Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Telecommunications relay service wikipedia , lookup
Hearing loss wikipedia , lookup
Hearing aid wikipedia , lookup
Noise-induced hearing loss wikipedia , lookup
Sensorineural hearing loss wikipedia , lookup
Audiology and hearing health professionals in developed and developing countries wikipedia , lookup
TRANSCRIPT OF AUDIO FILE: ASHA103009P ______________________________________________________________________________ Thank you for working with Accentance for your transcription needs. The text below represents a professional transcriptionist's understanding of the words spoken. No guarantee of complete accuracy is expressed or implied, particularly regarding spellings of names and other unfamiliar or hard-to-hear words and phrases. (ph) or (sp?) indicate phonetics or best guesses. To verify important quotes, we recommend listening to the corresponding audio. Timestamps throughout the transcript facilitate locating the desired quote, using software such as Windows Media or QuickTime players. BEGIN TRANSCRIPT: OPERATOR: Welcome to the American Speech-Language-Hearing Association’s podcast series, highlighting issues in the field of human communication. JOE: Hearing screening at school is critical care of the young. Often, such screening is the first step in detecting hearing loss that could otherwise have profound negative impact on children if it goes undetected. We will look at the national picture of hearing screening in public schools, what it is, why it is important, and how it is done, and when and where it is taking place or not taking place, such as the case currently in New York City. We will also discuss what parents can do to help ensure that their children are screened. Our guests are: Pam Mason. Pam is an audiologist as well as the Director of Audiology Professional Practices at the American Speech Language Hearing Association, or ASHA; Jim Potter, ASHA’s Director of Government Relations and Public Policy; and Laurie Hanin, PhD, Executive Director of the Center for Hearing and Communication in New York City. An ASHA member, Dr. Hanin is also an audiologist who has specialized in pediatric care. [0:01:11.2] Welcome, everyone, and thank you for being here. Pam, I would like to begin with you, if I may, and I have a simple question to start the discussion. Exactly what is hearing screening, and who says it is important for the young and why? PAM MASON: Well, thank you. First, let me define what a hearing screening is and what it is not. Hearing screening is not the same thing as a complete hearing evaluation. Instead, it is a quick and easy way to identify children who may have a hearing problem. Hearing screening programs remove children with normal hearing quickly, leaving children who refer and need further testing to find out more about the hearing loss, such as how bad is the hearing problems and what can be done to improve the hearing. [0:01:59.6] ______________________________________________________________________________________ 769826017 Page 1 of 7 In the United States today, over 90 percent of newborns have hearing screening before they go home from the birth hospital. As successful as these programs are, they still do not identify all children with hearing loss. The newborn hearing screening often does not identify children with mild hearing loss. These types of hearing loss can go unnoticed in the preschool years. Hearing screening at school entry may be the first time the hearing loss is identified. You know, it is not just ASHA that understands the importance of school hearing screening programs. The importance is recognized by several other leading children’s health and hearing organizations, including the CDC, Health Resources Services Administration, the American Academy of Pediatrics, the Educational Audiology Association, and the National Institute for Deafness and Other Communication Disorders. [0:02:59.2] JOE: That is a pretty impressive group that is concerned about hearing screening. What is known, Pam, about the extent of hearing loss among the young? PAM MASON: Well, I am going to throw out some numbers here, so I hope I am not confusing anyone. Approximately 15 percent of all school-age children have some degree of hearing loss in one or both ears. Most of this population of children have already been identified with hearing loss through the newborn hearing screening program that I mentioned. JOE: Right. PAM MASON: And they are receiving intervention services and are wearing hearing aids, cochlear implants, or using other technology. But for those with mild or unilateral hearing loss that is a hearing loss in one ear - those children may not have been identified during the newborn hearing screening and that number is about 2.5 million in the United States. That is one in every 20 school-aged child may have a mild or unilateral hearing loss, and without the proper identification and treatment, more than a third of this group of children are projected to fail at least one grade at school. And as you can see, this creates a huge, costly burden to the educational system. [0:04:16.3] JOE: Right. Dr. Hanin, Pam Mason has painted a pretty compelling picture of the need for hearing screening. I guess a question for you is why does the screening need to happen in schools as opposed to, for example, in an audiologist’s or a pediatrician’s office? DR. LAURIE HANIN: First of all, I just want to say that I could not agree with Pam more; she is right on the money. For many years schools have seemed to be the most effective place to ensure that screenings can happen and that they are done appropriately. I do not really see that a screening program could possibly be completed out by audiologists in their private offices for a couple of reasons. I do not think it is reasonable to expect that parents would necessarily bring their children in one at a time, and because of that it would be far more costly to have it done, if it even could be done effectively, and it would be very expensive to have audiologists actually do all the screenings. [0:05:18.3] In most school programs, as I understand it, the programs are supervised by an audiologist, but other individuals are trained to do the screenings. I think that staff in a pediatrician’s office ______________________________________________________________________________________ 769826017 Page 2 of 7 probably could be trained to do screenings, but I cannot imagine realistically how that effort would be supervised so that best practices audiologically would be in place. And I think another reason why it has really been done so much in school, in a way, similar to the universal newborn hearing screening programs, is that the children are captive in the school, they are there, and that I think for a long time we have believed that that is the best place to get to them all at various critical points in time. [0:05:58.2] JOE: For you, Dr. Hanin, what comes to mind in thinking about what is the most appropriate and effective way to actually conduct a hearing screening, be it in a school or anywhere else? DR. LAURIE HANIN: Well, I think it is important to distinguish between, you know, preschool and school age versus the newborn screening program. So since we are most concerned I think about that at this moment, you know, traditionally pure tone screenings have been done on school-age children either through plate (ph) conditioning techniques or children raising their hand, depending on their age and ability. And I believe that most often it is recommended that screening be conducted at 1,000, 2,000, and 4,000 hertz at 20 dB. And I do believe that it is most effective to pair this with tympanometry, or measuring the middle ear function, to be able to identify which of the referrals may be due to middle ear problems. I know that some programs incorporate a pure tone threshold surge, which is taking it one step further to also try to - for those children who do fail the initial screening - to really see if they can get some information on the level of the potential hearing loss. I believe that there is now some interest and pilot programs actually underway investigating the use of autoacoustic emissions for screening in this particular age population, and I do believe that the efficacy of this should be looked into. And if the results are good, it would definitely be easier to train staff to do it effectively. It would not require - hardly any cooperation on the part of the children and probably could be done quicker. [0:07:35.1] JOE: Pam Mason, what is the national picture with respect to hearing screening of the young in schools? PAM MASON: Well, the situation varies from state to state and there is no federal mandate. However, most states have mandates for hearing screening, and for the states with programs, each of them may have a different protocol. Who is qualified to screen? How are the screeners trained? At what year in school did the hearing screenings take place? Are there follow-up procedures in place to inform parents, physicians, teachers, et cetera? As you can see, there is a great deal of variability across the nation. JOE: Are there any examples of stellar programs that are taking place that could serve as models for other areas of the country? PAM MASON: Well, I can speak generally. I would say that a state with a mandate to provide school-based screening, as children enter school, and again, periodically during the school years, is a good first step. When a state has a program that is administered by an audiologist and has a ______________________________________________________________________________________ 769826017 Page 3 of 7 set of standard procedures for training, recording, reporting, I would consider them to be a model school screening program. [0:08:46.8] JOE: All right. I would like to ask both Pam Mason and Laurie Hanin about the question of who is - what type of professional or clinician is in the best position to administer a hearing screening. Because I know that we are going to be discussing the situation in New York City and that is an issue in that discussion there. So would you talk about that a bit? I mean what sort of qualifications or training should a person who is administering hearing screening have? Either one of you. [0:09:26.6] PAM MASON: It is Pam. I think you are talking about who is actually doing the screening. JOE: The screening, yes. PAM MASON: When I was speaking about administering the program, I meant that there should be an audiologist as the overseer of all of the components to the program. JOE: Okay. PAM MASON: It may include the specific training of the individuals that are doing the screening. What do you think, Dr. Hanin? DR. LAURIE HANIN: I agree with you. I think the supervisor of the program and overall coordinator really needs to be an audiologist, but I do not think that an audiologist needs to be the one who is actually giving the pure tone screening to the children, especially when we are talking about school-age children. I think there is a variety of individuals that could do it. I know that in New York it has been school nurses, paraprofessionals. I think there is a wide range of people who could be effectively trained if they are trained by an audiologist. [0:10:28.3] JOE: I see. PAM MASON: Absolutely. JOE: Okay, Jim Potter. Jim, in late June 2009, New York City decided to suspend hearing screening of its public school students, and that move has prompted ASHA to urge Mayor Bloomberg to restore the screening. Would you please summarize what is known about that decision, why it is of concern to ASHA, and what action ASHA has taken as a result. JIM POTTER: Thanks, Joe. The stated reason for the New York City’s Department of Education’s cancellation of this critical program is based on the statement in their regulations that the U.S. Preventative Services Task Force does not recommend hearing screening in schoolaged children. [0:11:11.0] Now, this reference is from an outdated 1996 report that focused on adult hearing screening, but also recommended against newly born hearing screening as well as hearing screening among ______________________________________________________________________________________ 769826017 Page 4 of 7 school-aged children. However, in 2008, the task force took a favorable recommendation for newborn hearing screening. It is also our understanding that the task force is currently revising this 1996 report that will focus only on adult hearing screening and they will not be carrying forward this recommendation against school-aged screening in its revised report which is due to be released in 2010. Beyond this, city officials have declined to elaborate on their decision. But clearly, there has been a paradigm shift in the last 15 years for early hearing detection and intervention among children, including screening recommendations. And there are serious questions and a general lack of credibility in the use of antiquated recommendations for the purpose of canceling this critical program for hearing screening amongst school-aged children in New York City. To challenge this decision, ASHA has embarked on an advocacy and media campaign to request that Mayor Bloomberg overturn this decision and reinstate hearing screening program for New York City school children. [0:12:28.6] JOE: How has ASHA communicated its position on the decision to the Bloomberg administration? JIM POTTER: ASHA’s President, Sue Hale, sent a letter to Mayor Bloomberg and copied other departments effecting this decision. We have continued to try to contact the mayor’s office and the other departments, but to date they have not wanted to engage in any explanation or respond to the letter itself. JOE: Okay. Dr. Hanin, you are there in New York City. I was wondering if you could comment on what you know to be the need for hearing screening there and what is your general take on the fact that it is no longer taking place in public schools. DR. LAURIE HANIN: Oh, I feel like I have so much to say on this, but I will keep it relatively brief. The one thing I can say is when I first heard what I thought was a rumor, that New York City cancelled the screenings, I really thought it was a rumor and then actually went online and found a memo to the principals from September that said that effective September ‘09 there would be no more screenings, so I knew it was true. [0:13:47.3] In New York City, here at the Center for Hearing and Communication where I work, we have actually received some private funding from foundations and individuals to screen preschoolers in a variety of different programs, and in the past four years we have screened about 13,000 children to date with a 26 percent failure rate. And now we clearly do not come close to reaching all of the children, so I know that there are children who are entering kindergarten with hearing loss. [0:14:15.9] JOE: Right. DR. LAURIE HANIN: The majority of these children have conductive hearing loss, and it is probably temporary. But at the time that they are failing the screening, they are not hearing, and what we are doing is a pure tone screening and tympanometry. Hearing screening in New York ______________________________________________________________________________________ 769826017 Page 5 of 7 City had already been cut quite a bit. My understanding is that what was happening was it had already been reduced down to screening children upon entry into school at kindergarten and first grade and it was not being done beyond that. I have some information from people that are involved in the program that that was not being done consistently either. There are stories that I have heard from some providers who see the children afterwards, of children who immigrated from non-English-speaking countries, who were placed in school at age nine or ten without screenings; one of them went through several months of school and he was deaf. His mother assumed that the professionals would just figure it out, so she did not let them know. [0:15:22.1] I think that screening in New York City is very difficult just due to sheer size. In 2008, there were 128,000 children who were registered in kindergarten and first grade in only the public schools. So there is no question that there has to be an efficient and accurate method and that is why I am a little intrigued about the use of autoacoustic emissions, if that would make it easier. So I know it is definitely a different challenge than in a smaller city. But I would argue that because of the size, it can almost be more important. And I think it was really not a good decision and there is no question the children will be hurt by this, and ultimately it will cost more with more medial education. [0:16:09.1] JOE: Interesting. Jim, putting aside the New York City situation, AHSA has been a leader in advocating for hearing screening of the young in other respects. Would you briefly talk about that and what future advocacy is being contemplated? JIM POTTER: Joe, ASHA has been a key proponent in fostering federal funding and state laws for early hearing detection intervention for newborns. Currently, ASHA’s efforts to restore school screening in New York City is part of a broader strategy to promote hearing screening among all ages. As part of its hearing screening across a life’s span campaign, ASHA is developing recommendations for school-age hearing screening and intervention. As Pam noted, while a majority of states mandate routine hearing screenings, requirements vary significantly. [0:16:58.3] ASHA’s efforts will then focus on three areas: one, implementing national uniform standards, techniques, and protocols for school-aged hearing screening and intervention; two, student and parent education on hearing loss and hearing protection, much like the anti-smoking efforts in schools today; and three, promoting classroom acoustics or reducing classroom noise through federal funding and helping state and local policymakers understand the negative impact that noisy classrooms can have on a child’s ability to learn. JOE: Pam, if you are a parent, what steps can you take to ensure that your children are being screened properly? I am speaking generally. If you are a parent anywhere in the country and you are listening to this and you want to find out about whether hearing screening is taking place, what sorts of steps can you take and what sorts of questions should one ask? [0:18:00.8] PAM MASON: Okay, well, first, if you do know that your particular school district does not offer school hearing screenings, I would recommend that you advocate with the school to have a routine school hearing screening program established under the direction of an audiologist, and ______________________________________________________________________________________ 769826017 Page 6 of 7 you can contact ASHA to locate more information and resources to support your advocacy efforts. However, in the meantime, discuss with your family doctor any concerns that you may have about your child’s speech, language, or hearing. And it is important to follow up on your concerns and have your child’s hearing fully evaluated by a certified audiologist. And I would like to add one more thing, please; that it is important to understand that the terms “mild,” “slight,” or “minimal” can be confusing to a family. These terms underemphasize the negative effects of - any degree of hearing loss can have on a child’s success at school. JOE: That is a great point. Dr. Hanin and Jim Potter, if you are a parent with children in New York City public schools at this point in time, which happens to be October 2009, what options do you have to get or to advocate for a hearing screening for them? Dr. Hanin, if you would go first, please. DR. LAURIE HANIN: Sure. And I just want to - again, a lot of it is similar to what Pam said. And I really also appreciate her comment about mild not really representing what happens to a child. There is a statistic that a child with a mild hearing loss can miss as much as 50 percent of what goes on in a classroom, and I think that that is important for everybody to know. [0:19:48.4] In New York City it is very similar to other parts of the country. If a parent has no concern about their child’s hearing, everything seems to be going along okay and the child has no significant history of middle ear problems, I would probably recommend asking the pediatrician if they do screenings in their office, because some do, and that is one area. [0:20:09.9] If there is any concern whatsoever, then I would talk to the pediatrician and really request a referral to an audiologist, if possible, one who does work a lot with children, for a full evaluation. Unfortunately, with the way insurance is most of the time, insurance won’t pay for a hearing screening. If it did, I think it would be interesting to just have every child screened by an audiologist, but insurance won’t cover that. And it is probably not necessarily the best route to say every child without any concern should have a full audiological evaluation. It is probably just not a doable thing. JIM POTTER: And Joe, New York City parents, grandparents, and other residents can write or e-mail Mayor Bloomberg, urging them to reverse this decision, by visiting online at ASHA’s website, and they can write to takeaction.asha.org. Again, that is takeaction.asha, A-S-H-A, dot org. [0:21:16.4] JOE: Very good. This has been a great discussion, everyone. Thank you for your participation. Listeners are invited to check out other ASHA podcasts at www.asha.org. They can also find an audiologist and speech language pathologist in their local area at www.asha.org/proserv/. OPERATOR: Be sure to check www.asha.org periodically for the latest pod cast in this continuing series. END TRANSCRIPT ______________________________________________________________________________________ 769826017 Page 7 of 7