Dear Audie 9

The delivery of hearing healthcare to communities that are not in suburb or urban areas is complicated. Multiple patient, family, and provider factors are barriers to timely care. Past research has shown that those who live in rural areas can be dramatically delayed in the diagnosis and treatment of hearing loss. 

Ask your Audiologist about telehealth appointments, as they can be done from the home over a computer or phone instead of driving a far distance to your health providers, audiologists, and speech pathologists. 

Look into getting services from a early intervention specialist as they can connect you to the right professionals and keep on track in terms of hearing tests and such. 

Fit as soon as possible (FIT before critical period)

This states that the first few years of a child’s life include the time during which language develops in the best conditions and after this period of time, language learning is much more difficult and less successful in the long run. The critical period is thought to be up until the age of 1.The first year of life has the greatest promise of molding the brain to learn language, therefore it is the most successful time to have intervention services. Services completed early as possible in the first year of life leads to postive effects and outcomes. 

 If your child has hearing loss, they likely are not receiving all the speech coming from you as the parents, family members, friends, teachers. Your child is and will continue to miss out on building a baseline for proper language development that is crucial later on for exceeding in school, social aspects, and so on, if amplification devices are not fit on the child. 

Cardon G, Campbell J, Sharma A. Plasticity in the developing auditory cortex: evidence from children with sensorineural hearing loss and auditory neuropathy spectrum disorder. J Am Acad Audiol. 2012 Jun;23(6):396-411; quiz 495. doi: 10.3766/jaaa.23.6.3. PMID: 22668761; PMCID: PMC3733172.

Hart and Risley (1995) have demonstrated that the number of words heard directly affects both the number of words in a child’s vocabulary and the child’s IQ at age 3 years. Children who heard 30,142 words in a 14-hour day had a vocabulary of 1,116 words and an IQ of 117 at age three years, while children who heard 8,624 words in a day had a vocabulary of 525 words and an IQ of 79.

There are many reasons as to why a child might have a lessened number of words in their vocabulary bank, e.g. social economic status and not reading to the child. Hearing loss is another one of the reasons that a child may not have a  large vocabulary bank. Not having the ability to hear the word means the child will not have the ability to learn the words. 

Ways to support word learning in your child is to start with exploring sounds. Play games with your child that teach imitation such as peakaboo and itsy bitsy spider.  Talk about the things your doing with the child, for example “Mommy is cooking dinner” or “We are going for a walk to the park.” Most importantly is to read to your child! Describe and point to the images in the book you’re reading, make sounds that the characters in the book would make. Play music and sing songs together with your child. 

These are just a few ideas of how you and your family can encourage and create access to speech and language for your child. 

Hart, B., & Risley, T. R. (1995). Meaningful differences in the everyday experience of young American children. Baltimore, MD: Paul H. Brookes Publishing Company

AAA 

*The start of counting up to 5-6 years only starts when the child has access to sound through  proper hearing aid amplification. This is considered the “listening age”. For example, a child may be 3 years old, but if they have a severe hearing loss and were only fit with hearing aids at 1 year old, their listening age is 2 years old because that is when they started to get consistent access to speech.

Consistent exposure to sounds in environmental context is the basis for prepping the auditory system so that sounds can be learned, this includes speech. Children do not just pick up speech from those who talk to them. They are picking up from conversations occurring between strangers at the grocery store, family members in another room of the house, what's happening on the TV, sounds that your pets are making, what the kids at the playground are saying, etc. If the infant or toddler with hearing loss can be provided with consistently audible speech through hearing aids or other technology, he or she should be able to learn to recognize speech, tell apart voices, and build vocabulary. Children with significant hearing loss similar to what your child has will not be able to monitor their own voice and speech sounds unless they are audible.

Regardless of the kind of method your partner and you pick for your child, whether that be learning spoken language, American Sign Language (ASL), or total communication (a mix of spoken language and signed language), action needs to be taken early. If actions for learning language does not occur within the first 6-12 months, hearing loss that is severe can negatively impact the ability for your child to have communication. This loss of ability to communicate can lead to poorer educational and social abilities as your child continues to grow with out proper intervention and hearing aids. 

However, if your child is receiving proper intervention services, they have the opportunity to grow and become successful individuals in terms of academics, social life, sports and hobbies, and so much more.  

If you don’t already have one, you’ll want to get a Early Interventionist Specialist (EIS) involved in your child’s journey to getting hearing aids and the support he or she needs. The staff specialists are responsible for creating, operating, and continuously improving services so that your child has access to getting hearing tests, culturally appropriate family support, and a medical home (Connection of doctors, audiologists, and other health professions working with your child). The link below has information on who to contact regarding getting an EIS, as well as more information on the Ohio EHDI (Early Hearing Detection & Intervention) program. 

Over 90% of children are born to parents without hearing loss. Therefore there are a lot for parents going through the same situation as you and your partner to learn about living with and managing hearing loss. Using an Early Interventionist Specialist is a great way to help parents coordinate all the services a child will need to be successful. 

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IDEA stands for Individuals with Disabilities Education Improvement Act. IDEA part C says that children under the age of 3 years (36 months) who are at risk of having developmental delays may be eligible for services. Developmental delays included may include one or more of the following: cognition, physical development, social/emotional development, and/or adaptive development. These services are provided through an early intervention system in your state. Through this system, you can ask for an evaluation. The link below gives a step by step process from applying to the end of being in the IDEA part C program. 

To summarize it, the process begins through referral. There are two types of referral, one from the doctor or the parents can contact the early intervention system directly and ask for an evaluation.  Five areas are to be assessed; cognition, physical development including vision and hearing, communication development, social development, and adaptive development. These assessments are completed to figure out what the needs of the child are. This process should be completed within 45 days after the beginning referral date. If the child is found to be eligible, a meeting is scheduled for a IFSP meeting. These meetings will be completed by a team of health professionals to determine where the child is at performance wise, what the family’s resources and priorities are, determine goals and outcomes, and other services the child will need to be sucessful. The IFSP is reviewed every 6 months to reassess goals and needs, and an annual meeting must occur with the whole team. This will repeat until the child is 90 days away from their 3rd birthday. There will be a transition plan/ meeting to leave Part C of IDEA and move on to Part B if necessary. 

This program helps children with special health care needs and their families who meet the medical and financial eligibility criteria.  Assistance is provided to children under the age of 21 who have special health care needs and are residents of the State of Ohio. Here are the two types of programs:

1.The diagnostic program helps to pay for diagnosis of medical conditions. Anyone can qualify for help

2.The treatment program helps pay for the treatment of medical conditions. These are available to those who qualify both medically and financially.

Your child may qualify for one or both programs if he or she is: -Younger than 21 years old - A permanent Ohio resident - Has a CMH qualified medical concern or diagnosed condition. -Seen by a CMH doctor annually

  If eligible, CMH may help to pay for these items and more: - Hearing aids - Office visits - Resources - Therapies - X-rays

Public health nurses will also help to coordinate services for your child

The link has more information about the program as well as how to apply. 

This program will assist families with incomes of between 200% and 400% of the federal poverty level with the purchase of hearing aids, earmolds, assistive listening devices, and hearing aid batteries for children from birth to age 21. (Families with income of less than 200% of the FPL should be referred to Medicaid or BCMH for services). Audiologist have a signed agreement in place with this assistance program and are able to assist with children eligible for the program. Your child can not be eligible if accepted by Medicaid or the Children with Medical Handicaps Program. Eligibility is determined by using the federal poverty guideline table provided on the website linked on this blog post. 

Hearing aids are covered under Medicaid.

Covered services include conventional hearing aids only including the cost of a warranty, testing and evaluation, ear molds, cleaning kit, batteries, up to three hours of counseling, and hearing aid repairs.

In general, reimbursement for a hearing aid will be limited to a maximum of one aid in any four-year period for a conventional hearing aid. Requests for more frequent replacement for medically necessary reasons will be considered when appropriate documentation is provided.  If a hearing aid is lost and is still covered by warranty, Medicaid will not cover any deductible or replacement charges not covered by warranty.

If government based resources listed below are not appropriate for you and your family, there are also local agencies in your area that may receive funds and donations to help with the needs of those with hearing loss. Speech and hearing centers through universities or some audiology private practice locations may have bundles that include a lower price when including the hearing evaluation. Check your local area on the internet for local programs to inquire about funding. 

ASHA provides a lengthy list of private resources for children, funding programs, and service organizations that might have something to support the financial needs for your child. Resources include phone numbers, addressees, and websites to visit for more information.