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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 Introduce yourself by name and role Confirm you have the right person Always use mothers first name to avoid Ms/Mrs/Miss Friendly greeting making appropriate reference to the baby – e.g. “Seems very content” “ keeping you busy I see” 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 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. Ask if mother had information about the screening test when she was pregnant. Give leaflet “Your Baby’s Hearing Screening Test” 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 Page 1 of 9 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. 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 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 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 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”. “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 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. 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. Page 2 of 9 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 Ensure that you know when Mum is planning on going home and explain the timing of the test. Flowchart dialogue for Day 2+ baby 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. Page 3 of 9 High Risk Babies (SCBU/NICU Flowchart) 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 “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 “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. Page 4 of 9 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”. Page 5 of 9 Scenario 3 OAE NO CLEAR RESPONSE FROM EITHER EAR AABR NEEDED – DAY 1 BABY ONLY “I haven’t been able to record/see clear responses today from either of <baby's name> ears using this test”. 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” 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. 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”. 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. 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. 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 “I haven’t been able to record clear responses today from either of <baby's name> ears”. 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. Page 6 of 9 Scenario 5 OAE NO CLEAR RESPONSE FROM EITHER EAR- 2nd screening BABY NEEDS ASSESSMENT “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) 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. 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. 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 Page 7 of 9 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: 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…. As scenario 5 AABR- clear response one ear BABY NEEDS ASSESSMENT “<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 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. Page 8 of 9 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”. . 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.” Page 9 of 9