Jan Stallard, Head of the Hearing Impaired Service for Hull, E.Riding, N Lincolnshire and NE Lincolnshire

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The Hearing-Impaired Service provides support for all hearing impaired children within Hull, E. Riding of Yorkshire, North Lincolnshire and North East Lincolnshire. Joint arrangements provide the opportunity for flexibility and width of provision to adapt to meeting the needs of a low incidence handicap such as hearing impairment. The Service is able to provide quality pre-school family support on a fifty-two week a year basis; primary and secondary unit provision for both oral/aural and total communication; regular support for families and pupils attending local school provision; support for post-sixteen students; adult education classes in both deaf awareness and BSL; technical support and back-up for equipment; in service training for schools; input into joint community, ENT and hearing aid clinics; assessments and regular multi-agency working.

In a catalogue, amongst a collection of pearls of wisdom, was a poster proclaiming, "Either you ride the waves of change or you go under them." Recent years have presented a whole ocean of change in both education and audiology. Flexibility and adaptability have been essential elements in the effective management of the Hearing-Impaired Service in order to be ready to meet the challenges of change and above all to gain the maximum potential benefits for all the children in our care. It has been important to try to be proactive in responding to and shaping change. The essential element and most valuable resource in managing change within the Service, is the staff. Amongst our valued team of a deputy head, teacher for total communication, unit and peripatetic teachers, technicians, office staff, teacher's aides, graphic visualisers, communicators and a Deaf instructor, we are also fortunate to have the contributions from seven qualified educational audiologists.

As with all Services, our priority is to ensure adaptable quality provision for all children in our region. All staff are important because of their valued contribution towards this overall aim. The Educational Audiologists contribute to this team approach by the establishment and maintenance of positive and effective multi-professional, multi-agency cooperation between Health and Education and by enabling shared planning within a wide range of initiatives including the Neonatal Hearing Screening Programme, clinical practice, assessments and hearing aid management. All the group members particularly appreciate their involvement within the Children's Hearing Services Working Group. Within a more practical context, the Educational Audiologists are able to participate fully within joint clinics within the community, with ENT Consultants and at hearing aid reviews as well as providing joint input into assessments for cochlear implants. This positive multi-professional approach is much appreciated by families and the professionals concerned.

The Educational Audiologists have an important role to play with individual children and families. They are present at the time of diagnosis and when families are informed that their child has a hearing impairment. From this point they provide the initial family support for the vast majority of children following diagnosis. They are usually the key worker at this important stage and can advise on aspects of approaches to language development, audiological choices, educational options and the contribution and role of other agencies, to enable the provision of quality support in the early years. The parents/carers then are able to access a variety of support strategies, which may include visits from the teacher for total communication to offer information on BSL/SSE or visits by the Deaf Instructor. The parent/carer then has the option of trialing another communication mode with a programme devised by the Teacher for Total Communication and Deaf Instructor. They also have the choice of keeping the Educational Audiologist as their keyworker or changing to the Teacher for Total Communication. The trial is continually assessed allowing flexibility for the family and giving them a strong basis, but more importantly time, on which to make a decision on communication mode and /or cochlear implant

Once initial relationships have been established, the links are maintained throughout the child's educational career through the provision of audiological oversight, assessments, Annual Reviews and hearing aid reviews.

Within the wider context of the Service, the Educational Audiologists have an important part to play within the Service Management Team. Their perspective is also important in informing and updating on important issues, particularly hearing aid developments and cochlear implants. They then offer training to staff on this ever-changing technology. Keeping in touch is an essential element in adapting and coping with change and maintaining the best possible provision for all children. With the help from the Educational Audiologists and other vital members of the Team we are able to maintain our position riding the waves of change providing a proactive influence on progress, to effectively meet the needs of all the children in our care.