Somerset Hearing Support Team

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Somerset Hearing Support Team

• Working in partnership with our specialist
  provisions

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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

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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 .

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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

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What we found

• Discrepancy number of children on role in
  specialist provisions known to have a hearing
  loss wasnt 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

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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

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Number of children screened in each school
against total population
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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.

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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.

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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

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What we didnt prepare for..

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Reactions from parents/carers
I cant manage him at the clinic, we wont come
He doesnt respond because he is autistic
Please dont tell me there is anything else wrong
I am not sure .they said hearing was probably
normal
The assessments used were not suitable
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Reactions from school staff.
He wont be able to do that test
They think you are here to find another difficulty
Can he/she hear ? yes - How do you know? I
dont know I just know
He doesnt like it when you cover your
mouth/cant see your face. it is part of the
syndrome..
Those behaviours are because of his autism
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Reactions from Medical staff
They have a lot to cope with
What do you want me to do?
Why have they been referred?
They will not be able to tolerate hearing aids..
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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

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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

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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..

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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?

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•  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
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• Localising beginning to actively seek where
  sound is coming from
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• Discriminating knowing when two sounds are the
  same or different
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• Recognition recognising a sound it has some
  meaning
•  Comprehension understanding a sound is related
  to what is happening
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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

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Listening passport

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

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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

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Thank You