1. Somerset Hearing Support Team Working in partnership with our specialist provisions

2. A few facts to set the scene… 1.65 babies per 1000 live births will be born with a hearing loss 2.05 children per 1000 will acquire a hearing loss after the age of 9 There is a lack of research to provide statistics for overall incidence of hearing loss in children with complex profile ASD : 4.2 per 100 Cerebral palsy: 2-3 per 100 Visual Impairment: 4- 57 per 100 Neurodevelopmental disorder: 2- 14 per 100 Downs Syndrome: 80 per 100

3. What we would expect to find in specialist schools/provisions…. A significant proportion of this population, studies have suggested up to nearly 40%, will have an identified hearing loss.

4. The implications of the newborn screen Early identification - leads to early intervention and support for the families Babies in special baby care automatically have a full assessment The implication of this is that hearing difficulties are usually one of the first factors to be identified in a baby who could be developing quite a complex profile Traditionally these babies may well have fallen into the category of ‘difficult to assess’ and in view of all the other difficulties possibly hearing may not have been followed up

5. What we found… Discrepancy – number of children on role in specialist provisions known to have a hearing loss wasn’t in line with expectations for this particular cohort of children and young people Looking at school/clinical records many children and young people with complex profile lacked clear data re their hearing thresholds Some had ‘DNA’ to follow up for hearing tests – this could have been been for a multitude of reasons and in the past repeat appointments were not offered Some had written reports saying: ‘difficult to assess but hearing is probably satisfactory’ ‘has adequate hearing for school and home because the conditions will be relatively quiet’ The possibility that child or young person may have hearing loss which is late onset, may be progressive or deteriorating over time was not being considered

6. The project – What we did A hearing assessment was offered to all pupils on role at specialist provisions across Somerset. The assessment required consent from parents All settings have taken part in the project. By the end of the Summer Term 2013 we had screened 273 pupils, 58.2% of the population in specialist provision

7. Number of children screened in each school against total population

8. What we found……. Out of the 273 pupils screened: 64% No further action 20% under review 11% newly identified 5 % already known to services This was more in line with expectations….

9. Memorable cases Three cases stand out : One pupil assessed was suspected to have a profound hearing loss – confirmed by further assessments – referred for a cochlear implant. One pupil picked up with a severe hearing loss – later discovered there is a familial link with deafness, mother has hearing aids and now the rest of the family are being tested. Pupil has now been fitted with hearing aids. One pupil came into assessment and told me that her ear does not work, found to have profound unilateral loss.

10. What were the key factors in ensuring the success of this screening process? Joint working with school staff Suitable location within the school Suitable assessment materials Joint working with Health colleagues Support from parents

11. What we didn’t prepare for…..

12. Reactions from parents/carers The assessments used were not suitable I am not sure ….they said hearing was probably normal Please don’t tell me there is anything else wrong He doesn’t respond because he is autistic I can’t manage him at the clinic, we won’t come…

13. Reactions from school staff…. He doesn’t like it when you cover your mouth/can’t see your face……. it is part of the syndrome….. Can he/she hear ? – yes - How do you know? I don’t know I just know He won’t be able to do that test Those behaviours are because of his autism…… They think you are here to find another difficulty

14. Reactions from Medical staff What do you want me to do? They have a lot to cope with Why have they been referred? They will not be able to tolerate hearing aids…..

15. Developments since the screening in some specialist provisions Increased partnership working Deaf Awareness training taken up by some specialist provisions Accredited training course – two teaching assistants have recently qualified Teaching assistants have been asked if they would like further training and sessions are being planned re looking at listening behaviours Health professionals working in schools The ‘listening’ profiles in the schemes of work / curriculum are being completed in conjunction with the teacher of the deaf Specific ‘Listening times’ are factored into the school timetable Listening passports Increased Multi agency working

16. Next steps…….. To extend training re what staff are looking for re listening behaviours To look at introducing ‘ an ears only time’ to more specialist settings Further develop partnership working To nominate a professional in each provision as a point of contact To look at the acoustic environment of classrooms To build parental confidence To formalise the screening process in specialist provision

17. Focussed Interventions HST staff now looking at working with schools and families to establish what stage of auditory development children/young people with a hearing impairment have reached and how they can be supported to reach the next stage…..

18. Starting point Look where the child is in terms of auditory development As teachers of the deaf we can focus at looking at how we can help support the child and family to show movement or progress in this area. Identify practical ways in which can help develop auditory awareness Before we can start on this plan we need to be sure how the child listens, what are the behaviours which indicate that they have heard sounds, are their responses one of enjoyment, distress?

19. Awareness: responds to sounds by unintentional behaviours such as blinking or startling Attention: intentionally responding to sound – this can be shown in a variety of ways Localising: beginning to actively seek where sound is coming from Discriminating: knowing when two sounds are the same or different Recognition: recognising a sound – it has some meaning Comprehension: understanding a sound is related to what is happening

20. The curriculum…… Have looked at ‘P’ scales and also the curriculum used in specialist provision and colour coded statements relating to the stages of auditory development child/young person would need to have reached in order to achieve the statements. English ‘P1’ ‘Blinks defensively’ - awareness ‘Shows awareness of sound’ - attention English ‘P4’ ‘seeks sound source’ - localising ‘looks at object when named’ - comprehension

22. Listening passport This is a good way to focus parents/carers/ other agencies upon their child’s responses to sound. It is important to stress that we are looking at listening only, no other visual/tactile cues should be used.

24. Looking at practical solutions Feedback – looked at placing speakers in head rests, looked at lengthening the tubing on aids. Discussing with OT /Physio colleagues head rest alternatives Intolerant of hearing aid – tactile defensive look at personal sound field system. Look at the pleasure that accessing sound can bring and try to access this in as many different ways as possible. Vibrotactile - via resonance boards - this can be linked in very well with daily physiotherapy sessions – it can help body to relax

26. Thank You