Stage 1 - Determining the parent-professional relationship and setting goals
Stage 2 - Generating strategies to achieve goals
Stage 3 - Decision-making and service delivery
The three stages of consultation are particularly useful to early interventionists who are able to visit families weekly in their homes. During weekly home visits, relationships and goal formation can happen gradually in an environment that is comfortable for families. In contrast, audiologists do not have the luxury to see families as frequently or outside the confines of the clinic. For that reason, rapport building is more difficult and relationships will take longer to evolve. How can audiologists enhance their relationships with families so they can work from a family-centered consultation model? The following scenarios provide examples of this approach
in an audiological setting.
Stage 1: Relationship Building and Setting Goals
Most parents of children with hearing loss will view the audiologist as the "expert". They may feel intimidated by what they don't know, and they may not feel comfortable asking for what they need. Audiologists can help to build relationships with parents by engaging in a collaborative relationship that allows the parents to be the experts on their child.
Sample Dialogue:
| Audiologist: | "Our goal for today's appointment is to do some testing in the sound booth so that we learn more about the quietest sounds that your child can hear. Are you ready to get started?" |
| Parent: | (seems hesitant and looks worried) "I hope so." |
| Audiologist: | "You seem a little hesitant. Do you have questions or concerns?" |
| Parent: | "I'm concerned that my child will be scared in the audio booth. He's not used to rooms like that, and he is shy around new people." |
| Audiologist: | "What do you think would help him to warm-up and feel at ease?" |
| Parent: | "I think that spending some time in the booth allowing him to explore and to play would be helpful before you begin the testing." |
| Audiologist: | "Let's try that today and see how far we get. If that's helpful for him, we can build in some extra time for warm-up the next time he comes." |
A scenario like this facilitates relationship building between parents and professionals in a number of ways. It is helpful for parents to be reminded at the outset of each appointment about what the professional needs to accomplish. A brief explanation of the reason for the appointment also is helpful when it is explained in family-friendly lingo. In the previous example, the audiologist did not discuss "hearing thresholds", but described the purpose of the testing in a more functional way. This is helpful as parents are learning about hearing loss. More technical jargon can be introduced later as appropriate for each families' learning style.
Asking parents for their questions or concerns before beginning an appointment also can help to make the appointment worthwhile and productive for both parties. In this scenario, tuning into the parent's hesitation allowed the audiologist to join with the parent in a way that communicates caring about the child and not just the professional's agenda for the day. Exploring this child's temperament and learning to work with it will also increase the likelihood for more successful sessions in the future.
Stage 2: Generating Strategies to Achieve Goals
As was illustrated in the previous example, professionals who collaborate with parents are more likely to achieve goals over time that will be beneficial to the child.
Outlining for parents long-term and short-term goals may be helpful in giving them the big picture for what needs to be accomplished.
Audiologist: "The ABR has provided us with a general idea about the severity of your child's hearing loss. We will be working together over time to learn more specifics about the hearing loss. We do that in several ways. What questions do you have right now? Let's start with those."
Sample Dialogue between an Audiologist and Parent of a Six Month Old Child:
| Parent: | "Will my child hear enough to be able to talk someday?" |
| Audiologist: | "That is a common question for parents to ask. It is difficult to answer at this stage because we are just beginning to gather information, and to make discoveries about what your child can or cannot hear." |
| Parent: | "We really want him to talk and to go to a neighborhood school with his siblings. How can we help him to do that?" |
| Audiologist: | "You have already thought about your long term goals and dreams for your child. Knowing that will help us to get started. Let's talk about what we need to do right now to work in that direction." |
In this case scenario, the audiologist is joining with the family to explore their goals for their child. Knowing what parents hope for is important because it allows the professional and the parents to work together toward a common goal.
Professionals may want to complete a "road-map" of sorts that shows families the short term and long term goals in their work together. Over time, this can be revisited as additional information is gathered that will either support staying on the predetermined path, or exploring different options. The audiologist did not promise the parents that their original goal was attainable but offered to join them and provide expertise that would assist them in learning more about their child's capabilities.
Consultation with parent-infant specialists and other team members working with families also can be useful when setting goals with families. Each professional has expertise to offer and working collaboratively can be of assistance to everyone.
Stage 3: Decision-Making and Service Delivery
Families dealing with the diagnosis of hearing loss are faced with many decisions, including communication modality, sign systems, school programming , etc. In the field of audiology, they have decisions to make about various kinds of hearing aids and cochlear implants. When working from a team approach, the question of who delivers what information sometimes becomes an issue.
For example, in the case of cochlear implantation, who decides when it is time to talk with parents about cochlear implants, and which professional is best equipped to have this discussion? Should it be the ENT doctor, the audiologist, the parent-infant specialist, the school district representative, or the services coordinator? It is fair to say that professionals in each of these disciplines probably have their own opinion about when and who should discuss implants with a family dealing with a newly diagnosed child. How might an audiologist handle this situation?
Sample Dialogue:
| Audiologist: | "We are planning to make ear molds today, and in about two weeks we will fit the ear molds and get started with a loaner hearing aid. How does that sound?" |
| Parent: | "How long will it take for the hearing aids to help him to hear?" |
| Audiologist: | "That is something that we won't know until we fit the aids and allow some time for your child to wear them." |
| Parent: | "My parents called last week and told me about a news story about a surgery that can be done to restore hearing. Can we have that done instead?" |
| Audiologist: | "They may be referring to cochlear implants. That is an option for some children. There is a process in place that helps a team of professionals to determine if your child would be a candidate. If you would like, I can get some information for you. In addition, with your permission, I can ask your parent-infant teacher to speak with you about it." |
| Parent: | "Yes, we'd like to know more about that option. Should we still try a hearing aid in the meantime? Maybe we won't need it if we get an implant." |
| Audiologist: | "Determining candidacy for an implant can take some time. It is a good idea during that time to go ahead and try the hearing aid to see what we can learn. This information will be useful whether your child receives an implant or not. How do you feel about going ahead and making the ear molds and proceeding with the loaner hearing aid trial?" |
| Parent: | "Let's go ahead with hearing aids, and we'll look into the implant too." |
Although each center has its own policies about hearing aid trials and implant candidacy, this scenario is becoming a common situation as children with hearing loss are being identified at younger ages and there is more information available in the media and through the internet. There is not necessarily a right or wrong time for this information to be discussed with families. If they ask for the information, the provider should assist them and provide that information. Delaying can result in misinformation, as families will seek information from a variety of sources. It can be helpful to ask families for permission to discuss their case with other team members. As families are proceeding through the hearing aid trial and the implant candidacy process, their early intervention specialist can be of assistance. Early intervention specialists are trained to help parents navigate the information as well as the emotions that surface during this time.
