Download SCREENER DIALOGUE Talking to parents

SCREENER DIALOGUE
Talking to parents
General approach
The screeners approach to both parents and staff must at all times be
 Open and friendly
 Never casual or disinterested - you may have seen and screened many babies but the
baby you are to screen is the only baby the parents are interested in.
 Not rushed
 Conversational tone to information not teaching
 Appropriate - not when mother sleeping, with midwife or other staff, being examined, on
telephone or feeding
 Respectful of confidentiality
Preparation
Screeners must approach the senior midwife at the start of each screening session to
ensure all relevant information is known (e.g. mum/baby not well, baby has died, possible
Down’s Syndrome, Cleft Lip/Palate, other medical condition).
Screeners must know the following before approaching the mother:
 Mother's home language. If mother not able to give informed consent in English then
arrange for mother to be seen with interpreter either in hospital or at home or clinic.
Provide mother with leaflets in appropriate language (if available).
 Mother's first name and family name
 Sex of baby
 When baby delivered
 Type of delivery and any complications
 Location of baby
 Predicted discharge
 Awareness of adoption or care order and consent rights
First contact with the mother before screening
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Introduce yourself by name and role
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Confirm you have the right person
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Always use mothers first name to avoid Ms/Mrs/Miss
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Friendly greeting making appropriate reference to the baby – e.g. “Seems very content” “
keeping you busy I see”
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Check sex of the baby and name. Always refer to the baby by use of he/she or name
and make a positive comment e.g. about name, baby's clothes or hair etc
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Check mother’s awareness of hearing screening tests e.g. “Is this your first baby? Did
your other children have hearing tests?” Some may already have experience of the
newborn hearing screen. Less commonly, mothers with older children would be aware of
the Health Visitor test at 7 months. If necessary, explain that this test is instead of the
Health Visitor test.
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Ask if mother had information about the screening test when she was pregnant.
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Give leaflet “Your Baby’s Hearing Screening Test”
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Tell mum that you will give her a chance to look at the information again and will come
back to answer any questions she may have and to talk about the screening in some
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more detail. Allow enough time for mum to read the leaflet or for other activities on the
ward - do not let the mum feel rushed into a decision.
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It may be appropriate to continue to talk to the mother at this time. You will need to adapt
your response according to the individual and your routine of working.
Using the Flowchart
General Information
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The flowchart is to be used by screeners both as an “aide memoir” for them and a visual
aid to help parents understand the tests and the screening process.
If testing a day 2+ well baby will not need to explain the AABR test.
When testing a Day 1 baby it is essential to explain that you will use one or both of the
tests.
If testing on NICU or SCBU, use NICU/SCBU flowchart.
Well Babies
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Explain why newborn hearing screening is offered – “One or two babies in every 1000
are born with a hearing loss. Studies have shown that if a baby has a hearing loss, the
earlier it is found and support offered, the better it is for baby's development, particularly
speech and language development”
“Hearing screening tells us which babies may have a hearing loss. The test shows us
which babies need more tests to decide if they have a hearing loss.”
Flowchart dialogue for Day 1 baby
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Explain that “there are two types of test I may use to screen baby’s hearing today. Both
tests are safe and there is no risk of harming your baby”
OAE’s – “I’ll start with this test (show OAE picture on flowchart). For this type of test a
soft earpiece designed for babies is placed in the baby's ear. It needs to fit snugly so
your baby may squirm, wriggle and squeak when the earpiece is placed in the ear as you
would if I put something in your ear when you were asleep, but it will not hurt. The
earpiece makes a soft clicking sound. This is quite soothing. The computer measures the
response of the ear to this sound. This test is best done when your baby is settled or
asleep and will not take longer than a few minutes”.
Explain about the possible screening test results and the next step for the baby
depending on the result, using the flow chart. “There are 2 possible test results, a clear
response from one or both ears or no clear response from either ear”.
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“Babies who have clear responses in one or both ears are very unlikely to have a
hearing loss and do not need any further screening tests.
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Some hearing problems can develop later on in childhood so it is always important to
check baby's responses to sound as he/she grows”.
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Explain reasons that clear responses may not be recorded. “If clear responses are not
seen in either ear, this does not necessarily mean your baby has a hearing loss. Clear
responses may also not be seen if your baby is unsettled, if there is fluid from the birth in
baby's ears or if there is too much noise near the baby at the time of the test.
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If we do not see clear responses on this test, we can do this other test straight away”
(show AABR picture on flowchart). I shall tell you about this test if I need to do it.
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Ask the mother if there are any questions she would like to ask
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Proceed to take consent if mother indicates that this is her choice or return later at a
convenient time for mother if she wishes to read leaflet/discuss with partner/consult the
family etc
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Ensure that you know when Mum is planning on going home and explain the timing of
the test.
Flowchart dialogue for Day 2+ baby
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This is the test I’ll be using today (show OAE picture on flowchart).
OAE's – “for this type of test a soft earpiece designed for babies is placed in the baby's
ear. It needs to fit snugly so your baby may squirm, wriggle and squeak when the
earpiece is placed in the ear as you would if I put something in your ear when you were
asleep, but it will not hurt. The earpiece makes a soft clicking sound. This is quite
soothing. The computer measures the response of the ear to this sound. This test is best
when your baby is settled or asleep and will not take longer than a few minutes”.
Explain about the possible screening test results and the next step for the baby
depending on the result, using the flow chart. “There are 2 possible test results, a clear
response from one or both ears or no clear response from either ear”.
“Babies who have clear responses in one or both ears are very unlikely to have a
hearing loss and do not need any further screening tests.
Some hearing problems can develop later on in childhood so it is always important to
check baby's responses to sound as he/she grows”.
Explain reasons that clear responses are not recorded. “If clear responses are not seen
in either ear, this does not necessarily mean your baby has a hearing loss. Clear
responses may also not be seen if your baby is unsettled, if there is fluid from the birth in
baby's ears or if there is too much noise near the baby at the time of the test.”
“If we do not see clear responses today we will offer you an appointment for another test
in clinic in the next week or two/ tomorrow if you are still in hospital”.
Ask the mother if there are any questions she would like to ask
Proceed to take consent if mother indicates that this is her choice or return later at a
convenient time for mother if she wishes to read leaflet/discuss with partner/consult the
family etc.
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High Risk Babies (SCBU/NICU Flowchart)
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Explain why newborn hearing screening is offered – “A small number of babies are born with
a hearing loss. Studies have shown that if a baby has a hearing loss, the earlier it is found
and support offered, the better it is for baby's development, particularly speech and language
development”
“Hearing screening tells us which babies may have a hearing loss. The test shows us which
babies need more tests to decide if they have a hearing loss.”
“Babies who have needed special care are more likely to have a hearing loss
This is the test we use to screen baby’s hearing. It is safe and does not hurt your baby.”
AABR – “small sticky pads are put on baby's head, neck and shoulder. Small earphones are
put on baby's ears and make a soft clicking sound. The responses to this sound are
measured by the machine. This test is best done when your baby is settled or asleep.
Explain about the possible screening test results and the next step for the baby depending on
the result, using the flow chart. “There are 3 possible test results. We may see a clear
response from both ears which means that your baby is very unlikely to have a hearing loss
and does not need any further screening tests.
Some hearing problems can develop later on in childhood so it is always important to check
baby's responses to sound as he/she grows”.
“We may not see a clear response from either ear, but this does not necessarily mean your
baby has a hearing loss. Clear responses may also not be seen if your baby is unsettled, if
there is fluid from the birth in baby's ears or if there is too much noise near the baby at the
time of the test.
If we do not see clear responses from either ear, I shall refer baby to the Audiology
department for further tests.”
“We may see a clear response in only one ear. As your baby has needed special care, it is
important to know that he/she hears well in both ears, so we recommend baby has further
tests in the Audiology department.”
Ask the mother if there are any questions she would like to ask and then proceed to take
consent if mum agrees.
Obtaining consent
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“I'll need to take your details to start with - can I check your name? Address and
postcode? Telephone number?”
“Can I take baby’s details…has baby got a name yet? And what will his/her family name
be?”
“This is the consent form which I’ll go through with you. It says that you have been told
about the hearing screen and have been given the leaflet.
It says you have had an opportunity to ask any questions you may have
It reminds you that screening does not detect all hearing loss or prevent hearing loss at a
later date
It says that we hold your baby’s details to manage and monitor the programme and that
we keep information on babies found to have a hearing loss up to the age of 5 years.
As part of our monitoring of the quality of our service, our tests are checked. Sometimes
babies are then called back to the hospital for another test.
The consent form gives your consent to screen < baby’s name>
Would you check all the details then sign the form please?”
If the mother declines the screening test then
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“I need to ask you to sign this form (Hearing screen declined form) to say that you
have had the information about the screen and have chosen that <baby name> will not
have the screen at this time.
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Can I take your details and check the baby's name…………
Would you sign the form please?
I'm going to give you this letter “Hearing screen declined” to keep. It gives you a
number to call if you decide to have the test in the next few weeks. We can test <baby’s
name> up to the age of six weeks. If we don’t hear from you, your baby will be offered a
hearing test at 9 months”.
Explaining the test result
Scenario 1
OAE CLEAR RESPONSES FROM BOTH EARS
NO FURTHER SCREENING TESTS NEEDED
 “<baby's name> has a clear response from both ears today.
 Babies with a clear response from one or both ears are unlikely to have a hearing loss that
will cause problems for development of speech and language. Your baby does not need any
more tests.
 Children can develop hearing problems later so it is always important to keep a check on
your baby’s hearing and tell your health visitor or family doctor if you have any worries.
 I'll give you this letter “A clear response”. This says that your baby had a clear response
from both ears today. This checklist tells you how babies respond to sound as they grow.
This information is also in baby’s red book”.
 “We send a letter to your GP and health visitor with the results of the screening test”.
Scenario 2
OAE CLEAR RESPONSES FROM ONE EAR
NO FURTHER SCREENING TESTS NEEDED
 “<baby's name> has a clear response from one ear today”.
 “I’ll give you this leaflet “Your baby's hearing screening test – A clear response in one
ear” and explain what this means. Newborn hearing screening aims to identify babies with a
hearing loss in both ears which will affect speech and language development. About a fifth,
or 20% of babies we test have a clear response in one ear at the time of the hearing screen –
it is very common. This doesn’t mean your baby has a permanent hearing loss in this ear - it
is likely your baby hears well with both ears”.
 You need to explain why you may not have had a clear response. “As I said before, clear
responses may not be seen if your baby is unsettled, if there is fluid from the birth in baby's
ears or if there is too much noise near the baby at the time of the test. Your baby will be
discharged from the screening programme now as he/she does not need any more hearing
screening tests and we shall write to your GP and HV to let them know”.
 “This leaflet tells you that you do have the choice to have another test if you wish. You may
have another screening test which will be done in a special hospital clinic or you can wait
until your baby is 9 months old and have a hearing test then. So take this leaflet home and if
you want to have a further hearing test, please phone this number within the next week. This
is because another screening test needs to be done while your baby is still small, so it would
need to be arranged soon.
 This checklist tells you how babies respond to sound as they grow. This information is also in
baby’s red book. You can keep this leaflet in baby’s red book.
 Children can develop hearing problems later so it is always important to keep a check on
<baby's name> hearing and tell your health visitor or family doctor if you have any worries”.
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Scenario 3
OAE NO CLEAR RESPONSE FROM EITHER EAR
AABR NEEDED – DAY 1 BABY ONLY
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“I haven’t been able to record/see clear responses today from either of <baby's name> ears
using this test”.
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Explain reasons. “As I mentioned, there can be a number of reasons why clear responses
may not be recorded. There may be fluid from the birth in the baby's ears which will clear on
its own over the next few days or weeks. The baby was a bit unsettled/too active or there
was a lot of noise on the ward”. (Adapt response to circumstances)
Explain that you would like to move on to the other type of test that you mentioned and that
you will explain it now - show AABR picture flowchart and refer to the leaflet “Your Baby's
Hearing Screening Test”
Explain the AABR. “For this test small sticky pads are put on baby's head, neck and
shoulder. I will need to undo or loosen <baby's name> babygrow to put the sticky pad on the
shoulder. Small earphones are put on baby's ears and make a soft clicking sound. The
responses to this sound are measured by the machine. This test is best when your baby is
settled or asleep. It can take a little longer than the other test I did”
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Explain about the possible screening test results and the next step for the baby
depending on the result, using the flow chart. “Again there are 2 possible test results, a
clear response from one or both ears or no clear response from either ear”.
“Babies who have clear responses in one or both ears are very unlikely to have a
hearing loss and do not need any further screening tests.
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As I said before, some hearing problems can develop later on in childhood so it is always
important to check baby's responses to sound as he/she grows”.
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Say again that for this test as well there are reasons why responses may not be recorded.
“There may be fluid from the birth in the baby's ears which will clear on its own over the next
few days or weeks, if baby becomes unsettled/too active or if there is a lot of noise on the
ward/interference from machines in the hospital.
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If we do not see clear responses from either ear after this test we shall refer baby to the
Audiology department for further tests.
Always give the mother time to ask any questions that she may want to at any stage.
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Explain that while the screen is happening “I'll stop talking to you just so it’s nice and quiet.
This can make it seem like the test is taking a long time”
Scenario 4
OAE NO CLEAR RESPONSE FROM EITHER EAR-1st screen Day 2+
2nd OAE SCREENING TEST NEEDED
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“I haven’t been able to record clear responses today from either of <baby's name> ears”.
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Explain reasons. “This does not necessarily mean your baby has a hearing loss. As I said
before, clear responses may also not be seen if your baby is unsettled, if there is fluid from
the birth in baby's ears or if there is too much noise near the baby at the time of the test.”
(adapt to circumstances)
“I can do this test again tomorrow while you are still in hospital/we will arrange an
appointment to screen <baby's name> again in clinic within the next two weeks”.
“We will send you a letter with the date and time of the appointment”
Discuss timing with the mother (if appropriate) and draw attention to the contact telephone
number.
Give leaflet “Second screening test required” to mothers leaving hospital and to mothers
seen in community.
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Scenario 5
OAE NO CLEAR RESPONSE FROM EITHER EAR- 2nd screening
BABY NEEDS ASSESSMENT
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“I haven’t been able to record/haven't seen clear responses today from either of <baby's
name> ears”. I shall arrange for your baby to be seen in the hospital Audiology department
for another more detailed hearing test.
Give the letter “Hearing assessment required” and the leaflet “Your Baby's visit to the
Audiology Clinic”. I’ll give you this letter which says that as no clear responses were seen,
we shall refer baby for an assessment. As I said before, this doesn’t necessarily mean your
baby has a hearing loss. We may not have seen clear responses because….(give
appropriate reason at this stage)
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I’ll also give you this leaflet which tells you why your baby needs another test and how likely it
is that your baby has a hearing loss. It also tells you what to expect when you go to the
Audiology Clinic. About 1 or 2 babies in every 1000 are born with a hearing loss and most of
these are born into families where no-one else has a hearing loss. It can be very difficult to
tell if a young baby has a hearing loss.
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For every 10 babies referred on for more tests at this stage, one of those will have a hearing
loss. This box shows you that.
The next bit of the leaflet tells you about the tests that may be done at the Audiology Clinic
and what the results might mean. You will be sent an appointment by the audiologist in about
4 weeks time. This time gives baby’s hearing pathway a chance to develop more. If you have
any questions or worries you can contact…..on this number….
We also have a website where you can find information about the assessment and the
address is here in the leaflet.
Give mother opportunity to ask any questions.
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Tell the mother's midwife/ health visitor that the baby will be having more tests as mother
may be upset/anxious later.
Scenario 6
Day 1 well baby who has had AABR after OAE test
AABR CLEAR RESPONSES FROM BOTH EARS.
NO FURTHER SCREENING TESTS NEEDED
Dialogue as for scenario1
AABR CLEAR RESPONSES FROM ONE EAR
NO FURTHER SCREENING TESTS NEEDED
Dialogue as for scenario2
AABR NO CLEAR RESPONSES FROM EITHER EAR
BABY NEEDS ASSESSMENT
Dialogue as for scenario 5
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Scenario 7
SCBU
AABR- clear responses both ears.
NO FURTHER TESTS NEEDED
Dialogue as for scenario1
AABR-no clear responses either ear.
BABY NEEDS ASSESSMENT
Dialogue as for Scenario 5 – except:
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For every 10 babies referred on for more tests at this stage, one of those will have a hearing
loss. This box shows you that. Babies who have needed special care are more likely to have
a hearing loss.
The next bit of the leaflet tells you about the tests that may be done at Audiology and what
the results might mean. You will be sent an appointment by the audiologist in about 8 week’s
time*. This may seem like a long time but this gives baby’s hearing pathway a chance to
develop more. If you have any questions or worries you can contact…..on this number….
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As scenario 5
AABR- clear response one ear
BABY NEEDS ASSESSMENT
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“<baby's name> has a clear response from one ear today”.
As the baby has a response in one ear need to explain again that “this does not necessarily
mean baby has a hearing loss in this ear. Clear responses may also not be seen if your baby
is unsettled, if there is fluid from the birth in baby's ears or if there is too much noise or
interference from other machines near the baby at the time of the test.” (Give appropriate
reason)
“However, babies who have needed special care are more likely to have a hearing loss and it
is important to know that your baby hears well with both ears, so I would like to refer your
baby to the hospital Audiology department for a more detailed test”.
Give “Hearing assessment required” letter and “Your baby’s visit to the Audiology
Clinic” leaflet and explain “here’s a letter to say <baby’s name> has been referred for an
assessment because there was a clear response in only one ear today.
I’ll also give you this leaflet which tells you why your baby needs another test and how likely it
is that your baby has a hearing loss. For every 10 babies referred on for more tests at this
stage, one of those will have a hearing loss. This box shows you that. Babies who have
needed special care are more likely to have a hearing loss.
The leaflet also tells you what to expect when you go to the Audiology Clinic and what the
results might mean. You will be sent an appointment by the audiologist in about 8 weeks
time*. This may seem like a long time but this gives baby’s hearing pathway a chance to
develop more. If you have any questions or worries you can contact…..on this number….
We also have a website where you can find information about the assessment and the
address is here in the leaflet.
* If pre-term baby
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If mother declines assessment – “I’ll give you this leaflet “A clear response in only one ear
– NICU/SCBU”. This is for parents of a baby who has a clear response in one ear who have
chosen to wait until their baby is 9 months for another test.
It explains why a clear response may not have been seen. It says that babies who have
needed special care are more likely to have a hearing loss so it is important to know that your
baby hears well with both ears.
You will get an appointment for <baby’s name> to have a hearing test at 9 months. This will
be done in a local clinic or hospital clinic.
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This checklist tells you how babies respond to sound as they grow. This information is also in
baby’s red book. If you have any concerns, speak to your health visitor or family doctor and
they can arrange for your baby to have a test earlier”.
If you change your mind and want to have a hearing test in the next few weeks, please
phone this number as soon as possible. We shall send a letter to your GP and health visitor
with the results of the screening test telling them that an appointment will be sent for a test at
9 months”.
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After spending time with a mother/family remember to thank them for their time.
Significant Conditions
Screeners complete a “Significant Conditions” form when they see a baby who may require
a follow up hearing test at nine months. The form is given to the Programme Manager who
will then check with the Professional Lead if a hearing test is needed. As screeners may not
be sure that the baby will need follow up, the following dialogue should be used for this
situation:
“A small number of babies are offered a hearing test at nine months because they may have
a higher risk of developing a hearing loss as they grow up. I will let the doctor know
(about….) and if they feel your baby should have a test they will send an appointment at
about nine months of age.”
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