What Audiologists are Thinking (at least three of them)

There are a number of us that go and see audiologists on a regular basis. Hmm. In fact, probably 99% of people reading this blog do! Have you ever wondered what goes on in their heads when they’re working with us (as kids, as teenagers…or even as parents)? Three brave (and willing) audiologists have agreed to let us have a sneak peek into their brains. Meet the audiologists: Elissa Robb graduated from the University of British Columbia with a Masters of Science Degree in Audiology. She is a Registered Audiologist and Hearing Instrument Practitioner at the Western Institute for the Deaf and Hard of Hearing in Port Coquitlam, British Columbia where she has been practicing for over 5 years. The Agency primarily serves the adult population and some youth. Elissa has a particular interest in post-secondary accessibility for Deaf and Hard of Hearing students. When Elissa isn’t working at the clinic or volunteering for the Canadian Hard of Hearing Association, Vancouver Branch, she can be found cycling, running or spending time with family. Donna Myer received her Bachelor of Nursing in 1989 and after 3 years of working as a nurse decided to return to study audiology.  Donna completed a Master of Science degree at McGill University in 1993. She initially worked with both adults (VGH and private practice) and children (BC Children’s) before moving to pediatrics full-time in 2001.  To date, Donna has been with BC Children’s Cochlear Implant Services for the past 17 years. This year marks her 25th year as an audiologist! Cindy Gustin graduated from the University of BC with a Masters in Audiology and worked as an audiologist for 37 years in BC and Ontario. For half of her career, Cindy worked with children and adults with cochlear implants and was coordinator of the BC Adult Cochlear Implant Program at St Paul’s Hospital in Vancouver from 2008 to 2015. Cindy returned to her pediatric roots at BC Children’s Hospital prior to her retirement in 2017. Cindy currently lives in Vancouver with her husband and an embarrassing number of cats. In your experience, how long have you worked with children and teenagers? E: Because most children in BC are seen through the public health units, and I work at a private clinic, I work primarily with adults. Our clinic sees some children and several teenagers. D: I’ve been working in pediatrics since 1993. C:  I worked with children and teenagers for 23years: as an Educational Audiologist in BC, with children and adults living with developmental disabilities, autism spectrum disorder and visual impairment at Surrey Place Centre in Toronto, as well as on several teams (Visually Impaired, Neonatal Follow-up and Cochlear Implant) at BC Children’s Hospital in Vancouver. For fourteen years, I worked with the BC Adult Cochlear Implant team at St. Paul’s Hospital in Vancouver, where I saw older teenagers who were newly implanted or were transitioning from the Children’s program. What are some of the challenges you’ve seen in your work? E: The most difficult reoccurring challenge I have is when a parent voices concern about the visibility of a hearing aid/ hearing aids. I don’t think the parent/ parents really realize how this negatively impacts the way their child will view their hearing aids moving forward. Also, it will greatly affect their self confidence. It’s most helpful when parents are supportive and maintain a positive outlook focusing on the benefits of hearing aids. D: For the youngest children it can be simply getting them to cooperate to do the necessary testing.  Developmental skills vary much more the younger the child. Attention spans are generally shorter and because sometimes they are often too young to understand “why” we are doing what we are doing, it can take quite a bit of creativity to get them to participate effectively.  It’s conversely the hardest, but often the most rewarding part of the job. For pre-teens and teenagers, it is usually getting them to open up and express themselves to help become an active participant in their care. C: Parents…and sometimes teachers…and sometimes therapists. Families come in infinite varieties and, in my experience, every family wants the best for their child.  What this looks like and how to achieve it may be very different for each family.  Parents know their child best and have the clearest understanding of how their family will be able to support their child. As audiologists we work with children and their parents, grandparents, and sometimes siblings in the context of their individual family culture/beliefs/resources as well as in the broader context of their community. Part of our job is to provide perspective, shape expectations and explore options to achieve the best results for each child.   I can confidently say that your audiologist is equally committed to your child’s success and gets great satisfaction in helping him or her achieve that success. For many years, I had this reminder displayed in my office: “Hearing is a sense. Listening is a skill.” This applies equally to audiologists, parents, teachers and therapists. A good working relationship based on listening, honesty and earned trust between families, audiologists and teachers/therapists means that time, energy and resources can go toward supporting each child. What do you find most interesting working with young children/teenagers? E: I find it interesting to hear children and teenagers’ observations about hearing aids. For example, one young boy said, “when I wear my hearing aids, I can hear my entire piano”. Another example from a young girl who was fit with new hearing aids said “I’m hearing differently than I was with my old hearing aids. It’s not bad. Just different”. These observations are so honest and valuable for clinicians to hear. D: In CI Services we follow children from birth to 18 years of age. I’m in a very fortunate position, in that I usually follow my patients over a long period of time.  I’ve worked with some children since they were in diapers and watched them go off to University. Watching their overall development, milestones and achievements is rewarding.  It’s interesting to work as part of a team (patient/parents/teachers/habilitationists) to help manage hearing loss and work together to find solutions to challenges children may encounter. C: I love the puzzle solving aspect of working with very young(and sometimes very old) people.  I get great satisfaction from seeing how they progress and how their hearing becomes “normalized”and the focus shifts to the bigger picture of what’s happening in their lives. I really enjoy working with teenagers. They are generally very fun and interesting people with unique insight on the world. I also love how incredibly comfortable kids are with technology. I have had a five-year-old showing her parents how to use a remote. (Not that we necessarily want to leave this in the hands of a five-year-old.) Do you often get kids/teenagers talking about their challenges in their day to day lives or are they most often quiet/non responsive? E: Most of them are quiet when they come in to the office, but by the end of the appointment, they’re comfortable and talkative. Most children and teens don’t openly discuss challenges. I often have to probe a bit with questions. I find parents are typically the ones who will introduce conversations about challenges. I will ask how things are going at school and if they’re using an FM System in class (and see if the information they said aligns with the data logging in the hearing aids). I will also check to make sure the hearing resource teacher is the same so that I can send an updated report to them after the visit. I will ask about home and hearing the television as well as extra curricular activities. Sometimes I will take notes about what seemed most important to the client during that visit. D: This really depends on the child, their age and personality.  You can’t get a 6 month old to express their daily challenges. Once a child has the language skills to express themselves, it’s always important to get them more involved in their care.  That may involve asking about school or favorite activities, to open the lines of conversation. I don’t like to lump children in a group, because they are so diverse, however, pre-teens can often be the most challenging to get feedback from.  This is where parents and teachers who work with them help fill in gaps. C: There are introverts and extroverts and conversations will be different for different types of people. I encourage them to talk about what’s working for them and what’s not. Is there anything they want to do but can’t because of their hearing? What options are available? Older kids and teens are usually open to some joint problem solving. When you get a quiet client in, how do you encourage them to ‘speak’ up? E: I will try to find something in common with them. For example, if a client is wearing a shirt with a sports team logo, I will strike up a conversation about sports while I’m setting up. Or ask what the most favourite part of their day was yesterday or their favourite song at this time. Often clients will start to open up and initiate conversations during the appointment after that. Sometimes for youth, I’ll ask them to help me by opening up computer programs, clicking buttons, entering information into the computer, etc. Once they’ve become comfortable, I will then ask more specific questions about their devices, ears, etc. Again, I sometimes make notes in their chart about what they’ve opened up about/ enjoyed doing in the past. D: It’s important to try and establish a trusting relationship.  If you can get them to talk about something personal they really enjoy and get them to open up to you, that is the start.  You have to have a trusting relationship established. Because I see my patients on a regular basis, it is fortunate to have time to build that trust. C: With younger kids, I ask questions. If they are shy, it’s usually a matter of time and allowing them to become comfortable over the visitor over several visits. With teenagers, I talk less. At the minimum, I expect the teen to answer questions for themselves. Parents can add to an answer but shouldn’t answer for them. How have you managed the relationship between parents and your client? (i.e: is most communication done with minimal involvement from the child?) E: Because I primary work with youth and teenagers, I always speak to the client. This gives a sense of ownership and empowerment. I will then summarize our appointment in front of the parent at the end. I also communicate with both the child and parents about low hearing aid/ FM usage, payments, and important warranty dates. D: Again, this depends on the child.  For younger children, communication will definitely be with the parent. As kids get older, I try to get them to share their feelings and concerns as much as they are able.  Some kids don’t feel comfortable discussing some things in front of their parents. Once a young person is mature enough, I give them the opportunity to talk with me one-on-one, without their parents present.  It helps foster a sense of independence and can allow them to take more ownership of their appointment time. C: I’m a big believer in the saying “Prepare the child for the path, not the path for the child.” In consultation with parents, I believe that children should start taking an active role in their clinic visits as soon as possible to whatever degree is appropriate. Communication should be with the client as much as possible as soon as possible. For school aged children, I will ask them questions directly about what school they go to, what grade, what they like to do outside of school, what they like/don’t like about their hearing, etc. During the visit, I give them choices between acceptable options whenever possible.  This is in addition to, not instead of, the conversation I’d have with the parents. With teenagers, I usually start by saying to the teen, “I’m going to ask your parents some questions in a minute but first I want to talk to you.”  Parents are always welcome to stay in the room for the whole visit but if they are comfortable, it can be helpful if they give the audiologist some one-to-one time with their older child/teen. Teenagers sometimes have a worry or a question that they may not be comfortable asking in front of their parents. Your audiologist is not here to take sides but can provide a third opinion if parents and teens have different opinions about a particular situation. Teenagers need to feel they have a meaningful say in the decisions that are being made. As teenagers get closer to transitioning to adult services, parents worry that they may not be included in appointments or decisions. (When I worked in the adult program, I had one parent say to me “We still pay for everything, you know.”) Parents can absolutely continue to attend appointments and be involved in decision making for their young adults; however, the expectation is that the client will now be responsible for their own care. By gradually transitioning responsibility from parent to teen over time, it becomes a very natural progression into adult services. What advice or tips would you give to a teenager or young adult that would make the visit to clinic meaningful/productive? (e.g. how much of an active role should they play?) E: Make a list of questions ahead of time so nothing is forgotten! This way the  Audiologist and client can work through the list together. If the list exceeds the amount of time scheduled for the appointment, it would be good circle the most important items you want covered that day. Ask the Audiologist to write important or technical information down that they’re asking you to remember. Be honest with your Audiologist. If you’re struggling with your hearing loss, friends, support, or equipment, they are there to help you. That’s part of their job, but more importantly, they want to help you and see you succeed! D: Keeping a regular log of any challenges (eg. listening in a particular environment), questions or concerns is helpful.  There can sometimes be several months to a year between visits. When a patient comes to an appointment, they may forget to mention something that is affecting them….good or bad.  Be prepared. Be well-rested. It’s not unusual for some patients to show up at an appointment overtired from a late night the night before. Being well-rested is important, so they can concentrate fully for CI programming.  It’s essential to getting a good CI map so they can hear their best between programming visits. Some people concentrate better at certain times of the day so scheduling appointments appropriately is important. And don’t be afraid to ask questions!  We’re here to work as a team!! C:  Understand why you are coming in for a clinic visit. Be on time. Let us know if you’ll be late or if you have to cancel or reschedule. Bring questions. Write them down. Ask questions. There are no dumb questions. Tell your audiologist what is working for you and what isn’t. Find out if there is anything new in technology that might be helpful to you. Is there anything you would like to discuss with your parents and your audiologist? Or anything you’d like your audiologist to discuss with your parents/family?