Providing Early Intervention, Audiology and

School Support for Children with Hearing Loss

via Tele-Practice

Hear and Say Program

• Auditory-Verbal Early Intervention Program: Birth to 6 years

• School Support Program

• Children with hearing aids and cochlear implants

(and a few who are unaided)

• Mild to profound hearing loss (including unilateral hearing loss)

• Implantable Technologies Program

o candidacy assessment

o cochlear implants & other implantable devices

o post implant services

General Locations- eAVT Families

Queensland • Townsville

• Yeppoon & Rockhampton

• Emerald & Blackwater

• Mackay & Moranbah

• Tannum Sands & Gin Gin

• Bundaberg

• Hervey Bay & Maryborough

• Gladstone

• Cecil Plains & Tara

Interstate (Northern NSW/NT) • Walgett (NSW)

• Lawrence (NSW)

• Manilla (NSW)

• Darwin (NT)

International Singapore Papua New Guinea

Qatar

Hear and Say- eMPOWER Model

eMPOWER Model Services

eAVT Auditory-Verbal Therapy (parent guidance and coaching) provided via web-conferencing medium

eAudiology Audiology services (including diagnostics and Tele-MAPping) provided remotely via a dedicated medium.

eTraining & Education (inc. eMentoring)

Hear and Say professional training programs provided online through a dedicated medium

eAlumni Communication, education, advocacy and peer support using on-line tools such as social media

eParent Support Parent education and peer support through web-based presentations and access to online resources/ materials

eMPOWERing Others

Hear and Say’s eAVT Program

Enrolments

o >50 children

o >20 % of Early Intervention Caseload; 80% school support program

Experience

o 1998 → 2013

o 1 skilled staff member → 10 skilled team members

o Broadened skill base from Bris only → Bris/ Twba/ Cairns/ Sunshine Coast (QLD wide)

Efficacy

o Equivalent outcomes as those attending centre-based programs

o Families not disadvantaged by distance

o Parent satisfaction -meets individual needs of families

o Competent and skilled professionals

o Positive feedback from professionals (internal and external)

o Sustainability

eAVT- Weekly Webcam Lessons

• Weekly Skype/ Lync contact

with families

o Planning Session one week

o AV Therapy Lesson next week

o Email contact between

• Sessions run for 45 to 60 mins

• Recorded for education/

mentoring

• Lesson boxes provided

(monthly rotation)

Benefits of eAVT (Tele-Practice)

• Hand-over to parents is immediate Parents get to practice skills

• Therapists unable to step-in/take over Therapists perfect their

skills at guiding and coaching parents

• Relies on provision of parent feedback , online and/or at end of

session Gradual increase in parent confidence and autonomy

• Dedicated Planning Sessions Time to discuss progress and any

issues or parent concerns

• Teaches parents to choose goals and plan subsequent activities, with

facilitation and support online as required Empowers parents

Challenges of eAVT (Tele-Practice)

Bandwidth

Therapist’s clinical skills & skills in guiding and coaching

parents

Funding

Parent learning styles and commitment to

follow-up

Audio and video quality for observing parent skills and

child responses

Broadband access

Access to Technology

eAVT – Supplementary F2F Sessions

• Face-to-face lessons/assessments each term o Home visits

o Centre visits

• Inclusive setting visits (local)

• Parent Education Sessions

• Group Social Skills Sessions

• Family Gatherings/ Networks

• Liaison with rural/remote professionals • Therapists

• Advisory Visiting Teachers (HI)

• Class Teachers

• Learning Support Staff

eAVT School Support Program

• Recent extension of our eAVT services to school age children in regional and

remote areas of Queensland

• Independent Schools & Education Queensland Schools (depending on

location of enrolled children)

• Flexibility of Services:

• Regular planning sessions and lessons via videoconference (web-

based)

• Regular consultations/ meetings via videoconference (web-based)

• Supplementary Face-to-Face visits (school visits)

• Auditory-Verbal Therapy and/or Educational Audiology support

• Assessments (Face-to-Face in Centre/ at school)

• Support of VidKids funding

Video of eAVT Lesson

Age: 2 years, 11 months

Hearing Loss: Moderate to severe sensorineural hearing loss

Hearing Age: 2 years, 6 months (hearing aid)

5 months (cochlear implant)

Devices Worn: Left ear: hearing aid

Right ear: cochlear implant

Orson

Video of eAVT Lesson

Orson

eAVT Research at Hear and Say

• 5 Auditory-Verbal Therapists completed questionnaires

• 13 of 17 parents completed questionnaires

Satisfaction Study - Telemedicine AV Therapy

Questionnaire Topic Outcome

Audio and video quality during lessons

Equipment/Software use General parent-therapist interaction and

communication during lessons

Service delivery and convenience Overall satisfaction with eAVT program

Constantinescu, G. (2012). Satisfaction with telemedicine for teaching listening and spoken language to children with hearing loss. Journal of Telemedicine and Telecare.

eAVT Research at Hear and Say

• 7 children in eAVT matched with face-to-face

• Age at amplification

• Age at enrolment in AVT

• Level of hearing loss

• No significant differences in language outcomes at 2 years post amplification

• Language scores for both groups in average range

• Telepractice is an effective service delivery method for

AVT

• Hear and Say eAVT Program is successfully ensuring an

equitable listening and spoken language service for children with hearing loss in rural and remote

Queensland to those living in metropolitan areas.

eAVT

Constantinescu, G., Waite, M., Dornan, D., Rushbrooke, E., Brown, J., McGovern, J. et al. (submitted). A pilot study of telepractice delivery for teaching listening and spoken language to children with hearing loss.

eMentoring & Professional Support

eAudiology at Hear and Say

Programming

Hardware

Facilitator

Client

Audiologist

Local Site

Remote Site Internet

connection

Hear and Say’s eAudiology Program

Video of Tele-MAPping

Zia

Age: 9 months

Hearing Loss: Left ear: Moderate to severe

Right ear: Severe to Profound

Hearing Age: 8 months (hearing aid)

2 weeks (cochlear implant)

Devices worn: Left ear: hearing aid

Right ear: cochlear implant

Video of Tele-MAPping

eAudiology Research

Audiology and Tele-MAPping

• Remote MAPping of Cochlear Implants in Children Rushbrooke, E. (2012). Remote MAPping for Children with Cochlear Implants.

Maters Thesis, the University of Queensland, Brisbane, Australia

(Journal Article in Press)

• Aim of the project was to validate the remote MAPping

procedure

• Results showed no significant difference between MAP levels

obtained remotely vs. F2F

• Satisfaction survey demonstrated a high level of satisfaction

with the remote procedure.

Telepractice Research and Publications

Constantinescu, G. (2012). Satisfaction with telemedicine for teaching listening and spoken language to children with hearing loss. Journal of Telemedicine and Telecare.

Constantinescu, G., Waite, M., Dornan, D., Rushbrooke, E., Brown, J., Ryan, M., McGovern, J., & Hill, A. (submitted). A pilot study of telepractice delivery for teaching listening and spoken language to children with hearing loss.

Constantinescu, G., & Dornan, D. (2013). International Applications of Telepractice in Speech-Language Pathology. In K.T. Houston (Ed.), Telepractice in Speech-Language Pathology. Plural Publishing.

Rushbrooke, E. (2012). Remote MAPping for Children with Cochlear Implants. Masters Thesis, the University of Queensland, Brisbane, Australia.

Rushbrooke, E., Hickson, L., Henry, B. & Russel, T. (submitted). Remote Mapping of Cochlear Implants in Children.

Future Directions

• Better broadband access in Rural and Remote

areas where it is needed most

• Provision of eAVT / Tele-Practice services to families

in Metropolitan areas

• Sickness

• Mobility

• “Home-based” services

• mHealth and applications in AV therapy

• Recording and monitoring of parent-child

interactions

• Growth of Tele-MAPping service provision

www.hearandsay.com.au

Hear & Say: bridging the “tyranny of distance”- ensuring

equitable access to all families dealing with hearing loss…

…. regardless of location

Michelle Ryan (Remote Team Leader, Speech Pathologist, LSLS Cert AVT) michelle@hearandsay.com.au