1. Hearing Aids: Helping Parents Understand the Good, the Bad, and the Ugly Patti Martin MS CCC-A Jan Stroud MS CCC-A Arkansas Childrens Hospital Nannette Nicholson PhD CCC-A University of Arkansas for Medical Sciences Arkansas Childrens Hospital

2. Pre-fitting Determine candidacy Consider pre-selection issues Complete pre-selection procedures Select appropriate hearing instrument Consider fitting issues Fitting Fit hearing aid Verify benefit Hearing instrument orientation and training Post-fitting Validate benefit Follow-up and referral American Academy of Audiology, 2003 What youre supposed to do...

3. What we did... Hearing Aid Fitting Fit earmold RECD Program hearing aid Make sure it works Counseling Care Use Maintenance Good Luck Return appointment

4. What we worried about... Families How they were getting used to it Questions they would ask What they thought we said What they told their therapist that they didnt know how to do How we felt Rushed Preachy Frustrated Inadequate

5. What we did about it... Quality Improvement Initiative Parent Survey 12 modified Likert scale (1 – 4) 3 open ended questions Sample of convenience 28 experienced parents

8. What information could your audiologist have given you that would have made the first few weeks/months of hearing aid use better? Emotional Support Parent support contact or group II Patience with process II Accessories Loss and damage prevention I Retention II Moisture, dri-aid kit, cleaning III Danger of HA batteries I Potential Complications With fluid and hearing fluctuation I Progression of hearing loss II Q1

9. What information could your audiologist have given you that would have made the first few weeks/months of hearing aid use better? Q1 I would have had a more positive attitude concerning deafness if I could have had someone to consult with about deafness in general. I felt as if I were on a dark fearful road with no hope in the future. I was told all of the general information about aids and deafness, but lacked the crucial information that all parents need to hear and be mentored on and that is "what the future holds". "We as parents" need support groups and people who can be contacted to help during the "scary hours".

10. What was your biggest worry when your child got hearing aids? Emotional Concerns Improvement in listening IIII I Acceptance of hearing aids by child IIII I Comfort/discomfort II Social Concerns Teasing at school II Learning to talk II Physical Concerns Keeping them on III Losing or breaking them IIII II Swallowing battery I Keeping clean and dry I Q2

11. What was your biggest worry when your child got hearing aids? Q2 Would she want to wear them? And it took me a few months actually to make her wear them. And when I actually took control of the situation and started making her wear them all waking hours, she got so comfortable with them and used to wearing them she had to be asleep, then I would take them out. You really have to be somewhat determined to make your child wear the hearing aids frequently so they get used to them and what to wear them.

12. What advice would you give new parents about hearing aid use? Emotional Support Find someone you can talk to I Patience with process II Learn to accept hearing loss I Perseverance IIIII Dont worry about what other people say II Dont be nervous/afraid of them I Care and use Wear all the time IIIII III Make sure working properly II Give hearing aid a home II Q3

13. Be more stubborn than your child. If they take out the hearing aids - put them back in. When your child is small get brightly colored ear molds. It makes the hearing aids easier to find if lost and it also lets strangers know that your child is wearing hearing aids. It also makes wearing hearing aids more fun for your child. What advice would you give new parents about hearing aid use?

14. What we do now... Pre-appointment Pre-fitting/pre-programming Estimated RECD

15. What we do now... Appointment Establishing rapport Questions about last session What has happened since then How are they getting along Decide on goals for session with parents What we are going to do How we will do it Do it Practice it Family centered approach Explain and demonstrate everything as we go Ask parents to demonstrate skills learned Provide written instructions

16. What we do now... Post-appointment –Call 2 days later –Send packet of resources –Return 2 – 4 weeks

17. What Have We Learned? Parents of younger children are different than later identified children Less confident Diagnosis Benefit of amplification Less convinced Impact of early listening on language development Need to intervene prior to delay More contact Reassurance –Other parents –Audiologist –Primary care physician Information –Advance technology –How to evaluate quality

18. What Have We Learned? Parents of younger children are different than later identified children More contact Reassurance Other parents Audiologist Primary care physician Information Advance technology How to evaluate quality

19. Next Steps Connections Other parents Parent mentors Deaf/hard hearing adults Continue to increase redundancy of message Give information in multiple formats Spoken in native language Written Audio/Video Outcomes Evidence based Age appropriate Family friendly Measured in natural environment