Audiology Refresher 2

presented in November 2002

Modernising hearing aid services for children (MHASC)

Guideline No.6:

AUDIOLOGY SERVICE LINKS BETWEEN HEALTH AND EDUCATION SERVICES FOR CHILDREN'S HEARING AID MANAGEMENT

Aims of MHASC: The aims of Modernising Hearing Aid Services for Children are to enable paediatric audiology and support services to:

• Fit all newly-identified deaf children with Digital Signal Processing (DSP) hearing aids appropriate for their hearing loss and audiological management
• Offer the caseload of existing child wearers with analogue aids the opportunity to change to DSP provision in a phased manner over a 24 month period following training
• Have fully trained staff who can fit, verify, evaluate and manage DSP hearing aids (and FM systems) in clinical, educational and home environments using appropriate protocols and guidelines
• Use outcome measures to monitor individual and service performance
• Liaise with local adult hearing aid services (often within the same department) to encourage sharing of skills and knowledge
• Put in place best practice for managing the child-adult service transition and health-education links
• Encourage further modernisation and quality assurance through the local Children's Hearing Services Working Group

1. Guidelines for ear impressions and earmoulds for children
2. Guidelines for testing NHS DSP hearing aids 'in the field', with the accompanying Notes on testing DSP aids 'in the field'
3. Hearing aids for children: fitting and verification guidelines
4. FM Advantage (MHAS-P team and Connevans Ltd)
5. Child-adult service transition guidelines (MHAS-P team and NDCS)
6. Guidelines on audiology service links between health and education services for children's hearing aid management.

Health-Education Links:

The firstwave experience highlighted the crucial importance of good communication and links between health and education services if use of complex DSP hearing aids and good earmould provision is to be successful for both children and families. Families have commented in the past that poor communication between services is one of their major concerns.

Proper channels of communication need to be established within a modernised service for efficient exchange of information regarding all aspects of the child's hearing care. This communication must be two-way and should provide clear information about, for example, the hearing aid settings and acoustic performance, the use of particular features such as noise reduction or feedback management circuits, and assessment of use and benefit. It is essential for ToDs to know the different programs set for each child, just as it is for audiologists to know about the educational settings in which the child will be using the hearing aids, and whether an FM system is used.

The following links should be established by all modernised sites:

1. Joint training events. To provide a fully comprehensive service, all those involved need to be aware of the equipment needs, capabilities, advantages and disadvantages, and maintenance of the hearing aids being fitted. This training is most productive when arranged jointly for health and education staff, and also serves to encourage closer liaison between these arms of the service to children and families.

   Professionals in both health and education should have a clear understanding of what the available technology can (and cannot) do for children on their caseload, and should keep up to date with the rapidly-changing field. Joint training sessions provide the opportunity to share this information and for services to explore how the health/education links can work at their most coherent and productive.

2. Sharing of written information. The communication between health and education is much facilitated by the sharing of written information.

Written information concerning audiological and hearing aid management which should pass from health (audiology) services to education services, with the usual safeguards with regard to the consent of the parents, is as follows:

• copies of all letters sent to the child/parent/GP
• information on the make, model and serial numbers of hearing aids fitted
• how the hearing aids are set up (see also Guideline no. 2: Testing NHS DSP hearing aids 'in the field', with the accompanying Notes on testing DSP aids 'in the field'): which prescription procedure; type of compression and output limiting circuits and whether linear, WDRC or other; how the compression time constants are set if known (slow/fast acting); FRC, Frequency Response Curves for 5OdB, 65dB and 80 dB inputs, specifying details of the input signal used; number of programs in use and settings for each; features activated (eg; feedback management/directional microphones/noise reduction/direct audio input)
• copies of all assessment data including pure tone audiometry, real ear measures, aided or unaided speech perception test results
• details of any changes in the hearing aid fittings

Written information concerning audiological and hearing aid management which should pass from education services to health (audiology) services.

with the usual safeguards with regard to the consent of the parents, is as follows:

• Summary of general use, which includes details of educational setting, general data on child's use of aid, any observations regarding hearing aid use and management
• Summary report (based on LIFE, LSQ or similar questionnaires) detailing the child's listening abilities and difficulties in various listening situations
• Parent and child (when old enough) feedback/observations about the hearing aids

All of the above information should be available for each of the child's hearing aid reviews, which should if possible be attended by the appropriate education team member.

3. Aid breakdowns, exchange, loan system. Systems need to be agreed between health and education services to manage breakdowns, and other fitting/emergency exchanges. Since most DSP aids cannot be set to an individual child's required settings without specialist equipment (which is unlikely to be immediately available to all ToDs in an area) and training, a system needs to be established for a fast and effective response to any fitting/breakdown problems. Possible systems include one-day turnaround replacement by health services, drop-in emergency clinics, ToDs with the specialist training and equipment required and loan aids, and so on. Which one of these or other systems for a particular health-education partnership is agreed will depend upon local circumstances and geography.

4. Impressions and earmoulds system. See Guideline No. 1: Ear impressions and earmoulds for children. The two services must agree systems for meeting the needs of children and families with regard to high quality earmoulds and fast earmould replacement as specified in Guideline No. 1.

5. Patient management systems. The modernisation of adult hearing aid services is built upon the use of Patient Management Systems. In the medium term, paediatric audiology departments will also be utilising these systems, and, subject to the usual strictures of the Data Protection Act, departments should be aiming to operate systems into which education services could enter outcomes data and also access hearing aid information specified above.

6. Regular meetings. To facilitate communication and the above requirements, there should be a mechanism for regular discussion and monitoring of the liaison between health and education services. This might best be done under the authority of the local CHSWG (Children's Hearing Services Working Group) since this Group should include not only health and education staff but also parents-who are central to the whole process.

Audiology refresher 2