Audiology Refresher 2
presented in November 2002
Modernising hearing aid services for children (MHASC)
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:
Guidelines: The following guidelines
have been produced in order to help achieve these aims, based on studies
and experience from firstwave sites:
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
- Guidelines for ear impressions and earmoulds for children
- Guidelines for testing NHS DSP hearing aids 'in the field',
with the accompanying Notes on testing DSP aids 'in the field'
- Hearing aids for children: fitting and verification guidelines
- FM Advantage (MHAS-P team and Connevans Ltd)
- Child-adult service transition guidelines (MHAS-P team and
- Guidelines on audiology service links between health and education
services for children's hearing aid management.
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:
- 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.
- 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.