1. Connecting with Appropriate Early Intervention Programs
Antonia Brancia Maxon, Ph.D
New England Center for Hearing Rehabilitation

2. Connecticut Birth to Three
Birth to Three Mission
To strengthen the capacity of families to meet the developmental and health-related needs of their infants and toddlers who have delays or disabilities.
Connecticut Birth to Three

3. CT Birth to Three Guidelines
Service Provision
Families will have equal access to a coordinated program of comprehensive services that:
foster collaborative partnerships
are family centered
occur in natural settings
recognize best practice in early intervention
are built on mutual respect and choice
CT Birth to Three Guidelines

4. Pediatric Audiologist Criteria
can evaluate a child’s hearing within a short time after being contacted for an appointment
specializes in working with infants and young children- worked with large numbers of them
provides hearing aids child in a timely manner
Service Guideline 5, CT Birth to Three (October, 1999)

5. Pediatric Audiologist Criteria
makes earmold impressions
dispenses hearing aids
has loaner hearing aids available
provides hearing aids on a trial basis
Service Guideline 5, CT Birth to Three (October, 1999)

6. Pediatric Audiologist Criteria
has resources to repair hearing aids quickly
has worked with the Birth to Three System
is familiar with the procedures of the Birth to Three System including IFSP development and procedures for acquiring hearing aids or assistive technology
Service Guideline 5, CT Birth to Three (October, 1999)

7. Pediatric Audiologist Criteria
will review the results of the audiogram with the family at the time of the evaluation
will provide a comprehensive written report, with a copy of the audiogram in a timely manner
Service Guideline 5, CT Birth to Three (October, 1999)

8. CT Birth to Three Guidelines
Enrollment
Establish guidelines
Eligible child
automatic enrollment criteria - diagnosed condition
significant developmental delay
Selecting a program
CT Birth to Three Guidelines

9. CT Birth to Three Guidelines
Enrollment
Develop Individualized Family Service Plan (IFSP)
All services
speech and language development
auditory development
assistive technology
Goals and objectives
Timelines
CT Birth to Three Guidelines

10. Principles of Intervention for Infants and Toddlers with Hearing Loss
1. Early identification and diagnosis is essential.
2. Ongoing audiological assessment and
management must be conducted by staff
trained to work with infants and young
children.
CT Birth to Three Guidelines

11. Principles of Intervention for Infants and Toddlers with Hearing Loss
3. The intervention team should assist the
family in learning about the nature of their
child’s hearing loss.
CT Birth to Three Guidelines

12. Principles of Intervention for Infants and Toddlers with Hearing Loss
4.Intervention requires a team approach. The family is the most important member of this team. The mission of the Birth to Three System is to support, assist and advise families on how to best meet their child’s unique needs. This should include access to a wide variety of information that is shared in an unbiased manner.
CT Birth to Three Guidelines

13. Principles of Intervention for Infants and Toddlers with Hearing Loss
5.Parents and children are partners in communication. Parents and children must develop a communication system in order for a language system to develop.
6.Language development begins as soon as a child is born and develops through interactions with the family in daily routines.
CT Birth to Three Guidelines

14. Principles of Intervention for Infants and Toddlers with Hearing Loss
7.Parents need to understand and mange the hearing aids and/or auditory equipment for their child. A program must help the family learn how to maintain any hearing aids or equipment.
8.Parents are advocates for their children who are deaf or hard of hearing. EI should help parents understand their legal rights.
CT Birth to Three Guidelines

15. Pediatric amplification fitting
Initiate amplification process immediately after diagnosis
Select, fit and validate amplification within first few months
Does not require exhaustive audiological data
Conduct real-ear measures
Use functional measures of benefit
Scheduling flexibility

16. Basic Audiological Information Used to Fit Amplification
Hearing Sensitivity
ABR click + low frequency pulse tones
Target audiogram: 500, 1000, 4000 Hz
Individual ear measures: insert phones, localization
Middle Ear Status
Tympanometry
Tolerance
Stapedial reflexes

17. Prescriptive Approach to Hearing Aid Fitting
Desired Sensation Level - DSL (Seewald, et al, 1996)
Uses minimal audiometric data
Real ear measures
Adjustments for pediatric ears
Used to determine target gain and output settings

18. DSL Goal Provide optimal gain across maximum frequency range
Infant acquiring language has access to speech of others
Infant acquiring language has access to own speech

19. Accessing the Speech Signal
Primary purpose of amplification
Maximal exposure to speech spectrum
Develop auditory feedback loop
Speech must be well above detection within an appropriate dynamic range

20. Hearing Aid Fitting/Validation
Ongoing process with flexible instrument
Clinical measures
More audiological data - setting adjustment
Observe behaviors, communication, environment
Audiologist
Family
Service providers

21. Pediatric Audiologist’s Responsibility
Must be able to schedule evaluations, earmolds, etc immediately
Must be able to make a decisions rapidly
Must be able to provide amplification rapidly
Must be aggressive about amplification
Immediate response to parents’ needs
Immediate response to infant’s needs

22. Benefits of Early Amplification
When diagnosis and hearing aid fitting occur in first six months of life and early habilitation is initiated, infants with hearing loss will perform at levels superior to those who do not have early appropriate diagnosis and habilitation (Yoshinago-Itano, 1997).
Infants with severe-profound hearing loss who use hearing aids by six months of age acquire language and vocal communication at ages equivalent to infants with normal hearing (Robinshaw, 1995).

23. Aural Habilitation Programming
Use of residual hearing
detection to discrimination
Integrated approach
speech perception/production
language/communication
Parent education
amplification
listening environment
facilitating language acquisition

24. Communication Modality
Spoken language options
oral/aural
cued speech
total communication
Signing Exact English
Seeing Essential English
American Sign Language (ASL)

25. Professional Issues: Pediatric Audiologists
Present number of pediatric audiologists
Guidelines for pediatric audiology
Credentialing pediatric audiologist
development of standards
overseeing agency
Establishing link from diagnostics to fitting

26. Professional Issues: Pediatric Aural Habilitation
Pediatric aural rehabilitationist
expertise in
infant development
infant auditory development
infant speech and language acquisition
experience working with infants and their families
flexibility in scheduling

27. Professional Issues: Pediatric Aural Habilitation
Present number of pediatric aural rehabilitation providers
Guidelines for pediatric aural rehabilitation providers
Credentialing pediatric aural rehabilitation providers
development of standards
overseeing agency
Establishing link from fitting to aural rehabilitation

28. Professional Issues: Audiological Guidelines
Must establish
Maximum time until diagnosis made
Minimal audiological information for amplification fitting
Maximum time until amplification fitting
Maximum time until enrollment in management program
Age-appropriate diagnosis and management

29. Medical Intervention
Hearing aid fitting is dependent on medical status of auditory system
Middle ear effusion has a significant impact on infants with sensorineural hearing loss
immediate access to medical intervention
ongoing medical management
Cochlear implant candidacy

30. Professional Issues: Medical Intervention
Pediatricians and ENTs with expertise in
infant hearing loss and otologic conditions
amplification for infants
pediatric cochlear implant candidacy
Physician experience working with early intervention agencies and personnel
facilitating referral and implementation of programming
Accommodation of families
flexible scheduling
time for counseling

31. Early Intervention Benchmarks
Infants enrolled in family-centered EI by 6 months old
Infants enrolled in family-centered EI program with professionals knowledgeable about communication needs of infants with hearing loss
Amplification use begins within one month of diagnosis when appropriate and agreed on by family
JCIH, 2000

32. Early Intervention Benchmarks
Infants with hearing loss have ongoing audiological management - not to exceed 3 month intervals
Language development in family’s chosen communication modality and commensurate with developmental level and similar to that for hearing peers of a comparable developmental age.
Families participate in and express satisfaction with self-advocacy.
JCIH, 2000