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staff in implementing evidence-based hearing screening

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and follow-up practices, and  we also reached out to many other

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early care and educational settings and those who  work in those

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settings to develop their hearing screening and follow-up practices

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as  well, such as programs like Part C or, um, Community Health

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Centers.

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So, we had  quite a diverse set of people who have registered for

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today's webinar from all of  those contexts, and we're really

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delighted to have you all with us today, so that we  can continue to

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share the information that we have that you may be able to put to use

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use.

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Before I go any further, I want to let you all know a couple of

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logistics.

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Today's webinar is being recorded and, so, what that means

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is that, within the next  couple days, if you go to kidshearing.org,

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you'll be able to stream this video, um,  and be able to just go to

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whatever portion you want to listen to again.

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It also  allows you to share this webinar with people who aren't

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attending live with us today,  so, keep that in mind as we progress.

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We're going to, um, present our information  for you today and,

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then, we'll open up the floor for questions, and we'll open up a Q  &

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A box, um, at that point.

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We won't be monitoring and interacting with questions

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throughout, we'll save them till the end and, hopefully, we'll

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anticipate some of  your questions, so you won't even to ask us.

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That's always our goal.

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I also want to  give a shout-out to our interpreters and our

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captioner today for your time and talents and helping us make this

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webinar as accessible as possible.

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To Gunnar, who is our tech person in the background and,

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um, to all of you for taking  the time out to think about these

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important issues related to communication with, um,  young

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children that we're all serving.

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We're joined today, um, by Terry Foust, who  is a pediatric

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audiologist and speech-language pathologist, who has served as a

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con consultant and a trainer with the ECHO Initiative since its very

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beginning and, so,  Terry, welcome.>>:  Thank you, William and,

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um, it's a pleasure to be with all of you this afternoon afternoon.

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As William mentioned, he and I, along with many other ECHO team

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staff, as  well as local collaborators, we've provided

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training on nearly every state.

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It's  really, literally, been, I think, thousands of staff from

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Early Head Start, Head  Start, American Indian alatchinga Native

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and Migrant Head Start, as well as other  education programs over the

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almost 20 years that William mentioned, but the important  thing

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is that we're always encouraged, just like we are today, with a huge

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amount of  interest that there is in establishing and improving

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evidence-based hearing screening programs, really so that children

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with hearing-related needs can be identified and  served.>>:  We

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always like to start out with, kinds kind of, addressing the

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question of why.

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The  work of the ECHO Initiative is based on the recognition that,

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each day, young  children who are deaf or hard of hearing are being

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served in early childhood education and healthcare centers

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without their hearing-related needs even being known known.

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Hearing loss is an invisible condition.

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So, how can we reliably identify which children have normal hearing

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and which may not?

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>>:  Well, the short answer to that question, William, is that early

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care and  education providers can successfully be trained to conduct

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evidence-based hearing  screening, just like you see here in the

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photos on your screen, and the ultimate out outcome of a hearing

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screening program is that we can identify children who are deaf  or

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hard of hearing, who have not yet been identified previously.

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So, if you look at  your screen, the procedure on the left is called

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otoacoustic emissions, or OAE hear hearing screening, which is the

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recommended method for children birth to 3 years of  age and

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increasingly recommended for children 3 to 5 years of age as

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well.

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Now, on  the right-hand side, you'll see the procedure called

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pure tone audiometry hearing screening, and that's historically

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been the most commonly used screening method for  children 3

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years of age and older, which you'll still see in many early care

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and  education settings and providers using, and we're going to

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be talking about both of  these methods today.>>:  So, let me give

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you, um, an overview of what we're going to cover today.

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While  this presentation is not a training per se, our goal is to

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provide an overview of the  big picture of what is involved in

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implementing evidence-based hearing screening for  children across the

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age spectrum birth to 5 years of age, and we're going to start  off

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by giving you an overview of the auditory system, or hearing system,

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which will  help lay a foundation for understanding how the hearing

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screening methods we'll be  talking about actually work.

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Then, we're going to talk about why we screen for hear hearing loss,

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what even makes it possible for us to seriously be engaged in

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systematic screening for hearing with young children.

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We're going to talk about the two methods Terry just mentioned,

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OAE and pure tone audiometry, starting with an over overview of

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OAE screening and followed by an overview of the pure tone

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audiometry  screening process.

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Next, we're going to address the important question, what do we  do

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next, when a child doesn't pass a screening?

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We'll summarize the follow-up steps  that are undertaken when a

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child doesn't pass a hearing screening on one or both ears ears,

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so you have a big picture of not only how to screen, but that

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important  follow-up part of the process.

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We'll wrap-up by showing you some of the resources  that are

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available to help you develop your evidence-based screening program,

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how to  get training and, um, and, then, answer whatever questions you

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might have, okay?

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So,  that's where we're headed, and you can follow the progression

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of these topics by  referring to the left side of your screen and,

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since this is a recorded webinar, this  left side menu can be helpful,

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if you return to this webinar and in the recorded format  and want to

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navigate to a specific portion of your our presentation to review

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again or to  share with others.

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So, before we launch into our content, I want to make sure you

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all know where to go after today's webinar to get additional resources,

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information,  and access to training.

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You know, before I do that, one of the things that you're  going to

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hear us say several times today is that we really want to make sure

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that you  all understand that implementing evidence-based hearing

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screening practices is more  than using a designated piece of

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equipment or a specific method.

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Would you agree  with that,

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Terry?

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>>:  Yes, absolutely.

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We want to really identify those children that are at risk for

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hearing loss and, um, and, then, provide for their follow-up.>>:  So,

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to implement evidence-based practices, the recommended

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equipment or methods  we'll be talking about today must be used

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according to a prescribed set of steps  under carefully controlled

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conditions, each step of which is carefully documented in  detail,

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and this is true whether you're using OAE screening or pure tone

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audiometry  screening.

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Over the years, the ECHO Initiative developed a wide range

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of resources  to help you achieve this goal, and our goal today is

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primarily to help you find all  of that information and the resources

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that you need.

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So, let's take a look at this website, kidshearing.org.

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You'll find, um, if you go here, you'll find a variety  of

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implementation tools and, certainly, before you sit down to develop

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something or  to write a letter to parents about your screening

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efforts or a referral letter or to create a form for documenting your

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results, please check out what's already -- audio  out -- many of

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the resources you'll find here are the result of various examples,

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early childhood programs shared with us.

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So, you can be assured that others have  used the language and

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the format of many of these resources to achieve the same goals

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that you have.

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We also know that many of you want to know about how to access

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train training.

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So, be assured that we can direct you to a specific location where

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you can  get the training you need, um, and, so, let me just show you a

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few of these, but,  again, take some time to, after the webinar, to

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get acquainted with these, um, re resources you'll find on our

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website.

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So, this is the landing page for kidshearing.

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kidshearing.org, which provides that, a variety of practical

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resources.

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The first  part of the page, um, places early childhood screening

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into the larger context of identifying children who are deaf

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or hard of hearing, expanding the traditional focus  on newborn

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screening to include a focus on identifying hearing loss throughout

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early  childhood.

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Now, if we scroll down, this is where you'll find all of the

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practical re resources most relevant to early childhood

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screening, starting with planning resource resources.

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Then, you'll see the area where to, um, access training and, um,

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you know know, which is, um, one of the most important pieces, but you

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always want to do your  planning first.

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As we said, for nearly 20 years, the ECHO Initiative was funded to

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provide in-person and virtual comprehensive training and

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evidence-based screening,  and we worked with thousands of people in

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various, um, Early Head Start and Head  Start and other early care

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and education programs, and that complete training process  is now

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available anytime you or your staff need it.

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So, we encourage you to check out that.

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We know that many of you are needing to know how to get training,

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so,  check out what we have there for, both, OAE and pure tone

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screening.

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The website, um um, is where you can access the comprehensive

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training and, you know, some of you may  have a group of staff who need

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training at the same time, while some of you may find  that your

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staff entering your program are coming in at different times and

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are need needing training throughout the year.

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So, having an online training option available  that can be done

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anytime and at any pace can serve a lot of different peoples' needs.

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So, um, we encourage you to check that out.

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Yep?

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>>:  Can I just interject on training that, um, the training

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William's referencing is  really different than the training that,

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um, your equipment manufacturer or the, um,  vendor that you buy your

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equipment from, they will be very technically proficient in  how to

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operate the equipment and to turn it on, but the training that comes

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with with  screening children, um, children handling probe fit issues,

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all of those things to  get a successful screening, as well as

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program management, are really crucial and key key, and that's

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what William is really referencing here in under the training.>>: 

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Thanks, Terry.

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The next part of our website has to do with screening resources,

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and these are all sorts of good resources to help you prepare for

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screening, the  protocol guides and forms, which we'll be referencing

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today, how to share results  with others, documenting your screening,

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um, outcomes, all of those things are found  there and, then, um, the

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next thing you'll find on the website are follow-up resource

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resources, how to track a group of children through the complete

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screening and  follow-up process and some tools to help you do that,

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as well as monitoring your  program, um, over time for quality.

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So, again, kidshearing.org is where you want  to go to look for

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those things.

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So, make a note of that, kidshearing.org.

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So,  let's put all these resources into context, and we're

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going to start by giving you a quick overview of the auditory or

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the hearing system.

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Terry, you want to take us through this?

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>>:  Yes.

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So, um, as many of you, um, may remember from school, there are

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three main  parts to the auditory system.

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There's the outer ear, the middle ear, and the inner  ear, or what we

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call the cochlea.

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So, when sound enters the outer ear, it causes the  ear drum to

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vibrate, which then moves three small bones in the middle ear, and

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this  movement stimulates thousands of tiny, sensitive hair cells in

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that snail-shape  portion of the ear that you see there called the

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cochlea.

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From the inner ear, the  sound signal is carried along special

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nerves to the hearing centers of the brain and,  then, the

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individual experiences, then, the sensation that we call sound.

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You can  see it just moving through right there.

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Okay, so, while this is how the auditory  system typically

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functions, we can have some exceptions.

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There can be some temporary issues, like a wax blockage, um, or

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fluid in the middle ear caused by ear infections  that we may

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discover and get addressed during hearing screening process, but it's

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key  to remember the primary target condition of the hearing screen is

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the functioning of  the inner ear, or cochlea, that snail-shape

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portion of the ear.

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Now, in some  instances, the sound travels through the outer and

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middle ear, but when it reaches the cochlea, the signal is not

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transmitted to the brain, and that results, then, in  what we would

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call a sensorineural hearing loss, and this condition is usually

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permanent, and this is the primary condition for which we are

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screening in mass  screening efforts, such as we're talking

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about today.

247
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Now, this might come as a surprise to you, but it is, um,

248
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it's an important fact for us to all know, that  sensorineural

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hearing loss is the most common birth defect in the United

250
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States.>>:  Yeah.

251
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In fact, about three children in a thousand are born with a hearing

252
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loss,  deaf or hard of hearing.

253
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Most newborns in the U.S.

254
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are now screened for hearing loss using evidence-based methods, most

255
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before even leaving the hospital,, but screening at  the newborn

256
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257
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period isn't enough.

258
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Research suggests that the incidence of newborn  hearing loss

259
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doubles between birth and school age, from about 3 in a thousand at

260
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birth, as you see here, to about 6 in a thousand by the time children

261
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enter school.>>:  And hearing loss can occur, um, anytime as the

262
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263
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result of, um, infection or, um, trauma.

264
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265
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There can be genetics.

266
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So, as you can see here, illness, physical trauma,  environmental

267
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factors, um, and genetics and, so, that's why we want to keep

268
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screening screening, because this is typically called late onset

269
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hearing loss.>>:  And that means, simply, that it's acquired after

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the newborn period.

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You know,  it's commonly understood that language

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development is at the heart of cognitive and  social emotional

273
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development and school readiness.

274
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Those things drive many of the practices that we see in early

275
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childhood settings.

276
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Think about how much emphasis is always being placed on early

277
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language development; counting the words children can  produce, etc.

278
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It's also important, though, to note that hearing health is at the

279
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heart of typical language development and that, if we're

280
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going to be conscientious  about promoting language development as

281
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apart of our commitment to school readiness,  we should be equally

282
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conscious conscientious about monitoring the status of hearing

283
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throughout  this early childhood period.

284
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If hearing is compromised, then typical language  development will

285
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ultimately be compromised as well, and we don't want to wait for a

286
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language delay to develop in order to discover that a child has a

287
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hearing loss, even  if it's a minor hearing loss.>>:  This is why we

288
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see so much emphasis being placed on monitoring the status of

289
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hearing in young children, so programs like Head Start, which,

290
00:19:16.430 --> 00:19:21.410
for years, have served  as mods models of comprehensive health and

291
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educational programs for young children and  their families,

292
00:19:23.430 --> 00:19:27.410
they've required hearing screenings for all of their children, even

293
00:19:27.430 --> 00:19:32.410
before we have the, um, excellent methods that we now have to do

294
00:19:32.430 --> 00:19:36.410
this.>>:  You know, sometimes, we use the term screening and we

295
00:19:36.430 --> 00:19:40.410
neglect to make sure that  everyone really understands what we really

296
00:19:40.430 --> 00:19:41.850
mean by that.

297
00:19:41.870 --> 00:19:47.850
So, as an audiologist,  Terry, how do you describe what screening

298
00:19:47.870 --> 00:19:48.850
is?

299
00:19:48.870 --> 00:19:53.850
Or, in this case, hearing screening.>>:  I think it's easy to

300
00:19:53.870 --> 00:19:59.850
think of screening, so, think of it as, kind of, a sorting  process,

301
00:19:59.870 --> 00:20:02.850
helping us to separate the children who are at risk of having a

302
00:20:02.870 --> 00:20:06.410
condition  from those who are far less likely to have the condition.

303
00:20:06.430 --> 00:20:10.410
So, those in that first at at-risk group are then followed

304
00:20:10.430 --> 00:20:14.410
with additional steps implemented by pediatric  audiologists and

305
00:20:14.430 --> 00:20:19.410
healthcare providers to continue to refine the sorting process until

306
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we've definitively identified or identified that small group of

307
00:20:23.430 --> 00:20:29.410
children that ac actually have hearing loss and, I guess, to be

308
00:20:29.430 --> 00:20:33.410
blunt, we screen, because we simply cannot provide a comprehensive

309
00:20:33.430 --> 00:20:39.410
audiological evaluation on each and every child.>>:  Yeah, so, try not

310
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to get too hung up by the term, screening, especially for  those of

311
00:20:44.430 --> 00:20:49.470
you who are working in, um, early intervention settings, like Part C.

312
00:20:49.490 --> 00:20:53.470
I  know you don't typically use the word screening as much as you

313
00:20:53.490 --> 00:20:59.460
use the word e evaluation, but the step is the same.

314
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315
00:21:00.590 --> 00:21:06.570
That first step in trying to determine whether  a child has

316
00:21:06.590 --> 00:21:11.570
typical hearing or not are these measures, these methods that we're

317
00:21:11.590 --> 00:21:14.050
going  to be talking about today.

318
00:21:14.070 --> 00:21:18.050
Screening, or evaluation, followed by appropriate

319
00:21:18.070 --> 00:21:23.050
audiological assessment and intervention can dramatically

320
00:21:23.070 --> 00:21:27.050
improve options and outdomscome outcomes for children who are deaf

321
00:21:27.070 --> 00:21:28.650
or hard of hearing.

322
00:21:28.670 --> 00:21:33.650
When hearing loss is  identified early, we can make sure a child has

323
00:21:33.670 --> 00:21:39.640
access to language and, as a result, children who are deaf or hard of

324
00:21:39.660 --> 00:21:40.650


325
00:21:40.670 --> 00:21:46.600
hearing are thriving in ways that used to be rare.

326
00:21:46.620 --> 00:21:51.600
By providing hearing screening, you can be apart of creating these

327
00:21:51.620 --> 00:21:54.440
amazing, life- life-changing outcomes.

328
00:21:54.460 --> 00:21:57.440
So, let's take a look at several examples of children with  severe

329
00:21:57.460 --> 00:22:01.440
to profound hearing loss, who have had the benefit of early

330
00:22:01.460 --> 00:22:06.440
intervention and  quality, or early identification and quality

331
00:22:06.460 --> 00:22:07.510
intervention.

332
00:22:07.530 --> 00:22:11.510
These children are learn learning, they're thriving, and

333
00:22:11.530 --> 00:22:13.310
communicating.

334
00:22:13.330 --> 00:22:19.300
So, let's just take a quick look.

335
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336
00:23:00.090 --> 00:23:02.070
Those two girls are deaf.

337
00:23:02.090 --> 00:23:06.070
They both have hearing aids, they're bilat sensorily deaf  and,

338
00:23:06.090 --> 00:23:11.070
because of early intervention and the support of technology, they're

339
00:23:11.090 --> 00:23:14.690
communicating pretty darn well with one another.

340
00:23:14.710 --> 00:23:20.680
Let's take a look at another example.

341
00:23:20.700 --> 00:23:21.700


342
00:23:21.720 --> 00:23:25.700
These, um, kids are using American Sign Language as their

343
00:23:25.720 --> 00:23:30.950
mode of  communication, which their parents chose.

344
00:23:30.970 --> 00:23:32.460
They're also proficient communicators.

345
00:23:32.480 --> 00:23:38.450
So So, let's have a look.

346
00:23:38.470 --> 00:24:15.770


347
00:24:15.790 --> 00:24:20.770
See, the idea here is to make sure that children have access  to

348
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language one way or another.

349
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This last example is of two boys who are also deaf,  and they'll

350
00:24:26.790 --> 00:24:32.750
tell you, um, what technology is supporting their ability to

351
00:24:32.770 --> 00:25:05.760


352
00:25:05.780 --> 00:25:09.810
communicate.

353
00:25:09.830 --> 00:25:13.810
So, the point here is to be reminded of children like them,

354
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that they are our goal.

355
00:25:15.830 --> 00:25:18.810
We want to make sure that all children have access to language

356
00:25:18.830 --> 00:25:22.810
one way or another,  regardless of whether they have a hearing loss,

357
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and the way to achieve that is to be  fully committed to quality

358
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periodic hearing screening.

359
00:25:30.270 --> 00:25:32.250
Terry, are you up with me now

360
00:25:32.270 --> 00:25:32.750
now?

361
00:25:32.770 --> 00:25:33.750
Are you able to continue?

362
00:25:33.770 --> 00:25:39.750
>>:  I think so, William.>>: Okay.>>:  So, um, let's talk about

363
00:25:39.770 --> 00:25:44.310
these two hearing methods that are used during early  childhood.

364
00:25:44.330 --> 00:25:48.310
So, if you're responsible for children who are under 3 years of

365
00:25:48.330 --> 00:25:53.310
age, then  the recommended method is OAE screening, that you'll see

366
00:25:53.330 --> 00:25:58.310
on the left here, but if  you're responsible for children, if you're

367
00:25:58.330 --> 00:26:01.310
responsible for screening children 3 years  of age or older, then,

368
00:26:01.330 --> 00:26:04.310
historically, as I mentioned earlier, pure tone screening has

369
00:26:04.330 --> 00:26:08.310
been considered the recommended method for this age group, and this

370
00:26:08.330 --> 00:26:12.310
is the headset  screening, where the child raises the hand or

371
00:26:12.330 --> 00:26:15.310
performs another task every time they  hear a sound that is

372
00:26:15.330 --> 00:26:21.310
presented into the ear phone, and you see this method, again,  being

373
00:26:21.330 --> 00:26:22.910
used on the right.

374
00:26:22.930 --> 00:26:25.910
Now, there's growing, um, recognition, I was just going to

375
00:26:25.930 --> 00:26:28.110
mention, William, that for a variety of reasons, as common as

376
00:26:28.130 --> 00:26:34.110
the pure tone method  has been, it may not always be the most feasible

377
00:26:34.130 --> 00:26:36.680
method to use with some of these younger children.

378
00:26:36.700 --> 00:26:40.680
Research has showed that about 20 to 25 percent of children in  that

379
00:26:40.700 --> 00:26:43.680
3 to 5 age group, um, can't be screened with this methodology,

380
00:26:43.700 --> 00:26:48.680
because they just  aren't developmentally able to follow the

381
00:26:48.700 --> 00:26:50.480
directions reliably, and that's really been  our experience as

382
00:26:50.500 --> 00:26:51.800
well.

383
00:26:51.820 --> 00:26:56.800
So, in those instances, OAE screenings are the preferred

384
00:26:56.820 --> 00:27:03.360
method for those children.

385
00:27:03.380 --> 00:27:07.320
William, I'm off again here.>>: Yeah, I am too, Terry.

386
00:27:07.340 --> 00:27:10.510
So, one of the things we want to make sure, and we know  a lot of

387
00:27:10.530 --> 00:27:12.510
people have questions about is whether, um, there are other

388
00:27:12.530 --> 00:27:16.160
methods.

389
00:27:16.180 --> 00:27:20.160
You  may have heard or seen other methods in the past, which are

390
00:27:20.180 --> 00:27:25.160
subjective, like ringing  a bell behind a child's head or depending

391
00:27:25.180 --> 00:27:29.410
solely on a caregiver's perceptions of a  child's hearing.

392
00:27:29.430 --> 00:27:33.410
Now, don't get me wrong, observations of a child's response

393
00:27:33.430 --> 00:27:37.410
to  sound, especially a lack of response can be helpful, and we

394
00:27:37.430 --> 00:27:43.410
should pay attention to  how children do or do not respond to

395
00:27:43.430 --> 00:27:47.410
their environment, but these sorts of  observations, um, do not

396
00:27:47.430 --> 00:27:52.410
constitute a hearing screening, because they're far too  crude and

397
00:27:52.430 --> 00:27:55.410
unreliable and, frankly, we can do so much more than that because of

398
00:27:55.430 --> 00:27:59.120
our  current technologies.

399
00:27:59.140 --> 00:28:04.120
We also want to make sure that we're aware that, um,  healthcare

400
00:28:04.140 --> 00:28:09.120
providers have, um, even though that they have incorporated, um,

401
00:28:09.140 --> 00:28:13.120
evidence- evidence-based hearing screening into well-child visits,

402
00:28:13.140 --> 00:28:17.120
this is not yet a  standardized practice, especially for children

403
00:28:17.140 --> 00:28:21.930
less than 4 years of age.

404
00:28:21.950 --> 00:28:25.490
Some  parents, Terry, did you have something to say?

405
00:28:25.510 --> 00:28:28.490
>>:  I was just going to chime in, saying that, um, and you're

406
00:28:28.510 --> 00:28:33.490
probably going this  same direction, but some parents, um, they report

407
00:28:33.510 --> 00:28:36.490
with a lot of certainty that their healthcare provider actually did

408
00:28:36.510 --> 00:28:40.490
perform a hearing screening, but I think it's really  important to

409
00:28:40.510 --> 00:28:44.490
understand, um, and I really can't emphasize this enough as an

410
00:28:44.510 --> 00:28:49.490
audiologist myself, that routine examinations of ears by healthcare

411
00:28:49.510 --> 00:28:54.490
providers should  not be mistaken as hearing screenings, and I know

412
00:28:54.510 --> 00:28:59.490
that may come as a disappointment to you, as it does to, you know,

413
00:28:59.510 --> 00:29:05.490
many of us, um, and parents who are really hoping  this is being taken

414
00:29:05.510 --> 00:29:08.490
care of during well-child visits to healthcare providers, but  it's

415
00:29:08.510 --> 00:29:12.490
precisely because it isn't yet happening in that context that

416
00:29:12.510 --> 00:29:16.490
programs like your yours are adopting hearing screening

417
00:29:16.510 --> 00:29:18.490
practices, because of that increased recognition  of the

418
00:29:18.510 --> 00:29:24.480
importance of monitoring hearing, and it's just now so feasible to do

419
00:29:24.500 --> 00:29:28.490


420
00:29:28.510 --> 00:29:34.490
it.>>:  Yeah, and, so, unless a healthcare provider and the medical

421
00:29:34.510 --> 00:29:39.490
records that you've  gotten from them include documentation of

422
00:29:39.510 --> 00:29:42.490
ear-specific hearing screening results and  the screening method

423
00:29:42.510 --> 00:29:47.490
that was used, we really should never assume a hearing screening

424
00:29:47.510 --> 00:29:53.490
was completed.>>:  Yeah, and another important point to remember

425
00:29:53.510 --> 00:29:59.480
is this, is that, well, OAE and pure tone screening highly reliable

426
00:29:59.500 --> 00:30:00.490


427
00:30:00.510 --> 00:30:05.490
screening methods, but they're still not perfect,  so that means

428
00:30:05.510 --> 00:30:08.490
there may be some rare conditions that are not identified through

429
00:30:08.510 --> 00:30:09.290
these  screenings.

430
00:30:09.310 --> 00:30:11.290
So, whenever a parent express expresses concern about a child's

431
00:30:11.310 --> 00:30:14.290
hearing or  language development, even if they've received and passed

432
00:30:14.310 --> 00:30:17.290
a hearing screening using  one of these methods, that child should

433
00:30:17.310 --> 00:30:22.290
still be referred for an evaluation from an  audiologist.>>:  So,

434
00:30:22.310 --> 00:30:26.290
before we go on, let me say one more thing about newborn hearing

435
00:30:26.310 --> 00:30:30.290
screening  results, because many of the children that you will see will

436
00:30:30.310 --> 00:30:32.290
have had newborn screen screenings.

437
00:30:32.310 --> 00:30:36.290
When children enter your program or system, during that first year

438
00:30:36.310 --> 00:30:41.290
of  life, always be sure to collect their newborn hearing screen

439
00:30:41.310 --> 00:30:43.190
newborn hearing screening result.

440
00:30:43.210 --> 00:30:48.190
If the  results are anything other than a pass on both ears, you

441
00:30:48.210 --> 00:30:52.810
want to make sure that  follow-up evaluations have occurred.

442
00:30:52.830 --> 00:30:56.810
If you don't see any evidence of that follow-up follow-up, you'll

443
00:30:56.830 --> 00:31:01.810
want to help circle the family back to their healthcare provider to

444
00:31:01.830 --> 00:31:04.370
get that accomplished.

445
00:31:04.390 --> 00:31:10.370
If you're in a program that requires an annual hearing screen

446
00:31:10.390 --> 00:31:13.370
screening, you can go ahead and use the newborn hearing screening

447
00:31:13.390 --> 00:31:19.370
result for that  first year of life, but you'd want to re-screen after

448
00:31:19.390 --> 00:31:24.370
that, because hearing screening  is only an indication of that child's,

449
00:31:24.390 --> 00:31:30.370
um, abilities at that point in time and, as we  said earlier, that can

450
00:31:30.390 --> 00:31:32.550
change.

451
00:31:32.570 --> 00:31:36.550
Okay, so, now, lets let's talk about the two screening  methods

452
00:31:36.570 --> 00:31:39.110
that are responsible for early childhood.

453
00:31:39.130 --> 00:31:41.310
If you're responsible for children  who are under 3 years of

454
00:31:41.330 --> 00:31:46.310
age, the recommended method is OAE screening, which you see  here on

455
00:31:46.330 --> 00:31:50.310
the left, and there really is no other evidence-based method that

456
00:31:50.330 --> 00:31:56.300
you'll find  out there as an option to that for this birth to 3

457
00:31:56.320 --> 00:31:57.310


458
00:31:57.330 --> 00:31:57.810
population.

459
00:31:57.830 --> 00:32:00.810
If you're responsible  for screening children 3 years of age

460
00:32:00.830 --> 00:32:05.810
or older, historically, pure tone audiometry  has been considered the

461
00:32:05.830 --> 00:32:09.740
recommended method for this age group.

462
00:32:09.760 --> 00:32:12.740
This is the headset  screening where the child raises a hand or

463
00:32:12.760 --> 00:32:16.740
performs another task each time they hear  a sound that's presented

464
00:32:16.760 --> 00:32:22.740
into an ear phone, and you see this method on, um, on the  right.>>: 

465
00:32:22.760 --> 00:32:26.740
And just, um, a reminder, what I mentioned a little earlier, that,

466
00:32:26.760 --> 00:32:29.740
um, as common  as the pure tone method has been, um, again,

467
00:32:29.760 --> 00:32:33.740
remember, it may not be the most feasible method to use with some of

468
00:32:33.760 --> 00:32:37.740
these younger children due to that 20 to 25  to 25 percent of those

469
00:32:37.760 --> 00:32:42.740
kids in the 3 to 5 age group that can't be screened with that

470
00:32:42.760 --> 00:32:44.740
methodology because they just aren't developmentally able to

471
00:32:44.760 --> 00:32:46.900
follow the directions re reliably.

472
00:32:46.920 --> 00:32:51.900
So, again, in that case, OAE screening is the preferred method

473
00:32:51.920 --> 00:32:57.890
for these  children.>>:  So, at a minimum, what Terry's saying is if

474
00:32:57.910 --> 00:32:58.900


475
00:32:58.920 --> 00:33:04.900
you're establishing evidence-based practices for 3 to 5 year olds, and

476
00:33:04.920 --> 00:33:08.900
if you're considering using pure tone screening,  you'll also need

477
00:33:08.920 --> 00:33:14.890
to be equipped and prepared to do OAEs on that 20 to 25 percent who

478
00:33:14.910 --> 00:33:16.900


479
00:33:16.920 --> 00:33:22.900
can't be screened with pure tones, or, alternatively, you'll need to

480
00:33:22.920 --> 00:33:26.900
have a means for  systematically referring all of those, you know,

481
00:33:26.920 --> 00:33:32.900
that 20 to 25 percent to an audiologist who can perform the

482
00:33:32.920 --> 00:33:37.900
screening and, frankly, that can be pretty  challenging to accomplish,

483
00:33:37.920 --> 00:33:43.900
because audiologists are hard to get into, and screening  is not, um,

484
00:33:43.920 --> 00:33:49.900
usually the thing they, um, want to make time for.>>:  And, maybe,

485
00:33:49.920 --> 00:33:54.900
William, to simplify things, um, a little bit, more and more, um,

486
00:33:54.920 --> 00:33:57.900
audiologists are recommending the use of OAEs uniformly with children

487
00:33:57.920 --> 00:34:02.900
3 years of age  and older, and it's because it's quicker than pure tone

488
00:34:02.920 --> 00:34:07.900
screening, both to learn and  to do, to actually implement, and it's

489
00:34:07.920 --> 00:34:11.900
far more likely to be a method that'll work  across the board,

490
00:34:11.920 --> 00:34:15.900
with all children in that 3 to 5 age group that you'd be screening,

491
00:34:15.920 --> 00:34:21.900
and it's equally as effective.>>: If you or your program are still

492
00:34:21.920 --> 00:34:25.900
undecided or you're asking this question again  about which method

493
00:34:25.920 --> 00:34:31.900
to use primarily for children ages 3 and older, we encourage you  to

494
00:34:31.920 --> 00:34:37.900
carefully review a document we have on our website that compares OAE

495
00:34:37.920 --> 00:34:41.000
screening and  pure tone screening for this population.

496
00:34:41.020 --> 00:34:44.000
So, take a look at that, it's under the  very first heading on

497
00:34:44.020 --> 00:34:48.000
our website, and I'll come back and show you that in a little  bit

498
00:34:48.020 --> 00:34:53.840
where you'll find that.

499
00:34:53.860 --> 00:34:59.830
Terry, let's dive into OAEs.>>: Thank you.

500
00:34:59.850 --> 00:35:02.210


501
00:35:02.230 --> 00:35:06.210
So, as William said, let's start with otoacoustic emissions, or OAE

502
00:35:06.230 --> 00:35:12.210
screening, and as we said, it's the recommended hearing screening

503
00:35:12.230 --> 00:35:14.210


504
00:35:14.230 --> 00:35:17.570
method for children  birth to 3.

505
00:35:17.590 --> 00:35:21.570
It's the evidence-based method recommended by the American Academy

506
00:35:21.590 --> 00:35:25.570
of  Audiology and the American speech language hearing association,

507
00:35:25.590 --> 00:35:31.570
known as ASHAler.>>:  So, OAE screening is the most appropriate

508
00:35:31.590 --> 00:35:34.570
method to identify young children at  risk for permanent hearing loss,

509
00:35:34.590 --> 00:35:40.560
because it's accurate, um, it's quick and easy.

510
00:35:40.580 --> 00:35:43.090


511
00:35:43.110 --> 00:35:45.970
Most children can be screened in just a minute or two.

512
00:35:45.990 --> 00:35:51.720
Sometimes, in as little as 30 seconds per ear.

513
00:35:51.740 --> 00:35:56.720
It's a flexible thal tool that can be used in a variety of

514
00:35:56.740 --> 00:36:00.720
environments,  including classrooms, homes, or healthcare settings.>>: 

515
00:36:00.740 --> 00:36:03.460
And most important of all, it's effective.

516
00:36:03.480 --> 00:36:07.460
It's effective in identifying children who may have a child

517
00:36:07.480 --> 00:36:10.460
hearing loss or loss in just one ear, as well as those  that have a

518
00:36:10.480 --> 00:36:15.530
severe bilateral hearing loss.

519
00:36:15.550 --> 00:36:19.530
In addition, it can be, um, helpful in  drawing attention to a

520
00:36:19.550 --> 00:36:22.540
broader range of hearing health conditions that may need  further

521
00:36:22.560 --> 00:36:23.430
medical attention.

522
00:36:23.450 --> 00:36:27.430
So, OAE screening, it can also help to identify children  who have

523
00:36:27.450 --> 00:36:32.430
a temporary hearing loss as a result of middle ear infections and,

524
00:36:32.450 --> 00:36:35.430
again, as  we mentioned earlier, although this isn't the primary

525
00:36:35.450 --> 00:36:39.430
goal of OAE, excuse me, of OAE hearing screening, it's definitely

526
00:36:39.450 --> 00:36:42.690
an added benefit of screening with this method.

527
00:36:42.710 --> 00:36:47.690
O OAE screening clearly meets the World Health Organization's, um,

528
00:36:47.710 --> 00:36:52.690
principles of screen screening.>>: So, let's take a look at these

529
00:36:52.710 --> 00:36:55.650
pictures for a second.

530
00:36:55.670 --> 00:36:59.650
These children you see  here are all being screened using the OAE

531
00:36:59.670 --> 00:37:03.650
method, and what do you notice about where  they're being

532
00:37:03.670 --> 00:37:04.270
screened?

533
00:37:04.290 --> 00:37:09.270
They aren't being pulled out into an environment that's  foreign or

534
00:37:09.290 --> 00:37:10.470
strange to them.

535
00:37:10.490 --> 00:37:15.470
We can go to them, they are being screened in every day  educational,

536
00:37:15.490 --> 00:37:20.470
home, or healthcare settings, where the children are already, hopefully,

537
00:37:20.490 --> 00:37:25.470
happily spending their time, and those that are doing the screening

538
00:37:25.490 --> 00:37:29.210
are, often,  people they already know.

539
00:37:29.230 --> 00:37:33.210
They're teachers, they're home visitors, health specialist

540
00:37:33.230 --> 00:37:38.210
specialists at the program, people they know.>>:  In insidious hearing

541
00:37:38.230 --> 00:37:42.210
screening works best when children are familiar and they're

542
00:37:42.230 --> 00:37:46.210
comfortable with the adult doing the screening and where they can

543
00:37:46.230 --> 00:37:50.210
play with a toy,  they can be held, or even sleep while the screening

544
00:37:50.230 --> 00:37:55.210
is being conducted.>>:  And, that's right, you heard it, they can sleep

545
00:37:55.230 --> 00:38:00.210
while they're being screened, which is a real added benefit for

546
00:38:00.230 --> 00:38:06.210
some of those kids in that, you know, 6 months to  to 18 months or

547
00:38:06.230 --> 00:38:10.400
20 months age range that could be, kind of, difficult to screen.

548
00:38:10.420 --> 00:38:15.400
So,  Terry, walk us through the OAE screening procedure, would you?

549
00:38:15.420 --> 00:38:16.600
>>:  Yeah, yeah.

550
00:38:16.620 --> 00:38:17.800
Thank you, William.

551
00:38:17.820 --> 00:38:20.800
So, to conduct an OAE screening, we're, first,  going to take a

552
00:38:20.820 --> 00:38:24.800
thorough look at the outer part of the ear to make sure that there's

553
00:38:24.820 --> 00:38:28.120
no visible sign of infection or blockage.

554
00:38:28.140 --> 00:38:33.120
After we've done that, a small probe on  which we've placed a

555
00:38:33.140 --> 00:38:39.110
disposable cover is then inserted into the ear canal, and that  probe

556
00:38:39.130 --> 00:38:40.120


557
00:38:40.140 --> 00:38:42.520
is in the ear canal delivers a low-volume sound stimulus into the

558
00:38:42.540 --> 00:38:46.520
ear.

559
00:38:46.540 --> 00:38:50.520
Now, a  cochlea, or that inner snail-shaped portion of the ear, a

560
00:38:50.540 --> 00:38:54.520
cochlea that is functioning normally will respond to this sound

561
00:38:54.540 --> 00:38:59.520
by sending the signal to the brain while also  producing an acoustic

562
00:38:59.540 --> 00:39:05.520
emission, and this emission is analyzed by the screening unit  in

563
00:39:05.540 --> 00:39:08.520
approximately  and, in approximately 30 seconds or so, the

564
00:39:08.540 --> 00:39:14.490
result will appear as either a pass or a  refer.

565
00:39:14.510 --> 00:39:19.490
Now, every normal, excuse me, every normal, healthy inner ear

566
00:39:19.510 --> 00:39:22.260
produces an e emission that can be recorded in this way.

567
00:39:22.280 --> 00:39:27.260
So, let's look at a video of an actual  realtime screening, just so

568
00:39:27.280 --> 00:39:33.260
you can see how it can go under ideal conditions.>>:  Yeah, so, the

569
00:39:33.280 --> 00:39:36.260
woman on the right is going to be pointing the probe in this  little

570
00:39:36.280 --> 00:39:37.060
guy's ear.

571
00:39:37.080 --> 00:39:41.060
She has the added benefit of a partner adult who's going to help

572
00:39:41.080 --> 00:39:44.520
manage this child's behavior.

573
00:39:44.540 --> 00:39:48.520
Now, a little boy this age may not really need the  help of that

574
00:39:48.540 --> 00:39:52.520
other adult, but if he was a year younger, it would really be

575
00:39:52.540 --> 00:39:57.520
valuable  to have that person there to help his hands be busy and not

576
00:39:57.540 --> 00:39:59.720
reach up and get interest interested in the probe going in

577
00:39:59.740 --> 00:40:00.860
the ear.

578
00:40:00.880 --> 00:40:02.860
So, let's take a look.

579
00:40:02.880 --> 00:40:08.850
This is a realtime  screening, no editing.

580
00:40:08.870 --> 00:40:23.450


581
00:40:23.470 --> 00:40:26.290
So, that means they got their results already.

582
00:40:26.310 --> 00:40:31.950
It was a pass  or refer, we don't know.

583
00:40:31.970 --> 00:40:37.940
They celebrate either way when they get a result.

584
00:40:37.960 --> 00:40:43.120


585
00:40:43.140 --> 00:40:48.780
There,  you see the device.

586
00:40:48.800 --> 00:40:53.790
Then another result.

587
00:40:53.810 --> 00:40:58.790
So, like many skillful tasks, competent  screeners can make it

588
00:40:58.810 --> 00:41:04.790
look so easy, and it, often, can be easy, once you've been  trained and

589
00:41:04.810 --> 00:41:06.790
have had a little practice.

590
00:41:06.810 --> 00:41:10.790
To assist screeners in developing all of the  different steps of the

591
00:41:10.810 --> 00:41:14.790
screening process and developing that as a habit, um, we have,  as

592
00:41:14.810 --> 00:41:20.790
apart of our training, a skills checklist for OAE screening, and

593
00:41:20.810 --> 00:41:21.800


594
00:41:21.820 --> 00:41:25.800
that's available  on kidshearing.org, and that checklist

595
00:41:25.820 --> 00:41:30.800
guides a screener through the OAE screening  process, and it's

596
00:41:30.820 --> 00:41:34.800
helpful, whether you're a screener or an experienced screener need

597
00:41:34.820 --> 00:41:37.800
needing a refresher, or if you're a manager, it can be used as a

598
00:41:37.820 --> 00:41:43.790
competency-based  observation tool for those that you're supersing

599
00:41:43.810 --> 00:41:44.410
supervising.

600
00:41:44.430 --> 00:41:47.280
So, that's what you see here on your screen.

601
00:41:47.300 --> 00:41:53.270
So, we'll show you where you can find those on our, um, website.

602
00:41:53.290 --> 00:41:56.430


603
00:41:56.450 --> 00:41:58.430
As  we've emphasized, evidence-based screening is more

604
00:41:58.450 --> 00:42:01.430
than just using a designated piece of equipment.

605
00:42:01.450 --> 00:42:07.430
We have to be trained to use that equipment and have a screening and

606
00:42:07.450 --> 00:42:13.430
follow-up process built around that equipment, but you do need to have

607
00:42:13.450 --> 00:42:14.230
appropriate  equipment.

608
00:42:14.250 --> 00:42:17.750
So, let's talk about this for just a minute.

609
00:42:17.770 --> 00:42:23.750
You should be aware that OA OAE equipment is available from several

610
00:42:23.770 --> 00:42:26.750
different companies and in models designed  specifically for

611
00:42:26.770 --> 00:42:31.750
screening by lay individuals, um, such as most of you who are

612
00:42:31.770 --> 00:42:33.500
participating with us today.

613
00:42:33.520 --> 00:42:39.500
These are the simpler and less expensive models, basic  OAE

614
00:42:39.520 --> 00:42:40.500


615
00:42:40.520 --> 00:42:43.500
equipment is what you're looking for and, currently, that costs, and

616
00:42:43.520 --> 00:42:49.500
I know  you're not going to like this, but it's about $3,800 for the

617
00:42:49.520 --> 00:42:54.740
device.

618
00:42:54.760 --> 00:42:58.740
Now, there are  also other equipment models intended for the

619
00:42:58.760 --> 00:43:03.740
use of audiologists, like Terry, that  are designed for diagnostic

620
00:43:03.760 --> 00:43:06.740
purposes, and those are more complicated and more  expensive,

621
00:43:06.760 --> 00:43:10.360
but they may come by the same name.

622
00:43:10.380 --> 00:43:16.360
So, you don't need or want those expensive or complicated models, so,

623
00:43:16.380 --> 00:43:22.360
as non-audiologists, be careful to ask for the  simplest version they

624
00:43:22.380 --> 00:43:25.570
have as a non-diagnostic model.

625
00:43:25.590 --> 00:43:31.570
Now, in addition to the cost  of the equipment, each time you screen,

626
00:43:31.590 --> 00:43:35.570
um, you have to have a disposable cover that  goes over the probe,

627
00:43:35.590 --> 00:43:40.570
that needs to be inserted snuggly into the ear canal and would  come

628
00:43:40.590 --> 00:43:45.460
in a variety of sizes to ensure a really snug fit.

629
00:43:45.480 --> 00:43:49.460
You'll need a good selection  of those and, again, they have a cost

630
00:43:49.480 --> 00:43:54.060
of about $1 to $1.50 each.

631
00:43:54.080 --> 00:43:58.060
Now, I just want to  interject here, you know we're not selling

632
00:43:58.080 --> 00:43:58.560
equipment.

633
00:43:58.580 --> 00:43:59.760
That's not us.

634
00:43:59.780 --> 00:44:03.350
We're just try trying to help you use this equipment.

635
00:44:03.370 --> 00:44:08.350
We know all too well the burden of the cost  of this, but it is

636
00:44:08.370 --> 00:44:14.050
part of what it takes to use this recommended method.

637
00:44:14.070 --> 00:44:20.050
Now, since  you'll not always select the proper size on the very

638
00:44:20.070 --> 00:44:24.050
first try, especially when  you're learning, you could end up using

639
00:44:24.070 --> 00:44:26.940
several probe covers for each child you're  attempting to screen.

640
00:44:26.960 --> 00:44:31.940
So, we always recommend purchasing at least twice as many

641
00:44:31.960 --> 00:44:37.700
probe covers as you have a total number of children to be screened.

642
00:44:37.720 --> 00:44:42.700
Now, you'll also  need some adult size probe covers as well, because

643
00:44:42.720 --> 00:44:48.700
during your learning process, as well as, really, on a regular basis,

644
00:44:48.720 --> 00:44:51.700
you'll be testing the equipment out on your own  ears and on

645
00:44:51.720 --> 00:44:53.500
another adult, to make sure it's functioning properly before

646
00:44:53.520 --> 00:44:57.680
screening.

647
00:44:57.700 --> 00:45:01.680
In fact, when you're being trained, before you even try to

648
00:45:01.700 --> 00:45:06.680
screen children, you'll  screen yourself and some other adults, so

649
00:45:06.700 --> 00:45:10.680
you'll need to make sure you have adult  probe covers as apart of

650
00:45:10.700 --> 00:45:11.830
your purchase.

651
00:45:11.850 --> 00:45:16.830
When you meet with an equipment <distribute  or salesperson, they

652
00:45:16.850 --> 00:45:22.830
may mention, as Terry referred to earlier, that they will offer  you

653
00:45:22.850 --> 00:45:27.830
training, and it's important that you understand that this training

654
00:45:27.850 --> 00:45:32.460
is rarely  sufficient to meet the training needs you have.

655
00:45:32.480 --> 00:45:36.050
Terry, do you want to say something  more about that?

656
00:45:36.070 --> 00:45:36.850
>>:  Yeah.

657
00:45:36.870 --> 00:45:42.850
You know, um, there's the practical hands-on how to screen

658
00:45:42.870 --> 00:45:45.850
kids perspect perspective that doesn't come with the, um, training

659
00:45:45.870 --> 00:45:51.850
from the vendor and, so, that training to help you get acquainted

660
00:45:51.870 --> 00:45:55.850
with your screening equipment, to give you  practice in selecting the

661
00:45:55.870 --> 00:45:59.850
correct size probe covers, to demonstrate how to insert  that

662
00:45:59.870 --> 00:46:03.850
probe snuggly into a wiggly child's ear, um, all of those learning

663
00:46:03.870 --> 00:46:07.850
experiences  will teach you how the equipment not just turns on and

664
00:46:07.870 --> 00:46:13.850
what buttons to push, but how  it actually functions under use as you

665
00:46:13.870 --> 00:46:14.350
screen.

666
00:46:14.370 --> 00:46:16.550
It'll help you by, first, learning to  screen on your own

667
00:46:16.570 --> 00:46:19.550
ears and, then, to screen other adults before you take on the

668
00:46:19.570 --> 00:46:23.690
challenge of trying to screen children.

669
00:46:23.710 --> 00:46:25.690
You should be guided through practices that  demonstrate, you

670
00:46:25.710 --> 00:46:30.690
know, how the equipment's going to function, um, under less than i

671
00:46:30.710 --> 00:46:34.690
ideal conditions, so if the individual you're screening moves

672
00:46:34.710 --> 00:46:39.690
or makes noises while  screening, or if there's noise in the room,

673
00:46:39.710 --> 00:46:42.150
things you can do about that.

674
00:46:42.170 --> 00:46:44.280
Then, you  add that challenge of screening children.

675
00:46:44.300 --> 00:46:49.280
So, the learning process should demonstrate, um, strategies for

676
00:46:49.300 --> 00:46:52.280
managing children's behavior while they're being  screened and, then,

677
00:46:52.300 --> 00:46:56.280
lastly, a good learning process will help you know how to use the

678
00:46:56.300 --> 00:47:01.280
information provided on the device to record results and, then, what

679
00:47:01.300 --> 00:47:03.680
those follow-up  steps are when a child doesn't pass the screening in

680
00:47:03.700 --> 00:47:09.670
one or both ears.>>:  Yeah, so, we always like to make this analogy; a

681
00:47:09.690 --> 00:47:10.680


682
00:47:10.700 --> 00:47:13.680
car salesman at a dealership  may train you per se to, about the

683
00:47:13.700 --> 00:47:18.680
various functions of the car and everything you  see on your

684
00:47:18.700 --> 00:47:21.680
dashboard, and that can be helpful, but that person is not going to

685
00:47:21.700 --> 00:47:27.670
teach  you how to drive or to parallel park, and it's the same

686
00:47:27.690 --> 00:47:33.680


687
00:47:33.700 --> 00:47:36.640
with purchasing hearing  screening equipment.

688
00:47:36.660 --> 00:47:39.230
You'll need another way to learn how to screen and, as we point

689
00:47:39.250 --> 00:47:41.840
pointed out, one way is to access the online resources that we have

690
00:47:41.860 --> 00:47:45.130
on our website  and, um, I'll show you again where to do that.

691
00:47:45.150 --> 00:47:51.130
Doing that and, if you can, having a  local audiologist who can,

692
00:47:51.150 --> 00:47:54.130
then, screen alongside you when you are just getting start started

693
00:47:54.150 --> 00:47:58.130
and can give you some helpful pointers, it's a great way to be

694
00:47:58.150 --> 00:48:02.130
sure that you  get your training needs met, and this is true whether

695
00:48:02.150 --> 00:48:07.390
you need training on OAE or the other method, pure tone audiometry.

696
00:48:07.410 --> 00:48:12.390
So, um, be aware that you do, in fact, need to  get training, don't

697
00:48:12.410 --> 00:48:15.930
attempt to teach yourself.

698
00:48:15.950 --> 00:48:21.930
So, just, um, so that you know, on  our website, you'll find, um,

699
00:48:21.950 --> 00:48:27.930
under equipment resources, um, this table which shows  you some of the

700
00:48:27.950 --> 00:48:31.930
available, um, different manufacturers' equipment options

701
00:48:31.950 --> 00:48:36.630
for you and  how to locate them.

702
00:48:36.650 --> 00:48:42.280
Um, so, and there's also a criteria for selecting equipment.

703
00:48:42.300 --> 00:48:48.280
We  had a webinar last week in which we asked, um, all of the

704
00:48:48.300 --> 00:48:51.280
participants who are  already experienced doing screening, and

705
00:48:51.300 --> 00:48:57.280
some of them said they were having difficulty screening children in,

706
00:48:57.300 --> 00:49:02.280
um, somewhat noisy, natural environments, and we  asked them

707
00:49:02.300 --> 00:49:04.280
what equipment they were using.

708
00:49:04.300 --> 00:49:09.280
Now, we don't ever, because we're federally-funded, we don't ever

709
00:49:09.300 --> 00:49:14.280
particularly recommend any specific manufacturer, but  we can tell you

710
00:49:14.300 --> 00:49:19.280
that the response to that particular poll was, um, the most

711
00:49:19.300 --> 00:49:25.280
common re response was that people were having success in those

712
00:49:25.300 --> 00:49:28.280
natural environments with this first row of equipment here, those

713
00:49:28.300 --> 00:49:31.080
three different devices there.

714
00:49:31.100 --> 00:49:36.080
So, um, and that's  not to say the others aren't, um, also, um,

715
00:49:36.100 --> 00:49:38.120
equally effective.

716
00:49:38.140 --> 00:49:44.120
We have had a lot of  experience with that second row of devices as

717
00:49:44.140 --> 00:49:48.740
well, and they work really well as well well.

718
00:49:48.760 --> 00:49:54.740
So, take a look at that, if you're in the position of needing

719
00:49:54.760 --> 00:49:55.940
to select  equipment.

720
00:49:55.960 --> 00:49:58.340
All right, so, we've talked about OAE screening.

721
00:49:58.360 --> 00:50:03.340
Let's shift our  attention over to pure tone screening now for

722
00:50:03.360 --> 00:50:07.340
those of you who may be considering this or may already be using pure

723
00:50:07.360 --> 00:50:13.340
tone screening, and we want to point out that pure  tone screening

724
00:50:13.360 --> 00:50:18.310
is never recommended for children under 3.

725
00:50:18.330 --> 00:50:20.310
As we've mentioned earlier earlier, it's the most common

726
00:50:20.330 --> 00:50:26.310
method used with 3 to 5 year olds, but even some of  those 3 year olds,

727
00:50:26.330 --> 00:50:28.310
we can't really successfully screen with that, as we've pointed

728
00:50:28.330 --> 00:50:30.560
out.

729
00:50:30.580 --> 00:50:35.560
Now, you probably recognize this method, um, either because you

730
00:50:35.580 --> 00:50:39.560
already use it  or because you've had your own hearing screened this

731
00:50:39.580 --> 00:50:42.160
way.

732
00:50:42.180 --> 00:50:44.160
In this procedure, musical note-like tones are presented to

733
00:50:44.180 --> 00:50:49.160
children through headphones, and children provide a  behavioral

734
00:50:49.180 --> 00:50:55.160
response to that tone, like raising a hand to indicate that they heard

735
00:50:55.180 --> 00:50:55.960
the  tone.

736
00:50:55.980 --> 00:50:59.960
Pure tone screening gives us a good idea of the functioning of the

737
00:50:59.980 --> 00:51:03.960
entire  auditory system, all inway the way to the train, with the

738
00:51:03.980 --> 00:51:08.960
child showing a physical or behavioral indication that they

739
00:51:08.980 --> 00:51:10.480
perceive the sound.

740
00:51:10.500 --> 00:51:14.480
It's a relatively affordable method, with the screening

741
00:51:14.500 --> 00:51:20.460
equipment, in this case, costing $800 to, maybe, $1,000.

742
00:51:20.480 --> 00:51:25.460
It's a relatively, um, it's a durable and portable piece of

743
00:51:25.480 --> 00:51:29.460
equipment, just like OAEs OAEs, which enable us to easily transport

744
00:51:29.480 --> 00:51:33.390
and use it in a variety of locations.

745
00:51:33.410 --> 00:51:38.390
The  difference, however, though, and we'll talk more about this, is

746
00:51:38.410 --> 00:51:41.390
you have to be, you  can't screen in a natural environment, you have

747
00:51:41.410 --> 00:51:47.380
to pull the children out into a quiet  space, and it also is a

748
00:51:47.400 --> 00:51:48.390


749
00:51:48.410 --> 00:51:52.390
piece of equipment and method that a wide range of individual

750
00:51:52.410 --> 00:51:56.180
individuals can be trained to perform.

751
00:51:56.200 --> 00:51:59.180
Terry, you want to walk us through how it's  done?

752
00:51:59.200 --> 00:51:59.980
>>:  Yeah.

753
00:52:00.000 --> 00:52:02.980
So, to conduct a pure tone screening, we're going to start

754
00:52:03.000 --> 00:52:06.980
just like we  did with OAE, we're going to, first, take a look at the

755
00:52:07.000 --> 00:52:09.980
ear, we're going to make sure  that there's no visible sign of

756
00:52:10.000 --> 00:52:14.980
infection or blockage, just like we do prior to doing  OAE screening

757
00:52:15.000 --> 00:52:18.980
and, then, if the ear appears normal, then, the screener, um,

758
00:52:19.000 --> 00:52:24.980
places  the headphones on the child's head and instructs or

759
00:52:25.000 --> 00:52:27.980
conditions the child in how to listen for a tone and respond by

760
00:52:28.000 --> 00:52:34.400
raising a hand or placing a toy in a bucket, a game  like that.

761
00:52:34.420 --> 00:52:39.400
This step can take some time, because we have to be sure that the

762
00:52:39.420 --> 00:52:42.400
child  is able to reliably complete the screening task, but once the

763
00:52:42.420 --> 00:52:46.400
screener is, um, has  observed that the child reliably responds to

764
00:52:46.420 --> 00:52:50.400
sounds that are presented, just as the  screener instructed, that's

765
00:52:50.420 --> 00:52:55.400
when the actual screening is started.>>:  So, that process,

766
00:52:55.420 --> 00:52:59.890
Terry, might take 5 minutes, right?

767
00:52:59.910 --> 00:53:01.090
>>:  It might.

768
00:53:01.110 --> 00:53:01.590
Yep.

769
00:53:01.610 --> 00:53:06.590
We have to make sure that that, um, that that response is, um,

770
00:53:06.610 --> 00:53:11.230
listen and respond response is strongly conditioned.

771
00:53:11.250 --> 00:53:17.230
Once it is, then, during that screening process, this listen and

772
00:53:17.250 --> 00:53:22.230
respond game is repeated at least twice at three  different pitches

773
00:53:22.250 --> 00:53:25.230
on each ear and, then, we note the child's response or their lack  of

774
00:53:25.250 --> 00:53:27.550
response after each tone is presented.

775
00:53:27.570 --> 00:53:31.550
Now, if the child responds appropriately  and they're

776
00:53:31.570 --> 00:53:34.550
consistent to the range of tones presented to each ear, that's when

777
00:53:34.570 --> 00:53:39.550
the  child passes the screening.>>: So, are you all getting the idea

778
00:53:39.570 --> 00:53:44.550
that there's some notable differences between O OAE screening

779
00:53:44.570 --> 00:53:47.340
and pure tone?

780
00:53:47.360 --> 00:53:52.340
There are two especially notable differences in that  the process

781
00:53:52.360 --> 00:53:57.340
requires children not only to be cooperative, but to be full

782
00:53:57.360 --> 00:54:03.340
participants  in the process, following directions and responding

783
00:54:03.360 --> 00:54:04.260
reliably.

784
00:54:04.280 --> 00:54:08.260
As we mentioned, that  means completing that additional process

785
00:54:08.280 --> 00:54:14.260
that we refer to as conditioning, or teach teaching the children and,

786
00:54:14.280 --> 00:54:18.260
then, carefully determining whether you're getting  reliable responses

787
00:54:18.280 --> 00:54:24.260
from them before even attempting to screen.>>:  And the other

788
00:54:24.280 --> 00:54:28.260
difference between pure tone and OAE screening is that the screen

789
00:54:28.280 --> 00:54:32.600
screening itself is not, um, automated as OAE is.

790
00:54:32.620 --> 00:54:36.600
Instead, in pure tone screening, you, as the screener, will need to

791
00:54:36.620 --> 00:54:40.600
manually step through the presentation of each  tone multiple

792
00:54:40.620 --> 00:54:43.970
times for each ear, recording each response.

793
00:54:43.990 --> 00:54:47.970
Then, following a very  specific protocol, you, as the screener,

794
00:54:47.990 --> 00:54:51.790
will determine whether the ear passed or not not.

795
00:54:51.810 --> 00:54:54.790
With pure tone screening, there's, um, considerably more potential

796
00:54:54.810 --> 00:55:00.790
for us as  screeners to make mistakes or for screener error, um,

797
00:55:00.810 --> 00:55:05.690
that can produce inaccurate results.

798
00:55:05.710 --> 00:55:08.690
So, there's a real need for thorough training and oversight, to

799
00:55:08.710 --> 00:55:10.690
make sure  all screeners are adhering to the prescribed

800
00:55:10.710 --> 00:55:12.170
screening protocol.

801
00:55:12.190 --> 00:55:17.170
We really can't  emphasize enough, um, the importance of training and

802
00:55:17.190 --> 00:55:21.170
periodic oversight, as even some of us experienced screeners will

803
00:55:21.190 --> 00:55:24.170
make errors that could inadvertently invalidate the

804
00:55:24.190 --> 00:55:29.170
screenings in ways that we might be unaware of.

805
00:55:29.190 --> 00:55:34.170
Now, on your screen here, you'll see see, this is an example of the

806
00:55:34.190 --> 00:55:38.170
actual screening steps that need to be documented for  each ear as you

807
00:55:38.190 --> 00:55:38.670
screen.

808
00:55:38.690 --> 00:55:41.670
So, through the training process, you'll learn all of the  steps of

809
00:55:41.690 --> 00:55:45.670
the conditioning and the screening process and all of the

810
00:55:45.690 --> 00:55:49.670
environmental  conditions that need to be monitored and met as you

811
00:55:49.690 --> 00:55:55.670
complete, um, a child's screening screening.>>:  Now, based on these

812
00:55:55.690 --> 00:56:01.660
results, the screener determines if each ear passes or not,  and the

813
00:56:01.680 --> 00:56:02.670


814
00:56:02.690 --> 00:56:08.660
device itself does not produce that result, as is the case in OAE

815
00:56:08.680 --> 00:56:09.670


816
00:56:09.690 --> 00:56:15.660
screening.

817
00:56:15.680 --> 00:56:18.720


818
00:56:18.740 --> 00:56:22.710
Now, mides my slides are not matched up, Terry.(Laughing.)>>: 

819
00:56:22.730 --> 00:56:27.710
So, as we go through this process, you will be, those checkmarks

820
00:56:27.730 --> 00:56:31.710
indicate how  many different manually-initiated attempts need to

821
00:56:31.730 --> 00:56:38.570
be done on each ear, at each tone.

822
00:56:38.590 --> 00:56:43.570
So, you try it at the 2,000 first, then you go 4,000-hertz and

823
00:56:43.590 --> 00:56:46.570
determine whether the  child passed or not, then 1,000 and, then, you

824
00:56:46.590 --> 00:56:48.970
do it on the other ear.

825
00:56:48.990 --> 00:56:54.970
You need to  get two responses out of four for that particular

826
00:56:54.990 --> 00:57:00.960
pitch to pass, and there needs to be passes on every pitch for both

827
00:57:00.980 --> 00:57:01.970


828
00:57:01.990 --> 00:57:07.960
ears for an overall screening pass.

829
00:57:07.980 --> 00:57:11.870


830
00:57:11.890 --> 00:57:15.870
So, we've  provided, also, a screening skills checklist for pure

831
00:57:15.890 --> 00:57:21.870
tone screening that walks  through all of those specific steps and, um,

832
00:57:21.890 --> 00:57:27.870
that's another helpful training tool, as  well as on an ongoing

833
00:57:27.890 --> 00:57:32.870
self-monitoring or supervisory monitoring for quality tool that

834
00:57:32.890 --> 00:57:39.470
you might want to look at.

835
00:57:39.490 --> 00:57:42.470
So, what's the next step, when a child doesn't pass a  hearing

836
00:57:42.490 --> 00:57:43.470
screening?

837
00:57:43.490 --> 00:57:47.280
We've talked about the two methods.

838
00:57:47.300 --> 00:57:50.280
Regardless of which method  you use, you will eventually have

839
00:57:50.300 --> 00:57:51.880
children who don't pass.

840
00:57:51.900 --> 00:57:57.260
So, what then?

841
00:57:57.280 --> 00:58:00.260
In order  to be evidence-based, your screening process has to

842
00:58:00.280 --> 00:58:03.260
include a follow-up protocol for when children don't pass, and we

843
00:58:03.280 --> 00:58:08.260
can't emphasize enough that our screening efforts  are only as good

844
00:58:08.280 --> 00:58:12.260
as our ability to systematically follow-up on children who don't

845
00:58:12.280 --> 00:58:16.000
pass the screening on one or both ears.

846
00:58:16.020 --> 00:58:19.000
So, let me give you a quick walk-through of  the protocol and,

847
00:58:19.020 --> 00:58:24.160
then, we can go look at it more closely on our website.

848
00:58:24.180 --> 00:58:28.160
The  percentages we're going to be talking about here today are

849
00:58:28.180 --> 00:58:33.160
from over 10,000 children,  birth to 3 years of age, on whom we've

850
00:58:33.180 --> 00:58:34.880
used the OAE method.

851
00:58:34.900 --> 00:58:40.880
So, um, the stats we're  about to give you are related to that

852
00:58:40.900 --> 00:58:41.380
scenario.

853
00:58:41.400 --> 00:58:45.380
We expect children in the, um, 4 to  to 5 age range to have slightly

854
00:58:45.400 --> 00:58:49.380
better pass rates, because they don't tend to have  ear infections

855
00:58:49.400 --> 00:58:55.380
as often as those younger children do, and they tend to be more coop

856
00:58:55.400 --> 00:58:56.280
cooperative.

857
00:58:56.300 --> 00:59:00.490
So, let's look at the protocol.

858
00:59:00.510 --> 00:59:04.490
We're going to screen a hundred percent of the children who will

859
00:59:04.510 --> 00:59:09.490
receive an initial OAE or pure tone screening on  both ears, and we

860
00:59:09.510 --> 00:59:14.490
expect about 75 percent of the children will pass on both ears and

861
00:59:14.510 --> 00:59:19.050
will not need any further follow-up.

862
00:59:19.070 --> 00:59:23.050
That will leave about 25 percent that will not  pass on one or both

863
00:59:23.070 --> 00:59:26.050
of their ears the first time they're screened and will need to

864
00:59:26.070 --> 00:59:32.040
have a second screening in about two weeks.

865
00:59:32.060 --> 00:59:34.750


866
00:59:34.770 --> 00:59:37.750
Now, the interesting thing is that, at  this point, a good many

867
00:59:37.770 --> 00:59:43.750
of the children who didn't pass the first screening will pass  this

868
00:59:43.770 --> 00:59:49.740
second screening, only about 8 percent will not pass the second

869
00:59:49.760 --> 00:59:50.750


870
00:59:50.770 --> 00:59:52.430
screening.

871
00:59:52.450 --> 00:59:55.430
These children will need to be referred to a healthcare provider,

872
00:59:55.450 --> 00:59:59.430
um, who will do a  middle ear evaluation to determine whether

873
00:59:59.450 --> 01:00:04.430
there's a wax blockage or an ear infection  or some other reason why

874
01:00:04.450 --> 01:00:10.420
the child may not have passed and, once the middle ear  problem, if

875
01:00:10.440 --> 01:00:11.430


876
01:00:11.450 --> 01:00:17.430
there is one, is resolved and you get medical clearance, you'll then

877
01:00:17.450 --> 01:00:23.410
screen the small number of children, this 8 percent, a third time, and

878
01:00:23.430 --> 01:00:28.430


879
01:00:28.450 --> 01:00:33.430
we expect that  less than 1 percent will still not pass that third

880
01:00:33.450 --> 01:00:36.430
screening, and those children will be referred to a pediatric

881
01:00:36.450 --> 01:00:42.180
audiologist for a complete audiological evaluation.

882
01:00:42.200 --> 01:00:45.180
So,  although a small subset of children will, indeed, need

883
01:00:45.200 --> 01:00:50.180
follow-up referral and further screening after the initial

884
01:00:50.200 --> 01:00:55.180
screening, we have used this protocol in thousands of  early

885
01:00:55.200 --> 01:00:58.180
childhood settings and have found that most programs find this to be

886
01:00:58.200 --> 01:01:02.000
feasible  to implement.

887
01:01:02.020 --> 01:01:05.000
It helps children get the medical and audiological attention they

888
01:01:05.020 --> 01:01:10.000
need need, while it also minimizes the number of unnecessary referrals

889
01:01:10.020 --> 01:01:12.020
for healthcare  providers, to healthcare providers.

890
01:01:12.040 --> 01:01:18.010
So, we're balancing the need to find children,  but, also, not to

891
01:01:18.030 --> 01:01:20.020


892
01:01:20.040 --> 01:01:21.190
over-refer.

893
01:01:21.210 --> 01:01:24.190
Once you're underway with your screening program,  you'll want to

894
01:01:24.210 --> 01:01:30.180
check, um, with these particular pass and refer rates, to make sure

895
01:01:30.200 --> 01:01:36.180
that yours are similar and, if they vary considerably from this, you'll,

896
01:01:36.200 --> 01:01:38.180
probably,  want to get some technical assistance or, maybe,

897
01:01:38.200 --> 01:01:41.580
some follow-up training.

898
01:01:41.600 --> 01:01:45.580
So, this  is another illustration, just overviewing what I just said,

899
01:01:45.600 --> 01:01:50.580
that outlines the screen screening and follow-up protocol, and this is

900
01:01:50.600 --> 01:01:55.580
available on our website, it's built in into the training modules

901
01:01:55.600 --> 01:02:01.580
that you'll find there and, just as a reminder, this  protocol is used

902
01:02:01.600 --> 01:02:03.580
regardless of which screening method you're using, OAE or pure

903
01:02:03.600 --> 01:02:09.350
tone.

904
01:02:09.370 --> 01:02:11.510
It's exactly the same process within each method.

905
01:02:11.530 --> 01:02:17.510
The only difference is that the percentages of not passes, maybe,

906
01:02:17.530 --> 01:02:21.510
somewhat differs with different age groups and with  the pure tone

907
01:02:21.530 --> 01:02:28.430
method, but this shows you the protocol overall.

908
01:02:28.450 --> 01:02:31.430
Terry, there's an  exception, right, to this protocol?

909
01:02:31.450 --> 01:02:32.830
Do you want to talk about that?

910
01:02:32.850 --> 01:02:36.830
>>:  Yes&we, and we touched on it earlier, but the exception is that

911
01:02:36.850 --> 01:02:40.830
whenever a parent  or a caregiver expresses concern, so, they have a

912
01:02:40.850 --> 01:02:44.830
concern about a child's hearing or their language development, that

913
01:02:44.850 --> 01:02:49.830
child should be referred for an evaluation from a  pediatric

914
01:02:49.850 --> 01:02:52.830
audiologist, ehaveen even if they passed a hearing screening, and

915
01:02:52.850 --> 01:02:55.830
this is true  because, if you recall, um, you know, we don't have

916
01:02:55.850 --> 01:03:00.830
that perfect hearing screening method, they're not a hundred

917
01:03:00.850 --> 01:03:04.830
percent accurate or perfect and, so, to be on the safe  side, whenever

918
01:03:04.850 --> 01:03:09.830
there's an explicit concern about hearing or language, make a direct

919
01:03:09.850 --> 01:03:15.830
referral and, of course, you can screen the child and send that

920
01:03:15.850 --> 01:03:21.080
result along, but  make the referral regardless.>>:  Thank you.

921
01:03:21.100 --> 01:03:24.080
All right, so, kidshearing.org, most important thing you can

922
01:03:24.100 --> 01:03:30.070
remember today is our website, because all of thethis things that

923
01:03:30.090 --> 01:03:31.070


924
01:03:31.090 --> 01:03:34.070
we talked about today  are available and explained at greater

925
01:03:34.090 --> 01:03:34.880
length there.

926
01:03:34.900 --> 01:03:40.780
It's also where you'll find the recording of today's webinar.

927
01:03:40.800 --> 01:03:44.270
So, we invite you to go check out the resources you'll  find there.

928
01:03:44.290 --> 01:03:48.270
Let me review them again and, while I'm doing this, um, Gunnar is

929
01:03:48.290 --> 01:03:53.270
going  to open up our Q & A field, so that you can type in some

930
01:03:53.290 --> 01:03:59.260
questions or comments.

931
01:03:59.280 --> 01:04:02.660


932
01:04:02.680 --> 01:04:05.660
When  we're done with questions, we're going to also open up,

933
01:04:05.680 --> 01:04:08.660
provide a link in the chat  for you to give us a quick evaluation of

934
01:04:08.680 --> 01:04:13.660
today's webinar, which will also produce a  certificate of

935
01:04:13.680 --> 01:04:18.250
attendance at today's webinar, if you need one of those.

936
01:04:18.270 --> 01:04:22.250
So, before  you run off, if you need a certificate for today, be

937
01:04:22.270 --> 01:04:25.440
sure to look in thetiality chat for that.

938
01:04:25.460 --> 01:04:31.430
So, this is our website, our landing page.

939
01:04:31.450 --> 01:04:32.440


940
01:04:32.460 --> 01:04:34.640
That top portion is general information that you might want to

941
01:04:34.660 --> 01:04:37.040
look at and, then, you'll go down to where you see  planning

942
01:04:37.060 --> 01:04:39.530
resources.

943
01:04:39.550 --> 01:04:42.370
This is where you'll see the big-picture resources.

944
01:04:42.390 --> 01:04:46.370
For those  of you who, um, may have gotten interested in my

945
01:04:46.390 --> 01:04:52.360
comment about if you need to decide about what method to use for 3 to

946
01:04:52.380 --> 01:04:53.370


947
01:04:53.390 --> 01:04:59.370
5 year olds, OAE or pure tone or both, in that big- big-picture

948
01:04:59.390 --> 01:05:05.370
resources drop-down, you'll find a document there that compares the

949
01:05:05.390 --> 01:05:09.370
two,  that will facilitate a good conversation, maybe with your

950
01:05:09.390 --> 01:05:13.370
health services advisory  committee, a consulting audiologist, or

951
01:05:13.390 --> 01:05:17.300
others who will help you in that decision.

952
01:05:17.320 --> 01:05:20.300
If you need an audiologist, which we encourage all of you to

953
01:05:20.320 --> 01:05:23.300
try, if you can, to part partner with an audiologist, you'll find a

954
01:05:23.320 --> 01:05:28.050
way to do that through that next drop-down drop-down.

955
01:05:28.070 --> 01:05:34.050
The first recommendation we give, ask your colleagues, there may be

956
01:05:34.070 --> 01:05:38.050
people who know of a local audiologist and, then, the second

957
01:05:38.070 --> 01:05:43.050
is to go to your state's  Early Hearing Detection and Intervention

958
01:05:43.070 --> 01:05:46.050
or newborn hearing screening program at the  state level, and we

959
01:05:46.070 --> 01:05:52.050
provide a link to your state's person right there, they know all

960
01:05:52.070 --> 01:05:58.050
the audiologists, the pediatric audiologists in your state, and a

961
01:05:58.070 --> 01:06:00.710
pediatric  audiologist is who you really want.

962
01:06:00.730 --> 01:06:03.550
The next part is screening equipment resources.

963
01:06:03.570 --> 01:06:09.550
So, you'll find that table there, along with criteria for selecting

964
01:06:09.570 --> 01:06:15.540
equipment and  other things related to, um, equipment needs.

965
01:06:15.560 --> 01:06:16.990


966
01:06:17.010 --> 01:06:21.000
The next category is how to access  training, both for OAE and

967
01:06:21.020 --> 01:06:21.800
pure tone.

968
01:06:21.820 --> 01:06:26.850
So, check out that.

969
01:06:26.870 --> 01:06:29.850
After you've got your  planning steps done, the next part will be

970
01:06:29.870 --> 01:06:31.050
to access training.

971
01:06:31.070 --> 01:06:35.050
The next portion is  all of the nitty-gritty stuff of actually

972
01:06:35.070 --> 01:06:40.050
doing screening on a daily basis, preparing  for screening resources,

973
01:06:40.070 --> 01:06:46.040
a checklist of all the materials you need, the protocol that  we

974
01:06:46.060 --> 01:06:47.050


975
01:06:47.070 --> 01:06:52.050
just went over, we have forms that match the protocol exactly, so you

976
01:06:52.070 --> 01:06:57.050
won't ever  skip a step and, then, resources for sharing your results,

977
01:06:57.070 --> 01:07:03.040
letters to parents,  referral letters to providers, all of that

978
01:07:03.060 --> 01:07:04.050


979
01:07:04.070 --> 01:07:08.050
is there, and some of our resources are  available in, both, English

980
01:07:08.070 --> 01:07:10.450
and Spanish, so, check those out.

981
01:07:10.470 --> 01:07:15.450
Oh, under the  preparing for screening, you'll also find letters

982
01:07:15.470 --> 01:07:19.210
to parents explaining your screen screening methods.

983
01:07:19.230 --> 01:07:25.210
The next, um, is follow-up resources, where you'll find, um, a

984
01:07:25.230 --> 01:07:28.210
tracking tool that is really useful for tracking a group of

985
01:07:28.230 --> 01:07:32.210
children through the  screening process and, then, other resources

986
01:07:32.230 --> 01:07:34.730
for monitoring the quality of your screening efforts.

987
01:07:34.750 --> 01:07:37.130
So, have a look at that.

988
01:07:37.150 --> 01:07:41.130
Remember, if you're a Head Start program, you can also get resources

989
01:07:41.150 --> 01:07:46.130
from Head Start's technical assistance, um,  centers, so,

990
01:07:46.150 --> 01:07:51.300
that's how you can access them as well.

991
01:07:51.320 --> 01:07:57.630
So, remember these three groups of children.

992
01:07:57.650 --> 01:07:59.080
This is what we're really talking about.

993
01:07:59.100 --> 01:08:05.070
You may not have ever thought  of it quite like this, but monitoring

994
01:08:05.090 --> 01:08:07.080


995
01:08:07.100 --> 01:08:11.080
the status of children's hearing is central to  quality early childhood

996
01:08:11.100 --> 01:08:16.080
programs that are committed to language development and  school

997
01:08:16.100 --> 01:08:16.860
readiness.

998
01:08:16.880 --> 01:08:20.860
When children with hearing loss are identified and connected with

999
01:08:20.880 --> 01:08:26.860
the intervention resources that they need, they can thrive, and you

1000
01:08:26.880 --> 01:08:32.860
can have the  satisfaction of knowing that you were part of that

1001
01:08:32.880 --> 01:08:35.460
outcome.

1002
01:08:35.480 --> 01:08:37.910
So, what questions can  we help you address?

1003
01:08:37.930 --> 01:08:42.130
>>:  So, William, I see the first one here on, um, calibration.

1004
01:08:42.150 --> 01:08:44.300
Can you speak to  calibration of equipment?

1005
01:08:44.320 --> 01:08:49.300
How often and challenges in remote areas, such as Alaska?

1006
01:08:49.320 --> 01:08:52.300
Really great question and not one that we really touched upon,

1007
01:08:52.320 --> 01:08:57.300
but we recommend your  equipment be calibrated annually and, of course,

1008
01:08:57.320 --> 01:09:03.290
you'll be wanting to do a check on your own hearing or someone who has

1009
01:09:03.310 --> 01:09:04.300


1010
01:09:04.320 --> 01:09:10.300
a known result and check their ears before every  screening session,

1011
01:09:10.320 --> 01:09:12.300
just so you know that that equipment's working, that you

1012
01:09:12.320 --> 01:09:17.300
screen an  ear, it has a known result, and you get that result, um,

1013
01:09:17.320 --> 01:09:22.300
just as a quick daily check,  but we recommend an annual calibration

1014
01:09:22.320 --> 01:09:23.830
for the equipment.

1015
01:09:23.850 --> 01:09:28.830
I know that that is hard  in rural areas, um, and, um, one of

1016
01:09:28.850 --> 01:09:33.830
the things in rural areas, sometimes, is if the  person doing

1017
01:09:33.850 --> 01:09:37.830
the calibration, if they need to take the equipment for any repair,

1018
01:09:37.850 --> 01:09:42.830
um,  see if you can address the option of getting a loaner piece of

1019
01:09:42.850 --> 01:09:47.830
equipment, um, while  they're working on your equipment there,

1020
01:09:47.850 --> 01:09:52.830
but annual calibration with daily checks to  ensure the equipment's

1021
01:09:52.850 --> 01:09:57.830
working before every screening session, um, and good  relationship

1022
01:09:57.850 --> 01:10:02.830
with, um, your vendor or the company that provides calibration,

1023
01:10:02.850 --> 01:10:05.830
so, hope hopefully, they'll work with you on loaners and other ways

1024
01:10:05.850 --> 01:10:08.830
to make sure rural setting  work a little easier.>>:  One of you

1025
01:10:08.850 --> 01:10:13.830
pointed out that when you type in kidshearing.org, it actually come

1026
01:10:13.850 --> 01:10:19.820
comes up in your address line as a subset of Infantehearing.org.

1027
01:10:19.840 --> 01:10:21.660


1028
01:10:21.680 --> 01:10:23.660
You're in the  right place.

1029
01:10:23.680 --> 01:10:29.660
Kidshearing.org is a subset of Infantehearing.org, which, um,

1030
01:10:29.680 --> 01:10:34.660
focuses on overall hearing screening and, so, if you type in

1031
01:10:34.680 --> 01:10:38.660
kidshearing.org, you  just get right to where you want to be for

1032
01:10:38.680 --> 01:10:42.910
early childhood screening resources.

1033
01:10:42.930 --> 01:10:48.900
Terry, the next question, if a child needs a complete audiological

1034
01:10:48.920 --> 01:10:52.900
evaluation, but  does not have health insurance, are there

1035
01:10:52.920 --> 01:10:57.010
resourcess to help families with the cost?

1036
01:10:57.030 --> 01:10:57.810
>>:  Yeah.

1037
01:10:57.830 --> 01:10:58.610
Thank you.

1038
01:10:58.630 --> 01:11:00.210
That's a great question.

1039
01:11:00.230 --> 01:11:03.210
There should be and, again, there may be rural challenges with this

1040
01:11:03.230 --> 01:11:09.210
and access with distance, but, um, most state  health departments,

1041
01:11:09.230 --> 01:11:13.210
their Early Hearing Detection Intervention program, their EHDI

1042
01:11:13.230 --> 01:11:18.210
program should work with and have a listing of places where, um, the

1043
01:11:18.230 --> 01:11:23.210
audiological e evaluations can be done and, so, if I use my own state,

1044
01:11:23.230 --> 01:11:27.210
for example, um, there's a listing of places and cost and

1045
01:11:27.230 --> 01:11:31.210
those that will work with, um, people that do not have  insurance

1046
01:11:31.230 --> 01:11:36.210
and, then, through, um, you know, state-provided services, they can

1047
01:11:36.230 --> 01:11:38.950
be  provided at no charge.

1048
01:11:38.970 --> 01:11:43.950
There's also, um, you know, the healthcare systems, if you  want to,

1049
01:11:43.970 --> 01:11:46.950
especially if they're not-for-profit, they are, um,

1050
01:11:46.970 --> 01:11:50.950
required by the  Affordable Care Act to have financial assistance

1051
01:11:50.970 --> 01:11:54.950
for those that are, that do not have  insurance and, so, um, if you

1052
01:11:54.970 --> 01:11:59.950
do not have insurance, I would specifically ask if they  can apply

1053
01:11:59.970 --> 01:12:05.950
for financial assistance with that, but I would double-check with your

1054
01:12:05.970 --> 01:12:10.950
state EHDI program for a listing of service providers and the data they

1055
01:12:10.970 --> 01:12:14.950
have on cost  for those.>>:  So, the next question is how do you

1056
01:12:14.970 --> 01:12:20.940
decide when a child who is 3 years old or  older needs to do OAE

1057
01:12:20.960 --> 01:12:22.950


1058
01:12:22.970 --> 01:12:23.950
screening rather than pure tone?

1059
01:12:23.970 --> 01:12:28.950
What would you see in a child that indicates that pure tone is

1060
01:12:28.970 --> 01:12:31.530
not appropriate?

1061
01:12:31.550 --> 01:12:32.230
.

1062
01:12:32.250 --> 01:12:37.230
I'm going to let Terry expand upon this, but the first thing is that

1063
01:12:37.250 --> 01:12:38.630
that is apart of the actual training.

1064
01:12:38.650 --> 01:12:42.630
We're not  going to be able to completely answer that question

1065
01:12:42.650 --> 01:12:47.630
here, but, Terry, give a preview of how one would know.>>:  Yeah, so,

1066
01:12:47.650 --> 01:12:50.630
the first thing that we look for is does the child have the ability

1067
01:12:50.650 --> 01:12:54.630
or  are they able, in the circumstances you're in, to

1068
01:12:54.650 --> 01:13:00.620
understand your instructions and to participate in that.

1069
01:13:00.640 --> 01:13:08.400


1070
01:13:08.420 --> 01:13:10.800
If they're not, that's going to be the firstthi that thing that

1071
01:13:10.820 --> 01:13:13.400
you'll  look for and, um, then, there's a lot of strategies that we

1072
01:13:13.420 --> 01:13:15.000
would look for there.

1073
01:13:15.020 --> 01:13:17.400
It  could be, um, you know, the inability to condition can be

1074
01:13:17.420 --> 01:13:19.600
related to a variety of  factors, such as language barriers, um,

1075
01:13:19.620 --> 01:13:24.600
developmental stage and, um, and those kinds  of things, but the

1076
01:13:24.620 --> 01:13:28.600
primary thing is being able to see if they can understand and

1077
01:13:28.620 --> 01:13:32.600
participate and be conditioned and, if they can't, we need to have our

1078
01:13:32.620 --> 01:13:37.600
backup method  or strategy ready.>>:  The next question is

1079
01:13:37.620 --> 01:13:42.600
Floridian teacher of the deaf and hard of hearing for a  public

1080
01:13:42.620 --> 01:13:44.940
school system.

1081
01:13:44.960 --> 01:13:47.940
Speech therapists and nurses usually conduct the pure tone

1082
01:13:47.960 --> 01:13:49.940
screenings.

1083
01:13:49.960 --> 01:13:52.540
Would it be beneficial for me to be trained, and would it be

1084
01:13:52.560 --> 01:13:54.540
beneficial  for the county to purchase an OAE machine?

1085
01:13:54.560 --> 01:13:59.540
Um, I'm going to start off with part of  the answer,, but, Terry,

1086
01:13:59.560 --> 01:14:01.140
you can chime in.

1087
01:14:01.160 --> 01:14:04.230
I am so glad that you're on here, um,  Shelly.

1088
01:14:04.250 --> 01:14:10.220
I would, first, um, encourage you to make sure that those who are

1089
01:14:10.240 --> 01:14:11.230


1090
01:14:11.250 --> 01:14:17.230
doing pure  tone screenings have been adequately trained and that

1091
01:14:17.250 --> 01:14:23.220
training refreshers are being  done, and I'm emphasizing that because

1092
01:14:23.240 --> 01:14:25.230


1093
01:14:25.250 --> 01:14:31.230
we have seen, you know, a, sort of, common  drift in peoples' skills,

1094
01:14:31.250 --> 01:14:35.230
particularly around pure tone screenings, because it is all

1095
01:14:35.250 --> 01:14:41.230
manual and, um, people can just make mistakes, where they're

1096
01:14:41.250 --> 01:14:44.670
passing more children  than they should be.

1097
01:14:44.690 --> 01:14:47.670
They may be thinking they're doing children a favor by helping

1098
01:14:47.690 --> 01:14:53.670
them and not realizing that they're helping them, so, really, getting a

1099
01:14:53.690 --> 01:14:58.670
tight grasp  on the importance of adhering strictly to the guidelines

1100
01:14:58.690 --> 01:15:03.180
of pure tone screening is  really important.

1101
01:15:03.200 --> 01:15:08.180
As for the second part of your question, would it be helpful to

1102
01:15:08.200 --> 01:15:12.180
have, um, an OAE device and for you to be trained on it, well, I'm

1103
01:15:12.200 --> 01:15:13.920
going to say yes.

1104
01:15:13.940 --> 01:15:16.010
Terry, what do you think?

1105
01:15:16.030 --> 01:15:18.010
>>:  I would say absolutely.

1106
01:15:18.030 --> 01:15:23.010
It's wonderful to have that, um, second backup for the  kids you're

1107
01:15:23.030 --> 01:15:23.510
serving.

1108
01:15:23.530 --> 01:15:30.090
I think it's just doing them a great service.>>:  Great.

1109
01:15:30.110 --> 01:15:33.090
The next question reads, Floridian speech pathologist and

1110
01:15:33.110 --> 01:15:34.690
work in early  intervention.

1111
01:15:34.710 --> 01:15:39.350
All of the students I evaluate have language concerns.

1112
01:15:39.370 --> 01:15:43.350
Should we  screen during the evaluation, even though you

1113
01:15:43.370 --> 01:15:49.350
recommend that we also refer them to a  pediatric audiologist?

1114
01:15:49.370 --> 01:15:51.550
In our educational setting, we have to be careful when we

1115
01:15:51.570 --> 01:15:55.620
recommend a private setting for follow-up.

1116
01:15:55.640 --> 01:15:56.620
Terry?

1117
01:15:56.640 --> 01:16:01.970
>>:  Yeah, I love this question.

1118
01:16:01.990 --> 01:16:04.970
So, the first part of it, should we screen during  the evaluation,

1119
01:16:04.990 --> 01:16:06.920
yes, absolutely.

1120
01:16:06.940 --> 01:16:12.920
That is our hope, um, that could be a standard  practice, standard

1121
01:16:12.940 --> 01:16:16.910
of care during a speech and language evaluation, that a hearing

1122
01:16:16.930 --> 01:16:22.920
screening was part of it and, so, if you could do that, um, that

1123
01:16:22.940 --> 01:16:28.910
would just really  move that whole process along for these kids and,

1124
01:16:28.930 --> 01:16:35.790
um, so, um, emphatic yes on my part part.>>:  Excuse me.

1125
01:16:35.810 --> 01:16:38.180
I want to add one thing.

1126
01:16:38.200 --> 01:16:44.180
In our earliest intensive data collection  of the ECHO Initiative,

1127
01:16:44.200 --> 01:16:46.180


1128
01:16:46.200 --> 01:16:51.180
we found that many of the children that were ultimately being

1129
01:16:51.200 --> 01:16:57.180
identified with a hearing loss as a result of the screenings, hearing

1130
01:16:57.200 --> 01:17:02.180
screenings that  were being done in the Early Head Start programs we

1131
01:17:02.200 --> 01:17:04.180
were working with were already enrolled in early intervention

1132
01:17:04.200 --> 01:17:10.180
programs and getting speech therapy, and nobody had  checked their

1133
01:17:10.200 --> 01:17:11.180


1134
01:17:11.200 --> 01:17:13.090
hearing.

1135
01:17:13.110 --> 01:17:15.090
That doesn't sound right, right?

1136
01:17:15.110 --> 01:17:21.090
I mean, it seems like it's putting things in the wrong order,

1137
01:17:21.110 --> 01:17:24.090
to start doing speech therapy or language therapy  interventions

1138
01:17:24.110 --> 01:17:28.090
with children when we haven't, first, established whether their

1139
01:17:28.110 --> 01:17:31.590
hearing  is compromised.

1140
01:17:31.610 --> 01:17:34.400
So, once again, yes, yes, yes.

1141
01:17:34.420 --> 01:17:40.400
We are big advocates of getting, um,  evaluations of language paired

1142
01:17:40.420 --> 01:17:45.400
with hearing screenings or hearing evaluations,  particularly in Part

1143
01:17:45.420 --> 01:17:48.540
C early intervention programs.

1144
01:17:48.560 --> 01:17:54.070
Those things just sensibly have to go hand in hand.

1145
01:17:54.090 --> 01:17:56.880
Okay, the next question.

1146
01:17:56.900 --> 01:18:00.880
I work with Early Head Start home- home-based families, and I'm

1147
01:18:00.900 --> 01:18:05.880
wondering if anyone else is experiencing more families  not

1148
01:18:05.900 --> 01:18:11.010
wanting their children hearing screened or re-screened.

1149
01:18:11.030 --> 01:18:15.010
It is as if they don't understand the importance and

1150
01:18:15.030 --> 01:18:20.010
cannot understand, cannot stand to upset their child in  any way, even

1151
01:18:20.030 --> 01:18:22.330
for a moment.

1152
01:18:22.350 --> 01:18:24.460
Um, great question.

1153
01:18:24.480 --> 01:18:28.460
We don't have a way right now to in instantly poll everybody about

1154
01:18:28.480 --> 01:18:31.460
this, um, but what it does underscore is the  importance of

1155
01:18:31.480 --> 01:18:33.460
family education, right?

1156
01:18:33.480 --> 01:18:39.450
And we do have some tools on our website that  you should look under

1157
01:18:39.470 --> 01:18:40.460


1158
01:18:40.480 --> 01:18:42.460
preparing to screen, where there's some information for  families

1159
01:18:42.480 --> 01:18:48.460
about the importance of hearing screening, underscoring those main

1160
01:18:48.480 --> 01:18:54.450
facts,  that hearing status of a child can change, and they can

1161
01:18:54.470 --> 01:18:55.460


1162
01:18:55.480 --> 01:18:57.240
change without us noticing.

1163
01:18:57.260 --> 01:19:01.240
You know, children will accommodate, to a certain degree,

1164
01:19:01.260 --> 01:19:07.230
and, kind of, trick us into  not knowing, um, that they're actually

1165
01:19:07.250 --> 01:19:08.240


1166
01:19:08.260 --> 01:19:10.620
accommodating for a hearing loss.

1167
01:19:10.640 --> 01:19:13.410
So, um,  check out those resources.

1168
01:19:13.430 --> 01:19:19.710
Thanks for sharing that observation though.

1169
01:19:19.730 --> 01:19:25.710
Um, so,  let's see.

1170
01:19:25.730 --> 01:19:27.590


1171
01:19:27.610 --> 01:19:30.440
Some of you are asking about a certificate of attendance today.

1172
01:19:30.460 --> 01:19:35.440
Look in  the chat field, there's a link there for the evaluation of

1173
01:19:35.460 --> 01:19:40.330
today, and that will  generate a certificate of attendance.

1174
01:19:40.350 --> 01:19:46.330
Um, Terry, the next question, late onset hear hearing loss

1175
01:19:46.350 --> 01:19:50.200
attributed to infection, trauma, environment, and genetics.

1176
01:19:50.220 --> 01:19:55.200
Is that the  order of the causes most frequent to least frequent?

1177
01:19:55.220 --> 01:19:59.390
Which specific infections can lead to hearing loss?

1178
01:19:59.410 --> 01:20:00.840
Can you address that, Terry?

1179
01:20:00.860 --> 01:20:01.640
>>:  Yeah.

1180
01:20:01.660 --> 01:20:03.240
That's a great observation.

1181
01:20:03.260 --> 01:20:08.650
That was, um, not necessarily the order of  causes.

1182
01:20:08.670 --> 01:20:11.650
If I were to just informally look at these, I would say that the

1183
01:20:11.670 --> 01:20:15.650
causes  would be, um, genetics, infection, and, um, would be, you

1184
01:20:15.670 --> 01:20:21.650
know, more at the top of  that list, but, um, so, no, they weren't

1185
01:20:21.670 --> 01:20:27.650
necessarily listed in order of, um, you know know, the most common

1186
01:20:27.670 --> 01:20:28.150
causes.

1187
01:20:28.170 --> 01:20:32.150
Then, infections can get, um, into, um, different type types, so

1188
01:20:32.170 --> 01:20:37.150
you can have, for example, CMV infection that can cause, um,

1189
01:20:37.170 --> 01:20:41.150
hearing loss  either at birth or later and, then, you could also

1190
01:20:41.170 --> 01:20:46.150
have a different part of the ear, with chronic middle ear infections

1191
01:20:46.170 --> 01:20:49.150
that causes what we would call a conductive hear hearing loss or a

1192
01:20:49.170 --> 01:20:53.150
problem before the sound even gets to the inner ear and, so, um,  you

1193
01:20:53.170 --> 01:20:57.150
can have infection that occurs at different, um, parts of the system

1194
01:20:57.170 --> 01:21:03.140
and at  different stages and times of life.>>:  The next question,

1195
01:21:03.160 --> 01:21:05.150


1196
01:21:05.170 --> 01:21:08.150
Terry, is do you always need a referral from a healthcare

1197
01:21:08.170 --> 01:21:11.890
provider to see an audiologist?

1198
01:21:11.910 --> 01:21:15.890
>>:  So, that's going to depend on, um, what the, um, coverage that

1199
01:21:15.910 --> 01:21:20.880
that individual individualory family or families family has and,

1200
01:21:20.900 --> 01:21:23.690
so, it will vary on health plan.

1201
01:21:23.710 --> 01:21:29.680
Most state Medicaid  programs, um, are, require a referral, so, um, I

1202
01:21:29.700 --> 01:21:34.680
would say, probably, more often than  not, a referral may be

1203
01:21:34.700 --> 01:21:40.680
necessary, but, again, it's going to be plan-dependent.>>:  The next

1204
01:21:40.700 --> 01:21:42.680


1205
01:21:42.700 --> 01:21:48.680
question is I see some people using a probe, or I think they mean probe

1206
01:21:48.700 --> 01:21:50.680
cover that is too big.

1207
01:21:50.700 --> 01:21:54.350
In those cases, would you get a false reading?

1208
01:21:54.370 --> 01:21:59.350
>>:  So, um, that's a great question, because this emphasizes

1209
01:21:59.370 --> 01:22:05.350
that probe fit is,  probably, the most critical factor in getting a

1210
01:22:05.370 --> 01:22:11.350
good, um, screening done, getting your OAE, um, accomplished and, so,

1211
01:22:11.370 --> 01:22:14.840
we want to have a good probe fit.

1212
01:22:14.860 --> 01:22:19.840
Generally, the  rule is we want to have the largest size probe that

1213
01:22:19.860 --> 01:22:23.840
will appropriately fit into that ear canal, so we get a good, snug

1214
01:22:23.860 --> 01:22:27.840
fit, and the probe stays stable in the ear without  you holding on to

1215
01:22:27.860 --> 01:22:30.840
it.

1216
01:22:30.860 --> 01:22:33.640
Now, if we have one that's too small, it will be loose, it  could

1217
01:22:33.660 --> 01:22:36.640
fall out, noise could get in, and you, probably, won't get your OAE

1218
01:22:36.660 --> 01:22:37.300
completed.

1219
01:22:37.320 --> 01:22:42.300
If the probe is too big, it will also be so large that it can't

1220
01:22:42.320 --> 01:22:44.360
quite fit in there  snuggly.

1221
01:22:44.380 --> 01:22:48.360
The most common thing I see with a probe that's too large is we just

1222
01:22:48.380 --> 01:22:51.540
can't  quite get it in, and it wants to fall out, um, easily.

1223
01:22:51.560 --> 01:22:55.100
The second part of your  question is on results.

1224
01:22:55.120 --> 01:23:01.100
So, if we get a refer, we know that we may, we, probably,  want to

1225
01:23:01.120 --> 01:23:03.550
try again and try a different size probe.

1226
01:23:03.570 --> 01:23:05.710
A refer, we don't necessarily know  why that is.

1227
01:23:05.730 --> 01:23:06.710
Is it due to noise?

1228
01:23:06.730 --> 01:23:08.710
Was the child chewing or sucking?

1229
01:23:08.730 --> 01:23:10.710
Did I have a  poor probe fit?

1230
01:23:10.730 --> 01:23:15.710
So, we want to try again, but when we get a pass, that means the

1231
01:23:15.730 --> 01:23:19.710
machine has actually detected and measured that emission, so the pass

1232
01:23:19.730 --> 01:23:25.700
result, um, is  a result that you can take.>>:  Terry, the next

1233
01:23:25.720 --> 01:23:27.710


1234
01:23:27.730 --> 01:23:33.710
question is what if you can't get a child to cooperate for a

1235
01:23:33.730 --> 01:23:34.290
screening?

1236
01:23:34.310 --> 01:23:40.280
>>:  Yeah, that's a great question.

1237
01:23:40.300 --> 01:24:17.870


1238
01:24:17.890 --> 01:24:19.870
That relates to that, all that training, um,  those training

1239
01:24:19.890 --> 01:24:22.470
issues and the, um, the reasons to have good training is because we

1240
01:24:22.490 --> 01:24:25.470
want to talk and train about how we can, um, work with children, um, to

1241
01:24:25.490 --> 01:24:27.670
get them  successfully screened and, so, there's a lot of varying

1242
01:24:27.690 --> 01:24:30.470
things that we can do, but we  may, um, without going into all the

1243
01:24:30.490 --> 01:24:32.670
specifics, um, but there are strategies we can do  with, um,

1244
01:24:32.690 --> 01:24:35.070
getting help with a caregiver that they know and are comfortable with,

1245
01:24:35.090 --> 01:24:37.670
we  can, um, come back again, and we can desensitize over a couple

1246
01:24:37.690 --> 01:24:38.170
days.

1247
01:24:38.190 --> 01:24:40.970
Um, lots of var varying things that we can try to do and, then,

1248
01:24:40.990 --> 01:24:43.370
it's also, if you're experienced, you'll learn when to call it and

1249
01:24:43.390 --> 01:24:45.370
when it's time to refer.

1250
01:24:45.390 --> 01:24:47.770
So, um, I apologize, but  we could, um, we could almost do

1251
01:24:47.790 --> 01:24:49.770
another webinar on that question.

1252
01:24:49.790 --> 01:24:51.770
It's a great  question.>>:  Yep.

1253
01:24:51.790 --> 01:24:54.370
The next question is I'm curious if there have been times when a

1254
01:24:54.390 --> 01:24:56.970
child has  failed a screening, but, later, is found to have autism or

1255
01:24:56.990 --> 01:24:58.570
sensory processing  disorder and not a hearing loss.

1256
01:24:58.590 --> 01:24:59.770
Are there resources for this scenario?

1257
01:24:59.790 --> 01:25:02.770
>>:  Love that question, because that, often, those are the kids

1258
01:25:02.790 --> 01:25:05.770
that would fall in  that 20 to 25 percent of pure tone screening,

1259
01:25:05.790 --> 01:25:11.770
where we couldn't get the screening done or we couldn't get reliable

1260
01:25:11.790 --> 01:25:17.770
responses, um, and, um, but if we're able to, um,  work with them,

1261
01:25:17.790 --> 01:25:23.770
we can, often, get an OAE complete on those kids and be able to at

1262
01:25:23.790 --> 01:25:29.770
least screen, um, up through the level of the cochlea and get a

1263
01:25:29.790 --> 01:25:35.770
response and, so, um,  we want to keep trying till we can rule out

1264
01:25:35.790 --> 01:25:40.770
hearing loss as, um, part of the things  that they're dealing

1265
01:25:40.790 --> 01:25:44.770
with.>>:  The next question, we're going to go quickly through these

1266
01:25:44.790 --> 01:25:46.770
remaining ones as we  can.

1267
01:25:46.790 --> 01:25:48.600
We're getting close to the bottom of the hour.

1268
01:25:48.620 --> 01:25:52.600
If you have to run off, um, be sure to check the chat for the link

1269
01:25:52.620 --> 01:25:57.750
for the evaluation and the certificate generator.

1270
01:25:57.770 --> 01:25:58.950
It's one link.

1271
01:25:58.970 --> 01:26:01.950
Okay, Terry, children in Early Head Start, where I work, are given

1272
01:26:01.970 --> 01:26:03.950
a  functional vision and hearing screening by a trained staff

1273
01:26:03.970 --> 01:26:06.330
member.

1274
01:26:06.350 --> 01:26:11.330
If the child  doesn't pass, they're monitored and re-screened

1275
01:26:11.350 --> 01:26:13.410
or referred.

1276
01:26:13.430 --> 01:26:14.410
Is this sufficient?

1277
01:26:14.430 --> 01:26:19.410
Or  how do I get, um, how do I get a copy of the newborn hearing

1278
01:26:19.430 --> 01:26:20.410
screening?

1279
01:26:20.430 --> 01:26:21.920
Well, I'll  answer the first thing.

1280
01:26:21.940 --> 01:26:24.920
I'm not going to speak about vision, but a functional hear

1281
01:26:24.940 --> 01:26:27.610
hearing screening is not considered evidence-based.

1282
01:26:27.630 --> 01:26:32.610
OAE screening for birth to 3 year olds is the only

1283
01:26:32.630 --> 01:26:36.610
evidence-based screening practice that you will find in the

1284
01:26:36.630 --> 01:26:39.560
literature that you can really defend as evidence-based.

1285
01:26:39.580 --> 01:26:42.560
Terry, do you concur with  that?

1286
01:26:42.580 --> 01:26:46.560
>>:  Yeah, absolutely.>>:  Um, as far as getting the newborn

1287
01:26:46.580 --> 01:26:51.600
screening result, um, it should be in a child child's health record.

1288
01:26:51.620 --> 01:26:55.600
So, you would ask for that from a child, where you would get,  like,

1289
01:26:55.620 --> 01:27:02.100
their immunization record or any other things like that.

1290
01:27:02.120 --> 01:27:07.100
Um, the next question question, Terry, is, in my area, the majority

1291
01:27:07.120 --> 01:27:13.090
of doctors use an objective tool to screen for hearing and/or a

1292
01:27:13.110 --> 01:27:14.100


1293
01:27:14.120 --> 01:27:19.100
subjective tool for hearing, um, screening is not done,  because the

1294
01:27:19.120 --> 01:27:22.510
child does not need it.

1295
01:27:22.530 --> 01:27:28.500
Um, our program currently accepts our doctors as  the screening tool.

1296
01:27:28.520 --> 01:27:29.600


1297
01:27:29.620 --> 01:27:32.390
What are your thoughts?

1298
01:27:32.410 --> 01:27:38.380
Um, what we would say to that is that  we never consider a hearing

1299
01:27:38.400 --> 01:27:39.390


1300
01:27:39.410 --> 01:27:42.390
screening that has been done that is subjective as a com completion

1301
01:27:42.410 --> 01:27:48.660
of a hearing screening regardless of who has done it.

1302
01:27:48.680 --> 01:27:51.660
That just because  it is a doctor doesn't mean that it, suddenly, is

1303
01:27:51.680 --> 01:27:55.720
a more valid screening.

1304
01:27:55.740 --> 01:27:59.230
Again, OAE  screening is the recommended method.

1305
01:27:59.250 --> 01:28:04.230
Now, if you're getting results of that from a  healthcare provider,

1306
01:28:04.250 --> 01:28:10.220
you want to make sure that you have documentation that it was an  OAE

1307
01:28:10.240 --> 01:28:11.230


1308
01:28:11.250 --> 01:28:16.230
and the results on each ear, not just an overall, but a left result

1309
01:28:16.250 --> 01:28:21.230
and a right  result and, with that, you would know you had a screening,

1310
01:28:21.250 --> 01:28:22.830
that it was completed.

1311
01:28:22.850 --> 01:28:28.830
Now, if there was a non-passing result, you would still need to do

1312
01:28:28.850 --> 01:28:30.430
the follow-up step steps.

1313
01:28:30.450 --> 01:28:35.430
So, um, we know this reality that you're talking about, it's familiar

1314
01:28:35.450 --> 01:28:41.420
to us,  but we always encourage people to recognize that, you know,

1315
01:28:41.440 --> 01:28:42.430


1316
01:28:42.450 --> 01:28:47.430
you're the front end of a  movement here that is understanding the

1317
01:28:47.450 --> 01:28:51.430
value of evidence-based hearing screening,  and not all healthcare

1318
01:28:51.450 --> 01:28:57.430
providers understand or support this process yet, but you can  help

1319
01:28:57.450 --> 01:29:00.630
them understand the value of that.

1320
01:29:00.650 --> 01:29:03.470
Everyone, we're at the bottom of the hour.

1321
01:29:03.490 --> 01:29:06.370
90 minutes has passed, so, we're going to have to end for today.

1322
01:29:06.390 --> 01:29:10.370
If we didn't get to  your question, feel free to contact us

1323
01:29:10.390 --> 01:29:15.370
through our website at kidshearing.org, and  we'll happily

1324
01:29:15.390 --> 01:29:17.770
respond to you there.

1325
01:29:17.790 --> 01:29:22.770
Remember to go to kidshearing.org, where  you'll find all of our

1326
01:29:22.790 --> 01:29:27.770
resources, including this webinar recording for you to review  again,

1327
01:29:27.790 --> 01:29:31.770
toed advance forward to, if there's a particular slide you want to look

1328
01:29:31.790 --> 01:29:35.770
at again  or a statement we made you want to hear again, and share

1329
01:29:35.790 --> 01:29:38.570
it with others who may not  have been able to attend live with us

1330
01:29:38.590 --> 01:29:40.460
today.

1331
01:29:40.480 --> 01:29:46.460
Thank you to our captioner, our interpreters, Terry, thank you,

1332
01:29:46.480 --> 01:29:50.460
thank you, Gunnar, for your technical support, and  thank you

1333
01:29:50.480 --> 01:29:56.460
to all of you for all that you're doing to make sure that, as apart

1334
01:29:56.480 --> 01:30:01.460
of your  commitment to children's language development and school

1335
01:30:01.480 --> 01:30:06.460
readiness, that they are  having their hearing carefully and

1336
01:30:06.480 --> 01:30:09.460
conscientiously considered periodically throughout  this

1337
01:30:09.480 --> 01:30:13.930
really important language acquisition period in life.

1338
01:30:13.950 --> 01:30:17.172
Thanks, everyone.