Submission to the Inquiry into the provision of hearing service under the National Disability
Insurance Scheme
Joint Standing Committee on the National
Disability Insurance Scheme
January 2017
Australian Hearing
Australian Hearing is the nation’s leading hearing specialist and largest provider of Government funded hearing services.
We were established by the Australian Government in 1947 to provide hearing services to children whose hearing was affected by a series of rubella epidemics and to assist veterans who suffered hearing damage during World War II.
Australian Hearing is a statutory authority constituted under the Australian Hearing Services Act 1991, reporting to the Minister for Human Services.
We focus on two key areas: Providing hearing health services through a national network of hearing centres. Undertaking research through the National Acoustic Laboratories (NAL).
Our Programs
We provide hearing services under the Australian Government Hearing Services Program, which is administered by the Department of Health and Ageing through the Office of Hearing Services (OHS).
The Hearing Services Program has two streams—the Community Service Obligation (CSO) program and the Voucher Program.
Our customers include children and young adults under the age of 26, veterans, Indigenous adults over 50 and pensioners. To be able to receive hearing health services under the CSO on or Voucher programs, customers must meet specific eligibility criteria outlined by the OHS.
We are the sole provider of services for CSO funding that can be accessed by children and young adults under the age of 26, Indigenous adults over 50 and adults with complex hearing needs. Aged pensioners and veterans are our largest client group and access services through the Voucher program.
Our Services
Our services include assessing hearing, fitting hearing devices and providing counselling and rehabilitative programs to enable eligible customers to manage their hearing impairment. Many of our audiologists specialise in particular fields of service delivery. These include paediatric, adults with complex rehabilitation needs and outreach services to Aboriginal and Torres Strait Islander clients.
Community Service Obligation funding also supports the National Acoustic Laboratories (NAL). NAL performs research in hearing habilitation and rehabilitation and the prevention of hearing loss. NAL is also a core party in the HEARing Cooperative Research Centre (CRC) which commenced in July 2007.
Page 1 of 5
1.b Delays in receiving services, with particular emphasis on early intervention services.
Hearing is the normal and easiest route by which people develop language. Early provision of audiological and educational intervention services is vital to optimise hearing-impaired children’s access to the spoken word, and to practise using their assisted hearing to learn language.
Research led by the National Acoustic Laboratories (NAL) has shown that children who receive their first hearing aids or cochlear implants at 12 months of age have language outcomes at ages 3 and 5 years lower, on average, than those who receive their hearing aids or cochlear implants at 6 months of age (Ching & Dillon, 2013; Ching et al, submitted).
International research has sought to identify the characteristics of services for hearing-impaired children that are most valued by the parents of those children (Bamford et al, 2000; Corcoran et al, 2000; Luterman & Kurtzer-White, 1999; Roush, 2000; Russ et al, 2004). The following characteristics summarise the findings of that research into what parents want:
-
A universal newborn hearing screening system;
-
Seamless, fast transfer to a highly expert diagnostic service for those who do not pass newborn screening;
-
Seamless, fast transfer to highly expert audiological and educational intervention services for those diagnosed with a permanent hearing loss;
-
Authoritative, unbiased information, empathically delivered, about the likely impact of the hearing loss on their child, including when the child has co-morbid disabilities;
-
Support in overcoming difficulties experienced and in making choices for their child;
-
Connection with other families who had already gone through the process of adjusting to congenital hearing loss; and
-
Hope for the future. Although this research has investigated what parents want early in the life of their child, the needs of children, and consequently their families, change rapidly as the child passes through different stages of development and involvement in different stages of education, at least up until early high school age.
Providing audiological services to children in general, and to infants in particular, is therefore complex and highly specialised. Despite the great importance of optimising hearing ability to infants and young children, these recipients are least able to provide feedback about the efficacy of interventions. Partly this is because of their young age and limited language, but partly also because hearing loss is all most of these children have ever known. Due to this complexity, audiologists dealing with children need a range of skills and knowledge different from those possessed by audiologists who competently provide hearing services to older people. Children number only a few percent of those who receive audiological rehabilitation services each year. Consequently, any audiologist with a mixed caseload of adults and children in proportion to the numbers in the hearing-impaired population will not be able to develop or maintain the skills needed to competently provide paediatric audiological habilitation.
The system of caring for children hearing impairment in Australia is held in high regard by experts around the world. For example, Professor Richard Seewald, arguably the world’s leading paediatric habilitation expert previously at the University of Ontario, said:
“Australia is the best place in the world to have a hearing impaired child. The quality of paediatric hearing services available here is unique and, if they are ever under threat, do everything you can to retain them” (Community Affairs Legislation Committee, 1998).
Page 2 of 5
A recent investigation by NAL, incidental to the carrying out of a major longitudinal study into the impact of hearing loss on children, showed that along the chain from new born-screening through diagnosis to intervention, loss to follow-up is almost unheard of. This is not the case in many countries overseas with more fragmented systems.
Any changes to the manner in which audiological services are provided, have the potential to impact on the characteristics found to be essential for quality services, as reported above. It is essential that audiological services for children are provided by audiologists who’s sole or principal job is providing services to children. These audiologists need access to training and clinical support, of a quality equivalent to that currently provided within Australian Hearing, if the quality of audiological services to children is not to deteriorate from its current high standard.
1.d The accessibility of hearing services, including in rural and remote areas.
In order to understand the needs for accessibility, it is first important to understand what is needed to help individuals with hearing loss to achieve optimal hearing and language outcomes and to participate fully in daily life. For most, if not all, individuals with hearing loss the provision of amplification is the first step on a journey which also includes the development and use of strategies to make the best use of their hearing and use of other assistive technology when required. A proportion of the community uses Auslan either to facilitate communication or as their primary mode of communication. For amplification to be successful it must be optimally fitted, maintained in good working order and used consistently. The required hearing services include:
-
Accurate assessment of hearing and ongoing monitoring so that hearing devices can be set to match the individual’s requirements and medical intervention initiated when required;
-
Fitting and accurate adjustment of amplification so that the individual can hear speech and other important sounds as clearly as possible, as often as possible;
-
Instruction about how to use the technology as effectively as possible;
-
Advice and instructions about how to cope in situations when the technology does not meet all the client’s needs and
-
Access to prompt, reliable battery supply, repairs and maintenance so that time “off air” is minimised.
Specialist techniques are required to assess hearing and to fit and monitor amplification for infants and for other clients who have physical or cognitive conditions that impact their ability to respond voluntarily to ‘standard’ test techniques.
Sophisticated, well-fitted technology is of limited benefit if it is not worn consistently, so hearing services also educate clients, families and carers to promote understanding of the hearing loss, self advocacy skills and to support them through the difficulties encountered in establishing hearing device use. Rehabilitation, habilitation and training in listening and communication skills are required to support the technology and improve outcomes from service provision.
Cultural factors have the potential to impact on the individual’s ability to understand and make use of important information. Outcomes for children who have a congenital hearing loss are negatively impacted by lower maternal education (less than or equal to 12 years of schooling). (Ching, 2014)
Page 3 of 5
For example, establishing or maintaining regular hearing device use for children can be affected by the emotions parents experience when they learn their child has a hearing loss, challenges in managing children’s behaviour as they develop and later the challenges posed as the young person comes to terms with their own hearing loss.
Families and young people value the relationship with their audiologist to support this process. Analysis of over 3,300 responses to Australian Hearing’s survey of young clients under 26 years of age and their parents/carers showed that 91% of families of children under 13 years of age and 80% of young clients aged from 13 to 25 rated continuity of audiologist as being important or very important. (Australian Hearing, 2016)
Given that hearing aids do not restore normal hearing, clients of all ages need to develop strategies to improve communication; those who have significant difficulties may also require intensive auditory training programs.
Issues that affect access to services
Taking the above into account, some clients with hearing loss need to travel to access specialist support or assessment procedures, which can place limitations upon their ability to take advantage of services. Access may be limited by the cost of travel and accommodation or by the ability of the individual or their carer to take leave from work to make the journey for services.
Travel for medical procedures is funded for some clients through such schemes as the Isolated
Patients’ Travel and Accommodation Assistance Scheme in New South Wales or the Patient Travel
Subsidy Scheme in Queensland, but not usually for audiological services that are unrelated to medical treatment.
When significant travel time is required to attend children’s appointments, it is possible that the overall benefit of the appointment is reduced because the child’s cooperation or responsiveness has been compromised by the travel time.
Access can be enhanced by flexibility of service provision. Most audiological clinical services are currently delivered face-to-face, although the use of tele-practice is increasing. Some services can be provided directly to the client in their own home – for example, information provision or completion of functional questionnaires. Others can be done using tele-practice with a trained assistant supporting the client close to home – for example, hearing assessment. Finally some activities must be provided in person, such as the making of impressions of the ear so that a custom-fitting ear-mould can be made for the hearing aid.
There are several client groups who have particular service access requirements:
-
Families of newly-diagnosed infants, because prompt action is essential for optimal outcomes. Current research evidence supports identification, amplification and intervention by six months of age and cochlear implantation (if required) by 12 months of age as providing the best outcomes for children with congenital hearing loss;
-
Adults in residential care facilities and those unable to physically attend the centre for services;
-
Clients who live in rural and remote areas;
-
Aboriginal and Torres Strait Islander Clients; and
-
Clients from culturally and linguistically diverse backgrounds, including Deaf clients who rely upon Auslan.
Page 4 of 5
Australian Hearing currently supports these groups by:
-
Working closely with newborn hearing screening programs and early intervention agencies to streamline service access. Newly diagnosed children are offered an appointment within 2 weeks of the referral receipt;
-
Providing home visits to clients in residential care and to those who are living at home but who are unable to travel to a hearing centre;
-
Providing services through a network of 148 permanent sites and over 350 visiting sites across urban, regional and rural locations;
-
Providing outreach services to Aboriginal and Torres Strait Islander clients in more than 230 community locations, through audiologists who have received training in cultural competency and service delivery. Service Agreements are negotiated with each community to ensure local needs are met. This program overcomes the geographical and cultural barriers to access, and the barriers associated with distrust of Government services and navigation of unfamiliar pathways to service;
-
Providing interpreters as required and whenever possible recruiting staff with language skills to match the needs of the local community. Key documents are translated into a range of community languages; and
-
Using tele-practice in selected locations to enable hearing aid fitting to Aboriginal children in Queensland and to improve access to services for any clients who are unable to attend the hearing centre as quickly as possible – for example families with seriously ill children, or those who live at a distance from the hearing centre.
References
Bamford, J., Davis, A., Hind, S., McCracken, W., Reeve, K. (2000). Evidence on very early service delivery: what parents want and don’t always get. A sound foundation through early amplification, Chicago, Phonak.
Ching, T. Y. & Dillon, H. (2013). Major findings of the LOCHI study on children at 3 years of age and implications for audiological management. Int J Audiol 52 Suppl 2: S65-68.
Ching, T.Y, Dillon, H., Button, L., Seeto, M., Van Buynder, P., Marnane, V., Cupples, L., Leigh, G. (Submitted). Age at intervention for congenital hearing loss influences population outcomes at 5 years of age.
Community Affairs Legislation Committee; Australian Hearing Services Reform Bill (1998). http://parlinfo.aph.gov.au/parlInfo/search/display/display.w3p;page=0;query=(Dataset%3Acommsen,commrep,com mjnt,estimate,commbill%20SearchCategory_Phrase%3Acommittees)%20CommitteeName_Phrase%3A%22communit y%20affairs%20legislation%20committee%22%20ParliamentNumber%3A%2238%22;rec=11 (Downloaded: 06 February 2017)
Corcoran, J.A., Stuart, M., Glynn, M., Woodman, D. (2000). Stories of parents of children with hearing loss: A qualitative analysis of interview narratives. A sound foundation through early amplification, Chicago, Phonak.
Luterman, D. & Kurtzer-White, E. (1999). Identifying hearing loss: parents’ needs. Am J Audiol 8(1): 13-18. Russ, S. A., Kuo, A., et al. (2004). Qualitative analysis of parents’ experience with early detection of hearing loss. Arch Dis Child 89(4): 353-358.
Australian Hearing (2016). Hearing aid usage, benefit and service satisfaction surveys, unpublished data.
Ching, TYC (2014). Longitudinal Outcomes of children with hearing impairment (LOCHI): 5‐year Outcomes Intervention (Presented at HEAL 2014, Italy) http://outcomes.nal.gov.au/Publications_Presentations_Newsletters/5Yr%20LOCHI%20update.pdf (Downloaded: 12 December 2016)
Page 5 of 5