WEBVTT

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ahead and get started.  My name is Will Eiserman.  I'm the director of the Early Childhood Outreach known as the 

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ECHO initiative.  It is housed within NCHAM at Utah State.  I'm the associate director there.  NCHAM 

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currently serving as the early hearing detection and intervention national technical resource center which is a 

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big, long name.  We're funded through the cooperative agreement with the child health bureau.  There's the 

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second poll for you to use.  I need to slide it out of my way.  We're funded by the maternal and child health 

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bureau.  We have been for about 20 years.  The ECHO initiative serves for about 20 years as the national 

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resource center with a focus on supporting early head start at head start program staff in implementing 

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the evidence-based hearing screening and follow-up practices.  We're delighted to continue to be able to 

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make our resources and other learning opportunities available to staff from head start programs and art si 

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programs, and really anybody in early care and education settings that can put the resources to use.  I'm joined 

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today by Terry Foust.  He's a pediatric audiologist and speech language pathologist who has served as a 

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consultant and trainer with the ECHO initiative since the very beginning.  Thank you for being with us today.  

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>> Thank you, William.  Yes.  William and I, along with other ECHO team staff as well just a lot of local 

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collaborators, we've provided training to nearly every state and thousands of staff from early head start and 

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American-Indian, Alaska native programs, migrant head start programs, and many other early care and 

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education programs other the 20 years.  I can't believe it's been that long that William mentioned.  We're always 

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encouraged as we are today by the huge amount of interest that there's an niching evidence-based hearing 

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screening programs so that children with hearing-related needs to be identified and served.  

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>> Yeah.  Thank you, Terry.  Today's webinar is primarily intended for those of you who already have some 

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experience implementing evidence-based hearing screening for children either in the birth to three age range or 

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three to five age range or both of those.  We're delighted to have well over 900 people register for today's 

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webinar from all over the country.  Many of you have submitted questions in advance.  What we're going to do is 

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we're trying to address your questions by incorporating them into what we're going to present.  But then we're 

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going to stop periodically throughout today's presentation and make sure that if there are any remaining 

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questions that you have an opportunity to ask them.  So we're hoping it will work well like that.  We did notice 

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that some of the questions that we received were from folks for whom evidence-based hearing screening is 

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new.  Which isn't exactly our argument for today.  If that's you, by all means you are welcome to stay.  But we 

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also want to alert you to the fact that next week on August 16th we're having an introductory webinar that will 

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present the topic of evidence-based hearing screening for children, birth to five, starting at the very 

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beginning.  Where we're jumping in the deep end today.  You'll see that  link.  They will post to the 

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registration.  We invite you to join us and share that also.  Keep that in mind.  You can always find that if you 

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misplace that link through kids hearing dot org.  Which is the primary web site that we're going to be refers to 

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today throughout our time together.  Okay.  Enough of looking at me.  Now you get to see the full screen without 

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watching me.  We're going to organize our time today around many of the questions that you all submitted.  

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We'll present information about each of the topics.  After each topic we'll check in with you to see if you have 

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any additional questions before we move on.  We're going to start off with a brief big picture review.  This will 

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help the newcomers who are here.  Also just get us all grounded on what the purpose of hearing screening in and 

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what the recommended methods are that we're going to be talking about today.  We'll then turn our attention to -- 

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to review the issues that are pertaining to pure tone audioometry.  Since many of you are getting ready 

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for a new round of screenings, we're going to go over some key steps you'll want to complete to prepare for this 

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this year.  We'll review the steps of the procedure itself and address any questions that you've raised about 

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pure tone screening.  After that, we'll address any additional questions that you have.  Then we'll move on to 

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otoacoustic emissions or OAE screenings.  Since many of you preparing for a new round of screening 

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for a group of children with OAE, we'll do the same things.  We'll over overview the steps.  We'll walk 

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through the procedure and some of the helpful hints and delve into your questions about children who may be 

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challenging to screen or other issues that you've raised.  That will be your opportunity to ask any additional 

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questions about the OAE method.  Next we're going to talk about the follow-up protocol.  Which will really 

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relate to everybody regardless of which screening method that you use.  It is the same recommended follow-up 

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protocol for what you do when a child doesn't pass the screening, regardless of which method that you use.  We'll 

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address the follow-up steps, and then we're going to also talk about the questions that some of you sent to us 

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about how to communicate with parents and professionals and encourage and get that follow-up action done.  What 

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it means to interface with the professionals that may not be as supportive as we would like them to 

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be.  We share those headaches.  We don't have magical answers.  We do have some ideas we can share with you. 

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 We'll then wrap up by talking about our technical assistance resources that we have online and to help you 

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find what you need to in order to progress from here forward.  I'm going to leave this up as a sort of side bar 

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today.  So that you can follow along and know that if you are going to ask a question, look and make sure that it 

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is related to the topic that you see highlighted on the left side.  But we're not going to invite questions 

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just yet, because as I said, we have a lot of people on with us today.  We're going to try to anticipate as many of 

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your questions as we can.  Thank you for sending us those questions in advance.  Now before I go any further, 

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I want to give a shout out to our captioner.  We have captioning services on today.  If that's helpful 

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to you, by all means use that.  That's a real live person who is doing that for us.  We really appreciate their 

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time and talents for helping us to make our presentations as accessible as possible.  All right.  Let's jump into 

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it.  You've probably seen the graphic before.  We always like to remind people the work of the ECHO initiative 

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is based on the recognition that each day young children who are deaf or hard of hearing are being served in 

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early childhood education and health care settings that often without their hearing, health related meaning being 

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known.  Since hearing loss is an invisible condition, how can we reliably identify which children have 

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normal hearing and which may not?  >> You know, the short answer to that question really is that early care and 

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education providers, such as many of you on today can be screened to conduct evidence-based hearing 

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screening just like you see depicted here in the photos.  The ultimate outcome of a hearing screening 

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program?  We can identify children who are deaf or hard-of-hearing who have not been identified previously.  

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

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That's the recommended method for children birth to three years of age.  It is increasingly recommended for 

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children three to five years of age as well.  On the right you'll see the procedure pure tone audiometry 

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screening which is used for three to five years of age and older.  You'll see many care and education providers 

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still using the method.  As William mentioned, we'll be talking about both of these methods today.  Keeping in 

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mind the hearing screening process does not diagnose a hearing loss, but it does identify children who need 

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further follow-up evaluation either by the health care provider or the audiologist.  And the ultimate aim of 

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Asianing a hearing loss.  If that exists, connecting the children with intervention services would be the 

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next step.  So your screening process is the first important accept in the whole entire process.  

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>> Some of you have asked whether you need to be certified to do screenings.  That tends to be a state issue.  

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Maybe even an organizational issue.  We don't really know of any states that require that.  There are some state 

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guidelines that influence your practices.  We can't begin to cover every state's regulations.  We 

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encourage you to check that out.  A good way to do that is by contacting your state's newborn hearing screening 

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office or the early hearing detention intervention coordinator, also known as the EHDI coordinator.  How am I 

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going to do that?  We have a link on the web site under the heading find an audiologist on our web site where 

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you'll find a link to your state's EHDI program.  You can ask if there are any special rules about hearing screening 

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that might limit who can be screened.  Some of you ask how we can be more effectively encourage parents to 

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follow up when the child hasn't passed the screening.  One way is to share information about the incident of 

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hearing loss and the fact that a child's hearing ability can change at any time.  Without us even recognizing 

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it.  You know, about three children in a thousand are born with hearing loss.  Deaf or hard of hearing.  Most 

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newborns in the U.S. are screened at birth for hearing loss using evidence-based methods.  Most of them 

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are screened before they even leave the hospital.  Screening at the newborn period isn't enough.  Research 

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suggests that the incidents of permanent hearing loss actually doubles between birth and school age 

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from three and 1,000 at birth to about six and 1,000 by the time children under school.  That's a really good 

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fact to commit to memory, so you can use that as you talk with parents and others about the importance of 

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follow-up.  >> Based on what William just shared with us, we can't only screen for 

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hearing loss at birth.  We need to screen throughout early childhood.  Hearing loss can occur at any time as 

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a result of illness, physical trauma, or environmental or genetic factors.  This kind of loss is often referred to 

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as late, onset hearing loss because it has acquired after the newborn period.  Changes in subtle vision.  We want to 

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be able to identify that, so they will have full access to language and all of the information that they are 

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exposed to as part of learning and growing.  Screening then is just the first step in the process.  The 

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process of identifying the disability, such as a hearing loss.  Since no screening method is perfect is 100% 

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effective in identifying possible areas of concern, parent or caregiver concern overpasses the screening 

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result, no matter what was used.  >> Yeah.  Any conversation that we have about screening and follow up 

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should always begin with a reminder that screening methods aren't perfect.  And that whenever a parent has a 

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concern about language or hearing, children should be referred for a more thorough evaluation.  Even if the 

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child passed the hearing screening.  That's true even with the highly reliable hearing screening methods 

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we're talking about today and that you are using.  >> Yes.  And additionally, we also 

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want to acknowledge right up front that for any number of reasons there will be an occasional child that you just 

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can't manage to screen.  Just won't be able to complete a screening on.  After you've tried everything that you 

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can do and you have a colleague try everything they can do as well, if you are -- you'll be faced with that 

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dilemma of what to do.  Here's the recommendation about that question which some of you raised.  If you 

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aren't successful screening a child, then refer that child to someone who can.  Often that's going to be a 

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pediatric audiologist.  Someone with the equipment and skill level to be able to screen the difficult to screen 

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children.  Keep in mind sometimes the children that you have a difficulty screening are the ones that have a 

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hearing loss.  We don't want to skip them and try again next year.  >> So we just mentioned the word 

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pediatric audiologist.  And the importance of having a pediatric audiologist in the picture.  A 

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pediatric audiologist, if you don't know, is a professional that specialized in the diagnosis and 

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non-medical treatment of hearing-related and other disorders associated with the earring.  A 

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pediatric audiologist specials in children.  Having access to the local pediatric audiologist can be helpful 

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to oversee the hearing screening and follow-up with activities.  They can help you with equipment questions, 

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consult with you about specific children who aren't passing, and importantly maybe one of your 

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resources when you need to refer to child for a further evaluation.  On our web site, you'll find a link under 

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the heading find an audiologist.  Which should help you.  >> Some of you also submitted very 

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specific questions about error messages on your equipment.  That's -- those are really great questions.  They are 

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difficult for us to address in the group setting like this, especially with the variety of equipment that's 

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out there.  You could pose those questions to the person that sold you the equipment.  While the equipment 

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distributors and sales people are not who you should look to for comprehensive training, the 

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comprehensive training that you need to develop your screening program, they can absolutely help you understand 

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your equipment functions, the various error messages, and things like that.  Having access to both the pediatric 

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audiologist and good relationship with your sales rep can be helpful for a variety of reasons.  We encourage you 

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to have the contact information ready when you need it.  Sometimes the equipment manual will help you as 

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well.  I want to make one point, in general the error message says we need to refit and retry.  If that doesn't 

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work, then your consulting audiologist and equipment rep can be specific with you with the error messages.  

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>> That's a great point.  We don't want to get too lost.  We'll talk about that in a minute.  Some people 

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submitted questions.  Let's just answer that question right now.  >> Yeah.  Thank you.  That's a really 

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common question and concern.  The quick answer is yes.  You absolutely can and should screen children whom you know 

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have PE tubes.  It is really a way to find out if the tubes are doing the job they put in to actually do.  

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Children with PE tubes should pass hearing screenings if the rest -- if those tubes are open, functioning, and 

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the rest of the auditory system is functioning normally.  So for those of you that are using the OAE method, 

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you'll want to just take a quick look at your equipment manual.  Make sure you don't have to do an extra button 

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push to adjust the setting.  In order to be able to screen them with PE tubes.  

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>> Yeah.  It is not a big deal.  To have to make that adjustment.  It is just that you push the button.  You do 

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the screening on the ear that has the BE tubes.  Check with your manual.  We're not trying to put all of this 

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off on you.  We have a variety of different brands of equipment that you are all using.  We don't want to 

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confuse you by trying to get equipment brand specific here today.  We have two screening methods that we're going 

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to talk about today.  If you are responsible for screening 3 years old or older, audiometry has been 

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considered the recommendation for the age group.  You hear the sound that's presented into the earphone.  You see 

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the method being used on the right here.  >> Several of you asked about why some 

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programs are no longer using pure tone audiometry with the three to five year old population and have switched to 

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OAEs.  That's really because there's a growing recognition that although the pure tone method has been the most 

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widely used, it may not be the most feasible method to use with the younger children.  Research has shown 

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that 20 to 25% of children in the three to five age group can't be successfully screened with this 

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methodology.  You'll recognize some of these reasons.  It's because they aren't development tally able to 

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follow the directions reliably for a variety of reasons.  It can be language barriers and cognitive 

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reasons.  That's been our experience as well.  If those instances, OAE screening is the preferred method for 

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the children.  As we emphasized a moment ago, we want to screen every child.  Even the ones that we find 

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challenging to screen; right?  >> I just noticed that some of you are already putting questions up for us.  

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If you could just hold tight for a minute and let us get to the topic that you are going to ask questions 

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about, maybe you'll be lucky and we'll address it.  We -- I -- I don't know how to today to both at the same time. 

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 Sit tight.  Let's ask questions about the topic.  We'll try to do that.  Back to what you were saying at the 

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minimum if you were establishing evidence-based practices and if you are considering using pure tone 

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screening, you'll also need -- did I jump ahead, Terry?  >> Nope.  You are good.  Yup.  

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>> You'll also need to be equipped and prepared to do OAEs on the 20 to 25% who can't be screened with pure tones. 

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 You'll need to have a means to systemically refer all of the children to audiologist who can perform the 

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screening.  Which frankly can be a fit challenging in its own right if you are referring 20% of your children to 

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00:23:46.000 --> 00:23:51.970
an audiologist, just for a screening.  >> Yes.  Maybe to simplify things, more and more audiologist are 

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recommending the use of OAE's uniformly with all children three years of age and older.  It is quicker both in 

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learning to do and implement.  It is far more likely to be a method that will work across the board with all 

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00:24:09.000 --> 00:24:14.980
children in the three to five-year age group that you are screening.  It is equally as effectively.  

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>> If your program is still undecided about which method to use foryou are asking that question again, we 

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encourage you to carefully review the document that we have on our web site under the -- I'll show you where this 

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00:24:33.000 --> 00:24:38.970
is in a moment.  It compares OAE and pure tone screening for the population of three to five years old and older.  

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Here's an important note though.  Some states have regulations about what methods are to be used based on age, 

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requiring pure tone for children three years and older at least as the primary method.  As you check, you'll 

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want to look at the state's regulations if you are thinking of using OAEs solely for the three to five group.  

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00:25:07.000 --> 00:25:12.970
You can always use it as a backup.  If you are going to do it solely, check with the state regulations before you 

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go on.  Now, Terry, we had another question that came in prior to our webinar about are there any other 

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00:25:20.990 --> 00:25:25.980


319
00:25:26.000 --> 00:25:31.980
methods, like sometimes it is hard; right?  To screen really little ones OAEs, because they won't sit still.  

320
00:25:32.000 --> 00:25:37.970
Are there any other recommended evidence-based methods that should be or could be considered instead of OAEs 

321
00:25:37.990 --> 00:25:46.980


322
00:25:47.000 --> 00:25:52.970
for the birth to three years old?  >> Thank you, William.  There really are not.  There are -- there's been 

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324
00:25:58.000 --> 00:26:03.970
some methods.  The only evidence-based method right now is otoacoustic emissions which has the complete 

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00:26:03.990 --> 00:26:33.980


326
00:26:34.000 --> 00:26:39.980
backing of the audiologist and American speech language association as well as others.  There are places that use 

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calibration for the OAE.  Who do you know to calibrate?  >> That's a great question.  I 

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329
00:26:47.000 --> 00:26:52.970
appreciate you being attendive to that need.  There are a lot of resources for calibration.  One of the quickest 

330
00:26:52.990 --> 00:26:54.980


331
00:26:55.000 --> 00:27:00.970
way would be to contract the distributor for the brand of equipment.  They should have approved 

332
00:27:00.990 --> 00:27:04.980


333
00:27:05.000 --> 00:27:10.970
people on -- in your area that -- they can refer to you and give you the contact information to provide that 

334
00:27:10.990 --> 00:27:15.980


335
00:27:16.000 --> 00:27:21.970
calibration for you.  There's also some nationwide companies that provide support for that.  I can put one of 

336
00:27:21.990 --> 00:27:22.980


337
00:27:23.000 --> 00:27:28.970
those maybe in the chat, William, as soon as I -- while we're talking here I may be able to pull up that 1-800 

338
00:27:28.990 --> 00:27:31.980


339
00:27:32.000 --> 00:27:36.980
number for some of them.  >> Okay.  We'll give you a chance to do that in the moment.  Why don't we 

340
00:27:37.000 --> 00:27:42.970
jump into pure tone screening now and talk about it?  >> Yeah.  Great.  Let's do that.  

341
00:27:42.990 --> 00:27:43.980


342
00:27:44.000 --> 00:27:49.970
Let's review it.  To conduct pure tone screening, we're going to want to take a good look at ear.  We're going to do 

343
00:27:49.990 --> 00:27:50.980


344
00:27:51.000 --> 00:27:56.970
that to make sure there's no visible sign of infection or blockage.  By the way, you'll always want to do this 

345
00:27:56.990 --> 00:28:00.980


346
00:28:01.000 --> 00:28:06.970
first, regardless of which method you use.  If the ear appears normal, then you as the screener are going to 

347
00:28:06.990 --> 00:28:07.980


348
00:28:08.000 --> 00:28:13.970
instructor condition the child how to listen for a tone and then provide a response by doing something like 

349
00:28:13.990 --> 00:28:16.980


350
00:28:17.000 --> 00:28:22.980
raising their hand and placing a toy in a bucket.  Once you've observed the child reliably responds to the sounds 

351
00:28:23.000 --> 00:28:28.970
that are presented just like you instructed, then you actually start the screening.  That's when the actual 

352
00:28:28.990 --> 00:28:30.980


353
00:28:31.000 --> 00:28:36.980
screening is started.  During the screening process, this listen and respond game is repeated at least 

354
00:28:37.000 --> 00:28:42.970
twice at three different pitches or frequencies on each ear.  Then you are going to be noting the child's 

355
00:28:42.990 --> 00:28:48.980


356
00:28:49.000 --> 00:28:54.980
response or lack of response after each of those tones is presented.  If the child responds appropriately and 

357
00:28:55.000 --> 00:29:00.970
consistently to the range of tones, then the child passes the screening.  Now during the screening process, the 

358
00:29:00.990 --> 00:29:01.980


359
00:29:02.000 --> 00:29:07.970
listen and respond game is repeated at least twice as I mentioned at three different pitches on each year.  Again 

360
00:29:07.990 --> 00:29:38.980


361
00:29:39.000 --> 00:29:44.970
we're going to note the response or the lack of response after each tone is repeated -- presented.  

362
00:29:44.990 --> 00:29:47.980


363
00:29:48.000 --> 00:29:52.980
>> As you present, you'll get ready when you start screening the children.  This goes for everyone, regardless of 

364
00:29:53.000 --> 00:29:58.970
the pedestrian that you'll be using.  You want to refresh yourself on the med.  You can look at resources to 

365
00:29:58.990 --> 00:30:02.980


366
00:30:03.000 --> 00:30:04.980
help you do that.  This is a landing page at kids hearing dot org.  This is a good moment for you to look for that 

367
00:30:05.000 --> 00:30:10.970
number, if you want to do that.  >> Thank you.  >> Yup.  

368
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369
00:30:19.000 --> 00:30:24.980
>> This is our landing page at kidshearing.org.  You are going to find a range of resources, including 

370
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general information and new staff acquainted with screening and more detailed information that you'll find 

371
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372
00:30:32.000 --> 00:30:37.970
here.  In the first category you'll find the big picture information.  You see there where it stays find an 

373
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374
00:30:39.000 --> 00:30:44.970
audiologist, that's where you can do -- find your local -- look for resources for finding a local audiologist, and 

375
00:30:44.990 --> 00:30:46.980


376
00:30:47.000 --> 00:30:52.970
that's also where you will find information to contact your states EHDI or newborn hearing screening 

377
00:30:52.990 --> 00:30:55.980


378
00:30:56.000 --> 00:31:01.970
program to find out about any state regulations or rules that you or your program should be aware of, regards 

379
00:31:01.990 --> 00:31:05.980


380
00:31:06.000 --> 00:31:11.970
who can screen or what methods need to be used.  You'll also find under the big picture resources, the information 

381
00:31:11.990 --> 00:31:13.980


382
00:31:14.000 --> 00:31:19.970
about comparing OAE and pure tone screening.  In the next group of resources, you'll find access to 

383
00:31:19.990 --> 00:31:22.980


384
00:31:23.000 --> 00:31:28.970
training.  Online training resources.  Both for OAE and pure tone.  If you are needing or other staff need 

385
00:31:28.990 --> 00:31:33.980


386
00:31:34.000 --> 00:31:38.980
complete training, this is a way to access it.  It is also great for a refresher training.  Check that out.  

387
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Then you'll find preparing for screening resources, the protocol guides, forms, all of those things 

388
00:31:44.990 --> 00:31:48.980


389
00:31:49.000 --> 00:31:54.970
that you can just download and use or adapt and referral letters to introduce your activities to others.  

390
00:31:54.990 --> 00:31:58.980


391
00:31:59.000 --> 00:32:04.970
You can find that there.  Then follow up resources, including our tracking tool, and you see under monitoring 

392
00:32:04.990 --> 00:32:05.980


393
00:32:06.000 --> 00:32:11.980
program quality, there's -- there are a checklist for OAE and pure tone.  Those checklists are really -- we're 

394
00:32:12.000 --> 00:32:17.970
going to be showing them here in a minute.  That's where you find those.  They are the things to go through as 

395
00:32:17.990 --> 00:32:20.980


396
00:32:21.000 --> 00:32:26.970
you get ready to screen.  They remind you of all of the steps when you are screening.  Those are good hand outs 

397
00:32:26.990 --> 00:32:27.980


398
00:32:28.000 --> 00:32:33.970
to refresh yourself with when you are ready to launch a new round of screening.  I see Terry just posted 

399
00:32:33.990 --> 00:32:41.980


400
00:32:42.000 --> 00:32:47.970
the 800 number for E3 diagnostics.  That's just one provider.  We don't endorse any particular environment -- 

401
00:32:47.990 --> 00:32:53.980


402
00:32:54.000 --> 00:32:59.980
provider as a federally funded program.  We're passing on the resource to help with the calibration of your 

403
00:33:00.000 --> 00:33:05.980
equipment.  Here's a pure tone screening checklist.  As you prepare for this round of screening, you'll 

404
00:33:06.000 --> 00:33:11.970
want to walk through the steps.  You'll see it is things like, you know, identify the environment that you are 

405
00:33:11.990 --> 00:33:16.980


406
00:33:17.000 --> 00:33:22.970
going to screen in.  Do a sound check of the environment and make sure that it's got a noise level under 50 

407
00:33:22.990 --> 00:33:27.980


408
00:33:28.000 --> 00:33:33.970
decibels.  You can download the app on just about any smartphone that will check the decibel levels.  That will 

409
00:33:33.990 --> 00:33:36.980


410
00:33:37.000 --> 00:33:41.980
be a smart thing to do as you are figuring out where you want to screen.  You want to have all of your 

411
00:33:42.000 --> 00:33:47.970
materials.  You want to get your equipment ready and seating adjusted and where you want to be oriented.  

412
00:33:47.990 --> 00:33:54.980


413
00:33:55.000 --> 00:34:00.980
You want to evaluate the condition of your equipment.  Maybe it's been in a closet or locked up.  Look at 

414
00:34:01.000 --> 00:34:06.970
condition of the cords and headphones.  Test it out.  Do a self check and make sure it is all operates as you would 

415
00:34:06.990 --> 00:34:12.980


416
00:34:13.000 --> 00:34:18.970
expect it to.  You want to do the self listening check.  The checklist tells you what to do.  How to do that.  Use 

417
00:34:18.990 --> 00:34:20.980


418
00:34:21.000 --> 00:34:26.970
this checklist as you are getting ready for your next round of screenings.  You'll see it covers not only just 

419
00:34:26.990 --> 00:34:27.980


420
00:34:28.000 --> 00:34:33.970
getting ready, but the full process of everything that you are to do.  This is a really helpful tool to have 

421
00:34:33.990 --> 00:34:42.980


422
00:34:43.000 --> 00:34:48.970
beside you as you are screening with the pure tone method.  We pointed out the conditions process in pure tone 

423
00:34:48.990 --> 00:34:55.980


424
00:34:56.000 --> 00:35:01.970
screening is essential.  The webinar today asked us.  How long should this take?  How long should the entire 

425
00:35:01.990 --> 00:35:02.980


426
00:35:03.000 --> 00:35:08.980
screening process take?  How do I know when I've spent enough time trying to condition a child and when I need to 

427
00:35:09.000 --> 00:35:14.970
just call it and say this isn't going to work?  >> Yeah.  Thank you, William.  

428
00:35:14.990 --> 00:35:15.980


429
00:35:16.000 --> 00:35:21.970
Children who are going to be successfully screened using the pure tone method ought to be able to be 

430
00:35:21.990 --> 00:35:22.980


431
00:35:23.000 --> 00:35:28.970
screened in about 10-15 minutes max each.  So the conditions really shouldn't take much more than five 

432
00:35:28.990 --> 00:35:29.980


433
00:35:30.000 --> 00:35:35.970
minutes.  Hopefully less.  They should get that pretty quickly.  If you can't condition a child in that amount of 

434
00:35:35.990 --> 00:35:37.980


435
00:35:38.000 --> 00:35:43.970
time, then you probably should consider using your back-up plan which is either to do an OAE or hopefully right 

436
00:35:43.990 --> 00:35:45.980


437
00:35:46.000 --> 00:35:51.980
then while you have the child there or you could go ahead and try on another day if you have the flexibility to do 

438
00:35:52.000 --> 00:35:57.970
that.  Just remember if you can't screen the child, you'll either need to do an OAE or refer the child to 

439
00:35:57.990 --> 00:35:58.980


440
00:35:59.000 --> 00:36:04.970
someone who will be able to successfully get a screening completed on the child.  And in many cases, it 

441
00:36:04.990 --> 00:36:07.980


442
00:36:08.000 --> 00:36:13.980
would be a pediatric audiologist.  As we said earlier, remember that some children who have hearing loss can be 

443
00:36:14.000 --> 00:36:19.970
the ones who are the most difficult to condition to do the screening.  Which makes sense.  They are not able to 

444
00:36:19.990 --> 00:36:24.980


445
00:36:25.000 --> 00:36:30.970
hear that and make that connection.  One way or another, we want to get every child screened.  Now once the 

446
00:36:30.990 --> 00:36:45.980


447
00:36:46.000 --> 00:36:51.970
child is conditioned, we condition and respond that.  Again noting their response or lack of response.  And if 

448
00:36:51.990 --> 00:36:58.980


449
00:36:59.000 --> 00:37:04.970
they respond appropriately and consistently to the range of tones.  Then they pass the screening.  It is 

450
00:37:04.990 --> 00:37:05.980


451
00:37:06.000 --> 00:37:10.980
really critical that you follow the steps exactly.  We recommend always starting with the right ear, just to 

452
00:37:11.000 --> 00:37:16.970
avoid any confusion for yourself.  Create the habit.  You start in the right ear and go to the left.  The 

453
00:37:16.990 --> 00:37:18.980


454
00:37:19.000 --> 00:37:24.970
goal of the screening process is to test the hearing, as you see, at three pitches or frequencies.  You can see 

455
00:37:24.990 --> 00:37:28.980


456
00:37:29.000 --> 00:37:34.970
them here.  2,000 hertz, 4,000 hertz, and 1,000 hertz.  We suggest and want you to screen them in the order.  Now 

457
00:37:34.990 --> 00:37:37.980


458
00:37:38.000 --> 00:37:43.970
the volume level during the screening must be set and remain at that 20 dB level during all tone presentations.  

459
00:37:43.990 --> 00:37:44.980


460
00:37:45.000 --> 00:37:50.970
Again this isn't the conditions part.  This is during the screening part.  You'll screen the right ear first and 

461
00:37:50.990 --> 00:37:55.980


462
00:37:56.000 --> 00:38:01.970
then the left.  In order for each ear to obtain a passing result for each frequency, the child needs to indicate 

463
00:38:01.990 --> 00:38:02.980


464
00:38:03.000 --> 00:38:08.970
the correct response at least twice.  At least two times.  Giving the child no more than four tries to get it 

465
00:38:08.990 --> 00:38:09.980


466
00:38:10.000 --> 00:38:15.970
right.  In order for the child to pass the screening overall, they need to get a pass on every pitch in both 

467
00:38:15.990 --> 00:38:16.980


468
00:38:17.000 --> 00:38:22.970
ears.  So if this is unclear to you or if you need a refresher, we really encourage you to seek some additional 

469
00:38:22.990 --> 00:38:24.980


470
00:38:25.000 --> 00:38:30.970
training and practice with this.  It is really critical that you understand it.  And the training resources linked 

471
00:38:30.990 --> 00:38:33.980


472
00:38:34.000 --> 00:38:39.970
to on kidshearing.org go into detail in all of that.  Now what you see here is an example of the screening steps that 

473
00:38:39.990 --> 00:38:41.980


474
00:38:42.000 --> 00:38:47.970
must be documented for each ear as you screen.  Based on these results, the screener determines, you determine if 

475
00:38:47.990 --> 00:38:51.980


476
00:38:52.000 --> 00:38:57.970
each ear passes or not.  The device itself does not produce that result as is the case with OAE screening.  Be 

477
00:38:57.990 --> 00:38:59.980


478
00:39:00.000 --> 00:39:05.970
sure you document the results as you go as you see here.  Our screening form walks you through it and permits you 

479
00:39:05.990 --> 00:39:07.980


480
00:39:08.000 --> 00:39:13.970
to do just that.  >> So this is the screening form that we have on the web site that you can 

481
00:39:13.990 --> 00:39:22.980


482
00:39:23.000 --> 00:39:28.970
download and use.  It takes you step by step that Terry just went through quickly.  You'll notice the form on 

483
00:39:28.990 --> 00:39:31.980


484
00:39:32.000 --> 00:39:36.980
the left includes the rules for the passing results on each ear and overall for the child.  Even though it 

485
00:39:37.000 --> 00:39:42.970
isn't automated, this form will help you reach the correct conclusions based on the results that you are 

486
00:39:42.990 --> 00:39:46.980


487
00:39:47.000 --> 00:39:52.980
getting.  Now Terry one of our questions from the participants was what if the child does fine in 

488
00:39:53.000 --> 00:39:58.970
responding at first.  You've conditioned them and gotten them through the first frequencies.  The 

489
00:39:58.990 --> 00:39:59.980


490
00:40:00.000 --> 00:40:05.970
2,000 and 4,000.  Now they are distracted and they are kind of decompensating.  You don't think it is 

491
00:40:05.990 --> 00:40:07.980


492
00:40:08.000 --> 00:40:13.980
-- you don't think you can go on.  What do you do?  >> Sure.  That can happen.  It does 

493
00:40:14.000 --> 00:40:19.970
happen.  What you want to do is be sure to document as far as you got.  Then you to do one of several things.  If 

494
00:40:19.990 --> 00:40:20.980


495
00:40:21.000 --> 00:40:26.970
you have your back-up method, the OAE, you can do go ahead and do that instead.  Or you can come back to the 

496
00:40:26.990 --> 00:40:27.980


497
00:40:28.000 --> 00:40:33.980
child on another day and you can continue where you left off.  Making sure however that you always start by 

498
00:40:34.000 --> 00:40:39.970
repeating that conditioning process before you continue with the screening steps, so that you are sure they have 

499
00:40:39.990 --> 00:40:43.980


500
00:40:44.000 --> 00:40:49.970
and understand the task.  Some kids have -- there's a variety of attention spans.  You may be able to get through 

501
00:40:49.990 --> 00:40:51.980


502
00:40:52.000 --> 00:40:55.980
a couple of frequencies.  It is better to come back and get them when you are paying attention and you are good 

503
00:40:56.000 --> 00:41:01.970
responses that you are confident with than to continue on and have lost their attention.  

504
00:41:01.990 --> 00:41:05.980


505
00:41:06.000 --> 00:41:11.970
>> Terry, I'm assuming that it would also be the case that you want to stop and come back another time if suddenly 

506
00:41:11.990 --> 00:41:12.980


507
00:41:13.000 --> 00:41:18.970
the environmental noise changed and you couldn't control it.  >> Exactly.  That's a really 

508
00:41:18.990 --> 00:41:23.980


509
00:41:24.000 --> 00:41:29.970
compounding factor.  That will affect the screening.  If you want to make sure you have a good environment.  If 

510
00:41:29.990 --> 00:41:30.980


511
00:41:31.000 --> 00:41:36.970
it changes and is no longer conducive to screening, you are going to want to cause and come back when it improves.  

512
00:41:36.990 --> 00:41:37.980


513
00:41:38.000 --> 00:41:43.970
>> If the child does proceed and everything goes well and meets the past criteria, you are done with that 

514
00:41:43.990 --> 00:41:46.980


515
00:41:47.000 --> 00:41:52.970
child.  If they don't pass, then you'll need to refer to the child for -- to the follow the protocol that we're 

516
00:41:52.990 --> 00:41:54.980


517
00:41:55.000 --> 00:42:00.970
going to be going over in a minute.  Incidentally it is identical for the pure tone and OAE method.  All right.  

518
00:42:00.990 --> 00:42:05.980


519
00:42:06.000 --> 00:42:11.970
Let's pause here for a moment and see if you have any questions about pure tone screening.  Conditioning a child. 

520
00:42:11.990 --> 00:42:16.980


521
00:42:17.000 --> 00:42:22.970
 Equipment.  Conducting the screening or documents the results.  We have one question about the pure tone odometers 

522
00:42:22.990 --> 00:42:26.980


523
00:42:27.000 --> 00:42:32.970
and asking us to recommend a particular brand of equipment for purchase.  You know, that's the one thing as a 

524
00:42:32.990 --> 00:42:36.980


525
00:42:37.000 --> 00:42:41.980
federally funded Senator we can't do.  You can imagine how happy companies would be with us if we weren't 

526
00:42:42.000 --> 00:42:47.970
recommending their company.  We have strict complains that get in the way of that.  But what we have on the web 

527
00:42:47.990 --> 00:43:10.980


528
00:43:11.000 --> 00:43:16.980
site under equipment is criteria for selecting either OAE or audiometry children.  The information about 

529
00:43:17.000 --> 00:43:22.970
equipment is where you can look for screening equipment.  You need to look for other people.  If you are in head 

530
00:43:22.990 --> 00:43:30.980


531
00:43:31.000 --> 00:43:36.970
start, you probably know about the my peers site.  It is a great place to post the question.  You don't have to 

532
00:43:36.990 --> 00:43:41.980


533
00:43:42.000 --> 00:43:46.980
be in head start to post the questions.  My peers, and we'll look at -- Lenore, maybe you could look that up 

534
00:43:47.000 --> 00:43:52.970
for us and find out the address and post it in the chat for us.  You register to be a part of it.  You can 

535
00:43:52.990 --> 00:43:54.980


536
00:43:55.000 --> 00:44:00.970
post questions like this.  You would get most likely get advice from people who have different pieces of equipment 

537
00:44:00.990 --> 00:44:04.980


538
00:44:05.000 --> 00:44:10.970
that they might have a strong feeling about whether liking it or not.  >> I would just add, William, there 

539
00:44:10.990 --> 00:44:17.980


540
00:44:18.000 --> 00:44:23.970
are a lot of great, basic audiometers out there.  Don't pay for what you need.  There's advanced capability for 

541
00:44:23.990 --> 00:44:27.980


542
00:44:28.000 --> 00:44:33.980
diagnostic purposes that you don't need.  When you pose that question you want a good, basic screening meter for 

543
00:44:34.000 --> 00:44:39.970
use to define the population.  There should be some really great options out there for you.  

544
00:44:39.990 --> 00:44:42.980


545
00:44:43.000 --> 00:44:48.970
>> Yeah.  It is interesting to see that you are having trouble with your audiometer.  Again that might be 

546
00:44:48.990 --> 00:44:53.980


547
00:44:54.000 --> 00:44:59.970
another question if you have a local pediatric audiologist that you could get their opinion and see what they 

548
00:44:59.990 --> 00:45:00.980


549
00:45:01.000 --> 00:45:06.970
use.  If the audiologist is supporting their efforts, it is easier if you are using the devices that they are 

550
00:45:06.990 --> 00:45:11.980


551
00:45:12.000 --> 00:45:17.970
familiar with too.  So you might want to just get some input from them as well.  I'm sorry we can't be more 

552
00:45:17.990 --> 00:45:21.980


553
00:45:22.000 --> 00:45:27.970
specific about what brand of equipment that we can recommend.  I don't see any other pure tone screening related 

554
00:45:27.990 --> 00:45:32.980


555
00:45:33.000 --> 00:45:38.970
questions.  I think we're going to just move on.  Again notice where you can find pure tone-related training on our 

556
00:45:38.990 --> 00:45:42.980


557
00:45:43.000 --> 00:45:48.970
web site.  And other resources related to implementing screening.  Again on the very bottom, the pure tone 

558
00:45:48.990 --> 00:45:50.980


559
00:45:51.000 --> 00:45:56.970
screening skills checklist, you want to download that and have it at hand.  That will be helpful to both start 

560
00:45:56.990 --> 00:45:58.980


561
00:45:59.000 --> 00:46:04.970
another round of screening as well as just to have beside you to remind you of all of those steps.  For those of 

562
00:46:04.990 --> 00:46:06.980


563
00:46:07.000 --> 00:46:12.970
you who do OAE screening, you can imagine how hard pure tone screening is when you have to manually step 

564
00:46:12.990 --> 00:46:14.980


565
00:46:15.000 --> 00:46:20.970
through all of those different frequencies and make an objective or subjective determination of whether 

566
00:46:20.990 --> 00:46:22.980


567
00:46:23.000 --> 00:46:28.970
the child perceived the sound or not.  OAE screening doesn't require any of that.  That's why getting good, 

568
00:46:28.990 --> 00:46:29.980


569
00:46:30.000 --> 00:46:35.970
quality training on pure tone screening, if you are doing it, is so important.  And making sure that 

570
00:46:35.990 --> 00:46:39.980


571
00:46:40.000 --> 00:46:45.970
everybody is following this process and refreshed on it, so they don't let -- get off track along the way.  All 

572
00:46:45.990 --> 00:46:49.980


573
00:46:50.000 --> 00:46:55.970
right.  So now let's turn our attention to otoacoustic emissions or OAE screening.  As we've said this is the 

574
00:46:55.990 --> 00:46:56.980


575
00:46:57.000 --> 00:47:01.980
recommended method for children birth to three years of age and increasingly being used for other children as well. 

576
00:47:02.000 --> 00:47:07.970
 Terry, walk us through the process and how it goes.  >> Okay.  So just like we did with 

577
00:47:07.990 --> 00:47:09.980


578
00:47:10.000 --> 00:47:15.970
pure tone screening, we're going to first take a thorough look at the outer part of the ear to make sure 

579
00:47:15.990 --> 00:47:17.980


580
00:47:18.000 --> 00:47:23.970
there's no visible sign for infection or blockage.  If the ear appears normal and healthy, we're going to 

581
00:47:23.990 --> 00:47:25.980


582
00:47:26.000 --> 00:47:31.970
take a small probe on which a disposable cover has been placed and we're going to firmly insert that into 

583
00:47:31.990 --> 00:47:33.980


584
00:47:34.000 --> 00:47:39.970
the ear canal.  Then a button is pushed on the equipment to start the automated screening process.  The 

585
00:47:39.990 --> 00:47:41.980


586
00:47:42.000 --> 00:47:47.970
problem needs to sit in the ear.  It delivers a low volume or pie et sound stimulus into the ear.  Then a cochlea 

587
00:47:47.990 --> 00:47:49.980


588
00:47:50.000 --> 00:47:55.970
or the inner snail-shaped portion of the ear that you see here.  If the cochlea is functioning normally, it 

589
00:47:55.990 --> 00:47:56.980


590
00:47:57.000 --> 00:48:02.970
will respond to the sound by sending the signal to the brain.  While at the same time also producing an acoustic 

591
00:48:02.990 --> 00:48:04.980


592
00:48:05.000 --> 00:48:10.970
emission.  This emission is analyzed by the screening unit and approximately 30 seconds or so a result appears 

593
00:48:10.990 --> 00:48:15.980


594
00:48:16.000 --> 00:48:21.970
either as a pass or a refer.  And every normal, healthy inner ear produces an emission that could be recorded, that 

595
00:48:21.990 --> 00:48:31.980


596
00:48:32.000 --> 00:48:37.970
can be recorded in this way.  >> As you prepare for another round of screening, we encourage you to do like 

597
00:48:37.990 --> 00:48:45.980


598
00:48:46.000 --> 00:48:51.970
we did when we were encouraging those using the pure tone method.  And to look at the OAE screening checklist.  

599
00:48:51.990 --> 00:48:53.980


600
00:48:54.000 --> 00:48:59.970
To remind you where that is, these are the various resources that we're showing you again and again.  Down 

601
00:48:59.990 --> 00:49:01.980


602
00:49:02.000 --> 00:49:07.970
here at bottom under monitor program quality is where you'll find the OAE screening skills checklist.  It will 

603
00:49:07.990 --> 00:49:10.980


604
00:49:11.000 --> 00:49:16.970
walk you through the various things that you need to get ready for the next round of screening.  By the way, 

605
00:49:16.990 --> 00:49:18.980


606
00:49:19.000 --> 00:49:24.970
we have it posted in the chat where the my peers link is where you post questions about people's equipment 

607
00:49:24.990 --> 00:49:29.980


608
00:49:30.000 --> 00:49:35.980
experiences to get some advice from your peers.  In addition to the list of steps that you are going to see on 

609
00:49:36.000 --> 00:49:41.970
the skills checklist, you are also on the right here a list of supplies.  Be sure to go over those and make sure 

610
00:49:41.990 --> 00:49:45.980


611
00:49:46.000 --> 00:49:50.980
that you got all of those ready to go.  Of course, you also want to test your equipment on yourself or others.  In 

612
00:49:51.000 --> 00:49:56.970
orderly they typically pass through the ears and the equipment is working properly.  You know, in fact, we 

613
00:49:56.990 --> 00:49:57.980


614
00:49:58.000 --> 00:50:03.970
recommend testing the equipment on yourself prior to every testing session.  If you are going to do a 

615
00:50:03.990 --> 00:50:07.980


616
00:50:08.000 --> 00:50:13.970
group of children today, you should test the equipment on yourself and make sure it is behaving properly.  If 

617
00:50:13.990 --> 00:50:15.980


618
00:50:16.000 --> 00:50:21.980
you haven't had the equipment calibrated, you want to do that and make sure it is working properly and 

619
00:50:22.000 --> 00:50:27.970
has all of the recent updates on the software perspective for OAE.  Regardless of what hearing screening 

620
00:50:27.990 --> 00:50:29.980


621
00:50:30.000 --> 00:50:35.970
method that you use, you want to make sure you communicate with parents and other program staff whose cooperation 

622
00:50:35.990 --> 00:50:38.980


623
00:50:39.000 --> 00:50:44.970
you are depending on.  So you'll want to do that.  Again on our web site, there are some letters that we've 

624
00:50:44.990 --> 00:50:47.980


625
00:50:48.000 --> 00:50:53.970
written for you that you can send out explaining your screening process, why you are doing it, and how you'll be 

626
00:50:53.990 --> 00:50:57.980


627
00:50:58.000 --> 00:51:03.970
communicating those results.  >> I wanted to mention here.  Some of those of you who are participating 

628
00:51:03.990 --> 00:51:04.980


629
00:51:05.000 --> 00:51:10.970
asked about how to prepare children for hearing screening.  And our main recommendation is to keep it fun, 

630
00:51:10.990 --> 00:51:12.980


631
00:51:13.000 --> 00:51:18.980
regardless of which method that you are using.  Rather than referring to the activity as a screening or hearing 

632
00:51:19.000 --> 00:51:24.970
test, call it a listening game.  You can engage teachers and parents in some activities that include noticing 

633
00:51:24.990 --> 00:51:36.980


634
00:51:37.000 --> 00:51:41.980
the child's body parts, nose, ears, maybe and then expand on the idea of what animals have ears as well.  If 

635
00:51:42.000 --> 00:51:47.970
you haven't seen it, you want to look at it.  If you have an opportunity to send a link to parents and show it in 

636
00:51:47.990 --> 00:51:50.980


637
00:51:51.000 --> 00:51:56.970
the classroom if you are working in the classroom.  That's just one fun way to get children kind of ready and geared 

638
00:51:56.990 --> 00:51:58.980


639
00:51:59.000 --> 00:52:04.970
for doing screening.  I'll play you a quick little segment of it.  [music]  

640
00:52:04.990 --> 00:52:09.980


641
00:52:10.000 --> 00:52:15.970
>> The dogs ear stands up high, high, high.  The elephant's ears flap, flap, flap.  While the bunny's ears droop, 

642
00:52:15.990 --> 00:52:21.980


643
00:52:22.000 --> 00:52:27.970
droop, droop.  And the little kid's ears listen up.  We have ears so we can hear.  Check us out from ear to 

644
00:52:27.990 --> 00:52:28.980


645
00:52:29.000 --> 00:52:34.970
ear.  I need to hear every tiny sound to learn and grow by leaps and bounds.  

646
00:52:34.990 --> 00:52:37.980


647
00:52:38.000 --> 00:52:43.970
>> So if you haven't seen that, that's a -- just one -- whoops, one tool that you might be able to use as Terry said 

648
00:52:43.990 --> 00:52:49.980


649
00:52:50.000 --> 00:52:55.970
make it fun.  Once again you'll find that on the web site under -- let's see where it says prepare for 

650
00:52:55.990 --> 00:53:00.980


651
00:53:01.000 --> 00:53:06.970
screening right there.  You'll find those resources along with a to do list for getting ready to screen, 

652
00:53:06.990 --> 00:53:08.980


653
00:53:09.000 --> 00:53:14.970
handouts for parents, handouts for teachers, a letter to health care providers, some of you have asked us 

654
00:53:14.990 --> 00:53:16.980


655
00:53:17.000 --> 00:53:22.970
about how do we tell health care providers about what we're up to with our hearing screening?  You can send 

656
00:53:22.990 --> 00:53:25.980


657
00:53:26.000 --> 00:53:31.970
them this handout along with the screening referral of the Guinn child.  They will know more about what you 

658
00:53:31.990 --> 00:53:40.980


659
00:53:41.000 --> 00:53:46.970
are up to.  Take a look at this prepare for screening set of resources.  Like so many skillful tasks, competence 

660
00:53:46.990 --> 00:53:48.980


661
00:53:49.000 --> 00:53:54.980
greaters can make it look so easy.  I know sometimes in our trainings we can look like we're making things look 

662
00:53:55.000 --> 00:54:00.970
easier than we are.  We all have children that we struggle to screen for various reasons.  Let's talk about 

663
00:54:00.990 --> 00:54:01.980


664
00:54:02.000 --> 00:54:07.970
some of the strategies for screening and we'll start by looking at these photos.  One of the things that you'll 

665
00:54:07.990 --> 00:54:09.980


666
00:54:10.000 --> 00:54:15.970
see in the photos is that these children are being screened in a lot of different places.  They are being 

667
00:54:15.990 --> 00:54:20.980


668
00:54:21.000 --> 00:54:26.970
screened in places where they are participating happily.  Whether that's game, snack table, or just being held 

669
00:54:26.990 --> 00:54:28.980


670
00:54:29.000 --> 00:54:34.970
by somebody they are already feeling safe and comfortable with.  We can go and screen where they already are.  

671
00:54:34.990 --> 00:54:40.980


672
00:54:41.000 --> 00:54:46.970
Think about that.  That's one of the advantages.  We don't need a totally silent, separate, unfamiliar room.  We 

673
00:54:46.990 --> 00:54:52.980


674
00:54:53.000 --> 00:54:58.970
can go to them.  Be mindful of the benefit of that.  Take advantage of that.  

675
00:54:58.990 --> 00:54:59.980


676
00:55:00.000 --> 00:55:05.970
>> The screening works best when the children are familiar and comfortable.  Especially when the children can play 

677
00:55:05.990 --> 00:55:06.980


678
00:55:07.000 --> 00:55:12.980
with a toy or be held or sleep while the screening is conducted.  We have a lot of options.  Now some equipment is 

679
00:55:13.000 --> 00:55:18.970
more effective than others when attempting to screen in natural environments.  Most of them can work 

680
00:55:18.990 --> 00:55:19.980


681
00:55:20.000 --> 00:55:25.970
just fine under the conditions.  There are several keys to successful screening though to keep in mind.  In 

682
00:55:25.990 --> 00:55:28.980


683
00:55:29.000 --> 00:55:34.970
the four keys, we'll just go through those real quickly.  But the four keys to successful screening are first good 

684
00:55:34.990 --> 00:55:37.980


685
00:55:38.000 --> 00:55:43.970
probe fit.  That's really crucial.  And then second is to minimize movement, third is to minimize internal noise or 

686
00:55:43.990 --> 00:55:46.980


687
00:55:47.000 --> 00:55:52.980
noise that is generated from the child.  And then minimize external noise which is noise in the nearby 

688
00:55:53.000 --> 00:55:58.970
environment.  Now the goal with proper -- let's talk through these.  The goal with proper probe placement is that 

689
00:55:58.990 --> 00:56:19.980


690
00:56:20.000 --> 00:56:25.970
you have a really snug fit.  It seals out all of the noise from the environment.  It can stay in place by 

691
00:56:25.990 --> 00:56:26.980


692
00:56:27.000 --> 00:56:32.980
itself.  You have to let go.  If you hold on to it, your touch can losen it allowing your noise to get in and 

693
00:56:33.000 --> 00:56:38.970
disrupt the screening process.  So when you select the probe covers, always aim for the biggest ones that will fit 

694
00:56:38.990 --> 00:56:42.980


695
00:56:43.000 --> 00:56:48.970
in the child's ear canal.  There's no great secret aside from experience and being able to make a good probe cover 

696
00:56:48.990 --> 00:56:50.980


697
00:56:51.000 --> 00:56:56.970
selection.  Practice, practice, practice.  >> Some brands of OAE equipment have a 

698
00:56:56.990 --> 00:56:57.980


699
00:56:58.000 --> 00:57:03.970
compressible foam probe cover which tend to be the easiest to achieve success.  If foam covers are an option 

700
00:57:03.990 --> 00:57:04.980


701
00:57:05.000 --> 00:57:10.970
for the brand of equipment that you have, you want to give those a try.  >> Yeah.  They are the closest that 

702
00:57:10.990 --> 00:57:12.980


703
00:57:13.000 --> 00:57:18.970
you might find to the one-size-fits all with the youngest kids.  Now also, William, let me just mention a little 

704
00:57:18.990 --> 00:57:21.980


705
00:57:22.000 --> 00:57:27.970
aside about probe covers.  You can only use the probe covers intended for your device.  If you have a particular 

706
00:57:27.990 --> 00:57:28.980


707
00:57:29.000 --> 00:57:34.980
brand of equipment, you need to use that brands probe covers or that are intended for that equipment.  Even 

708
00:57:35.000 --> 00:57:40.970
though you'll see with others on the market, you can only use that -- those that are made for your brand of 

709
00:57:40.990 --> 00:57:41.980


710
00:57:42.000 --> 00:57:47.980
equipment.  Because that equipment is set up and calibrated with those particular covers.  If you don't, you 

711
00:57:48.000 --> 00:57:53.970
could get inaccurate results.  >> Yeah.  You can get inaccurate results if you don't use the ones that 

712
00:57:53.990 --> 00:57:55.980


713
00:57:56.000 --> 00:58:01.970
come with your equipment.  Now some of you have expressed the concern -- which I totally emphasize with that 

714
00:58:01.990 --> 00:58:24.980


715
00:58:25.000 --> 00:58:30.970
you are worried you could hurt a child by inserting the probe.  >> It is a great concern for 

716
00:58:30.990 --> 00:58:31.980


717
00:58:32.000 --> 00:58:37.970
screening.  When you take them out, most will say that's the one area that they feel most improved.  The concern 

718
00:58:37.990 --> 00:58:38.980


719
00:58:39.000 --> 00:58:44.970
is gone away.  What I want to tell you though those probe lengths, they've been carefully designed so that you 

720
00:58:44.990 --> 00:58:49.980


721
00:58:50.000 --> 00:58:55.970
can't put them in too far.  Now a child with an active ear infection or an infected ear canal, they may 

722
00:58:55.990 --> 00:58:57.980


723
00:58:58.000 --> 00:59:03.970
experience pain with a probe insertion.  That's one of the reasons we want to carefully inspect the ear prior to 

724
00:59:03.990 --> 00:59:05.980


725
00:59:06.000 --> 00:59:11.970
screen.  Otherwise they are designed to fit snuggly in and won't go in to cause any harm to the child's ear.  

726
00:59:11.990 --> 00:59:14.980


727
00:59:15.000 --> 00:59:20.970
>> So the videos that we have in the online training that you get through kids hearing show you about proper 

728
00:59:20.990 --> 00:59:25.980


729
00:59:26.000 --> 00:59:31.970
probe insertion and you'll want to look at that.  It is kind of like you see here where they -- we pull back the 

730
00:59:31.990 --> 00:59:35.980


731
00:59:36.000 --> 00:59:41.970
ear and point the probe directly towards the nose and twist it until it is snug making sure, right, Terry, 

732
00:59:41.990 --> 00:59:44.980


733
00:59:45.000 --> 00:59:50.980
that the cord is always clipped to the clothing so that it doesn't wait down that probe and pull it out of the 

734
00:59:51.000 --> 00:59:56.980
ear.  >> Yeah.  That clip does two things.  It takes the weight of the probe -- 

735
00:59:57.000 --> 01:00:02.970
excuse me, the weight of the cord from pulling it on the probe causing it to come out or come lose.  It also gets 

736
01:00:02.990 --> 01:00:03.980


737
01:00:04.000 --> 01:00:09.970
that cord out of the way and back behind the child.  As many things as we can remove from their attention the 

738
01:00:09.990 --> 01:00:10.980


739
01:00:11.000 --> 01:00:16.970
better.  And then you always want to let go of the probe as I mentioned.  So you want to give it a slight twist, 

740
01:00:16.990 --> 01:00:22.980


741
01:00:23.000 --> 01:00:28.970
get it snug.  Then let go.  You always let go.  It should stay put.  >> So if you don't get a passing 

742
01:00:28.990 --> 01:00:31.980


743
01:00:32.000 --> 01:00:37.970
result on a given child, you always want to do these things.  You want to reposition the child.  You want reduce 

744
01:00:37.990 --> 01:00:40.980


745
01:00:41.000 --> 01:00:46.970
expersonal noise, check the probe for wax and clean it or replace it with a new cover.  You want to quiet the 

746
01:00:46.990 --> 01:00:52.980


747
01:00:53.000 --> 01:00:58.970
child, reducing the movement of the child.  Try producing unique or quiet toys and maybe even elicit the help of 

748
01:00:58.990 --> 01:00:59.980


749
01:01:00.000 --> 01:01:05.980
another adult or screener.  Regardless of what we said earlier of the error messages, we are always going to do 

750
01:01:06.000 --> 01:01:11.980
these things.  If you don't understand the error message, don't get too worried about that.  Because you are 

751
01:01:12.000 --> 01:01:17.970
always going to repeat the same things anyway.  >> Yeah.  And many of those error 

752
01:01:17.990 --> 01:01:20.980


753
01:01:21.000 --> 01:01:26.980
messages are really alerting you to the strategies that you have just mentioned.  We've received a number of 

754
01:01:27.000 --> 01:01:31.980
questions asking for suggestions on how to screen children who are just challenging to get to sit still or for 

755
01:01:32.000 --> 01:01:37.970
whom you just can't seem to complete the screening on.  We'll go over some strategies.  If you have any 

756
01:01:37.990 --> 01:01:39.980


757
01:01:40.000 --> 01:01:45.980
additional questions, we can take those as well.  So there are several strategies that will help make it a 

758
01:01:46.000 --> 01:01:51.970
positive experience for children and for you, I hope.  As we mentioned, we want to really create a fun feeling 

759
01:01:51.990 --> 01:01:53.980


760
01:01:54.000 --> 01:01:59.970
about the screening activity.  So we want to position the child, position the child, we want to position 

761
01:01:59.990 --> 01:02:02.980


762
01:02:03.000 --> 01:02:08.970
yourself and other helpers in a way that's comfortable.  And that allows the child's behavior to be naturally 

763
01:02:08.990 --> 01:02:13.980


764
01:02:14.000 --> 01:02:18.980
directed.  You want to use toys and distracters and rewards.  You want to document the screening results 

765
01:02:19.000 --> 01:02:24.980
accurately.  Let's look at each of those things that I mentioned for a moment.  Creating a fun feeling around 

766
01:02:25.000 --> 01:02:30.970
the screening involves establishing rapport with children.  This is the one thing that most of you are so 

767
01:02:30.990 --> 01:02:31.980


768
01:02:32.000 --> 01:02:37.970
great at.  For example, you may tell a child that you want to play a listening game and include another 

769
01:02:37.990 --> 01:02:46.980


770
01:02:47.000 --> 01:02:52.980
adult.  Placing the probe near their ear, asking them if they could hear the birdie sing.  Be sure to ask what 

771
01:02:53.000 --> 01:02:58.970
child might be the most cooperative and sets the screen first.  That's a good example.  We have children line up.  

772
01:02:58.990 --> 01:03:01.980


773
01:03:02.000 --> 01:03:07.970
They want to participate when it is really seen as a fun and desirable thing to do.  Now I want to say here 

774
01:03:07.990 --> 01:03:09.980


775
01:03:10.000 --> 01:03:15.980
in the experience, this is what I think you are all so great at.  We can teach the technical skills.  But the natural 

776
01:03:16.000 --> 01:03:21.970
ability to work well with children is something that I've really admired when we work with many of you.  

777
01:03:21.990 --> 01:03:25.980


778
01:03:26.000 --> 01:03:31.980
>> Now when eliciting children's cooperation, you still want to tell them what you are going to do rather 

779
01:03:32.000 --> 01:03:37.980
than ask them if they want to participate.  >> Yeah.  That's actually so 

780
01:03:38.000 --> 01:03:43.970
important.  Don't give them the opportunity to say no.  You do concern you direct the screening.  

781
01:03:43.990 --> 01:03:45.980


782
01:03:46.000 --> 01:03:50.980
>> Yeah.  You may even suggest to other children that they have to wait their turn.  Just like they would with other 

783
01:03:51.000 --> 01:03:56.970
fun activities.  Assume they are going to perceive this as a fun activity.  It is not your turn yet.  You are 

784
01:03:56.990 --> 01:04:02.980


785
01:04:03.000 --> 01:04:08.970
going to be next.  That creates anticipation about being next.  Be sure to use terms that describe the 

786
01:04:08.990 --> 01:04:10.980


787
01:04:11.000 --> 01:04:16.970
activity as fun, interesting, and avoid using phrases like we're going to test your ears or screen your ears.  Even 

788
01:04:16.990 --> 01:04:32.980


789
01:04:33.000 --> 01:04:38.970
stating the activity won't hurt or won't be painful.  We don't say that about other fun things.  Now in 

790
01:04:38.990 --> 01:04:39.980


791
01:04:40.000 --> 01:04:45.970
regards to positioning, position them to the side of or slightly behind the child.  That gives you good access to 

792
01:04:45.990 --> 01:04:48.980


793
01:04:49.000 --> 01:04:54.970
ears to insert probe position.  If at all possible, have another adult hold the child or keep their hands occupied 

794
01:04:54.990 --> 01:04:56.980


795
01:04:57.000 --> 01:05:02.970
with another activity.  It is often great to just sit on the floor at their level.  Having some good toys as 

796
01:05:02.990 --> 01:05:04.980


797
01:05:05.000 --> 01:05:10.980
distractors is great.  It is always helpful.  You want to present novel or new toys or distractors at the moment 

798
01:05:11.000 --> 01:05:16.970
when you most need the child's cooperation.  If the child loses interest, have one ready to switch out 

799
01:05:16.990 --> 01:05:19.980


800
01:05:20.000 --> 01:05:25.970
and present to them.  >> Sometimes just a gentle touch on a different -- like on their forehead 

801
01:05:25.990 --> 01:05:26.980


802
01:05:27.000 --> 01:05:32.970
while their ear is being manipulated can distract them from what's going on in their ear.  

803
01:05:32.990 --> 01:05:33.980


804
01:05:34.000 --> 01:05:39.970
>> Yeah.  Introducing something that captures their attention through another sense can distract them from 

805
01:05:39.990 --> 01:05:44.980


806
01:05:45.000 --> 01:05:48.980
the sensation of that probe being in their ear.  Now also consider playing a child's song on -- on a portable 

807
01:05:49.000 --> 01:05:54.970
music device.  Presenting the ear bud to the ear that's not being screened, for example.  

808
01:05:54.990 --> 01:05:57.980


809
01:05:58.000 --> 01:06:03.980
>> Once complete, you want to reward that child with praise.  Maybe give them a sticker or some other reward, 

810
01:06:04.000 --> 01:06:09.970
making sure that same praise or reward is given no matter what the screening outcome is.  

811
01:06:09.990 --> 01:06:12.980


812
01:06:13.000 --> 01:06:18.970
>> Yeah.  And it is really helpful to screen in teams where you have a -- one adult that can manage the child 

813
01:06:18.990 --> 01:06:43.980


814
01:06:44.000 --> 01:06:49.970
while the other one can be focused on completing the screening.  We would like to show you the we can simply 

815
01:06:49.990 --> 01:07:04.980


816
01:07:05.000 --> 01:07:10.970
grab the finger or hand.  >> You can also familiarize the probe by attempting to insert it into the 

817
01:07:10.990 --> 01:07:17.980


818
01:07:18.000 --> 01:07:23.970
ear and take their probe and touch their hand or cheek, so you can feel it is soft.  You can elicit the 

819
01:07:23.990 --> 01:07:25.980


820
01:07:26.000 --> 01:07:31.980
child's help.  >> Exactly.  >> Sometimes the young child will cry. 

821
01:07:32.000 --> 01:07:37.970
 They will try maybe when the probe is inserted or maybe when they first hear the sounds from the probe.  You don't 

822
01:07:37.990 --> 01:07:46.980


823
01:07:47.000 --> 01:07:52.970
want to necessarily remove the probe.  That might be your impulse.  Let the child relax with the probe in their 

824
01:07:52.990 --> 01:07:53.980


825
01:07:54.000 --> 01:07:59.970
ear.  We tend to -- we end to want to take it out because we think we've hurt them.  We haven't.  Have your 

826
01:07:59.990 --> 01:08:02.980


827
01:08:03.000 --> 01:08:08.970
finger close on the start button while that probe is still in the ear.  As soon as the child pauses that try for 

828
01:08:08.990 --> 01:08:11.980


829
01:08:12.000 --> 01:08:17.970
a moment, start the screening.  You'll be surprised as how often you'll be able to get a successful screening in 

830
01:08:17.990 --> 01:08:19.980


831
01:08:20.000 --> 01:08:25.970
the moment.  Even if the child continues to be fussy.  >> Now if the child is uneasy about 

832
01:08:25.990 --> 01:08:27.980


833
01:08:28.000 --> 01:08:33.970
being screened, but you are able to soothe them by a pacifier or snack, something you can eat.  You can 

834
01:08:33.990 --> 01:08:42.980


835
01:08:43.000 --> 01:08:48.980
attempt to screen.  You can go ahead and try.  We can try to screen in between when they -- for example, as 

836
01:08:49.000 --> 01:08:54.980
they are sucking and they pause.  We may be able to get them to pause long enough to be able to complete the 

837
01:08:55.000 --> 01:08:59.980
screening.  If the result is a refer, you'll need to repeat the screening when the child is not sucking or 

838
01:09:00.000 --> 01:09:05.970
chewing.  >> Terry -- let me just clear up something that you just said.  The 

839
01:09:05.990 --> 01:09:07.980


840
01:09:08.000 --> 01:09:13.970
device will start and stop while the child is chewing.  So it will pick -- it will continue as the child gets 

841
01:09:13.990 --> 01:09:14.980


842
01:09:15.000 --> 01:09:20.970
quiet and if it is just a little moment, it might progress in between.  Allowing you to get a result.  If you 

843
01:09:20.990 --> 01:09:23.980


844
01:09:24.000 --> 01:09:29.980
get a pass while the child is sucking or chewing, you are good.  You can go with that result.  If you get 

845
01:09:30.000 --> 01:09:35.970
something other than a pass, you are going to need to rescreen that child without them chewing or sucking to get 

846
01:09:35.990 --> 01:09:49.980


847
01:09:50.000 --> 01:09:55.980
a result.  >> Exactly.  This will help them to become more 

848
01:09:56.000 --> 01:10:01.970
comfortable and less fearful of the process.  As long as they see others having a positive experience.  You'll 

849
01:10:01.990 --> 01:10:03.980


850
01:10:04.000 --> 01:10:09.970
want to start with the child that you or the teacher and let them set that example or tone for the screening and 

851
01:10:09.990 --> 01:10:13.980


852
01:10:14.000 --> 01:10:19.970
set the example that you are hoping for.  >> Sometimes children who have been 

853
01:10:19.990 --> 01:10:21.980


854
01:10:22.000 --> 01:10:27.970
treated repeatedly for ear infections or conditions may be really reluctant about having you do something with 

855
01:10:27.990 --> 01:10:30.980


856
01:10:31.000 --> 01:10:36.970
your ear.  They may need more time to watch other children participate or just get comfortable with it.  If the 

857
01:10:36.990 --> 01:10:38.980


858
01:10:39.000 --> 01:10:44.970
child remains uncomfortable.  You may want to screen them when they are asleep.  Which remains an option.  

859
01:10:44.990 --> 01:10:53.980


860
01:10:54.000 --> 01:10:59.980
>> Actually, you don't need a reason to screen children while they are asleep.  Remember if you don't get a passing 

861
01:11:00.000 --> 01:11:05.970
result as long as the child is cooperative, try the ear again.  Making sure you have a good probe fit 

862
01:11:05.990 --> 01:11:06.980


863
01:11:07.000 --> 01:11:12.970
and you've minimized the external and internal noise.  Once the screening is complete, you are sure to document the 

864
01:11:12.990 --> 01:11:14.980


865
01:11:15.000 --> 01:11:20.970
results accurately.  >> Yeah.  There you see the screening form.  Know that you can download that 

866
01:11:20.990 --> 01:11:23.980


867
01:11:24.000 --> 01:11:29.970
from our web site.  It follows the follow-up protocol.  We're going to move along here.  Let's see if we can 

868
01:11:29.990 --> 01:11:31.980


869
01:11:32.000 --> 01:11:37.970
industry questions that we haven't adequately addressed.  You are look for the picture of the ear.  That's on 

870
01:11:37.990 --> 01:11:45.980


871
01:11:46.000 --> 01:11:51.970
our web site.  Look through our resources on the -- under the protocol.  You'll find the ear and the 

872
01:11:51.990 --> 01:11:56.980


873
01:11:57.000 --> 01:12:02.970
follow-up protocol there.  So you can use that.  You'll also find the video on the web site which is -- I'll show 

874
01:12:02.990 --> 01:12:03.980


875
01:12:04.000 --> 01:12:09.970
you again in a moment that you can download it or play it directly from the web site.  So in the interest of 

876
01:12:09.990 --> 01:12:16.980


877
01:12:17.000 --> 01:12:22.970
time, let's move into the protocol really quickly.  We didn't get a lot of questions specifically about the 

878
01:12:22.990 --> 01:12:23.980


879
01:12:24.000 --> 01:12:29.970
protocol.  We want to remind everybody our best screening efforts are only worthwhile if we implement effective 

880
01:12:29.990 --> 01:12:33.980


881
01:12:34.000 --> 01:12:39.970
follow up.  This is the protocol for the OAE and pure tone.  You'll find this outlined in detail on our web 

882
01:12:39.990 --> 01:12:42.980


883
01:12:43.000 --> 01:12:48.970
site.  If you need to walk through this and remind yourself again, cothat.  Make sure if you are adhering to it 

884
01:12:48.990 --> 01:12:58.980


885
01:12:59.000 --> 01:13:04.970
both in the order and in the timed sequencing.  Remember there's really one primary role.  The child is done 

886
01:13:04.990 --> 01:13:08.980


887
01:13:09.000 --> 01:13:14.970
when the child has passed the screening on both ears or the child has gone to see an audiologist.  All of the other 

888
01:13:14.990 --> 01:13:18.980


889
01:13:19.000 --> 01:13:24.970
steps in between, all of those steps are in process.  And it is not until you either have a pass result on both 

890
01:13:24.990 --> 01:13:29.980


891
01:13:30.000 --> 01:13:35.970
ears or have been to the audiologist that you are really done.  Make sure you are looking at those results.  Now 

892
01:13:35.990 --> 01:13:50.980


893
01:13:51.000 --> 01:13:56.970
we know that protocol can be difficult to complete.  If you have health care providers who simply aren't really 

894
01:13:56.990 --> 01:13:58.980


895
01:13:59.000 --> 01:14:04.970
supporting your efforts in being able to complete that.  I've jumped forward a little bit here.  We really want to 

896
01:14:04.990 --> 01:14:10.980


897
01:14:11.000 --> 01:14:16.970
think about, you know, what can we do?  These challenges are absolutely real.  We don't have magic solutions.  Here's 

898
01:14:16.990 --> 01:14:24.980


899
01:14:25.000 --> 01:14:30.970
what we can say.  When making referral, you want to provide clear documentation and as a part of that, 

900
01:14:30.990 --> 01:14:31.980


901
01:14:32.000 --> 01:14:37.970
explain your screening and follow-up protocol.  I showed you before under the letters part on the web site, we 

902
01:14:37.990 --> 01:14:39.980


903
01:14:40.000 --> 01:14:45.970
have information for health care providers that you can use or adapt to your liking that explains what you are 

904
01:14:45.990 --> 01:14:48.980


905
01:14:49.000 --> 01:14:54.970
doing.  And the referral letters explain also what you are looking for from them in your completion of the 

906
01:14:54.990 --> 01:14:57.980


907
01:14:58.000 --> 01:15:03.970
screening process.  Obviously, you also want to make sure the parents understand that.  Make sure they have 

908
01:15:03.990 --> 01:15:05.980


909
01:15:06.000 --> 01:15:11.970
clear documentation of the screening outcomes and that you've talked to them about how hearing is like vision. 

910
01:15:11.990 --> 01:15:14.980


911
01:15:15.000 --> 01:15:20.970
 It can change subtly.  We won't necessarily notice it.  But our kids could all of the sudden slowly finding 

912
01:15:20.990 --> 01:15:23.980


913
01:15:24.000 --> 01:15:29.970
it harder to learn things.  Harder to understand new words or to use them.  And we wouldn't necessarily pick that 

914
01:15:29.990 --> 01:15:32.980


915
01:15:33.000 --> 01:15:38.970
up until sometime later.  That's why we want to make sure we can identify them as soon as possible so it doesn't 

916
01:15:38.990 --> 01:15:42.980


917
01:15:43.000 --> 01:15:48.970
develop into a big deal problem.  Sometimes having parents to take a photo of the screening results, so 

918
01:15:48.990 --> 01:15:50.980


919
01:15:51.000 --> 01:15:56.970
that they have that on their phone when they go in to the office, they can -- there's no question what were the 

920
01:15:56.990 --> 01:16:00.980


921
01:16:01.000 --> 01:16:04.980
results.  They have it on their phone.  Terry, what else can you think of for empowering families and helping them 

922
01:16:05.000 --> 01:16:10.970
with appointments and things like that?  >> Yeah.  Many of you already do a 

923
01:16:10.990 --> 01:16:12.980


924
01:16:13.000 --> 01:16:18.970
variety of really wonderful things to empower and support your families.  And as, you know, -- as William 

925
01:16:18.990 --> 01:16:20.980


926
01:16:21.000 --> 01:16:26.970
mentioned, consider assisting them in setting up appointments, getting the appointments on their calendars, their 

927
01:16:26.990 --> 01:16:27.980


928
01:16:28.000 --> 01:16:31.980
appointments on your calendar as well.  Make a plan with them that you will be in touch with them the day after an 

929
01:16:32.000 --> 01:16:37.970
appointment to find out the results.  Then be sure to follow up and do that.  

930
01:16:37.990 --> 01:16:39.980


931
01:16:40.000 --> 01:16:45.970
>> Yeah.  And these are not really our ideas.  These are things that we've heard from folks like you who have 

932
01:16:45.990 --> 01:16:49.980


933
01:16:50.000 --> 01:16:55.970
said, oh, yeah, as the health coordinator, this is what I do to try to get in there and support families.  

934
01:16:55.990 --> 01:17:00.980


935
01:17:01.000 --> 01:17:06.970
I sometimes set along with them and slowly empower them over time.  Again here's the web site.  Let me refresh 

936
01:17:06.990 --> 01:17:08.980


937
01:17:09.000 --> 01:17:14.970
you on some of the things that we talked about today.  We've got -- let me go here.  All right.  So we start 

938
01:17:14.990 --> 01:17:16.980


939
01:17:17.000 --> 01:17:22.970
off by talking about how to find an audiologist, information about your state, rules and regulations, and 

940
01:17:22.990 --> 01:17:25.980


941
01:17:26.000 --> 01:17:31.970
equipment information, you'll find that under planning resources.  The next group of resources is where you would 

942
01:17:31.990 --> 01:17:33.980


943
01:17:34.000 --> 01:17:39.970
link to comprehensive training.  Which we really encourage everybody to get and to refresh themselves on a regular 

944
01:17:39.990 --> 01:17:40.980


945
01:17:41.000 --> 01:17:46.970
-- at least annual basis.  Make sure if you are a group of staff that you are all doing it the same way.  And having 

946
01:17:46.990 --> 01:17:47.980


947
01:17:48.000 --> 01:17:53.970
an audiologist work through with you on that training can be really helpful.  One of the strategies that we've heard 

948
01:17:53.990 --> 01:17:56.980


949
01:17:57.000 --> 01:18:02.970
about people using which we strongly endorse is go ahead and do this training independently.  But then have 

950
01:18:02.990 --> 01:18:06.980


951
01:18:07.000 --> 01:18:12.970
your pediatric audiologist partner come and screen with you.  For an afternoon or hour.  You may have to pay them.  

952
01:18:12.990 --> 01:18:15.980


953
01:18:16.000 --> 01:18:21.980
You may have a volunteer.  Having them work with you just once even can really be helpful.  Then you can start 

954
01:18:22.000 --> 01:18:27.970
building a relationship with them where you can call them if you have difficulty or refer a child to them if 

955
01:18:27.990 --> 01:18:30.980


956
01:18:31.000 --> 01:18:36.970
 couldn't accomplish the screening or need to make the referral for full evaluation.  The next group of 

957
01:18:36.990 --> 01:18:40.980


958
01:18:41.000 --> 01:18:46.970
resources are the preparing for screening.  It is under there, Mary Kay, where you'll find the link to the 

959
01:18:46.990 --> 01:18:47.980


960
01:18:48.000 --> 01:18:53.970
video that you were asking about, under prepare for screening.  That's where you'll find the child video.  You can 

961
01:18:53.990 --> 01:18:57.980


962
01:18:58.000 --> 01:19:03.970
download or view it live right there, stream it live right there.  You'll find all of the letters explaining 

963
01:19:03.990 --> 01:19:04.980


964
01:19:05.000 --> 01:19:10.970
your screening practices under prepare for screening.  In the next bullet you'll see the protocol guides and 

965
01:19:10.990 --> 01:19:15.980


966
01:19:16.000 --> 01:19:21.970
forms.  That is where you'll find the picture of the ear and other resources if you want to illustrate what it is 

967
01:19:21.990 --> 01:19:26.980


968
01:19:27.000 --> 01:19:31.980
that you are doing.  And then the letters and scripts.  Some of you have asked us what cowe say that parents at 

969
01:19:32.000 --> 01:19:37.970
different points in the protocol, so we say the right things that are going to lead to them following through.  We 

970
01:19:37.990 --> 01:19:38.980


971
01:19:39.000 --> 01:19:44.970
have a page of scripts of things to say and each step in the screening process.  Check it out there under 

972
01:19:44.990 --> 01:19:55.980


973
01:19:56.000 --> 01:20:01.970
share results.  In the next group, you'll find a tracking tool.  That's tracking through the complete process. 

974
01:20:01.990 --> 01:20:04.980


975
01:20:05.000 --> 01:20:10.980
 Have a look at that, if you are not acquainted with that.  That can really be useful.  And then under monitoring 

976
01:20:11.000 --> 01:20:16.970
program quality, there are several resources.  And the two that we talked about today were the checklist for 

977
01:20:16.990 --> 01:20:19.980


978
01:20:20.000 --> 01:20:25.970
pure tone and OAE screening that help you get ready for a round of screening and also guide you step-by-step 

979
01:20:25.990 --> 01:20:27.980


980
01:20:28.000 --> 01:20:33.970
through the actual screening implementation and follow-up process.  So that's everything that we have to 

981
01:20:33.990 --> 01:20:36.980


982
01:20:37.000 --> 01:20:42.970
talk about today.  We've got a few more minutes.  Are there any other additional questions that we can 

983
01:20:42.990 --> 01:20:51.980


984
01:20:52.000 --> 01:20:57.970
address for you right now?  We would be happy to do that.  Know that kidshearing.org -- if you don't 

985
01:20:57.990 --> 01:21:00.980


986
01:21:01.000 --> 01:21:06.980
remember anything else from what we've said today.  We've covers a lot of ground in the last 90 minutes.  

987
01:21:07.000 --> 01:21:12.970
Remember kidshearing.org.  You'll find everything that we said there in the videos that you can access there and 

988
01:21:12.990 --> 01:21:17.980


989
01:21:18.000 --> 01:21:23.970
in the print materials that you'll find there.  You'll also find through the access training a link to learn to 

990
01:21:23.990 --> 01:21:29.980


991
01:21:30.000 --> 01:21:35.970
screen dot org which is an NCHAM web site that offering comprehensive, online training in pure tone and OAE 

992
01:21:35.990 --> 01:21:38.980


993
01:21:39.000 --> 01:21:44.970
screening.  So if you are needing that, that's an excellent resource for getting that accomplished.  Doing that 

994
01:21:44.990 --> 01:21:48.980


995
01:21:49.000 --> 01:21:54.970
in combination to having the audiologist support you, having pure support like you can get through my 

996
01:21:54.990 --> 01:22:05.980


997
01:22:06.000 --> 01:22:11.970
peers.org, and if not my peers, you'll see the lengthier.  You can pose questions to others who are facing the 

998
01:22:11.990 --> 01:22:15.980


999
01:22:16.000 --> 01:22:21.970
needs to do OAE screening or pure tone screening.  I'm looking to see if there are any other questions.  Terry, 

1000
01:22:21.990 --> 01:22:31.980


1001
01:22:32.000 --> 01:22:37.980
wait a minute.  Let me see here.  I'm not scrolling down.  Let's see here.  Terry, is there a way to screen a 

1002
01:22:38.000 --> 01:22:43.970
child whose outer ear is not in tact?  >> That's a great question.  That's one reason we're going to take a good 

1003
01:22:43.990 --> 01:22:47.980


1004
01:22:48.000 --> 01:22:53.970
look at the ear.  There are methods to screen a child whose outer ear is not in tact.  They can be fairly 

1005
01:22:53.990 --> 01:22:54.980


1006
01:22:55.000 --> 01:23:00.970
technical.  That is a great one to refer to the pediatric audiologist.  It is done through the bone vibration, 

1007
01:23:00.990 --> 01:23:05.980


1008
01:23:06.000 --> 01:23:11.970
skull vibration, or bone conduction.  But there are inti quasis and complexities to that in order to 

1009
01:23:11.990 --> 01:23:19.980


1010
01:23:20.000 --> 01:23:24.980
separate and screen each ear.  That's a great referral.  >> The -- there are -- here's a great 

1011
01:23:25.000 --> 01:23:30.970
question.  What do you think about reusing probes?  Meaning reusing the probe covers on the OAEs?  

1012
01:23:30.990 --> 01:23:36.980


1013
01:23:37.000 --> 01:23:42.970
>> We don't reuse them.  Let me qualify that.  We use new probe covers for each child, but you can use the same 

1014
01:23:42.990 --> 01:23:47.980


1015
01:23:48.000 --> 01:23:53.970
probe cover for the same child to screen both ears.  But they are disposable and meant to be single use 

1016
01:23:53.990 --> 01:23:59.980


1017
01:24:00.000 --> 01:24:05.970
per child.  >> Yeah.  For some reason, Mary Kay, you are not finding the web site.  It 

1018
01:24:05.990 --> 01:24:10.980


1019
01:24:11.000 --> 01:24:16.970
is kidshearing.org.  As you see on the screen here, I don't think it is down today.  Maybe Hunter or Gunner, you 

1020
01:24:16.990 --> 01:24:21.980


1021
01:24:22.000 --> 01:24:27.980
could check really quick for us.  You'll find all of the resources there.  How long do probe covers and 

1022
01:24:28.000 --> 01:24:33.970
probes, I guess, last, Terry?  >> Yeah.  Let's start with the probe.  The probe will be the part that is 

1023
01:24:33.990 --> 01:24:37.980


1024
01:24:38.000 --> 01:24:43.970
attached to your screening equipment through the cord.  That probe itself should -- can last as long as your 

1025
01:24:43.990 --> 01:24:45.980


1026
01:24:46.000 --> 01:24:51.970
equipment does if it is cared for.  It is the most fragile part.  It can be dropped, stepped on, et cetera.  Most 

1027
01:24:51.990 --> 01:24:52.980


1028
01:24:53.000 --> 01:24:58.970
probes, if they are taken care of, can last a long time.  The probe covers which are the individual cover that 

1029
01:24:58.990 --> 01:25:00.980


1030
01:25:01.000 --> 01:25:06.970
goes on to screen the child the one that I said was disposable and meant to be single use, you know, I'm 

1031
01:25:06.990 --> 01:25:08.980


1032
01:25:09.000 --> 01:25:14.970
thinking maybe your question perhaps could be how long would they last as you buy the initial quality?  How long 

1033
01:25:14.990 --> 01:25:17.980


1034
01:25:18.000 --> 01:25:23.970
are they good for?  I've had probes that have functioned and worked well that are several years old.  So I 

1035
01:25:23.990 --> 01:25:27.980


1036
01:25:28.000 --> 01:25:33.970
think they store well.  You can use them.  For a long time.  But again we don't want to reuse them and so they 

1037
01:25:33.990 --> 01:25:34.980


1038
01:25:35.000 --> 01:25:40.970
would be single use and disregarded after they've been used on one child.  >> Well, we are at the bottom of the 

1039
01:25:40.990 --> 01:25:41.980


1040
01:25:42.000 --> 01:25:47.970
hour.  Which means our time is just about up.  We want to thank everybody.  There's a certificate available for 

1041
01:25:47.990 --> 01:25:51.980


1042
01:25:52.000 --> 01:25:57.980
the attending today's webinar in the chat.  There's going to be a link that you see right now.  If you click on 

1043
01:25:58.000 --> 01:26:03.970
that, it will take you to the quick evaluation of how we did today.  That will produce a certificate of 

1044
01:26:03.990 --> 01:26:05.980


1045
01:26:06.000 --> 01:26:11.970
attention for your webinar today.  We want to really thank you for all of the excellent questions and remember 

1046
01:26:11.990 --> 01:26:15.980


1047
01:26:16.000 --> 01:26:21.970
the resources that we have are there for you to use at any time.  Put them to use.  They have been generated over 

1048
01:26:21.990 --> 01:26:23.980


1049
01:26:24.000 --> 01:26:29.970
lots of time and experience with people just like yourselves.  And so rather than recreate the wheel, always look 

1050
01:26:29.990 --> 01:26:34.980


1051
01:26:35.000 --> 01:26:40.970
at what's there before you try to create something new.  Because maybe, just maybe, somebody already did.  

1052
01:26:40.990 --> 01:26:45.980


1053
01:26:46.000 --> 01:26:51.970
Thank you for your time and expertise today and to the captioner for your services, Gunnar for your help, and 

1054
01:26:51.990 --> 01:26:52.980


1055
01:26:53.000 --> 01:26:58.970
for everybody to help identify children who have hearing loss.  They can have the greatest opportunity possible to 

1056
01:26:58.990 --> 01:27:02.980


1057
01:27:03.000 --> 01:27:08.970
learn and grow alongside all of their peers.  Thanks, everybody.  Remind everybody that if you know of anyone 

1058
01:27:08.990 --> 01:27:11.980


1059
01:27:12.000 --> 01:27:17.970
who needs an introductory opportunity on evidence-based screening that we have, and you'll see it earlier on in 

1060
01:27:17.990 --> 01:27:28.980


1061
01:27:29.000 --> 01:27:34.970
the chat.  We have a webinar next Thursday on August 16th.  No, next Tuesday.  Sorry.  On birth to five 

1062
01:27:34.990 --> 01:27:39.980


1063
01:27:40.000 --> 01:27:44.980
screening.  Which you'll talk about introductory information starting at the beginning, rather than in the deep 

1064
01:27:45.000 --> 01:27:59.148
end as we did today.  Thanks again, everybody.  >> Have a great afternoon.