Mission Impossible: Collaboration (Are We Succeeding?)

collaboration

 

Ellie’s parents were optimistic about her transition from her private preschool for children with hearing loss to her neighborhood public school kindergarten.  After all, Ellie’s speech and language skills had improved greatly since enrolling her in the preschool. Ellie’s previous school had an audiologist who came to the school daily to check all the children’s equipment and interacted easily with Ellie’s speech-language pathologist and teachers of the deaf.  However, only a few weeks into kindergarten, Ellie’s mother was already concerned that the new speech-language pathologist was not checking Ellie’s cochlear implant on a regular basis.  The audiologist for the school district was responsible for 250 children at multiple schools throughout the county so how attentive could she be to Ellie’s needs?  Would Ellie tell her teacher if her implant wasn’t working, or if her battery was dead?  Would Ellie’s implant audiologist at the hospital share her test results with the speech-language pathologist, as Ellie’s mother had requested?

Scenarios such as this one are familiar to those of us who work with children with hearing loss.  Children are being identified and treated for hearing loss earlier than ever thanks to universal newborn hearing screenings and enhanced technologies.  The same children who 30 years ago would have been in specialized educational settings are now entering mainstream classrooms across the nation.  Clearly this was our goal, and we are excited to see the progress that has been made on this front.  However, when a child is in a general education classroom, sees her audiologist twice a year for programming at a hospital 50 miles from home, gets private speech therapy one hour a week at ABC Therapy, and sees the school SLP for 30 minutes twice a week, coordination of care can fall through the cracks.  It was this disconnect between the professions of speech-language pathology and audiology that first drove me to pursue both my Au.D. and SLP degrees and become dually certified.  I wanted to be able to treat the whole patient, from diagnosing the hearing loss to helping them achieve listening and spoken language outcomes.

In 2011-2012, I conducted a survey under the direction of Anne Marie Tharpe, Ph.D. examining this issue.  We wanted to know whether or not audiologists and speech-language pathologists believed they were collaborating effectively, and we wanted to see if the parents of children with significant (moderate-profound) hearing loss agreed.  We surveyed 189 individuals, essentially evenly divided between parents, audiologists, and speech-language pathologists.  Almost all respondents to the survey felt that collaboration between the two professions was important.  “Collaboration” meant everything from sharing test results to attending IEP meetings.  The take-home message from the survey results was that about 1/3 of the parents and audiologists, and 1/4 of SLPs surveyed did not agree that professionals were working collaboratively.  So one out of every three parents with whom you interact may feel there is something more we could be doing to work better as a team.

The most often-cited barriers by clinicians to collaboration included time constraints and large caseloads.  One of the most rewarding findings in the survey was that 100 percent of parents of children ages birth-3 years felt that professionals were working collaboratively.  This tells us that we have indeed done a good job in improving our service delivery to this population with a focus on family-centered care.  However, we are still challenged by how to provide collaborative hearing care to children and their families when they reach school.

So what are your thoughts? Do you feel you work well as part of the parent-audiologist-speech-language pathologist team?  What are your biggest frustrations? How might we improve our collaborations with other professionals – perhaps by embracing new technology that allows us to communicate and collaborate in a more timely manner? As we think about Better Speech and Hearing Month this May, let’s focus on working toward better collaboration with one another so that children such as Ellie have the best chance to succeed.

 

Adrian Taylor, Au.D., M.S., CCC-A/SLP is an audiologist and speech-language pathologist at the Vanderbilt Bill Wilkerson Center in Nashville, Tenn.  She works primarily in the area of cochlear implants and aural (re)habilitation in both the pediatric and adult populations. Adrian may be contacted at Adrian.l.taylor@Vanderbilt.edu.