, you'll screen yourself and some other adults, so
you'll need to make sure you have adult probe covers as apart of
your purchase.
When you meet with an equipment <distribute or salesperson, they
may mention, as Terry referred to earlier, that they will offer you
training, and it's important that you understand that this training
is rarely sufficient to meet the training needs you have.
Terry, do you want to say something more about that?
>>: Yeah.
You know, um, there's the practical hands-on how to screen
kids perspect perspective that doesn't come with the, um, training
from the vendor and, so, that training to help you get acquainted
with your screening equipment, to give you practice in selecting the
correct size probe covers, to demonstrate how to insert that
probe snuggly into a wiggly child's ear, um, all of those learning
experiences will teach you how the equipment not just turns on and
what buttons to push, but how it actually functions under use as you
screen.
It'll help you by, first, learning to screen on your own
ears and, then, to screen other adults before you take on the
challenge of trying to screen children.
You should be guided through practices that demonstrate, you
know, how the equipment's going to function, um, under less than i
ideal conditions, so if the individual you're screening moves
or makes noises while screening, or if there's noise in the room,
things you can do about that.
Then, you add that challenge of screening children.
So, the learning process should demonstrate, um, strategies for
managing children's behavior while they're being screened and, then,
lastly, a good learning process will help you know how to use the
information provided on the device to record results and, then, what
those follow-up steps are when a child doesn't pass the screening in
one or both ears.>>: Yeah, so, we always like to make this analogy; a
car salesman at a dealership may train you per se to, about the
various functions of the car and everything you see on your
dashboard, and that can be helpful, but that person is not going to
teach you how to drive or to parallel park, and it's the same
with purchasing hearing screening equipment.
You'll need another way to learn how to screen and, as we point
pointed out, one way is to access the online resources that we have
on our website and, um, I'll show you again where to do that.
Doing that and, if you can, having a local audiologist who can,
then, screen alongside you when you are just getting start started
and can give you some helpful pointers, it's a great way to be
sure that you get your training needs met, and this is true whether
you need training on OAE or the other method, pure tone audiometry.
So, um, be aware that you do, in fact, need to get training, don't
attempt to teach yourself.
So, just, um, so that you know, on our website, you'll find, um,
under equipment resources, um, this table which shows you some of the
available, um, different manufacturers' equipment options
for you and how to locate them.
Um, so, and there's also a criteria for selecting equipment.
We had a webinar last week in which we asked, um, all of the
participants who are already experienced doing screening, and
some of them said they were having difficulty screening children in,
um, somewhat noisy, natural environments, and we asked them
what equipment they were using.
Now, we don't ever, because we're federally-funded, we don't ever
particularly recommend any specific manufacturer, but we can tell you
that the response to that particular poll was, um, the most
common re response was that people were having success in those
natural environments with this first row of equipment here, those
three different devices there.
So, um, and that's not to say the others aren't, um, also, um,
equally effective.
We have had a lot of experience with that second row of devices as
well, and they work really well as well well.
So, take a look at that, if you're in the position of needing
to select equipment.
All right, so, we've talked about OAE screening.
Let's shift our attention over to pure tone screening now for
those of you who may be considering this or may already be using pure
tone screening, and we want to point out that pure tone screening
is never recommended for children under 3.
As we've mentioned earlier earlier, it's the most common
method used with 3 to 5 year olds, but even some of those 3 year olds,
we can't really successfully screen with that, as we've pointed
out.
Now, you probably recognize this method, um, either because you
already use it or because you've had your own hearing screened this
way.
In this procedure, musical note-like tones are presented to
children through headphones, and children provide a behavioral
response to that tone, like raising a hand to indicate that they heard
the tone.
Pure tone screening gives us a good idea of the functioning of the
entire auditory system, all inway the way to the train, with the
child showing a physical or behavioral indication that they
perceive the sound.
It's a relatively affordable method, with the screening
equipment, in this case, costing $800 to, maybe, $1,000.
It's a relatively, um, it's a durable and portable piece of
equipment, just like OAEs OAEs, which enable us to easily transport
and use it in a variety of locations.
The difference, however, though, and we'll talk more about this, is
you have to be, you can't screen in a natural environment, you have
to pull the children out into a quiet space, and it also is a
piece of equipment and method that a wide range of individual
individuals can be trained to perform.
Terry, you want to walk us through how it's done?
>>: Yeah.
So, to conduct a pure tone screening, we're going to start
just like we did with OAE, we're going to, first, take a look at the
ear, we're going to make sure that there's no visible sign of
infection or blockage, just like we do prior to doing OAE screening
and, then, if the ear appears normal, then, the screener, um,
places the headphones on the child's head and instructs or
conditions the child in how to listen for a tone and respond by
raising a hand or placing a toy in a bucket, a game like that.
This step can take some time, because we have to be sure that the
child is able to reliably complete the screening task, but once the
screener is, um, has observed that the child reliably responds to
sounds that are presented, just as the screener instructed, that's
when the actual screening is started.>>: So, that process,
Terry, might take 5 minutes, right?
>>: It might.
Yep.
We have to make sure that that, um, that that response is, um,
listen and respond response is strongly conditioned.
Once it is, then, during that screening process, this listen and
respond game is repeated at least twice at three different pitches
on each ear and, then, we note the child's response or their lack of
response after each tone is presented.
Now, if the child responds appropriately and they're
consistent to the range of tones presented to each ear, that's when
the child passes the screening.>>: So, are you all getting the idea
that there's some notable differences between O OAE screening
and pure tone?
There are two especially notable differences in that the process
requires children not only to be cooperative, but to be full
participants in the process, following directions and responding
reliably.
As we mentioned, that means completing that additional process
that we refer to as conditioning, or teach teaching the children and,
then, carefully determining whether you're getting reliable responses
from them before even attempting to screen.>>: And the other
difference between pure tone and OAE screening is that the screen
screening itself is not, um, automated as OAE is.
Instead, in pure tone screening, you, as the screener, will need to
manually step through the presentation of each tone multiple
times for each ear, recording each response.
Then, following a very specific protocol, you, as the screener,
will determine whether the ear passed or not not.
With pure tone screening, there's, um, considerably more potential
for us as screeners to make mistakes or for screener error, um,
that can produce inaccurate results.
So, there's a real need for thorough training and oversight, to
make sure all screeners are adhering to the prescribed
screening protocol.
We really can't emphasize enough, um, the importance of training and
periodic oversight, as even some of us experienced screeners will
make errors that could inadvertently invalidate the
screenings in ways that we might be unaware of.
Now, on your screen here, you'll see see, this is an example of the
actual screening steps that need to be documented for each ear as you
screen.
So, through the training process, you'll learn all of the steps of
the conditioning and the screening process and all of the
environmental conditions that need to be monitored and met as you
complete, um, a child's screening screening.>>: Now, based on these
results, the screener determines if each ear passes or not, and the
device itself does not produce that result, as is the case in OAE
screening.
Now, mides my slides are not matched up, Terry.(Laughing.)>>:
So, as we go through this process, you will be, those checkmarks
indicate how many different manually-initiated attempts need to
be done on each ear, at each tone.
So, you try it at the 2,000 first, then you go 4,000-hertz and
determine whether the child passed or not, then 1,000 and, then, you
do it on the other ear.
You need to get two responses out of four for that particular
pitch to pass, and there needs to be passes on every pitch for both
ears for an overall screening pass.
So, we've provided, also, a screening skills checklist for pure
tone screening that walks through all of those specific steps and, um,
that's another helpful training tool, as well as on an ongoing
self-monitoring or supervisory monitoring for quality tool that
you might want to look at.
So, what's the next step, when a child doesn't pass a hearing
screening?
We've talked about the two methods.
Regardless of which method you use, you will eventually have
children who don't pass.
So, what then?
In order to be evidence-based, your screening process has to
include a follow-up protocol for when children don't pass, and we
can't emphasize enough that our screening efforts are only as good
as our ability to systematically follow-up on children who don't
pass the screening on one or both ears.
So, let me give you a quick walk-through of the protocol and,
then, we can go look at it more closely on our website.
The percentages we're going to be talking about here today are
from over 10,000 children, birth to 3 years of age, on whom we've
used the OAE method.
So, um, the stats we're about to give you are related to that
scenario.
We expect children in the, um, 4 to to 5 age range to have slightly
better pass rates, because they don't tend to have ear infections
as often as those younger children do, and they tend to be more coop
cooperative.
So, let's look at the protocol.
We're going to screen a hundred percent of the children who will
receive an initial OAE or pure tone screening on both ears, and we
expect about 75 percent of the children will pass on both ears and
will not need any further follow-up.
That will leave about 25 percent that will not pass on one or both
of their ears the first time they're screened and will need to
have a second screening in about two weeks.
Now, the interesting thing is that, at this point, a good many
of the children who didn't pass the first screening will pass this
second screening, only about 8 percent will not pass the second
screening.
These children will need to be referred to a healthcare provider,
um, who will do a middle ear evaluation to determine whether
there's a wax blockage or an ear infection or some other reason why
the child may not have passed and, once the middle ear problem, if
there is one, is resolved and you get medical clearance, you'll then
screen the small number of children, this 8 percent, a third time, and
we expect that less than 1 percent will still not pass that third
screening, and those children will be referred to a pediatric
audiologist for a complete audiological evaluation.
So, although a small subset of children will, indeed, need
follow-up referral and further screening after the initial
screening, we have used this protocol in thousands of early
childhood settings and have found that most programs find this to be
feasible to implement.
It helps children get the medical and audiological attention they
need need, while it also minimizes the number of unnecessary referrals
for healthcare providers, to healthcare providers.
So, we're balancing the need to find children, but, also, not to
over-refer.
Once you're underway with your screening program, you'll want to
check, um, with these particular pass and refer rates, to make sure
that yours are similar and, if they vary considerably from this, you'll,
probably, want to get some technical assistance or, maybe,
some follow-up training.
So, this is another illustration, just overviewing what I just said,
that outlines the screen screening and follow-up protocol, and this is
available on our website, it's built in into the training modules
that you'll find there and, just as a reminder, this protocol is used
regardless of which screening method you're using, OAE or pure
tone.
It's exactly the same process within each method.
The only difference is that the percentages of not passes, maybe,
somewhat differs with different age groups and with the pure tone
method, but this shows you the protocol overall.
Terry, there's an exception, right, to this protocol?
Do you want to talk about that?
>>: Yes&we, and we touched on it earlier, but the exception is that
whenever a parent or a caregiver expresses concern, so, they have a
concern about a child's hearing or their language development, that
child should be referred for an evaluation from a pediatric
audiologist, ehaveen even if they passed a hearing screening, and
this is true because, if you recall, um, you know, we don't have
that perfect hearing screening method, they're not a hundred
percent accurate or perfect and, so, to be on the safe side, whenever
there's an explicit concern about hearing or language, make a direct
referral and, of course, you can screen the child and send that
result along, but make the referral regardless.>>: Thank you.
All right, so, kidshearing.org, most important thing you can
remember today is our website, because all of thethis things that
we talked about today are available and explained at greater
length there.
It's also where you'll find the recording of today's webinar.
So, we invite you to go check out the resources you'll find there.
Let me review them again and, while I'm doing this, um, Gunnar is
going to open up our Q & A field, so that you can type in some
questions or comments.
When we're done with questions, we're going to also open up,
provide a link in the chat for you to give us a quick evaluation of
today's webinar, which will also produce a certificate of
attendance at today's webinar, if you need one of those.
So, before you run off, if you need a certificate for today, be
sure to look in thetiality chat for that.
So, this is our website, our landing page.
That top portion is general information that you might want to
look at and, then, you'll go down to where you see planning
resources.
This is where you'll see the big-picture resources.
For those of you who, um, may have gotten interested in my
comment about if you need to decide about what method to use for 3 to
5 year olds, OAE or pure tone or both, in that big- big-picture
resources drop-down, you'll find a document there that compares the
two, that will facilitate a good conversation, maybe with your
health services advisory committee, a consulting audiologist, or
others who will help you in that decision.
If you need an audiologist, which we encourage all of you to
try, if you can, to part partner with an audiologist, you'll find a
way to do that through that next drop-down drop-down.
The first recommendation we give, ask your colleagues, there may be
people who know of a local audiologist and, then, the second
is to go to your state's Early Hearing Detection and Intervention
or newborn hearing screening program at the state level, and we
provide a link to your state's person right there, they know all
the audiologists, the pediatric audiologists in your state, and a
pediatric audiologist is who you really want.
The next part is screening equipment resources.
So, you'll find that table there, along with criteria for selecting
equipment and other things related to, um, equipment needs.
The next category is how to access training, both for OAE and
pure tone.
So, check out that.
After you've got your planning steps done, the next part will be
to access training.
The next portion is all of the nitty-gritty stuff of actually
doing screening on a daily basis, preparing for screening resources,
a checklist of all the materials you need, the protocol that we
just went over, we have forms that match the protocol exactly, so you
won't ever skip a step and, then, resources for sharing your results,
letters to parents, referral letters to providers, all of that
is there, and some of our resources are available in, both, English
and Spanish, so, check those out.
Oh, under the preparing for screening, you'll also find letters
to parents explaining your screen screening methods.
The next, um, is follow-up resources, where you'll find, um, a
tracking tool that is really useful for tracking a group of
children through the screening process and, then, other resources
for monitoring the quality of your screening efforts.
So, have a look at that.
Remember, if you're a Head Start program, you can also get resources
from Head Start's technical assistance, um, centers, so,
that's how you can access them as well.
So, remember these three groups of children.
This is what we're really talking about.
You may not have ever thought of it quite like this, but monitoring
the status of children's hearing is central to quality early childhood
programs that are committed to language development and school
readiness.
When children with hearing loss are identified and connected with
the intervention resources that they need, they can thrive, and you
can have the satisfaction of knowing that you were part of that
outcome.
So, what questions can we help you address?
>>: So, William, I see the first one here on, um, calibration.
Can you speak to calibration of equipment?
How often and challenges in remote areas, such as Alaska?
Really great question and not one that we really touched upon,
but we recommend your equipment be calibrated annually and, of course,
you'll be wanting to do a check on your own hearing or someone who has
a known result and check their ears before every screening session,
just so you know that that equipment's working, that you
screen an ear, it has a known result, and you get that result, um,
just as a quick daily check, but we recommend an annual calibration
for the equipment.
I know that that is hard in rural areas, um, and, um, one of
the things in rural areas, sometimes, is if the person doing
the calibration, if they need to take the equipment for any repair,
um, see if you can address the option of getting a loaner piece of
equipment, um, while they're working on your equipment there,
but annual calibration with daily checks to ensure the equipment's
working before every screening session, um, and good relationship
with, um, your vendor or the company that provides calibration,
so, hope hopefully, they'll work with you on loaners and other ways
to make sure rural setting work a little easier.>>: One of you
pointed out that when you type in kidshearing.org, it actually come
comes up in your address line as a subset of Infantehearing.org.
You're in the right place.
Kidshearing.org is a subset of Infantehearing.org, which, um,
focuses on overall hearing screening and, so, if you type in
kidshearing.org, you just get right to where you want to be for
early childhood screening resources.
Terry, the next question, if a child needs a complete audiological
evaluation, but does not have health insurance, are there
resourcess to help families with the cost?
>>: Yeah.
Thank you.
That's a great question.
There should be and, again, there may be rural challenges with this
and access with distance, but, um, most state health departments,
their Early Hearing Detection Intervention program, their EHDI
program should work with and have a listing of places where, um, the
audiological e evaluations can be done and, so, if I use my own state,
for example, um, there's a listing of places and cost and
those that will work with, um, people that do not have insurance
and, then, through, um, you know, state-provided services, they can
be provided at no charge.
There's also, um, you know, the healthcare systems, if you want to,
especially if they're not-for-profit, they are, um,
required by the Affordable Care Act to have financial assistance
for those that are, that do not have insurance and, so, um, if you
do not have insurance, I would specifically ask if they can apply
for financial assistance with that, but I would double-check with your
state EHDI program for a listing of service providers and the data they
have on cost for those.>>: So, the next question is how do you
decide when a child who is 3 years old or older needs to do OAE
screening rather than pure tone?
What would you see in a child that indicates that pure tone is
not appropriate?
.
I'm going to let Terry expand upon this, but the first thing is that
that is apart of the actual training.
We're not going to be able to completely answer that question
here, but, Terry, give a preview of how one would know.>>: Yeah, so,
the first thing that we look for is does the child have the ability
or are they able, in the circumstances you're in, to
understand your instructions and to participate in that.
If they're not, that's going to be the firstthi that thing that
you'll look for and, um, then, there's a lot of strategies that we
would look for there.
It could be, um, you know, the inability to condition can be
related to a variety of factors, such as language barriers, um,
developmental stage and, um, and those kinds of things, but the
primary thing is being able to see if they can understand and
participate and be conditioned and, if they can't, we need to have our
backup method or strategy ready.>>: The next question is
Floridian teacher of the deaf and hard of hearing for a public
school system.
Speech therapists and nurses usually conduct the pure tone
screenings.
Would it be beneficial for me to be trained, and would it be
beneficial for the county to purchase an OAE machine?
Um, I'm going to start off with part of the answer,, but, Terry,
you can chime in.
I am so glad that you're on here, um, Shelly.
I would, first, um, encourage you to make sure that those who are
doing pure tone screenings have been adequately trained and that
training refreshers are being done, and I'm emphasizing that because
we have seen, you know, a, sort of, common drift in peoples' skills,
particularly around pure tone screenings, because it is all
manual and, um, people can just make mistakes, where they're
passing more children than they should be.
They may be thinking they're doing children a favor by helping
them and not realizing that they're helping them, so, really, getting a
tight grasp on the importance of adhering strictly to the guidelines
of pure tone screening is really important.
As for the second part of your question, would it be helpful to
have, um, an OAE device and for you to be trained on it, well, I'm
going to say yes.
Terry, what do you think?
>>: I would say absolutely.
It's wonderful to have that, um, second backup for the kids you're
serving.
I think it's just doing them a great service.>>: Great.
The next question reads, Floridian speech pathologist and
work in early intervention.
All of the students I evaluate have language concerns.
Should we screen during the evaluation, even though you
recommend that we also refer them to a pediatric audiologist?
In our educational setting, we have to be careful when we
recommend a private setting for follow-up.
Terry?
>>: Yeah, I love this question.
So, the first part of it, should we screen during the evaluation,
yes, absolutely.
That is our hope, um, that could be a standard practice, standard
of care during a speech and language evaluation, that a hearing
screening was part of it and, so, if you could do that, um, that
would just really move that whole process along for these kids and,
um, so, um, emphatic yes on my part part.>>: Excuse me.
I want to add one thing.
In our earliest intensive data collection of the ECHO Initiative,
we found that many of the children that were ultimately being
identified with a hearing loss as a result of the screenings, hearing
screenings that were being done in the Early Head Start programs we
were working with were already enrolled in early intervention
programs and getting speech therapy, and nobody had checked their
hearing.
That doesn't sound right, right?
I mean, it seems like it's putting things in the wrong order,
to start doing speech therapy or language therapy interventions
with children when we haven't, first, established whether their
hearing is compromised.
So, once again, yes, yes, yes.
We are big advocates of getting, um, evaluations of language paired
with hearing screenings or hearing evaluations, particularly in Part
C early intervention programs.
Those things just sensibly have to go hand in hand.
Okay, the next question.
I work with Early Head Start home- home-based families, and I'm
wondering if anyone else is experiencing more families not
wanting their children hearing screened or re-screened.
It is as if they don't understand the importance and
cannot understand, cannot stand to upset their child in any way, even
for a moment.
Um, great question.
We don't have a way right now to in instantly poll everybody about
this, um, but what it does underscore is the importance of
family education, right?
And we do have some tools on our website that you should look under
preparing to screen, where there's some information for families
about the importance of hearing screening, underscoring those main
facts, that hearing status of a child can change, and they can
change without us noticing.
You know, children will accommodate, to a certain degree,
and, kind of, trick us into not knowing, um, that they're actually
accommodating for a hearing loss.
So, um, check out those resources.
Thanks for sharing that observation though.
Um, so, let's see.
Some of you are asking about a certificate of attendance today.
Look in the chat field, there's a link there for the evaluation of
today, and that will generate a certificate of attendance.
Um, Terry, the next question, late onset hear hearing loss
attributed to infection, trauma, environment, and genetics.
Is that the order of the causes most frequent to least frequent?
Which specific infections can lead to hearing loss?
Can you address that, Terry?
>>: Yeah.
That's a great observation.
That was, um, not necessarily the order of causes.
If I were to just informally look at these, I would say that the
causes would be, um, genetics, infection, and, um, would be, you
know, more at the top of that list, but, um, so, no, they weren't
necessarily listed in order of, um, you know know, the most common
causes.
Then, infections can get, um, into, um, different type types, so
you can have, for example, CMV infection that can cause, um,
hearing loss either at birth or later and, then, you could also
have a different part of the ear, with chronic middle ear infections
that causes what we would call a conductive hear hearing loss or a
problem before the sound even gets to the inner ear and, so, um, you
can have infection that occurs at different, um, parts of the system
and at different stages and times of life.>>: The next question,
Terry, is do you always need a referral from a healthcare
provider to see an audiologist?
>>: So, that's going to depend on, um, what the, um, coverage that
that individual individualory family or families family has and,
so, it will vary on health plan.
Most state Medicaid programs, um, are, require a referral, so, um, I
would say, probably, more often than not, a referral may be
necessary, but, again, it's going to be plan-dependent.>>: The next
question is I see some people using a probe, or I think they mean probe
cover that is too big.
In those cases, would you get a false reading?
>>: So, um, that's a great question, because this emphasizes
that probe fit is, probably, the most critical factor in getting a
good, um, screening done, getting your OAE, um, accomplished and, so,
we want to have a good probe fit.
Generally, the rule is we want to have the largest size probe that
will appropriately fit into that ear canal, so we get a good, snug
fit, and the probe stays stable in the ear without you holding on to
it.
Now, if we have one that's too small, it will be loose, it could
fall out, noise could get in, and you, probably, won't get your OAE
completed.
If the probe is too big, it will also be so large that it can't
quite fit in there snuggly.
The most common thing I see with a probe that's too large is we just
can't quite get it in, and it wants to fall out, um, easily.
The second part of your question is on results.
So, if we get a refer, we know that we may, we, probably, want to
try again and try a different size probe.
A refer, we don't necessarily know why that is.
Is it due to noise?
Was the child chewing or sucking?
Did I have a poor probe fit?
So, we want to try again, but when we get a pass, that means the
machine has actually detected and measured that emission, so the pass
result, um, is a result that you can take.>>: Terry, the next
question is what if you can't get a child to cooperate for a
screening?
>>: Yeah, that's a great question.
That relates to that, all that training, um, those training
issues and the, um, the reasons to have good training is because we
want to talk and train about how we can, um, work with children, um, to
get them successfully screened and, so, there's a lot of varying
things that we can do, but we may, um, without going into all the
specifics, um, but there are strategies we can do with, um,
getting help with a caregiver that they know and are comfortable with,
we can, um, come back again, and we can desensitize over a couple
days.
Um, lots of var varying things that we can try to do and, then,
it's also, if you're experienced, you'll learn when to call it and
when it's time to refer.
So, um, I apologize, but we could, um, we could almost do
another webinar on that question.
It's a great question.>>: Yep.
The next question is I'm curious if there have been times when a
child has failed a screening, but, later, is found to have autism or
sensory processing disorder and not a hearing loss.
Are there resources for this scenario?
>>: Love that question, because that, often, those are the kids
that would fall in that 20 to 25 percent of pure tone screening,
where we couldn't get the screening done or we couldn't get reliable
responses, um, and, um, but if we're able to, um, work with them,
we can, often, get an OAE complete on those kids and be able to at
least screen, um, up through the level of the cochlea and get a
response and, so, um, we want to keep trying till we can rule out
hearing loss as, um, part of the things that they're dealing
with.>>: The next question, we're going to go quickly through these
remaining ones as we can.
We're getting close to the bottom of the hour.
If you have to run off, um, be sure to check the chat for the link
for the evaluation and the certificate generator.
It's one link.
Okay, Terry, children in Early Head Start, where I work, are given
a functional vision and hearing screening by a trained staff
member.
If the child doesn't pass, they're monitored and re-screened
or referred.
Is this sufficient?
Or how do I get, um, how do I get a copy of the newborn hearing
screening?
Well, I'll answer the first thing.
I'm not going to speak about vision, but a functional hear
hearing screening is not considered evidence-based.
OAE screening for birth to 3 year olds is the only
evidence-based screening practice that you will find in the
literature that you can really defend as evidence-based.
Terry, do you concur with that?
>>: Yeah, absolutely.>>: Um, as far as getting the newborn
screening result, um, it should be in a child child's health record.
So, you would ask for that from a child, where you would get, like,
their immunization record or any other things like that.
Um, the next question question, Terry, is, in my area, the majority
of doctors use an objective tool to screen for hearing and/or a
subjective tool for hearing, um, screening is not done, because the
child does not need it.
Um, our program currently accepts our doctors as the screening tool.
What are your thoughts?
Um, what we would say to that is that we never consider a hearing
screening that has been done that is subjective as a com completion
of a hearing screening regardless of who has done it.
That just because it is a doctor doesn't mean that it, suddenly, is
a more valid screening.
Again, OAE screening is the recommended method.
Now, if you're getting results of that from a healthcare provider,
you want to make sure that you have documentation that it was an OAE
and the results on each ear, not just an overall, but a left result
and a right result and, with that, you would know you had a screening,
that it was completed.
Now, if there was a non-passing result, you would still need to do
the follow-up step steps.
So, um, we know this reality that you're talking about, it's familiar
to us, but we always encourage people to recognize that, you know,
you're the front end of a movement here that is understanding the
value of evidence-based hearing screening, and not all healthcare
providers understand or support this process yet, but you can help
them understand the value of that.
Everyone, we're at the bottom of the hour.
90 minutes has passed, so, we're going to have to end for today.
If we didn't get to your question, feel free to contact us
through our website at kidshearing.org, and we'll happily
respond to you there.
Remember to go to kidshearing.org, where you'll find all of our
resources, including this webinar recording for you to review again,
toed advance forward to, if there's a particular slide you want to look
at again or a statement we made you want to hear again, and share
it with others who may not have been able to attend live with us
today.
Thank you to our captioner, our interpreters, Terry, thank you,
thank you, Gunnar, for your technical support, and thank you
to all of you for all that you're doing to make sure that, as apart
of your commitment to children's language development and school
readiness, that they are having their hearing carefully and
conscientiously considered periodically throughout this
really important language acquisition period in life.
Thanks, everyone.