Will Eiserman is the Director of the Early Childhood Hearing Outreach (ECHO) Initiative, at the National Center for Hearing Assessment and Management, Utah State University. As Director of the ECHO Initiative, he has led a national effort to assist Early, Migrant, and American Indian/Alaska Native Head Start programs in updating their hearing screening and follow-up practices. Working in close collaboration with a team of pediatric audiologists and other Early Hearing and Detection Initiative (EHDI) experts, Eiserman has been responsible for the design of training systems, mechanisms for tracking and follow-up, and evaluation strategies associated with early and continuous hearing screening activities. His career has focused on a variety of efforts to improve early intervention systems for children with special needs, and on meeting the psycho-social needs of children with craniofacial disfigurements and their families. Eiserman’s perspective is influenced by his extensive international and cross-cultural experiences that include work in Ecuador, Vietnam, Costa Rica, Russia, and Indonesia.
ED: How did you begin your career in early learning and development?
WE: I first earned my doctorate in educational research and development, and then had an opportunity to do post-doctoral work in early intervention research that was funded by the U.S. Department of Education’s Office of Special Education Programs (OSEP). The project, based at Utah State University, looked at a common set of assumptions about early intervention for young children with disabilities and developmental delays. This was back in the late 1980s, and we were exploring questions such as, “Is early really better in terms of when we intervene with children with disabilities? Is more intervention better than less? What types of interventions are more effective with children experiencing different types of developmental delays?” It was really exciting. Ours was part of the research that set the stage for developing the early intervention (EI) and early childhood special education (ECSE) programs that are now under the Individuals with Disabilities Education Act (IDEA).
I continued my work on EI/ECSE when I moved to the University of West Florida, where we focused on inclusion and family engagement. We provided a lot of training and technical assistance (TA) for local programs on supporting the role of families in EI, and helped programs think of ways to provide interventions for young children with disabilities in more inclusive environments. I then had an international opportunity through a Fulbright fellowship in Indonesia, where I taught research and development methods in social sciences.
A common thread across these experiences is the social integration and empowerment of individuals with special needs or disabilities. They allowed me to see how often there is a constellation of variables that impact the social placement of individuals with disabilities, and how that can be addressed through policies and support.
ED: What are periodic hearing screenings and why are they so important for healthy early learning and development?
WE: When you ask early childhood educators what is important for young children, one of the things they discuss is language development. Language is at the heart of social-emotional development, cognitive development, and school readiness. As conscientious as most early childhood professionals are about promoting language, there is less awareness about the importance of monitoring the status of hearing throughout the early years of development. We tend to think about language primarily as expressive, but we are not as attentive to receptive abilities. Monitoring children’s hearing status is an important investment in healthy language development. If there are concerns, we can intervene and ensure there is minimal impact on language development.
I direct the Early Childhood Hearing Outreach (ECHO) Initiative, which is part of the National Center for Hearing Assessment and Management (NCHAM). NCHAM has been funded for over 25 years by the U.S. Department of Health and Human Services (HHS) Health Resources and Services Administration’s Maternal and Child Health Bureau (HRSA/MCHB) as a national resource center. It has been instrumental in expanding
- hearing screenings, and
- the follow-up that may be necessary based on the results of the hearing screening for young children.
Over the last two decades, significant advancements have been made through the provision of newborn hearing screenings. These screenings are now available to more than 95 percent of the children born in the U.S. This is transformative and has dramatically changed the life landscape for individuals who are born hard-of-hearing or deaf.
The work of the ECHO Initiative arose from the observed success of newborn hearing screening efforts across the nation. Recognizing the significant changes newborn hearing screening represented for children and families, the HHS Head Start Bureau (now Office of Head Start) raised an important question about the technology that was making newborn hearing screening possible: whether any of it could be used to continually monitor the status of hearing for the children ages birth–3 years old who were being served in Early Head Start (EHS) programs. Head Start and EHS programs are required to ensure that all children in their programs receive evidence-based hearing screenings. We couldn’t think of any reason why the newly available technology wouldn’t work with this population, but it had never been done. This would require EHS program staff to be trained to screen young children with the Otoacoustic Emissions (OAE) screening method. While research suggested increased likelihood that continuous screening would result in additional identification of children with hearing loss as a result of late-onset or progressive loss, we weren’t sure what we would actually find.
The ECHO Initiative began as a pilot project with a handful of EHS programs in three states: Oregon, Washington, and Utah. From this pilot we discovered that yes, we can train early childhood program staff to conduct the OAE screenings and, in fact, staff often already had the set of skills most needed for conducting the screenings—getting young children to cooperate! Additionally, we found that when you screen 0–3-year-olds with the OAE, you do in fact find children with hearing loss that have not been previously identified. Newborn hearing screening programs have been shown to identify approximately three babies in 1,000 with permanent hearing loss. We found that in the 0–3-years-old range, subsequent to newborn screening, we typically identify another one to three children in 1,000 who have permanent hearing loss. This finding was consistent with research that had suggested the incidence of permanent hearing loss doubles between birth and the time children enter school; from about three in 1,000 at birth, to about six in 1,000 when children reach school-age. This finding was very compelling and led to what has been a multi-decade commitment from the Office of Head Start, in collaboration with HRSA/MCHB, to support the provision of evidence-based hearing screening and follow-up practices for all children in EHS and Head Start across the nation. This has occurred through the availability of online resources, training, and TA. Our website includes a broad array of resources and information about training and TA opportunities that help promote evidence-based hearing screening for young children.
ED: What are some of the challenges you have experienced in promoting regular hearing screenings, and what strategies have you tried to overcome them?
WE: Obviously, the use of technology nearly always involves some costs. Hearing screening equipment has associated costs, whether you’re using OAE, the recommended hearing screening method for children 0–3 years of age, or Pure Tone screening (historically used with 3–5-year-olds). Training is critical and needs to be provided in a timely fashion. It should also respond to high staff turnover, which is a reality in nearly all early care and education environments. To address these needs, the ECHO Initiative offers online trainings. We also partner with audiologists in locations across the country who can assist individual programs to conduct evidence-based hearing screening and follow-up practices.
Another challenge inherent in implementing any health or educational screening program has to do with ensuring the necessary follow-up occurs when children do not pass. There are multiple reasons why a child might not pass a hearing screening. Our data show that about 25 percent of children in the birth-to-age-3 range don’t pass the initial OAE hearing screening on one or both ears. We don’t recommend, however, that all of those children be referred for further evaluation. Instead, our protocol recommends screening these children again in 2 weeks, at which point we consistently see the “not pass” rate decline to about 8 percent. This may be due to screener error during the first screening; a transient condition that caused fluid in the middle ear and prevented an ear to pass the screening; or even a temporary wax blockage that worked its way out during the transpiring 2 weeks. For children who don’t pass the second screening, we recommend families go to a health care provider for a middle ear evaluation and treatment, if necessary. It is not uncommon that these children are found to have had an ear infection that wasn’t noted. This is not the completion of the screening process, however. Once any middle ear disorder is addressed, we screen the child again to see if they pass. If they still do not pass, then the child is referred to a pediatric audiologist for a complete audiological evaluation. You can see that there are potential challenges in supporting families to complete these many follow-up steps. Additionally, the availability of pediatric audiologists can present as a challenge. We have found that EHS and Head Start staff are often very skilled and innovative in supporting families through the completion of all follow-up, and recognizing that monitoring hearing is a critical part of promoting language development during the early years.
Spreading the message about the importance of hearing screenings is an ongoing challenge. We want to increase the awareness of this for parents, caregivers, and providers of health and educational services throughout early childhood. Given that the status of hearing can change at any time in a child’s life, we cannot rely on any single screening, but must screen periodically. We’ve developed several short videos about the importance of monitoring hearing throughout early childhood, and we invite viewers to share them and help us spread the word:
- Introduction to Periodic OAE Hearing Screening
- As Close as We Look We Can’t See a Hearing Loss
- It’s Natural: An Important Message for all Parents of Newborns
ED: What suggestions do you have for others interested in expanding regular hearing screenings as part of high-quality early learning programs?
WE: We encourage people to explore the resources and learning opportunities we have available on the ECHO website. In developing our various resources, we have recognized that those doing hearing screening nearly always have many other responsibilities as well. We have tried to provide a comprehensive set of resources so that programs can easily develop evidence-based practices without having to recreate the wheel. And we’ve tried to provide resources that are applicable and relevant across a variety of early childhood program contexts, including center-based or home-based programs; rural or urban program settings; and programs serving children in Head Start-funded programs, IDEA Part C, or health care settings. We also try to make our resources helpful across our stakeholder groups, which include many partners with an interest in increasing periodic hearing screenings—health care providers, IDEA Part C early intervention programs, EHS and Head Start programs, child care providers, families, and the Early Hearing and Detection Initiative (EHDI) programs within states.
My final suggestion is to be aware of the assumptions we often make in early childhood. We don’t ever want to assume a child can hear before that has been verified. For example, even if a child turns toward sound, that doesn’t give you enough information to know that the child’s hearing is in the normal range. We also don’t want to just assume a child has been assessed. Unless you have ear-specific results from an objective screening that was conducted within the last year, you really can’t be certain of the current status of a child’s hearing. Finally, we must caution that, even if a child passes an objective hearing screening, any concerns about a child’s hearing ability or language development would warrant a referral for a complete audiological evaluation.
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