According to the Centers for Disease Control and Prevention (CDC), over 98% of babies born in the United States participate in newborn hearing screening. In 2019, the most recent year for which data are available, it was noted that approximately 1.7% of newborns failed their screening. Of those who failed, approximately 27.5% were identified as loss to follow-up (LFU) or loss to documentation (LTD). 1 Although several factors may impact a family’s ability to have their child participate in follow-up testing, one factor that may contribute is a shortage of hearing health care professionals trained to work with very young children. Factors that may contribute to such a shortage are discussed below along with some potential resolutions.
BARRIERS TO PEDIATRIC HEARING HEALTH CARE ACCESS
Several professionals have reported on the shortage of pediatric audiologists in the US 2–4, particularly in rural areas. 2,5 This shortage results in longer wait times for appointments and makes it particularly challenging for families who reside in rural areas to attend appointments since they must travel great distances to receive hearing health care. This can be particularly challenging for audiological follow up, as most pediatric audiologists work in large medical centers located in densely populated areas.
There are several factors that may contribute to the reduced availability of pediatric hearing health care providers, including a reduced comfort level for working with young children. Recently, Blaiser and Mahshie evaluated the impact that training and education had on the self-reported comfort level of pediatric audiologists and speech-language pathologists when working with young children who are deaf or hard of hearing (DHH). 6 They found that many providers lack confidence in their ability to serve the needs of such children, particularly those in early intervention or preschool. Among all respondents, 28.6% reported they received no formal training for working with children who are DHH and that comfort working with children in the birth to 3 years age range was primarily related to information obtained from colleagues and mentors. Additional analyses revealed that affiliation with the American Speech-Language Hearing Association’s Special Interest Group on Childhood Hearing (ASHA SIG 9) was also a significant predictor of comfort working with the 0-3 age group. The only significant source of knowledge predictive of comfort working with preschool-aged children was online courses. Thus, it is likely that lack of appropriate training, which inevitably leads to lack of comfort working with the 0-3 population, contributes to the lack of pediatric audiologists and also contributes to some of the difficulties families experience when seeking assistance following a failed newborn hearing screen. Their results also indicate that online learning can positively impact the comfort level of professionals who work with young children.
Finally, costs associated with the provision of pediatric hearing services likely impact availability of care. It’s more expensive to provide hearing health care to children than adults, since their appointments are typically longer and more appointments are needed to diagnose, treat, counsel, and provide rehabilitative services. Additionally, reimbursement rates are typically low for pediatric audiology services. Both factors increase the cost of providing care to young children and reduce the likelihood that audiologists in private practice are able to provide such services, reducing the overall number of audiologists who are able to provide pediatric care. These two factors often lead to reduced funds being available for continuing education, limiting the ability of professionals to expand their knowledge and expertise.
The factors mentioned above have impacted the availability of pediatric hearing health care services across the U.S and have likely contributed to delays in diagnosis and treatment of infant hearing loss. Unfortunately, such delays have negative implications for long-term outcomes obtained by children who are DHH. This includes a reduced ability to develop listening and spoken language skills, which we know is increasingly possible with early and appropriate intervention.
PART OF THE SOLUTION: EXPANDING AND UP-LEVELING PEDIATRIC HEARING HEALTH CARE PRACTICE
We recognize that meeting the needs of children with hearing loss requires specialized skill, training, and expertise and that such training differs from that required when professionals work with adults. The study of Blaiser and Mahshie 6 indicated that such training is needed, even for professionals who currently work with children who are DHH in the 0-3 age range, and that such training has the potential to improve professionals’ comfort level when working with young children. Provision of training could benefit others as well, including those who do not currently work with children, as such training could empower them to expand their practice to include infants and young children. Inclusion of graduate students in such training could increase their awareness of the benefits of a career in pediatric hearing health care and may increase the number of professionals trained to work with young children.
NEW OPPORTUNITIES TO EXPAND AND UP-LEVEL PEDIATRIC AUDIOLOGY PRACTICE
Since 2015, Hearing First has been providing learning experiences for professionals who work with children who are DHH. Hearing First is a wholly owned subsidiary of the Oberkotter Foundation 7, a charitable organization that helps caring adults support infants and toddlers who are DHH to have the same listening, spoken language, and literacy opportunities as their hearing friends. One of Hearing First’s goals is to equip families and professionals with the resources, communities, and learning experiences they need to improve outcomes for children with hearing loss through listening and spoken language. As part of that mission, approximately 26,000 professionals have registered for the 115+ courses that have been offered thus far at Hearing First.
In 2022, Hearing First expanded its offerings to focus on the needs of pediatric audiologists. The Hearing First website (www.hearingfirst.org) 8 includes an online, educational model based on solid theories of adult learning with traditional content delivery paired with experiential education and relationship facilitation. The model focuses on two key stakeholder groups: families and professionals.
Hearingfirst.org is accessible free of charge and provides resources and comprehensive information for both families and professionals regarding treatment and habilitation of hearing loss. It includes a Family-to-Family support community and Family Facebook group where members can receive parenting advice and emotional support from other parents. It also includes a professional learning community where professionals can seek input and information from other professionals. Importantly, Hearing First offers a series of learning experiences aimed at increasing and improving the knowledge of both families and professionals to educate both groups about the importance of early identification of hearing loss, early access to hearing technology, and early access to intervention services. All the Hearing First Learning Experiences are offered free of charge, and learners can earn continuing education units from the American Speech-Language Hearing Association, the American Academy of Audiology, and/or the Alexander Graham Bell Association for the Deaf and Hard of Hearing at no cost.
Listening and Spoken Language (LSL) topics covered in the learning experiences have included Strength-Based Coaching and Mentoring, Tele-practice, a Video Observation series, Partnering with Parents, Speech Acoustics, and Auditory-Verbal Strategies, to name a few. In 2022, topics focused on pediatric audiology were added to 1) help pediatric audiologists stay current and up-to-date in their knowledge and skills, 2) provide learning opportunities for existing audiologists who do not work with pediatric patients, in hopes that such training will increase their confidence and skill for providing such services, and 3) supplement the training received by AuD students in hope that more of them will choose to specialize in pediatric audiology. Because all courses offer learners the ability to earn continuing education units free of charge, they additionally help professionals meet or maintain their state license and professional organization requirements for continued learning.
Pediatric audiology courses provided by Hearing First in 2022 were led by renowned hearing health care experts and covered a variety of topics, including Pediatric Amplification, Facilitation of Hearing Device Use, Medical Management of Pediatric Hearing Loss, Genetics, Congenital Cytomegalovirus, Unilateral Hearing Loss, Cochlear Implant Referral, Electrophysiologic Measures, Behavioral Testing, and Auditory Neuropathy Spectrum Disorder. Topics scheduled for 2023 include a repeat of some courses offered in 2022 plus new experiences focused on Hearing Assistive Technology, Pediatric Cochlear Implant Programming, Middle Ear Testing and Otoacoustic Emissions, Speech Perception Testing, and Bone Conduction, to name a few.
Hearing First has seen an increase in the number of hearing health care providers who are willing to take advantage of these opportunities to up their level of knowledge and skill for working with infants and toddlers who are DHH. Because these learning experiences focus on best practices and stress evidence-based pediatric care, they are increasing the comfort level of professionals who currently provide pediatric services. Additionally, these experiences are supporting professionals who do not currently work with children, with the goal that they will expand their services to include infants and young children. Last, thanks to the support and recommendation of many AuD, SLP, and TOD faculty, numerous graduate students have registered for Hearing First learning experiences. These courses provide important information that supplements graduate education and training and should positively impact the number of hearing health care professionals who choose to provide services to infants and young children. We encourage you to visit www.hearingfirst.org to learn more about the ways Hearing First is meeting the needs of families of children with hearing loss and the professionals who serve them.
1. Centers for Disease Control and Prevention 2022 Annual Data: Early Hearing Detection and Intervention (EHDI) Program. Retrieved from: https://www.cdc.gov/ncbddd/hearingloss/ehdi-data.html
2. Shaw G 2013 Pediatric Audiologist Shortage Leaves Providers Searching for a Solution The Hearing Journal 66 18 20,22. https://doi.org/10.1097/01.HJ.0000437992.50195.39
3. Planey AM 2019 Audiologist availability and supply in the United States: a multi-scale spatial and political economic analysis Social Science & Medicine 222 216 224 https://doi.org/10.1016/J.SOCSCIMED.2019.01.015
4. Nagaraj N, Mertens E, Magimairaj B, Winston-Gerson R, Whicker J, White K 2019 Access to pediatric audiological evaluation facilities for infants and young children in the United States: results from the EHDI-PALS system The Journal of Early Hearing Detection and Intervention 4 46 56 https://doi.org/10.26077/0vw5-cx45
5. Bush ML, Kaufman MR, McNulty BN 2017 Disparities in access to pediatric hearing health care Current Opinion in Otolaryngology & Head and Neck Surgery 25 359 364 PMID: 28665808; PMCID: PMC5973811. https://doi.org/10.1097/moo.0000000000000388
6. Blaiser K, Mahshie J 2022 Cofort levels of providers serving children who are deaf/hard of hearing: discrepancies and opportunities. American Speech-Language-Hearing Association The ASHA Leader ■ ■ https://doi.org/10.1044/2022_PERSP-22-00030
7. Overkotter Foundation. Retrieved from: www.Oberkotterfoundation.org
8. Hearing First. 2022. Retrieved from: www.hearingfirst.org