NDIA Accountability Project

Provision of hearing services under the National Disability Insurance Scheme (NDIS)

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Inquiry into the provision of hearing services under the

National Disability Insurance Scheme (NDIS)

Attention: Committee Secretariat PO Box 6100 Parliament House Canberra ACT 2600

Terms of Reference

  1. That the Joint Committee Inquiry into and report on the provision of hearing services under the National Disability Insurance Scheme (NDIS), with particular reference to:

    a) the eligibility criteria for determining access to, and service needs of, deaf and hearing impaired people under the NDIS;

    b) delays in receiving services, with particular emphasis on early intervention services;

    c) the adequacy of funding for hearing services under the NDIS;

    d) the accessibility of hearing services, including in rural and remote areas;

    e) the principle of choice of hearing service provider;

    f) the liaison with key stakeholders in the design of NDIS hearing services, particularly in the development of reference packages;

    g) investment in research and innovation in hearing services; and

    h) any other related matters.

To whom it may concern,

Thank you for inviting comment into the Inquiry into the provision of hearing services under the NDIS. I would also appreciate the opportunity to personally address the Joint Standing Committee at a public hearing to present further on the matters outlined within this submission.

In 2017, Hear and Say will celebrate 25 years of providing hearing, speech and language support to children with hearing loss and their families. We are a not-for-profit organisation located in Queensland and a member of First Voice, the national voice for member organisations whose primary focus is the provision of listening and spoken language therapy services for children with hearing loss in Australia and New Zealand. Hear and Say has been a contributing part to, and is supportive of, the separate First Voice commentary which has been submitted for this Inquiry.

The Hear and Say experienced transdisciplinary team comprises audiologists, speech and language pathologists, teachers of the deaf, occupational therapists, clinical social workers and physiotherapists who work with families to not only provide an end-to-end service package that meets families’ health, education and disability needs and also achieves a set of outcomes for these children/adults which allows them to interact in the community just like children/adults with natural hearing.

The evidence based programmes at Hear and Say interface state-of-the-art hearing technology

(digital hearing aids and implantable technology such as cochlear implants) with the Auditory-Verbal Therapy approach.

Hear and Say has one of the largest hearing implant and listening and spoken language programmes in Australia.

Our specialist transdisciplinary team assists each individual child and family using a coordinated approach, with a dedicated case manager or key worker who involves the family in all decisions related to their child’s care.

Hear and Say provides nearly 70% of its services to families of children with hearing loss living outside of the Brisbane metropolitan area and it is for this reason that it has opened centres in the Gold Coast, Sunshine Coast, Toowoomba, Cairns and Townsville. Our Telepractice programme ensures that families living remotely can obtain the same level of services from their lounge room, as those families accessing our centre-based programmes, reducing the cost and stress of having to travel to a centre.

The State Government provides some support however only through the support of Corporates, Philanthropists and the broader community, has Hear and Say been able to nurture the development of Queensland’s children with hearing loss, preparing them with age-appropriate speech, language and social skills to enter their local primary school – not a special school. Through these ongoing partnerships we are committed to continuing equitable and quality services across all regions and settings in Queensland. With no other full service delivery models like Hear and Say in Queensland, our pioneering programmes, forward-thinking approach and capacity to attract quality staff and international networks have allowed us to remain at the forefront of paediatric clinical and therapeutic excellence.

Hearing issues at any age affect a child’s social interactions, emotional development and academic performance. Hear and Say is collaborating on a number of projects to broaden our services so we can diagnose and treat children who may suffer late-on-set or temporary hearing loss throughout Queensland, especially at the commencement of their formal education journey.

The opportunity exists for the NDIA to increase their collaboration with proven service providers to deliver whole-of-life support for individuals and families impacted by hearing issues that meet their ongoing health, education and disability needs. Hear and Say is an NDIS Provider and already has a number of families, using this new national funding stream, selecting to obtain their support from Hear and Say.

Hear and Say has also developed a position statement which specifically looks at the impact of specialised Listening and Spoken Language programmes for children with hearing loss. This document and further discussion on the Joint Committee Inquiry Terms of Reference are attached.

Please do not hesitate to contact me if I may provide any further information or if there is an opportunity for me to present to the Joint Committee.

Yours sincerely,

Chris McCarthy Chief Executive Officer Hear and Say

COMMENTARY FOR CONSIDERATION REGARDING THE PROVISION OF HEARING SERVICES UNDER NDS

  1. Eligibility criteria for determining access to, and service needs of, deaf and hearing impaired people under the NDIS.

Section 25 of the NDIS Act recognises the importance of Early Intervention (EI) as part of the philosophical approach to the scheme as a social insurance scheme not a welfare system. This system being based on four main principles:

  • That funding is based on an actuarial estimate of the reasonable and necessary support needs of the target population;
  • That NDIS takes a whole of life view minimising total costs to the community by investing early to build capacity resulting in greater outcomes later in life;
  • Research and innovation is encouraged; and
  • NDIS will act at a systemic level, as well as funding individual needs.

Australia currently has a successful Universal Newborn Hearing Screening (UNHS) Program that identifies hearing loss in around 1.2 – 1.5 babies in every 1,000 born. The Nations’ decision to invest in UNHS recognises the importance of systematically identifying and addressing the profound impact of early childhood hearing loss. Accordingly children with any degree of hearing loss from birth clearly meet the EI requirements of having an impairment that is permanent, will undoubtedly benefit from EI reducing the child’s future needs for supports in relation to disability. Additionally ensuring access to NDIS funded Listening and Spoken Language (LSL) EI support for all children with hearing loss will potentially remove the disabling effect of the child’s hearing loss and provide the best opportunity for them to reach their full communication, social, emotional and academic potential in line with their hearing peers. Access to LSL EI for all children identified through UNHS will also prevent any further deterioration of, and in fact is likely to enhance, the child’s functional capacity.

All children identified with any level of hearing loss require support to achieve their full potential. Specialised LSL EI support means that these children have the opportunity to realise their full language, social, emotional, academic and life potential. The traditional definition and treatment of hearing loss does not address the needs of the majority of the children identified with hearing loss in this new millennium.

Opportunity

Recognise the importance of specialised LSL EI programs for ALL children with hearing loss and appropriately fund evidence based EI programs that are able to demonstrate their compliance with the key NDIS principles as outlined. Develop a reference package specifically targeted at LSL EI programs for children with hearing loss OR create a specially funded EI package for children with hearing loss that aims at achieving age appropriate, clear, natural LSL outcomes which minimise any future reliance of LSL EI program participants on the NDIS.

2. Delays in receiving services, with particular emphasis on early intervention services.

Queensland Department of Health funds a Healthy Hearing program with Family Support Facilitators as part of Childrens Health Queensland and work in partnership with families, Australian Hearing (AH) and non-government EI service providers to ensure that children identified with hearing loss as part of the UNHS program are supported and that delays in access to EI services are minimized. Hear and Say is supportive the international Joint Committee on Infant Hearing best practice guidelines for children with hearing loss which recognise the critical window of opportunity in which to diagnose and remediate hearing loss in infants for optimal outcomes. These timings advocate that:

  • All children should have access to hearing screening by no later than 1 month of age;

  • All children who do not pass the initial hearing screening and subsequent re-screening should have appropriate audiological and medical evaluations to confirm the presence of hearing loss by no later than 3 months of age.

  • All children with confirmed permanent hearing loss should receive EI services as soon as possible after diagnosis but by no later than 6 months of age. (Hear and Say would advocate that these EI services should be specialise, evidence based and recognize the home language of the child’s family)

Every child and circumstance is different however a hearing loss may affect a child’s opportunity to:

  • Develop age-appropriate speech and language,

  • Learn to read and write,

  • Initiate conversations,

  • Express their feelings and emotions,

  • Be included in social conversations and games,

  • Be fully included in large groups,

  • Develop confidence and self-esteem, and

  • Learn appropriate social behaviours.

There is a critical period for learning spoken language, and 85% of neural development happens within the first 3 years.

Opportunity

NDIS EI programs should recognise the neurological emergency that is newborn hearing loss and accept all children on diagnosis of hearing loss and ensure simplified referral pathways for families to access to specialised, evidence based EI programs in line with international best practice guidelines.

3. Adequacy of funding for hearing services under the NDIS.

Based on anecdotal evidence from other States, Hear and Say is concerned that proposed NDIS funding arrangements are inadequate for infants and children participating in a specialised LSL EI program. Having only a limited number NDIS participants in Queensland funded under NDIS, it is difficult to provide evidence around the gap between levels of funding provided to parents of children with hearing loss and actual costs of service delivery.

  With more than 95 % of children who are deaf or hearing impaired born to parents with normal hearing it is vital that NDIS funding models recognise the requirement for these children to be appropriately funded to participate in an intensive, evidence based LSL EI program.

Opportunity Ensure NDIS adopt a scalable model that provides adequate funding for specialised, intensive and evidence based EI programs which aim to achieve and maintain age-appropriate communication for all children with hearing loss.

  1. Accessibility of hearing services, including in rural and remote areas.

Current Federal Government funding models do not effectively fund Telepractice models and have not kept pace with evidence-based developments and innovations in clinical service delivery particularly in relation to Tele-therapy and Tele-mapping (not in scope for NDIS).

Hear and Say have undertaken extensive research in the provision of Tele-practice (both listening and spoken language therapy and remote programming of cochlear implants). There is a growing body of evidence that validates a Tele-practice model of care and Hear and Say research has shown that there is no significant difference in outcomes for those receiving services face-to-face versus through Tele-practice, for the services that we are delivering. We know that specialist services cannot be made available at all locations, however Tele-practice may offer a solution to better enable equity of access. Future NDIS funding models must incorporate tele-health services.

A contemporary approach to funding of remotely delivered health AND allied health services will enable service providers to offer a more flexible approach to service provision with no detriment to client outcomes and offer greater choice and access of specialist services for participants.

Opportunity Ensure Tele-practice services receive the same funding as face to face services ensuring better access to much needed specialist and allied health services and better utilisation of NBN in regional and remote areas. The health service delivery environment is changing and we hope that NDIS will ensure that allied health services are also funded when delivered remotely.

  1. The principle of choice of hearing service provider Research continues to demonstrate improved outcomes for children with hearing loss enrolled in Listening and Spoken Language (LSL) Early Intervention (EI) programs. Some of this research included below demonstrates how children who are deaf or with hearing loss:
  • Graduate from LSL EI programs with no gap between their chronological and language ages and developed spoken language in line with hearing peers
  • Made, on average, 12 months progress in 12 months for their language development, which is in line with expectations for children with normal hearing.
  • Progressed at the same rate for spoken language, self-esteem, reading and mathematics as a matched group of children with normal hearing.
  • Achieved age appropriate language as early as 6 months after amplification and around 12 months of age - when identified at birth and fitted with optimal amplification and enrolled in Auditory-Verbal Therapy before 12 months of age.
  • Performed better for language and listening than a matched group of children in an Auditory- Oral (listening and lip reading), or Bilingual-Bicultural program (AUSLAN and written English) by 3 years of cochlear implant use. The Hear and Say model of care, like many other EI programs, promotes a transdisciplinary approach and places the child and family at the centre of this team uniquely recognising the vital role parents play as the natural language teach of their child.

Importantly, Hear and Say connects a child to their first community, their family, and does this by acknowledging how that particular family community communicates and connects and recognises that the first language of that family is usually based on listening and spoken language.

Removing the handicapping nature of hearing loss by enabling age appropriate listening and spoken language outcomes provides an economic and qualitative benefit to the individual and the wider community. Due to the etiology of hearing loss (ie linkage to birth rates and known incidences of acquired hearing loss) the NDIS budget required to address this issue is finite and can be reasonably well estimated.

Attached to this submission is a document outlining in simple terms, but with accompanying research references, the need to offer access to listening and spoken language as the first option for all children with hearing loss titled Listening First: The Changing Face of Hearing Loss - Access to Listening and Spoken Language Should be the First Option for Children with Hearing Loss – Position Paper 2016.

Opportunity

Hear and Say supports the First Voice submission to this Inquiry highlighting the specific and increasing weight of evidence demonstrating that an appropriately funded LSL EI program for children who are deaf or with a hearing loss not only has significantly better life outcomes for the individual child and their family but also has positive economic and social impacts on the broader community.

Opportunities

6. The liaison with key stakeholders in the design of NDSI hearing services, particularly in the development of reference packages.

While Hear and Say is represented on the NDIA’s Early Intervention (Hearing) Expert Reference Group, the group has met infrequently and it remains to be seen if this limited contact has had any impact of the design of NDIS hearing services or reference packages.

Australia holds world leading knowledge and expertise in childhood hearing services and in partnership with the NDIS there is an opportunity to develop a best practice model of care for children with hearing loss.

It must be acknowledged that the Expert Reference Group does represent a wide range of service provider groups, peak bodies, parent representative bodies and others sometimes with differing views on the best approach to the design of NDIS hearing services and the development of reference packages.

Opportunity

Continue to enable the NDIA EI Intervention (Hearing) Expert Reference Group to influence the design of NDIS hearing services, and the development of the scheme’s reference packages.

7. Investment in research and innovation in hearing services

Hear and Say self-funds research and innovation within the organisation that works in collaboration with other parties and on ‘in-house’ initiatives to provide an evidence base for the vital clinical work done by the organisation each day for children with hearing loss and their families.

Hear and Say research and innovation acts as a catalyst for bringing together many innovative minds working together to enhance hearing health and to bridge the gap between science and better hearing for all. Currently our research scope includes:

  • Innovation in hearing devices;
  • Neurodevelopmental basis of listening and spoken language;
  • Treatment of hearing loss in newborns;
  • Prevention of hearing loss in children and adults;
  • New techniques fast-tracking auditory brain development in children with hearing loss, resulting in better listening and spoken language development;
  • Creative solutions to better understanding of spoken language;
  • Telemedicine for hearing health management for children and adults in rural and regional area;
  • e-Learning strategies for training hearing health professionals and research collaborations;

The rollout of NDSI brings with it a significant risk of EI service providers that are not delivering services in line with evidence based best practice. It is important that the NDIS recognise and partner with EI programs, peak bodies and representative groups that are undertaking research and / or delivering demonstrable, quality outcomes for children with hearing loss and their families.

Opportunity

Maintain the NDIA EI(Hearing) Expert Reference Group to ensure the ongoing development of guidelines for the delivery of best practice, evidence based EI programs

8. Other related matters - Break the Sound Barrier

Hear and Say is also an advocate and contributor to the ‘Break the Sound Barrier’ campaign being coordinated the Deafness Forum of Australia and principally supports the six-point plan outlined to improve the lives of people living with hearing conditions. Additionally, Hear and Say supports the call to make Hearing Health number 10 on the Federal Government list of National Health Priorities.

Specifically, Hear and Say is already working on three of the six points outlined in the campaign, specifically action items / steps:

  • (1) hearing checks for all children at key stages of life;
  • (2) providing a national hearing awareness promotion campaign; and
  • (6) not letting children fall through the gaps with changes to the way hearing services will be delivered across Australia.

More information on Hear and Say can be found at www.hearandsay.com.au. More details on the Break the Sound Barrier campaign can be found here http://breakthesoundbarrier.org.au/

Listening First: The Changing Face of Hearing Loss

Access to Listening and Spoked Language

Should be the First Option for Children with Hearing Loss

Position Paper

2015

Hear and Say – Centre for Deaf Children Ltd ACN 058 430 069 Postal Address PO Box 930, Toowong QLD 4066 P +61 7 3870 2221 | F +61 7 3870 3998 | E mail@hearandsay.com.au | www.hearandsay.com.au ABN No 32 058 430 069

Children with Hearing Loss Have

the Potential to Listen and Speak

Hearing loss is the most common disability in Professional estimates suggest that more than 90% of children born with hearing loss have the physical structures of the ear present that would allow them to receive maximum listening benefit from modern 92% of children with permanent hearing loss hearing technologies such as digital hearing are born to hearing parents (Mitchell & aids, middle ear implants or cochlear Karchmer, 2004). implants (Adunka et al., 2006; Rance, 2005).

This means that each year, babies will continue to be born with hearing loss, and Advances across the range of modern often to families with no immediate family hearing technologies have meant that members with hearing loss themselves. more children are now able to be optimally amplified. This, combined with changes in The remaining 8% of children with candidacy criteria for implantable devices, persistent hearing loss have one or both has meant that the vast majority of children parents with a hearing loss, and who may with hearing loss have the potential to learn also identify themselves as culturally Deaf. to listen and speak if provided with the opportunity to do so.

All babies are born with their brains pre- wired to learn listening and language from birth (Flexer, 1999).

There is a critical period for learning spoken language, and 85% of neural development happens within the first 3 years (Shonkoff & Phillips, 2000). The key to developing clear, natural spoken language is early access to the auditory brain.

Children with Hearing Loss are Born to Hear

Page 2

Auditory-Verbal Therapy

Auditory-Verbal Therapy is Most Effective for Developing

Listening and Spoken Language

Listening and Spoken Language

to maximise listening and spoken language enabling children to make meaning of what development, children with hearing loss they hear and laying down neural pathways require optimal amplification in for speech and language development combination with specialised listening and (AG Bell Academy for Listening and Spoken spoken language early intervention. Language 2013; Chermak et al. 2007; Cole & Flexer 2007). Amplification alone does not allow for optimal spoken language development Recent research is showing that learning (Wilkins & Ertmer, 2002). through listening is the most effective way of developing spoken language, cognition and literacy skills (Cole & Flexer, 2007).

                                            Auditory-Verbal Therapy, with its foundation
                                                        in teaching through  listening, has been
                                      proven to be most effective in developing
                                          the spoken language and  educational
                                    outcomes of children with hearing loss.

In Auditory-Verbal Therapy, parents are valued members of the early intervention team. In partnership with the Auditory- Verbal Therapist, parents are guided and coached to facilitate their child’s spoken language development through listening.

Children with Hearing Loss are Born to Hear

                                                                                           Page 3

What is Research Telling Us?

amplification and around 12 months of age

Our research shows that children with hearing loss in an Auditory-Verbal Therapy program:

  • Graduated with no gap between their chronological and language ages and developed spoken language in line with normally hearing peers (Constantinescu, Waite, Dornan, Rushbrooke, Brown, Close & McGovern, submitted).

  • Performed better for spoken language and listening than a matched group of children in an Auditory-Oral (listening and lip reading), or Bilingual-Bicultural program (AUSLAN and written English) by 3 years of cochlear implant use (Dettman, Wall, Constantinescu, & Dowell, 2013).

  • Made, on average, 12 months progress in 12 months for their spoken language development, which is in line with expectations for children with normal hearing (Dornan, Hickson, Murdoch, & Houston, 2007, 2009; Dornan, Hickson, Murdoch, Houston, & Constantinescu, 2010; Rhoades & Chisolm, 2000).

  • Progressed at the same rate for listening, spoken language, self-esteem, reading and mathematics as a matched group of children with normal hearing (Dornan, Hickson, Murdoch, Houston, & Constantinescu, 2010).

The Australian Context and the Changing Face of Hearing Loss

This is the changing face of hearing loss and these babies are in the best position to receive maximum benefit from listening and spoken language intervention within the critical period of neural development.

350 children are born with hearing loss each year in Australia and every child counts (Ching, 2013).

In the 21st Century, early diagnosis via Universal Newborn Hearing Screening (UNHS), early access to optimal amplification (hearing aids and/or cochlear implants) and early intervention is now the norm in Australia.

There is now the evidence and opportunity to support and set listening and spoken language as the benchmark for all children with hearing loss.

The Hear and Say Auditory-Verbal Therapy program in Queensland is currently supporting approximately 65% of Queensland young children diagnosed with hearing loss in Australia and for progress and outcomes to be matched against objective evidence.

Hear and Say has an established track record of spoken language outcomes for children with hearing loss, where 100% of graduates over the last few years have entered mainstream schooling. In 2012, the typically developing children with hearing loss who graduated from Hear and Say had spoken language skills in line with their hearing peers.

Babies are also entering early intervention programs soon after birth, and this steady trend is estimated to continue long-term.

At Hear and Say, these outcomes are now the norm (Hear and Say, 2012).

What Parents, Professionals and the Community Should be Asking their Early Intervention Provider

Hear and Say’s strong focus on research outcomes has meant that research is guiding evidence-based practice; helping to set clinical benchmarks for spoken language expectations and progress for children with hearing loss; and ensuring that parents are best informed about the potential outcomes that are achievable for their children.

New research evidence, advances in hearing technology and changing candidacy criteria are now driving change in the expectation for maximum spoken language outcomes for children with hearing loss. Parents, professionals and the broader community should, and are entitled to, expect these optimal outcomes from early intervention service providers.

As a community, we should also expect all early intervention service providers to have answers, based on research evidence, to the following questions:

  • What experience do you have working with children with hearing loss?
  • What communication and educational philosophy does your program follow?
  • What research evidence shows that your early intervention program is effective?
  • How is your program different, more effective than other programs?
  • What is the commitment of families to your program?
  • How do you measure outcomes?
  • What outcomes can be expected in your program and how do these outcomes compare for children with normal hearing?
  • Do most children go on to mainstream schooling?
  • Will children be able to interact with and contribute independently to the broader community?
  • What are the risks in choosing this early intervention approach?
  • What happens if your program doesn’t work for a particular child and family?

References

Adunka, O., Roush, P., Teagle, H., Brown, C., Zdanski, C., & Jewells, V, et al. (2006). Internal auditory canal morphology in children with cochlear nerve deficiency. Otology & Neurotology, 27(6), 793-801.

AG Bell Academy for Listening and Spoken Language. (2013). The AG Bell Academy for Listening and Spoken Language. See http://www.listeningandspokenlanguage.org/AGBellAcademy/(last checked 1 Jan 2013).

Australian Hearing. (2013). Types of Hearing Loss. See http://www.hearing.com.au/types-of-hearing-loss(last checked 1 July 2013).

Canalis, R.F., & Lambert, P.R. (2000). The ear: Comprehensive otology. Philadelphia: Lippincott Williams & Wilkins Genetic hearing loss may be autosomal dominant, autosomal recessive, or X-linked (related to the sex chromosome).

Chermak, G., Bellis, T., & Musiek, F. (2007). Neurobiology, cognitive science and intervention. In G. Chermak & F.Musiek(Eds.), Handbook of (central) auditory processing disorder: Vol. 2. Comprehensive intervention(pp. 3- 28). San Diego, CA: Plural Publishing.

Ching, T. (2013). Do children with hearing loss who receive early intervention catch up with their normal- hearing peers by elementary grades? Australian Hearing Hub Inaugural Conference, Sydney, April 2013.

Cole, E., & Flexer, C. (2007). Children with hearing loss: Developing listening and talking birth to six. San Diego, CA: Plural Publishing.

Constantinescu, G., Phillips, R., Davis, A., Dornan, D., & Hogan, A. (submitted). Benchmarking social inclusion for children with hearing loss in listening and spoken language early intervention.

Constantinescu, G., Waite, M., Dornan, D., Rushbrooke, E., Brown, J., Close, L., & McGovern, J. (submitted). Outcomes of an Auditory-Verbal Therapy program for young children with hearing loss.

Dettman, S., Wall, E., Constantinescu, G., & Dowell, R. (2013). Communication outcomes for groups of children using cochlear implants enrolled in Auditory-Verbal, Aural-Oral, and Bilingual-Bicultural early intervention programs.Otology & Neurotology, 34, 451-459.

Dornan, D., Hickson, L., Murdoch, B., & Houston, T. (2007). Outcomes of an Auditory-Verbal program for children with hearing loss: A comparative study with a matched group of children with typical hearing. The Volta Review, 107, 37-54.

Dornan, D., Hickson, L., Murdoch, B., & Houston, T. (2009). Longitudinal study of speech and language for children with hearing loss in Auditory-Verbal Therapy programs. The Volta Review, 109, 61-85.

Dornan, D., Hickson, L., Murdoch, B., Houston, T., & Constantinescu, G. (2010). Is Auditory-Verbal Therapy effective for children with hearing loss?*The Volta Review,*110, 361-387.

Flexer, C. (1999).Facilitating hearing and listening in young children(2nd Ed.). San Diego:Singular Publishing Group.

Fulcher, A., Purcell, A.A., Baker, E., & Munro, N. (2012). Listen up: Children with early identified hearing loss achieve age-appropriate speech/language outcomes by 3 years-of-age.International Journal of Pediatric Otorhinolaryngology, 76,1785-1794.

Hear and Say(2012). Annual Report 2011-2012.

Hogan, S., Stoke, J., White, C., Tyszkiewics, E., & Woolgar, A. (2008). An evaluation of AVT using rate of early language development as an outcome measure.Deafness and Education International, 10(3), 143-167.

Mitchell, R.E., & Karchmer, M.A.(2004). Chasing the mythical ten percent: Parental hearing status of deaf and hard of hearing students in the United States.Sign Language Studies, 4(2), 138–163.

Rance, G. (2005).Auditory neuropathy/dys-synchronyand its perceptual consequences.*Trends in Amplification,9, 1- 43.

Rhoades, E.A., & Chisolm, T.H. (2000). Global language progress with an Auditory-Verbal approach for children who are deaf and hard of hearing.The Volta Review*, 102, 5-24.

Shonkoff, J.& Phillips, D.A. (**Eds.).(2000). From neurons to neighborhoods.Washington, DC:Nat Academy of Science. Wilkins,M.,&Ertmer,D.(2002).Introducing youngchildrenwhodaredeorhardofhearingtospokenlanguage: Child’s Voice,an Oral School.Language,Speech,and Hearing ServicesinSchools,33(3), 198-204.

The Auditory-Verbal Therapy Program

Introducing Hear and Say provides early intervention from diagnosis of hearing loss through to entry into Year 1 of school.

Hear and Say is one of the leading paediatric Auditory-Verbal Therapy (AVT) and Implantable Hearing Technologies (including cochlear implants) organisations in the world.

For 22 years this not-for-profit organisation has worked with parents to help teach children who are deaf to hear, listen and speak.

The main centre is in the inner Brisbane suburb of Auchenflower, with 5 regional centres in the Sunshine Coast, Gold Coast, North Queensland, Townsville and the Darling Downs.

Hear and Say also runs a dedicated telepractice program for rural and remote families using eAVT and eAudiology.

Brisbane Centre & Registered Office: 29 Nathan Avenue, Ashgrove QLD 4060 PO Box 930, Toowong QLD 4066 Regional Centres: -Sunshine Coast - Nambour -Gold Coast - Robina -Darling Downs - Toowoomba -North Qld - Cairns & Townsville Telepractice Program for rural and remote families using eAVT and eAudiology

Contact Information: -(07) 3850 2111 -mail@hearandsay.com.au -www.hearandsay.com.au -ABN 32 058 430 069

Children with Hearing Loss are Born to Hear