The impact of mild and moderate deafness in the classroom

Vicki Kirwin, Audiology Specialist, NDCS

Vicki Kirwin, Audiology Specialist, NDCS

New research carried out by The Ear Foundation, with funding from the National Deaf Children’s Society (NDCS), is being published today. The research highlights issues that children with mild to moderate deafness encounter, gathered from the views of their parents and Teachers of the Deaf.

I previously blogged about mild deafness when NDCS ran a pilot weekend for families with children with mild deafness, who reported similar feelings to the new report findings. Common themes included lack of understanding of the impact of mild to moderate deafness on family and education and a belief that the terms “mild” and “moderate” are not helpful in describing the potential impact for a lot of children.

This blog provides a reminder of the impact of mild and moderate deafness and explores why this impact is so often overlooked.

Impact of mild deafness

  • A child can usually hear everything that is said to them in a quiet room, but not if there is lots of noise present or they are far away from the speaker.
  • A child would not be able to follow a whispered conversation.
  • Some children with mild deafness use hearing aids.
  • A child with glue ear will usually have mild deafness.
  • A child with mild deafness will miss 25% to 50% of the teacher’s voice in a classroom.
  • The teacher’s voice is typically heard at about 70dB at the front and 40 dB at the back of the class. A child with mild deafness (21-40 dB) will typically not hear anything of the teacher’s voice at the back of the class.

Impact of moderate deafness

  • Most children with moderate deafness use hearing aids.
  • Without their hearing aids, they could hear most of what someone says to them in a quiet room as long as they speak clearly, but could not follow a conversation in a large group, if there is lots of background noise or they are far away from the speaker.
  • A child with moderate loss will miss over 50% of the teacher’s voice in a classroom.

Why is the impact of mild and moderate deafness so often overlooked?
Adults can find it very difficult to understand the impact of mild and moderate deafness on children. This is because any child they meet with a mild and moderate deafness is likely to have clear speech and be able to answer questions asked directly of them. But classrooms are typically noisy and background noise can have a significant impact on speech understanding for a child with mild and moderate deafness. This is because the adult brain is much better at filtering out background noise than a child’s.

Also, the adult brain is very good at filling in the gaps of missed information – speech sounds or parts of words – that weren’t heard. Children with mild and moderate deafness are not able to do this – they lack the knowledge, vocabulary and context to be able to fill in the gaps. This means they miss out on a lot of the new vocabulary and concepts being taught every day at school.

Diagnosis
Newborn hearing screening does not usually identify mild hearing loss in very young babies because it is designed to pick up greater levels of deafness, and many children develop hearing loss during early childhood. It is important that parents and health professionals are vigilant about the child’s development and refer them to an audiologist at any stage if they are concerned about their hearing or speech development.

Parents’ views should be taken seriously. If they have concerns about a child’s hearing they should be referred for testing without delay.

Once a hearing loss is identified it’s vital a child is offered information, advice and possibly hearing aids or other intervention as soon as possible. It isn’t acceptable that they wait longer because their hearing loss is viewed as being more borderline or not as ‘significant’ as other children’s.

What can be done to help?
The research report calls for more support to parents and young people with mild and moderate deafness. It also calls for teachers to have greater awareness of the impact that mild and moderate deafness can have and for local authorities to ensure that services are sufficiently resourced to provide the necessary support.

NDCS’s website has more information about the resources available to families of children with mild or moderate deafness.

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NEW Devon CCG abandons plans to ration hearing aids! Four reasons why this decision would have breached the CCG’s statutory duties.

Image of Sarah Collinson, NDCS Regional Director for the South West

Sarah Collinson, Regional Director for the South West

The North East and West (NEW) Devon CCG has confirmed that it has abandoned its decision to ration deaf patients over the age of 18 to just one NHS hearing aid. The policy to restrict hearing aids had been announced in an ‘Urgent and Necessary Measures’ notice issued in December and was intended to affect all adult hearing aid users in the NEW Devon CCG area; the only exceptions would be people with additional sensory disabilities and patients with conditions such as autism ‘where social cues may be particularly important.’

As NDCS supports young deaf people into early adulthood and campaigns for all deaf children and young people to have access to good quality audiology care, the NEW Devon CCG’s moves called for a swift response, not only because it was due to be introduced with immediate effect, but also because other cash-strapped CCGs might be considering similar measures and would be watching the Devon situation closely.

With local campaign action by NDCS members, regional TV news coverage and letters to the CCG and local MPs, we pulled out all the stops to try to convince the CCG to think again. Along with pressure from Ben Bradshaw MP and Action on Hearing Loss, our action seemed to pay off, with the CCG announcing shortly before Christmas that it would suspend the decision to ration hearing aids until the issue had been considered by its Clinical Policy Committee (CPC).

When I discovered that the CCG’s Governance Committee was to look at the issue again in early January, I sent a second letter to the CCG’s Chair outlining our concerns with the proposed policy and highlighting a number of key areas where it would seem to breach the CCG’s statutory duties under the NHS Constitution and the Health and Social Care Act (HSCA). This additional pressure has borne fruit, as just a few days after looking at the issue again, the CCG has announced a complete U-turn, with the rationing of hearing aids now entirely shelved.

In case other CCG’s might have been thinking of restricting adults’ hearing aids in this way, it’s worth highlighting the main reasons why they would be wrong to do so, as I pointed out to the NEW Devon CCG:

  • The CCG is duty-bound under the NHS Constitution and the HSCA to promote equality through the services that it provides and to pay particular attention to groups or sections of society where improvements in health are not keeping pace with the rest of the population. Deaf young adults are already significantly more likely to suffer mental health problems and face higher barriers to education; deaf people are four times more likely to be unemployed that hearing people. Any measure that will compromise their ability to use their hearing as effectively as possible will exacerbate these risks and disadvantage them further.
  • Patients have the right to expect local decisions on funding of treatments to be made rationally following a proper consideration of the evidence. NEW Devon claimed in the Urgent and Necessary Measures notice issued in December that ‘Evidence suggests that correcting hearing in the second ear … is far less cost-effective even though people derive some benefit from it.’ Yet, for 20 years or more, binaural aiding has been universally accepted as the most appropriate and effective treatment for the majority of cases of bilateral hearing loss. Not only would we dispute the apparent cost-savings to be made for the CCG, but we can’t accept that one hearing aid is as good as two. In fact, there is evidence that bilaterally deaf hearing aid users are disadvantaged if they have to rely on one-sided hearing. Hearing with just one ear or one hearing aid leads to problems for the brain processing sounds, understanding speech in background noise and localising the source of a sound.
  • The NHS Constitution also gives patients the right to be given information about the risks of treatment options available. The CCG’s Urgent and Necessary Measures notice didn’t mention the risks of one-sided aiding for people who are deaf in both ears. This would have to be taken into account in any comparative cost-benefit analysis of providing one hearing aid instead of two. Quite apart from the heightened risk of mental health problems and other comorbidities, there is also a risk of monaural aiding of bilaterally deaf people doing harm to the patient by causing non-reversible auditory deprivation to the unaided side. In a significant number of patients, auditory deprivation has been found to be significant and irreversible, and it isn’t possible to predict which patients are likely to be affected in this way.
  • The Health and Social Care Act stipulates that the CCG must make arrangements to ensure that individuals to whom the services are being provided are involved in the development and consideration of proposals where the proposals would have an impact on how services are delivered or the range of health services available. To our knowledge, the CCG conducted no consultation with patients and other stakeholders on possible hearing aid rationing prior to issuing the Urgent and Necessary Measures notice in December. The lack of transparency around the Quality and Equality Impact Assessment that should have been undertaken in advance of making any decisions on this issue  is very worrying, particularly given the substantial negative impacts that hearing aid rationing would have on large numbers of deaf people  across Devon.

We are relieved at NDCS the restriction on provision of NHS hearing aids has been abandoned in Devon, at least for now. However, we will have to remain vigilant going forward, not only in Devon but also nationally, in case other CCGs seek to address financial shortfalls with similarly crude and potentially harmful rationing measures.

URGENT: NEW Devon CCG restricting deaf young adults to just one hearing aid!

Liz Partridge, Campaigns Manager

Liz Partridge, Campaigns Manager

NEW Devon Clinical Commissioning Group (CCG) has recently made an extremely concerning decision to restrict deaf adults (18 yrs and upwards) to just one hearing aid, meaning they will no longer pay for a second hearing aid for deaf young adults with bilateral hearing loss.

Not only is this decision shocking because of the potential impact it will have on deaf young adults but we also believe this decision has been taken without a full consultation with those the decision will impact on. We are working hard to seek a reversal of this decision, and we hope you can help.

Take action!
If you live in Devon, I urge you to complain to NEW Devon CCG about this. Please note this CCG does commission services in most areas in Devon, but if you live in some parts of South Devon you may want to double check which CCG provides services in your area before complaining. NEW Devon CCG does include both Plymouth and Exeter.

You can email your complaint to: pals.devon@nhs.net or complaints.devon@nhs.net , telephone on 01392 267 665 or 0300 123 1672 or text them for a call back on: 07789 741 099.
You may wish to include the following points in your complaint:
• Reverse this decision immediately
• This decision will have a severe impact on young adults at a critical time in their life when an emphasis should be placed on maximising hearing so that deaf young adults are able to fully access further education and/or early working life.
• I am aware that one of your equality objectives states that you will produce an Equality Impact Assessment (EIA) for all changes to new policies and you have said they will publish an EIA within or next to the relevant document on their website. However I cannot find evidence of this EIA. Please can you publish this information immediately as I want to know that deaf young people were properly consulted before this decision was made.

Please do also include your own personal stories as well, if applicable.

When you receive a response please forward it to us at: campaigns@ndcs.org.uk

You could also contact your MP about this issue and ask them to contact NEW Devon CCG about their decision. You can find out who your MP is here: http://www.theyworkforyou.com/mps/

We are currently in talks with the CCG and have already achieved some media coverage. We will provide further updates shortly.

We need to take action now to put pressure on the CCG to reverse this shocking decision!

International Week of the Deaf

NDCS Campaigns Blog - Suzanne Lagan, Deaf Child Worldwide

Suzanne Lagan, International Communications Coordinator

22nd – 29th September, is International Week of the Deaf 2014. Many of Deaf Child Worldwide partner organisations will mark this week with a range of events and activities to raise awareness of deafness around the world. With the spotlight already on the issue, many of our partners are taking this opportunity to campaign for rights and improved services for deaf people around the world.

Samuha, a Deaf Child Worldwide partner in Karntaka, India have planned a procession expected to be attended by over 500 people. The procession will end at the Tahasildar (revenue administrative office), where they will present a memorandum reminding the Government of their commitments to deaf people including provision of housing and hearing aids.international week of the deaf

Across the country in West Bengal, Deaf Child Worldwide partner organisation SUK are leading a workshop on the development and empowerment of persons with disability. Over 200 attendees are expected including the State Commissioner of Disabilities of West Bengal State and other Government officials, making this an excellent opportunity to raise awareness, to highlight needs of deaf people and to hold Governments accountable.

In Kenya, we support the development of a Young Deaf Advocacy Group through our partner Undugu, who have arranged meetings with key stakeholders including the Ministry of Youth Affairs to discuss the need for inclusive programmes to support deaf youth.

This is just a snapshot into some of the exciting campaigning activities planned throughout the week across the world. Please follow us on twitter #DeafchildWW and our website for more news throughout the week.

Isabel and Matthew’s Story: Right support, bright future

Isabel Matt and Brody

Isabel, Matthew and Brody (Photographer- Diana Martin)

Matthew and I are profoundly deaf and genetically on paper we were aware there was a 50/50 chance of having a hearing impaired child (Matthew comes from a family of five deaf generations, I have hearing parents, one hearing sister and one deaf sister). Throughout my pregnancy we were so sure our baby was hearing when I dropped a plate and he moved in my tummy! In June 2013, I gave birth to Brody at Whipps Cross Hospital, Waltham Forest in a water pool and the very next day he failed his first hearing test which is normal for most babies born in water.

Afterwards, we were told that there’s a special machine which bypasses the water in the ears.  An appointment will be made for Brody to have this in one week or so, but then it was done immediately 30 minutes after the first hearing test. She came back and put sticky electrodes on Brody’s face and head. He was furious! It was a 20 minutes test and we stopped after 5 minutes. We felt it was very intrusive. Brody failed his second test then the third test which was four hours long at Wood Street Health Centre with the audiologist who we couldn’t lip-read.

We started to lose patience but Brody slept peacefully through it all. We were told that Brody had a mild to moderate hearing loss. We were very confused and expected a very straightforward answer which was – profoundly deaf or severely deaf. We left quickly and looked up on the Internet and were surprised to see mild to moderate hearing loss does exist. We knew there was varying degrees of hearing loss but wasn’t aware that it was called “mild to moderate”.

Living in the Redbridge borough of East London, using Waltham Forest & Redbridge council services, we were given support straight away after Brody was diagnosed hard of hearing. Suddenly we had access to everything we did not know about before he was born: Coffee mornings at Early Years Centre EaST 17 in Walthamstow, Roding School in Roding Valley with Parent Workers, and other parents with deaf children.

Brody got his own Teacher of the Deaf with her monthly visits. She even helped out with his nursery by teaching the staff deaf awareness and answering all of our questions! He has been to speech therapist twice at Redbridge Children’s Speech & Language Therapy Service and an interpreter was provided both times. Audiology appointments were at Whipps Cross University Hospital Audiology Service Hearing Assessment Centre where he had his hearing aids fitted at 4 months old with cool red ear moulds! The tests showed he responded much better to sounds with his hearing aids than without. We felt really lucky with the rich resources out there available for our child.

Overall, I found the speech therapy appointments the hardest because of the language development and skills that are required at his age. Brody is very vocal but I can’t make out what vowel and sound he is making, but at home we make sure we teach him all sounds like music, animal noises and buy musical toys. Brody likes to create sounds by himself by banging the saucepans!

With our own mixed experiences growing up deaf, we want the best for Brody and we make sure we use our voices and BSL with him since he was a baby; he has turned out to be a very attentive happy little fella. Without all the support we are receiving for Brody, especially his Teacher of the Deaf (she’s a godsend!), we would definitely struggle with how to go forward with Brody’s deafness and for him to fit in with society, to make sure he is treated as an equal with his hearing peers and not to be isolated. We believe this won’t be the case because we are confident Brody’s interests are being cared for.

We feel the future is bright for Brody who is 13 months old as there are hearing members of his maternal family, whilst also having Deaf members of his family to guide him through his life. We feel reassured that the outcome of this environment means he will have the best of both worlds. Knowing NDCS is out there challenging cuts to deaf children’s services like Teacher of the Deaf support, to ensure families like ours get the best services they can is great. Please join us as members of the Campaigns Network today to ensure every deaf child receives the support they need.

 

 

Arti’s story: Fighting every step of the way

Arti Patel

Arti Patel, Membership Assistant

In 1994, my parents made the biggest decision of my life. They decided I would have a bone anchored hearing aid (Baha). Today, I sit here with the biggest smile on my face and say it was the best decision they ever made for me.

I was born with Treacher Collins Syndrome and a moderate hearing loss. At 2 years old, after much pushing from my parents, I was diagnosed with a hearing loss and fitted with the behind-the-ear hearing aids. Although these worked well, they weren’t the best for me.  When I was fitted my Baha, my parents noticed a huge difference and they were very happy with the results.

Arti blog

Arti, aged two

However, it wasn’t all plain sailing. First they had to fight for me to get the Baha. Then after I started school, they had to push for my educational support. It was a fight to maintain the support I received during the later years of school such as a fab Teacher of the Deaf and to ensure that I had a Statement of Special Educational Need. It was one battle after another, but they never stopped believing in my ability and fought for me every step of the way.

I’m pleased to say all their efforts were worth it. Currently, I work as a Membership Assistant at NDCS and I couldn’t be happier. To be a part of a charity that helps to ensure all deaf children can reach their full potential fills me with gratitude. I’m often asked why I work for NDCS. My reply is simple. It fills me with great horror to see that some children are not getting the same opportunities as I did and I must be part of a team that does something to change this.

That’s why I joined the NDCS Campaigns Network. I get all the latest information about their campaigns and advice about how I can support their work and raise awareness. So, why not join me and make a difference for deaf young people?

10 things GPs in Wales should do for deaf patients

Elin

Elin Wyn, Policy and Campaigns Officer for Wales

Did you know that deaf people in Wales have certain rights when they go to see their doctor?

The NHS in Wales has published a set of Standards on Accessible Communication and Information for People with Sensory Loss. These standards tell GPs and hospitals what they should be doing to make sure deaf people hear and understand everything they need to know about their healthcare needs. This should make it easier for deaf young people to become more independent when they visit the GP. And to make life easier for you here are 10 things GPs in Wales SHOULD be doing to help deaf patients:

1)   Asking patients what communication needs they have.

2)   Setting up a flagging system to record that information on the patient’s paper or computer record.

3)   Checking that the environment encourages effective communication – e.g. checking lighting and background noise

4)   If a patient is referred from the GP to a hospital the GP should also transfer information about their communication needs.

5)   Patients should be able to make appointments in different ways e.g. by email, texting, textphones and websites.

6)   The GP reception and consulting rooms should be fitted with a hearing loop and staff should know how to check they are working.

7)   Reception staff should have arrangements in place to make sure deaf people don’t miss their appointment.

8)   Every patient who needs communication support should have it – and it’s the GP practice that should arrange this and that pays for this support.

9)   All staff should be trained in how to communicate effectively with deaf people

10)   The GP practice should promote the different forms of communication that are available to deaf patients.

These standards are a part of your rights as a deaf young person in Wales. If your GP doesn’t do these things you can complain to the Local Health Board that your GP practice is not sticking to the Standards on Accessible Communication.

For advice for deaf young people on visiting the GP independently have a look at our “My life my health” resources.