Materials for primary care providers
Children who are deaf or hard of hearing face a potential developmental emergency and should be identified as quickly as possible so that appropriate intervention services can be started. The AAP provides a comprehensive overview of Early Hearing Detection and Intervention (EHDI).
Early diagnosis and intervention, and avoiding language deprivation are crucial to the development of speech, language, cognitive, and psychosocial abilities. The Joint Committee on Infant Hearing (JCIH) guideline is 1-3-6: screening by one month of age, diagnostic testing by three months, and early intervention (EI) services initiated by six months.
Where to have diagnostic testing?
Early Intervention
The key role of EI is to provide an enriched language environment as early as possible to the infant’s developing brain and promote optimal early language learning during this sensitive period of development (1).
Who should be referred?
- Infants who have been diagnosed with permanent hearing loss of any degree (that includes mild and unilateral or bilateral) are eligible for EI services in MA at no cost to the family.
- Infants suspected of having hearing loss may be referred to EI although a diagnosis has not yet been confirmed. Clinical judgement can be used to initiate the referral.
- Children who have certain diagnosed conditions quality for EI (i.e. cleft lip and palate, microtia/atresia, Congenital CMV, Trisomy 21, etc). The complete Diagnosed Conditions List can be found in the Massachusetts Department of Public Health Early Intervention Operational Standards.
What is the referral process?
EI providers are assigned based on regions. Enter the family’s home town on the Family Ties website to find the provider that serves their area.
Direct referrals may be made to (800) 905-8437.
How to assure hearing loss expert on support team?
Specialty service providers (SSP) are specialists with targeted skills and knowledge around hearing loss. These providers are key members of the family’s support team. They partner with the EI provider to provide services and are generally contracted through the EI agency at no cost to the family. Families may request more than one SSP.
How do EI and specialty service providers support development?
Language development is dependent on early input to the infant’s developing language acquisition center during a critical window. The initiation of language stimulation right away is very important in the longterm development of language and communication. Prompt initiation of amplification, auditory input, and language input (spoken and visual) is associated with improved long-term outcomes. Establishment of EI services is complex and decisions about the best plan for providing an enriched language environment require parent education (2). Essential parent information includes support in:
- Understanding the hearing loss diagnosis and results of their child’s hearing diagnostic evaluation.
- Information on communication development from infancy through childhood.
- Communication choices and language exposure: this refers to all listening, spoken, and visual or signed language or combination thereof. For example, some families planning on a cochlear implant may opt to use multiple modes by initiating the use of sign language prior to receiving the cochlear implant.
- Choices in amplification.
- Educational resources and choices (3).
Family resources
Family TIES of Massachusetts provides information and referral services, emotional support, and trainings to parents of children and youth with special needs. They also have a family matching program in which newer families can be matched with a family further along in their journey — both having children with similar special health needs. These mentor families can offer tremendous support.
There are a wealth of terrific family resources available. Please explore the family page.
Risk factors
There are certain known hearing loss risk factors. Parental concern is one of the major risk factors.
Cytomegalovirus
Cytomegalovirus, or CMV, is the most common infectious cause of birth defects in the United States. About 1 out of 200 babies is born with congenital CMV. Hearing loss is common in babies with congenital CMV, even those without symptoms at birth. Learn more about CMV and newborn hearing loss in Dr. Fowler's, University of Alabama at Birmingham, article for the American Academy of Pediatrics.
Additional resources
- CMV Information
- Milestones for Speech & Language Development
- Laws and regulations
- Setting Language in Motion: Family Supports and Early Intervention for Babies who are Deaf or Hard of Hearing is a free, web-based resource developed as a collaborative effort between the Laurent Clerc National Deaf Education Center and the Deaf and Hard of Hearing Program of Boston Children's Hospital.
- NCHAM (National Center for Hearing Assessment and Management) serves as the National Technical Resource Center for the implementation and improvement of comprehensive and effective Early Hearing Detection and Intervention (EHDI) systems. As a multidisciplinary Center, our goal is to ensure that all infants and toddlers with hearing loss are identified as early as possible and provided with timely and appropriate audiological, educational, and medical intervention.
- EHDI 101 presentation from AAP (PDF)
References
- Werker CJ, Hensh TK. Critical periods in speech perception: new directions. Annu Rev Psychol 2015;66:173-96.
- Yoshingo-Itano C. Principles and guidelines for early intervention after confirmation that a child is deaf or hard of hearing. J Deaf Stud Deaf Educ 2014;19:143-75.
- Stewart J, Bentley J. Hearing Loss in Pediatrics: What the Medical Home Needs to Know. Pediatr Clin N Am 66(2019)425-436.
Articles
- The Forum Newsletter
- National Early Childhood Assessment Project (NECAP)
- The Journal of Early Hearing Detection and Intervention
- The Outcomes of Children with Hearing Loss Study
- Pediatrics: Yoshinago-Itano, 2017
Universal Newborn Hearing Screening program data
Materials for early intervention providers
Early Intervention Programs are encouraged to subcontract with appropriate low incidence/specialty service specialists if they are not able to accommodate a child’s needs within their own program. Staff should consult with their supervisor/program director before referring children to specialty providers to ensure that a contractual relationship exists between the provider and the Early Intervention Program. It is expected that children served by specialty providers will remain active in their Early Intervention Programs. The Early Intervention Program is holder of the Individualized Family Service Plan and coordinates transition to the LEA, as well as providing whatever early intervention services are appropriate to the child and family.
Connect with the Massachusetts Commission for the Deaf and Hard of Hearing Children’s Specialists to help your families better understand how hearing loss might affect development and review options for services and supports.
(617) 740-1600 Voice
(617) 740-1700 TTY
(617) 326-7546 Video Phone
National Center for Hearing Assessment and Management (NCHAM) serves as the National Technical Resource Center for the implementation and improvement of comprehensive and effective Early Hearing Detection and Intervention (EHDI) systems. As a multidisciplinary Center, our goal is to ensure that all infants and toddlers with hearing loss are identified as early as possible and provided with timely and appropriate audiological, educational, and medical intervention.
Setting Language in Motion: Family Supports and Early Intervention for Babies who are Deaf or Hard of Hearing is a free, web-based resource developed as a collaborative effort between the Laurent Clerc National Deaf Education Center and the Deaf and Hard of Hearing Program of Boston Children's Hospital. It is based on the Building Blocks of Intervention webinar series created by the Deaf and Hard of Hearing Program at Children's. The goal of Setting Language in Motion is to foster an understanding of the importance of early language acquisition that supports robust linguistic competence and conceptual development in children who are deaf or hard of hearing. Early intervention providers, deaf educators, early childhood specialists and allied professionals, parents, and other caregivers will benefit from this resource.
The Clarke Wednesday Webinar Series is intended to make information about listening and spoken language development for children who are deaf and hard of hearing accessible to all.
The Decibels Foundation has created an on-line calendar for events for children with hearing loss and their families. Help parents connect with other families and spread the word about this resource.
Materials for Audiologists
Events calendar
The Decibels Foundation has created an on-line calendar for events for children with hearing loss and their families. Help parents connect with other families and spread the word about this resource.
National Center for Hearing Assessment and Management (NCHAM)
NCHAM serves as the National Technical Resource Center for the implementation and improvement of comprehensive and effective Early Hearing Detection and Intervention (EHDI) systems. As a multidisciplinary Center, our goal is to ensure that all infants and toddlers with hearing loss are identified as early as possible and provided with timely and appropriate audiological, educational, and medical intervention.
Setting Language in Motion
Setting Language in Motion: Family Supports and Early Intervention for Babies who are Deaf or Hard of Hearing is a free, web-based resource developed as a collaborative effort between the Laurent Clerc National Deaf Education Center and the Deaf and Hard of Hearing Program of Boston Children's Hospital. It is based on the Building Blocks of Intervention webinar series created by the Deaf and Hard of Hearing Program at Children's.
The goal of Setting Language in Motion is to foster an understanding of the importance of early language acquisition that supports robust linguistic competence and conceptual development in children who are deaf or hard of hearing. Early intervention providers, deaf educators, early childhood specialists and allied professionals, parents, and other caregivers will benefit from this resource.