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How to Increase Access to Pediatric Audiology Care

McCreery, Ryan PhD

doi: 10.1097/01.HJ.0000449897.18819.88
Building Blocks

Dr. McCreery is associate director of audiology and staff scientist at Boys Town National Research Hospital in Omaha, NE.



The need for audiologists who specialize in pediatrics may be at its highest, driven upward by universal newborn hearing screening and early identification of hearing loss. At the same time, families are experiencing long waits and limited access to qualified providers.



It would be ideal to have a national public health system that provides audiology services to children, like Australian Hearing or the Canadian Provincial Health Services Authority's Early Hearing Programs. However, such an approach would require a significant shift in the overall healthcare delivery system in the United States that could take many years to implement.

In the meantime, what intermediate steps can our profession take to ensure timely delivery of services for children who are deaf and hard of hearing in the United States?

Encourage a minimum level of competency in pediatrics for all audiologists.

Not every audiologist has the interest or desire to work with children. However, if the patient sitting in your booth is a child who needs audiology services, every audiologist should be willing to provide basic care.

A minimum competency level in pediatrics would mean that the audiologist is able to perform audiometric assessment and earmold remakes for school-age children and adolescents.

On the other hand, audiologists would need to recognize the limitations of their expertise when it comes to infants and younger children. These limits might be based on the equipment available or the professionals’ training and experience with specific aspects of pediatric audiology.

Achieving competency would not only require course work in pediatrics, but also clinical experiences that provide exposure to the unique needs of children who are deaf and hard of hearing. This brings us to our next step.

Offer high-quality clinical placements that enable students to work with children.

Providing clinical experiences to audiology doctoral students in a busy pediatric clinic can be challenging. Students may come into the experience with limited exposure to pediatric audiology and need extensive support and supervision.

However, without strong clinical placement opportunities in pediatric audiology, audiology students may never have the chance to develop the skills and passion for serving children and their families.

Many of the clinical staff in our center only became interested in pediatric audiology after an engaging clinical experience during graduate school. The time and effort dedicated to offering these experiences will pay dividends for the profession.

Recognize services that demand special expertise in pediatric audiology.

Several areas in pediatric audiological care not only require advanced training and experience, but also could have substantial negative implications for a child if administered or interpreted improperly.

For example, diagnostic auditory brainstem response assessment of infants and young children is an advanced service that should only be provided by audiologists with sufficient equipment, training, and experience in performing these procedures.

Failure to accurately assess hearing in infants or children who cannot participate in behavioral tests can lead to delays in the identification of hearing loss and permanent negative developmental consequences.

Look to educational audiologists as a great resource.

While the availability of educational audiologists and the services they provide vary widely across the United States, many communities that do not have access to a pediatric audiology clinic may have educational audiologists.

These professionals can play an important role in providing community-based pediatric audiology services.

Clinical audiologists should avoid blanket recommendations for accommodations and work directly with educational audiologists to ensure consistent use of hearing technology in the school setting.

When available, educational audiologists should be part of the team discussing amplification to ensure that the devices selected are compatible with hearing assistive technology and classroom amplification.

Address the opportunities and challenges of telehealth for pediatric audiology.

Telehealth offers a unique opportunity to provide care to families with deaf and hard of hearing children who may not otherwise have easy access to services in their communities.

Remote programming of amplification and mapping of cochlear implants, and even remote auditory brainstem response assessment of infants who failed newborn hearing screening, have been successfully tested.

Regulatory and reimbursement issues may continue to limit the widespread use of these technologies in the short term, but the barriers are resolvable.

One concern audiologists have expressed about the diagnostic assessment of infants and children via telehealth is whether adequate emotional support can be offered when a diagnosis of hearing loss is given to parents who are in a different location.

Solutions to these new challenges will help to increase the acceptance of telehealth in pediatric audiology. Parents and caregivers may come to expect that audiology services are delivered via telehealth as other health services transition to this delivery model.

Continue to educate yourself.

Just like audiology in general, pediatric audiology is evolving rapidly. Practices that were once considered the standard of care may be replaced by more effective protocols.

The appropriateness of various hearing aid signal-processing strategies for children is constantly being evaluated. The importance of pediatric-specific continuing education for audiologists who work with deaf and hard of hearing children has never been more crucial.

Many live audiology conferences have pediatric tracks or groups of sessions on topics in pediatric audiology. Online continuing education providers have a wealth of pediatric courses featuring experts from around the world.

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The shortage of pediatric audiology providers in the United States is a multifaceted problem. No single solution will completely solve it.

However, exposure early in audiology training programs to clinical experiences and didactic learning in pediatrics can help to encourage new audiologists to pursue a career working with children who are deaf and hard of hearing.

Furthermore, advances in technology, such as online and distance continuing education, can help to keep current pediatric practitioners up to date on the latest technologies and practices.

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