Who makes up the team for managing hearing loss in children? Hearing loss is complicated and the bigger the team the better chance we have of meeting the needs of a child with hearing loss. Some of the team members are obvious. The permanent fixtures of the team are the child, parents, extended family, the audiologist, pediatrician and otolaryngologist. Other members will change as the child’s needs change.
Babies and young children need intervention. There will likely be a speech pathologist or listening and spoken language specialist – auditory therapist and/or teacher of the deaf providing intervention. There may be a social worker or psychologist providing counseling for the family. If the baby has other issues, there may be other therapists – occupational and/or physical therapists – who contribute to the baby’s care.
When the child gets a little older and enters preschool, a classroom teacher will join the team, and if the preschool is a special education preschool another speech pathologist may join the team. As kids get older and enter school there are more people involved. Regular classroom teachers, special teachers – art, music, gym, etc. If the child needs assistance, he may be in a resource room with another teacher. Some kids will “graduate” from listening therapy and not see a speech pathologist or auditory therapist for a while. After-school activities may include scoutmasters, ballet teachers, art or religious instruction.
Whew! That’s a lot of people! How do we get them to all work together? Who is the team leader?
The team leader will change with time. On one level it is always the parents. They make the final decision. We as clinicians provide them with information. In this age of the Internet they will most likely find information in other places. Initially the audiologist has the key leadership role. Once a child is fully involved in intervention, the interventionist may be the leader. We may make minor decisions – which hearing aid, what to do in therapy on a particular day, but the path is driven by parents. They have to decide where the path is going. What is their goal for their child? Where do they want the child to be at age 3, 6, 10, 20? We can help them understand what it will take to get there, but they choose. It is not always easy for us when we disagree with the parents’ choice, but it is, after all, their choice.
Listening to other team members
The kids who are most successful have a team that works well together. What does that mean? I think it means that everyone does their own job and works well with the other team members. What does that mean? To me, with my audiologist hat, it means that I monitor technology, do everything I need to do to be sure it is working as I want it to, and communicate with ALL the other people on the team to be sure that they know how to maximize the technology use and that I hear what their concerns are.
When I see a child for an evaluation, I want to know what the therapists working with the child think. Is he progressing the way we expect? Can he hear all the sounds of speech? If the therapist tells me the child can’t hear, I have to do something. It is NOT okay for me to say, “I set the hearing aids according to manufacturer’s specs and got real-ear measurements so my job is done.” My job is not done until the child hears everything she needs to hear.
Too often, I hear from parents or clinicians that the audiologist doesn’t listen to them. This week I heard from a family of a young girl who felt her cochlear implant was no longer providing what it used to provide. She was mishearing more words, making more consonant confusions, and was no longer able to hear from a distance. She went for a MAPping and the audiologist told her the MAP was fine and she just needed to get used to it. This has now been going on for almost a year. In my view, the audiologist is not doing her job. She is not participating as a team member. She is not listening to the other members of the team – in this case the young woman, her mother and her therapist.
I recently heard from an auditory verbal therapist about a little one who was not making good progress. The child could not hear from more than 3 feet away with her technology and could not hear high-frequency phonemes. She had tried to talk to the audiologist, describing in detail what her concerns were. The audiologist told her that the technology was set appropriately and the child “was just not ready to listen yet.” Well, that is not a good answer. The parents got a second opinion, got the technology setting changed, and the child was able to hear the things she had not been able to hear before.
Audiologists aren’t always the bad guys. I hear from audiologists about children who are hearing well with technology and not making speech and language progress because the clinicians they are working with do not have auditory goals for the child.
I would like to tell you that these are unusual situations but I hear these things weekly from families and clinicians. We need to do a better job.
We all have the same goal – helping kids to be the best they can be. It would be perfect if once a month or so everyone who is involved with a particular child could sit in the same room and talk about how things are going. That is not going to happen. We each need to figure out how to communicate with other team member in our particular settings. We need to be sure team members know we are open to listening and ready to do whatever we need to do to maximize a child’s performance. Sometimes that means we need to ask for help to solve a child’s listening problems. Sometimes it means we need to change direction. Phone and email are good ways to communicate. Some clinicians have check lists that they ask other clinicians to complete before an evaluation so they can see what others are thinking. Anything we do to improve communication is good.
One caution – let’s not assign parents the job of messenger – especially if there are concerns. If an audiologist has concerns about therapy she needs to talk with the therapist directly and vice versa. It puts the parents in a very bad position when they are asked to transmit concerns. They need to continue to work with both people.
We can do this – just jump on board and take a deep breath…