Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697629731262.pdf (Australia)
Inquiry into the Hearing Health and Wellbeing of Australia Attention: Committee Secretariat PO Box 6021 Parliament House Canberra ACT 2600 Terms of Reference 1.

The current causes and costs of hearing loss, and ear or balance disorder to the Australian health care system should existing arrangements remain in place; 2.

Community awareness, information, education and promotion about hearing loss and health care; 3.
Access to, and cost of services, which include hearing assessments, treatment and support, Auslan language services, and new hearing aid technology; 4.

Current access, support and cost of hearing health care for vulnerable populations, including: culturally and linguistically diverse people, the elderly, Aboriginal and Torres Strait Islanders and people living in rural and regional areas; 5.
Current demand and future need for hearing checks and screening, especially for children (12 years and younger) and older Australians at key life stages 6.

Access, availability and cost of required drugs, treatments and support for chronic ear and balance disorders sufferers; 7.

Best practice and proposed innovative models of hearing health care to improve access, quality and affordability; 8.
Developments in research into hearing loss, including: prevention, causes, treatment regimes, and potential new technologies; 9.

Whether hearing health and wellbeing should be considered as the next National Health Priority for Australia; and 10.

Any other relevant matter.

Inquiry into the Hearing Health and Wellbeing of AustraliaSubmission 67 To whom it may concern, Thank you for inviting comment into the inquiry into hearing health and wellbeing of Australians.
In 2017, Hear and Say will celebrate 25 years of providing hearing, speech and language support to children with hearing loss and their families.

We are a not-for-profit organisation located in Queensland and a member of First Voice, the national voice for member organisations whose primary focus is the provision of listening and spoken language therapy services for children with hearing loss in Australia and New Zealand.

A separate First Voice commentary has also been submitted.
The Hear and Say experienced transdisciplinary team comprises audiologists, speech and language pathologists, teachers of the deaf, occupational therapists, clinical social workers and physiotherapists who work with families to not only provide an end-to-end service package that meets families’ health, education and disability needs and also achieves a set of outcomes for these children/adults which allows them to interact in the community just like children/adults with natural hearing.
The evidence based programs at Hear and Say interface state-of-the-art hearing technology (digital hearing aids and implantable technology such as cochlear implants) with the Auditory- Verbal Therapy approach.

Hear and Say has one of the largest hearing implant and listening and spoken language programs in Australia.
Our specialist transdisciplinary team assists each individual child and family using a coordinated approach, with a dedicated case manager or key worker who involves the family in all decisions related to their child’s care.

Hear and Say provides nearly 70% of its services to families of children with hearing loss living outside of the Brisbane metropolitan area and it is for this reason that it has opened centres in the Gold Coast, Sunshine Coast, Toowoomba, Cairns and Townsville.
Our Telepractice program ensures that families living remotely can obtain the same level of services from their lounge room, as those families accessing our centre-based programs, reducing the cost and stress of having to travel to a centre.
The State Government provides some support however only through the support of Corporates, Philanthropists and the broader community, has Hear and Say been able to nurture the development of Queensland’s children with hearing loss, preparing them with age-appropriate speech, language and social skills to enter their local primary school – not a special school.

Through these ongoing partnerships we are committed to continuing equitable and quality services across all regions and settings in Queensland.
With no other full service delivery models like Hear and Say in Queensland, our pioneering programs, forward-thinking approach and capacity to attract quality staff and international networks have allowed us to remain at the forefront of paediatric clinical and therapeutic excellence.

Hearing issues at any age affect a child’s social interactions, emotional development and academic performance.
Hear and Say is collaborating on a number of projects to broaden our services so we can diagnose and treat children who may suffer late on-set or temporary hearing loss throughout Queensland, especially at the commencement of their formal education journey.
The opportunity exists for Federal and State Governments to increase their collaboration with proven service providers to deliver whole of life support for individuals and families impacted by hearing issues that meet their ongoing health, education and disability needs.

Hear and Say is a NDIS Provider and already has a number of families, using this new national funding stream, selecting to obtain their support from Hear and Say.
Inquiry into the Hearing Health and Wellbeing of AustraliaSubmission 67 THREE KEY OPPORTUNITIES TO IMPROVE HEARING HEALTH AND WELL-BEING OF AUSTRALIA 1.

Investment in long term outcomes NDIS The NDIA states that NDIS is a social insurance scheme not a welfare system.
This system being based on four main principles:   That funding is based on an actuarial estimate of the reasonable and necessary support needs of the target population; That NDIS takes a whole of life view minimising total costs to the community by investing early to build capacity resulting in greater outcomes later in life;  Research and innovation is encouraged; and  NDIS will act at a systemic level, as well as funding individual needs.
Currently a whole-of-government funding imbalance exists between Early Intervention programs that provide listening and spoken language outcomes for children with hearing loss that overcome the disabling impact of deafness and hearing issues compared to culturally based approaches using visual communication techniques.
When considering that more than 90% of children with hearing loss are born to hearing, listening and speaking parents it is incumbent on this Government to usher in a new generation of deaf children, one that utilises 21st Century technology and one that is overcoming the traditional barriers to communication and integration into broader community.

The traditional definition and treatment of hearing loss does not address the needs of the majority of children with hearing loss in this new millennium.
Opportunity Redirect and / or appropriately fund evidence based LSL EI programs that are able to demonstrate their compliance with the key NDIS principles as outlined.

A reference package specifically targeted at LSL EI programs for children with hearing loss OR develop a specially funded LSL EI package for children with hearing loss that aims at achieving age appropriate, clear, natural LSL outcomes which minimise any future reliance of LSL EI program participants on the NDIS.
Medicare The Department of Health is responsible for developing Medicare policy.

Medicare does not effectively fund Telepractice models and has not kept pace with evidence-based developments and innovations in clinical service delivery particularly in relation to:   Tele-therapy: requires a therapist to be present on both ends and the rebate is the same as a face to face session.

Evidence-based models of Tele-therapy indicates a therapist is only required at one end.
Tele-mapping: does not provide a rebate for Tele-mapping of cochlear implants via evidence-based Tele-practice models.

Hear and Say have undertaken extensive research in the provision of Tele-practice (both listening and spoken language therapy and remote programming of cochlear implants).
There is a growing body of evidence that validates a Tele-practice model of care and Hear and Say research has shown that there is no significant difference in outcomes for those receiving services face-to-face versus through Tele-practice, for the services that we are delivering.. We know that specialist services cannot be made available at all locations, however Tele-practice may offer a solution to better enable equity of access.
A review and expansion of Medicare rebates to incorporate tele- health services is required.
Inquiry into the Hearing Health and Wellbeing of AustraliaSubmission 67 Opportunity Ensure Tele-therapy and Tele-mapping receives the same Medicare rebate as face to face services (specifically Audiology and LSL / Speech Therapy) recognising the requirement for only one clinician and ensuring better access to much needed specialist and allied health services and better utilisation of NBN in regional and remote areas.
By way of example, there are two Medicare item numbers that currently limit our ability to expand our Telepractice services: • Non-determinant audiometry 11306 • Mapping/programing 11312 (for cochlear implants) Under the conditions of Medicare, for Hear and Say to claim on these item numbers, it is required that a clinician be physically present for the delivery of the service.

In remote areas, This is not possible and visiting services are not always time or cost effective.
The health service delivery environment is changing and we hope that Medicare may consider bringing additional allied health services in line with other health services which are Medicare claimable when delivered remotely.
A contemporary approach to funding of remotely delivered health AND allied health services will enable service providers to offer a more flexible approach to service provision with no detriment to client outcomes and offer greater choice and access of specialist services for participants.

Inquiry into the Hearing Health and Wellbeing of AustraliaSubmission 67 2.
National School Hearing Checks for all Prep aged children Hear and Say was one of the key advocates for the introduction of new born hearing screening and as a consequence of this plea to Government, all babies born in Australia after December 2010 are now screened for hearing loss at birth under the Australian Government’s Universal Newborn Hearing Screening program administered by the Department of Health.
Despite this world leading newborn hearing screening program, deafness can occur at any time as some childhood hearing losses have a later onset.

With an ever increasing immigrant and refugee population, we also know that children born in other countries, now living in Australia may not have had access to newborn hearing screening programs.

Research shows that between nine and twelve children per 10,000 will be born with a moderate or greater hearing loss in both ears (Australian Hearing, 2014).
The introduction of Universal Newborn Hearing Screening has allowed for these children to be identified and seek the appropriate assistance through early intervention.

This ensures these children access sound early which in turn improves their long term outcome.
However, research also shows that the incidence of hearing loss doubles by the time children reach school age with around 15% of children acquiring a hearing impairment by the age of 17 through accident, illness or other causes (Australian Hearing, 2014).

Currently in Australia, there is no universal second-tier hearing screening program, therefore children with hearing loss could effectively be falling through the cracks.
Even a mild hearing loss can be a major disadvantage in a world of ever-faster information exchange.

People who cannot hear spoken language well enough to process it may find themselves cut off from others at school, work, or home as communication development and behavioural skills are influenced by a child’s ability to hear.

A hearing loss also has the ability to affect a child’s social interactions, emotional development and academic performance.
Additionally, transient hearing loss from Otitis media or middle ear infection is one of the most common illnesses among children (Bluestone & Klein, 2000).

It affects 75% to 90% of all children, aged between six months and six years (Bluestone & Klein, 2000).

But even a transient loss can be devastating.

Effects can range from speech and language difficulties to trouble in social situations to increased risk of academic failure.
According to the World Health Organisation, Australia’s Aboriginal and Torres Strait Islander people have one of the highest rates of middle ear disease in the world being 10 times more likely to suffer from ear disease and hearing loss than non- Indigenous people.

It is estimated that between 40 to 50 percent of indigenous children could be experiencing hearing loss from middle ear disease at any one time.
Recurrent infection leads to persistent ear discharge and perforated ear drums in 40% of Aboriginal children in remote areas before 18 months of age.

Some have no ear drums at all.

With the support of philanthropic funding, Hear and Say launched a School Hearing Program in early 2016 and has found, on average around 20%-25% of children have hearing issues on the day of screening.
In October 2016, after screening more than 6,500 children across Brisbane, Sunshine Coast and Gold Coast schools (the number of children screened has now grown to more than 10,000 children however, at time or writing further data analysis is required to update the following key findings), Hear and Say has found the results vary from more than 40% fail rate to 10% fail rate at each school.

In some individual Prep classrooms, the rate of hearing issues has been higher than 50%.
While the Hear and Say School Hearing Screening Program was officially launched by the Hon.

Kate Jones, Queensland Minister for Education, we advocated for and are still advocating for a consistent, coordinated and universal screening program for all Prep students.
Inquiry into the Hearing Health and Wellbeing of AustraliaSubmission 67 It is concerning to note some of the significant achievements and results of the screening program (as at October 2016) to date including: • • • • • • Screening undertaken at more than 80 public, private and independent schools Over 1,400 children failed one or more aspects of the screen and required follow-up More than 4 children diagnosed with permanent hearing losses Many children with perforated ear drums Several children with foreign objects found in ears (buttons, beads, etc.)
Around 75% of children who fail have middle ear issues which need to be followed-up All of these hearing issues were previously undiagnosed!

Opportunity This Hear and Say piloted school hearing screening program has been based on demand from schools and parents and since it was officially launched has identified around 25% of students on the day of screening not hearing at their optimum.
These results are significant and concerning indicting that there is a real risk that one in four children are starting their formative school years with a hearing issue that may impact on their ability to learn and to develop socially, emotionally and to perform at their full potential in the classroom or the playground.
A nationally coordinated 2nd tier hearing screening program will ensure ALL children with hearing issues are identified before they ‘fall through the cracks’ and will improve social, emotional, academic and whole-of-life outcomes for these ‘at-risk’ children.

These improved outcomes will also have a subsequent impact on community health, wealth and wellbeing.

Inquiry into the Hearing Health and Wellbeing of AustraliaSubmission 67 3.
Social, emotional and economic independence – Individual, Family and Community Evidence-based Practice of Listening and Spoken Language (LSL) Early Intervention (EI) Research continues to demonstrate improved outcomes for children with hearing loss enrolled in Listening and Spoken Language (LSL) Early Intervention (EI) programs.
Some of this research included below demonstrates how children who are deaf or with hearing loss:  Graduate from LSL EI programs with no gap between their chronological and language ages and developed spoken language in line with hearing peers (Constantinescu, Dornan, Rushbrooke, Brown, McGovern, Close, Hickson & Waite, submitted; Dornan, Hickson, Murdoch, & Houston, 2007, 2009; Dornan, Hickson, Murdoch, Houston, & Constantinescu, 2010; Fulcher, Purcell, Baker, & Munro, 2012; Hogan, Stokes, White, Tyszkiewicz, & Woolgar, 2008; Rhoades & Chisolm, 2000).
 Made, on average, 12 months progress in 12 months for their language development, which is in line with expectations for children with normal hearing (Dornan, Hickson, Murdoch, & Houston, 2007, 2009; Dornan, Hickson, Murdoch, Houston, & Constantinescu, 2010; Rhoades & Chisolm, 2000).

 Progressed at the same rate for spoken language, self-esteem, reading and mathematics as a matched group of children with normal hearing (Dornan, Hickson, Murdoch, Houston, & Constantinescu, 2010).
 Achieved age appropriate language as early as 6 months after amplification and around 12 months of age - when identified at birth and fitted with optimal amplification and enrolled in Auditory-Verbal Therapy before 12 months of age (Constantinescu, Waite, Dornan, Rushbrooke, Brown, Close & McGovern, submitted).
 Performed better for language and listening than a matched group of children in an Auditory- Oral (listening and lip reading), or Bilingual-Bicultural program (AUSLAN and written English) by 3 years of cochlear implant use (Dettman, Wall, Constantinescu, & Dowell, 2013).
The Hear and Say model of care, like many other EI programs, promotes a transdisciplinary approach and places the child and family at the centre of this team uniquely recognising the vital role parents play as the natural language teach of their child.
Importantly, Hear and Say connects a child to their first community, their family, and does this by acknowledging the how that family community communicates and connects and recognises that the first language of that community is usually based on listening and spoken language.
Attached to this submission are two documents outlining in simple terms, but with accompanying research references, the need to offer access to listening and spoken language as the first option for all children with hearing loss and a ‘what you need to know’ questionnaire for parents guiding them as to the questions they should be asking of any EI provider.
These attachments are titled:  Listening First: The Changing Face of Hearing Loss - Access to Listening and Spoken Language Should be the First Option for Children with Hearing Loss – Position Paper 2016; and  What you need to know about our Early Intervention Program Opportunity Hear and Say supports the First Voice submission to this Inquiry highlighting the specific and increasing weight of evidence demonstrating that an appropriately funded LSL EI program for children who are deaf or with a hearing loss not only has significantly better life outcomes for the individual child and their family but also has positive economic and social impacts on the broader community.
Removing the handicapping nature of hearing loss by enabling age appropriate listening and spoken language outcomes provides an economic and qualitative benefit to the individual and the wider community.

Due to the etiology of hearing loss (ie linkage to birth rates and known incidences of acquired hearing loss) the budget required to address this issue is finite and can be reasonably well estimated.
Inquiry into the Hearing Health and Wellbeing of AustraliaSubmission 67 Break the Sound Barrier Hear and Say is also an advocate and contributor to the ‘Break the Sound Barrier’ campaign being coordinated the Deafness Forum of Australia and principally supports the six-point plan outlined to improve the lives of people living with hearing conditions.

Additionally, Hear and Say supports the call to make Hearing Health number 10 on the Federal Government list of National Health Priorities.
Specifically, Hear and Say is already working on three of the six points outlined in the campaign, specifically action items / steps: (1) hearing checks for all children at key stages of life; (2) providing a national hearing awareness promotion campaign; and (6) not letting children fall through the gaps with changes to the way hearing services will be delivered across Australia.

More information on Hear and Say can be found at www.hearandsay.com.au .
More details on the Break the Sound Barrier campaign can be found here http://breakthesoundbarrier.org.au/ Inquiry into the Hearing Health and Wellbeing of AustraliaSubmission 67