Final Word | October 2013 Hearing Review
By Dennis Van Vliet, AuD
My granddaughter is 7 years old. She likes drawing pictures; acting out complicated stories to tell to any audience she can gather; has taken the training wheels off of her bicycle; loves the trampoline; could spend the entire day in a swimming pool if we would let her; and is at grade-level academically. She is also on the autism spectrum.
The autism spectrum is very broad. It is broad enough that we can easily understand the often repeated quote: “If you have seen one child with autism, you have seen one child with autism.” We can expect that the next one we see will have different needs and capabilities. These children need specialized and individualized educational treatment to accommodate for their needs.
This fall, I attended an Individualized Educational Plan (IEP) meeting at her school district. Expert resources we contacted told us that the theme of the meeting should include strategies that will help her obtain “Access to the educational curriculum.” Any goals for speech and language should be phrased in a way to describe “meaningful communication” as opposed to rote responses, vocabulary, and sentence complexity. The meeting should address our expectations as family members for her future over the long run, not just what she can do, or behaviors she shouldn’t exhibit today. The meeting was to refine a plan for this school year and beyond.
I can’t help but compare this to meetings I have attended over the years for hearing-impaired children. The problem of access to the academic curriculum is for different reasons, yet the comprehensive process and the ultimate goals are similar.
Developing a Process and Goals for Our Patients
Think about our approach to patients as they walk into our offices. Do we talk to the family and the individual as unique individuals, or do we plug them into a category and take a familiar approach that is convenient for us?
In the case of my granddaughter, we know that she can learn, but she learns differently than the other second graders, and accommodations need to be made to ensure access to the curriculum. She cannot be plugged into a typical classroom, and a typical catch-all resource room probably won’t work either. Accommodations need to be based on what works for her.
A careful review of patient needs and a good action plan apply to many complex situations. Further, the best action plans often come from well-informed stakeholders with a common goal.
It shouldn’t be different with any patient we see. They need access not only to sound in general, but to specific sounds in a variety of environments. In my experience, initial patient complaints about their hearing are often rather vague and it takes some digging to find out what situations are problematic, and what priorities we need to place on the accommodations necessary for their success.
Patient self-advocacy and understanding the concept of teamwork. The process will involve work on our part, as well as work on the part of the patient. Do we clearly outline the fact that our patients need to be active participants in the process? A complaint about difficulty hearing in noise is all too common from our patients. Hearing aids alone won’t often resolve the issue. Once we have met our objectives for audibility and comfort, it is mostly up to the patient to get busy with recommended rehabilitative efforts—and active advocacy for themselves. Many complaints may be resolved with better seating arrangements in social situations or in restaurants. More advantageous seating doesn’t happen without self-advocacy.
In the case of an IEP in a school setting, the responsibilities of the team involved are carefully outlined in a legal document that serves as a foundation for what happens in the coming school year. If things aren’t working out, the team gets together and reworks the plan. That’s what happened at the meeting I attended; the team couldn’t come to an agreement because of “staffing limitations” that prevented them from offering a plan that everyone could agree upon. The school was offering a “plug in” that didn’t match up well with the student’s needs. Resolution of the conflicts will take additional meetings and undoubtedly compromises.
With our patients, we have the opportunity to establish a cooperative agreement from the start. Any limitations of the hearing loss and the patients’ ability to participate in rehabilitation or advocacy may be addressed and documented up front, and accommodated for as best as possible in the treatment plan that is developed. In the case of hearing aids, if a patient needs features that require a larger custom aid, or a standard BTE or RIC product, and cannot accept the possibility of a hearing aid that may be seen by others, a compromise will need to be made at the time of the treatment plan.
With a collaborative effort, a reasonable solution may be agreed upon.
The Final Word? A careful review of the needs and an action plan apply to many complex situations. It makes good sense to plan ahead and develop a plan that fits for all stakeholders. The best plans often come from well-informed stakeholders with a common goal. We don’t need a legal document, but a well thought out plan is crucial.
About the Author
Dennis Van Vliet, AuD, has been a prominent clinician, columnist, educator, and leader in the hearing healthcare field for nearly 40 years, and his professional experience includes working as an educational audiologist, a private-practice owner, and VP of audiology for a large dispensing network. He currently serves as the senior director of professional relations for Starkey Technologies, Eden Prairie, Minn. Correspondence can be addressed to HR or: [email protected]
Citation for this article: Van Vliet D. Developing a personalized plan for a successful hearing rehabilitation approach. Hearing Review. 2013;20(11):62.
October 2013 Hearing Review