The role of audiologists

From American Speech-Language-Hearing Association they produced a 2007 position paper called "Principles and Guidelines for Early Hearing Detection and Intervention Programs" that was adopted by a joint committee on infant hearing. Below is the position statement:

The Joint Committee on Infant Hearing (JCIH) endorses early detection of and intervention for infants with hearing loss. The goal of early hearing detection and intervention (EHDI) is to maximize linguistic competence and literacy development for children who are deaf or hard of hearing. Without appropriate opportunities to earn language, these children will fall behind their hearing peers in communication, cognition, reading, and social-emotional development. Such delays may result in lower educational and employment levels in adulthood (Holden & Diaz, 1998). To maximize the outcome for infants who are deaf or hard of hearing, the hearing of all infants should be screened no later than 1 month of age. Those not passing screening should have a comprehensive audiologic evaluation no later than 3 months of age. Infants with confirmed hearing loss should receive appropriate intervention no later than 6 months of age from health care and education professionals with expertise in hearing loss and deafness in infants and young children. Regardless of previous hearing-screening outcomes, all infants with or without risk factors should receive ongoing surveillance of communicative development beginning at 2 months of age during well-child visits in the medical home (American Academy of Pediatrics [AAP] Medical Home Initiatives, 2002). EHDI systems should guarantee seamless transitions for infants and their families through this process.

This was a 2007 position paper where a number of revisions were made to improve it from the 2000 position paper. One thing that was updated can be seen on page 2 in the Early Invention section:

• Early intervention services for infants with confirmed hearing loss should be provided by professionals with expertise in hearing loss, including educators of the deaf, speech-language pathologists, and audiologists.
• In response to a previous emphasis on “natural environments,” the committee recommends that both home-based and center-based intervention options should be offered.

And on page 3 on Communication that was updated for 2007:

• Families should be made aware of all communication options and available hearing technologies (presented in an unbiased manner). Informed family choice and desired outcome guide the decision-making process.

Throughout the position paper it brings up sign language several times such as this one on page 23.

Early intervention professionals should follow family-centered principles to assist in developing communicative competence of infants and toddlers who are deaf or hard of hearing (Baker-Hawkins & Easterbooks, 1994; Bamford, 1998; Fischer, 1994). Families should be provided with information specific to language development and access to peer and language models as well as family-involved activities that facilitate language development of children with normal hearing and children who are hard of hearing or deaf (Marschark, 1997; Thompson, 1994). Depending on family choices, families should be offered access to children and adults with hearing loss who are appropriate and competent language models. Information on spoken language and signed language, such as American Sign Language (Pollack, Goldberg, & Caleffe-Schenck, 1997) and cued speech, should be provided.

And then we get to what the role is for audiologists from the National Joint Committee on Infant Hearing 2007 Position paper on EDHI programs. The National Joint Committee is a multidisciplinary committee.

An audiologist is a person who, by virtue of academic degree, clinical training, and license to practice, is qualified to provide services related to the prevention of hearing loss and the audiological diagnosis, identification, assessment, and nonmedical and nonsurgical treatment of persons with impairment of auditory and vestibular function, and to the prevention of impairments associated with them. Audiologists serve in a number of roles. They provide newborn hearing-screening program development, management, quality assessment, service coordination and referral for audiological diagnosis, and audiological treatment and management. For the follow-up component, audiologists provide comprehensive audiological diagnostic assessment to confirm the existence of the hearing loss, ensure that parents understand the significance of the hearing loss, evaluate the infant for candidacy for amplification and other sensory devices and assistive technology, and ensure prompt referral to early intervention programs. For the treatment and management component, audiologists provide timely fitting and monitoring of amplification devices. Other audiologists may provide diagnostic and auditory treatment and management services in the educational setting and provide a bridge between the child/family and the audiologist in the clinic setting as well as other service providers. Audiologists also provide services as teachers, consultants, researchers, and administrators.

The position paper also states at the end in the document (page 32) on who adopted the position statement by naming joint committee members (and please note the bolded words).

Joint committee member organizations that adopt this statement include (in alphabetical order): the Alexander Graham Bell Association for the Deaf and Hard of Hearing, the American Academy of Audiology, the American Academy of Otolaryngology-Head and Neck Surgery, the American Academy of Pediatrics, the American Speech-Language-Hearing Association, the Council on Education of the Deaf (see individual organizations listed above), and the Directors of Speech and Hearing Programs in State Health and Welfare Agencies.

What's interesting is to see that members of this joint committee include the Council on Education of the Deaf, and Alexander Graham Bell Association of the Deaf and Hard of Hearing
with names like:

Beth S. Benedict, PhD
Galluadet University
Washington, DC

Bobbie Scoggins, EdD
Sioux Falls, SD

Judy Harrison, MA (AG Bell Staff)
Washington DC

Recognize Bobbie Scoggins? She is the president of NAD. And you have a representive of Gallaudet University that adopted the position paper as well along with a representative from AG Bell on the role of audiologists.

I think the audiologists' role seem to be well defined here as seen in the position paper along with some broad defining roles added to it. I think the CAA has a legitimate concern over the revised August 20th AB2072 bill from that of the August 17th bill which they accepted seeing how their role as audiologists was compromised in this most recent AB2072 bill revision. There should be some flexibility to what an audiologist can do along what it cannot do rather than assuring that they be completely constrained.

Now, I've read Marla's Musings seeing how she seemed have twisted some words regarding CAA, the Mendoza letter and the audiologist's role. Some responses had no real bearing on the role of audiologists since for infant hearing screening they help ensure early intervention through referrals to early intervention specialists, including access to ASL. Regardless, I think this will get addressed soon enough.

California Academy of Audiology responds to blog readers' comments on AB2072 bill controversy

An email was sent to me today from the CAA in regards to my yesterday's blog in the effort to answer many of the readers' responses. They asked me to do this and so I am putting this email response in my blog. No names will be divulged here so please DO NOT ask me for them! The CAA's responses are below and answers some of the responses/questions seen yesterday in my blog comment box.

Hi Mike,

I and my board read your blog and the comments to yesterday’s post. We would like the opportunity to respond. Please let your readers know it comes from the CAA board of directors and legislative committee..do not use my email as it is from work…

1. Anonymous asked about the decibel level of the second screening….This pamphlet is to be given out at the diagnosis of hearing loss, not the outpatient screening. Some babies who fail the outpatient screening just have fluid in their ears etc. and just need time or medical treatment to resolve. We are being asked to hand this out to ALL children who have permanent hearing loss, of any kind and any degree…so yes even parents whose child has a mild loss or unilateral loss will be required to get this pamphlet and have ALL of the options for communication reviewed with the family.

2. Linda should know that we actually did not amend the language form the 17th…We actually endorsed that language and asked the author to go back to it. We did not take it as a gag order as to discuss all forms of communication options IS in our scope of practice…we objected to the August 20th amendments that was given to the author from legislators and the opposition, NOT CAA.

3. This is not about screenings..Please read the bill..it is about children diagnosed with hearing loss, any kind, any degree.

4. We are not even going to address the cochlear implant concerns as that is NOT a communication option…it is a device that is surgically implanted and is not part of this bill and will/should not be a part of the pamphlet…

It saddens us that the DHH community has such misinformation about our profession and our training. One of the biggest problems we feel the bill does not address is our families who use total communication as their option..they were not even included in the negotiations or the panel..We believe the panel and the costs incurred but the State is not necessary as there are pamphlets out there that are non biased and include all options, including ASL and SEE sign. We also believe at this point the bill is so far from its original intent that we cannot support, nor do we think given the polarizing options on the panel that the process will be arduous.
As audiologists we are trained in spoken speech and language development as well as different sign languages, including ASL. Some audiologists’ practices are not diagnostic but actually are educational and or rehabilitative only, and work with families in the development of spoken and visual language. It is referred to as aural rehabilitation, or in the case of a child, habilitation.

Because we too felt this bill was getting into a political battle rather than about communication and educational choices we asked to be removed as the primary pamphlet distributors and asked that the educators hand out the pamphlet but we would be happy to answer questions regarding anything in the pamphlet or direct the parent to the appropriate agency or reference material. This was rejected by the author…….Hope this clears up some of the misconceptions….

Thanks for your efforts and your fair representation of the facts……We hope this answers at least some of your readers questions…Thanks for asking!

If you have questions or comments and would like to direct them at CAA use their contact page to submit your questions or comments.

Thank you!