https://orcid.org/0000-0002-1588-5599
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ABSTRACT
Many Aboriginal and Torres Strait Islander children are affected by chronic middle ear infection or otitis media from infancy that has a negative impact on development of listening and communication skills. Deficits in these skills are often not detected until school-age when the opportunity for early intervention is lost. Primary health and early childhood workers need screening tools to assist them with detecting the problem early, but there is a scarcity of tools. This study reports the development and validation of a screening tool for detecting communication problems in young Aboriginal and Torres Strait Islander children. The tool, called the Hearing and Talking Scale (HATS), relies on a systematic use of parent observations of communication behaviours of their children in everyday situations. Developed by using a co-design approach, the HATS is culturally and linguistically appropriate for use with parents/carers of young children by front-line workers not trained in speech-language pathology. We validated the HATS by comparing the HATS score of 68 children (46 Indigenous and 22 non-Indigenous children) with their performance in standardised assessments. The accuracy of the HATS was 80% and 81% when compared to the ASQ-TRAK and the Expressive Vocabulary Test respectively. The HATS takes 5 minutes to administer, and is easy to score and interpret. It can be used as part of a standard ear and hearing health check for young children to support early detection so that those with problems can be referred for specialist diagnosis and treatment at a young age.
Acknowledgements
We would like to acknowledge the traditional owners of the land on which the reported work was conducted, and pay our respects to Elders past, present and emerging.
The authors wish to thank the children and families that participated in this study.
We thank all the clinicians of the Hearing Assessment Program and Outreach services in Hearing Australia for their assistance with this study. We would also like to thank Michele Clapin, leader of the Hearing Assessment Program, for her support for this study.
We would like to thank Aimee-Kate Parkes for her assistance in collecting data.
We are grateful to Jaidine Fejo for contributions to the co-design workshops and data collection.
We are grateful to all the healthcare workers and teachers from Tharawal and Waranwarin centre in Sydney, Wurli and Binjari in Katherine, and Birra Li in Newcastle who contributed to this study through participation in co-design workshops and data collection.
We would like to thank all the staff at Hunter ENT for providing a location and for supporting the filming of a training video for the PLUM and HATS tools.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Notes on contributors
Teresa Y.C. Ching, PhD heads the Communication Sciences Department at the National Acoustic Laboratories, Australia. She leads research on (re)habilitation of hearing loss in children. Her current research includes methods for fitting hearing-aids, measuring benefits of hearing-aids and cochlear implants, identifying factors influencing outcomes of children with hearing loss, and devising electrophysiological and behavioural methods for predicting candidacy for cochlear implants in infants, children and adults. Recent research focuses on co-production of methods for early detection and intervention for hearing and communication problems in Aboriginal and Torres Strait Islander children. Teresa is particularly interested in the translation of research results to manufacturers and service-providers.
Michelle Saetre-Turner is a speech pathologist and researcher in the Communication Sciences Department at the National Acoustic Laboratories. She has a Bachelor of Science (Speech Pathology) with Honours and is due to complete a Masters of Public Health specialising in Epidemiology at the end of 2020. Michelle's clinical experience includes working in private practice and within schools to support children with speech, language and communication needs. She is involved in research that focuses on improving outcomes for children with hearing loss, and in the development of tools to promote the early identification of hearing and communication difficulties in Aboriginal and Torres Strait Islander children.
Samantha Harkus is based in Sydney and lives on Gadigal land. She completed a Masters of Public Health specialising in Aboriginal health and wellbeing at the University of New South Wales in 2018 and has degrees from Macquarie University including a Postgraduate Diploma (Audiology) and a Bachelor of Arts (Psychology). Sam is currently Principal Audiologist, Aboriginal & Torres Strait Islander Services at Hearing Australia. Sam's clinical experience has been in the area of paediatric and complex adult rehabilitative services, and feels privileged to have worked with urban, regional and remote Aboriginal & Torres Strait Islander communities in different parts of the country. Sam is involved in research that focusses on tools and pathways that lead to equity of access to and uptake of hearing health services for Aboriginal and Torres Strait Islander children and adults.
Louise Martin is a speech pathologist and researcher in the Communication Sciences Department at the National Acoustic Laboratories. She has a Bachelor of Science/Laws (Hons) as well as a Masters of Speech Pathology. She has a diverse range of experience working with children with disabilities, particularly those with hearing impairment. She is involved in research that focuses on improving outcomes for children with hearing loss and in the development of tools to promote the early identification of hearing and communication difficulties in Aboriginal and Torres Strait Islander children. Louise is particularly passionate about communicating research results effectively and using research to drive policy changes.
Meagan Ward is an audiologist who has specialised in paediatric habilitation, working with newly diagnosed infants and their families, providing ongoing audiological care through to the children's young adulthood. Her clinical practice entails working closely with early intervention agencies and schools. She has worked extensively in urban, regional and remote Aboriginal communities. Currently she is involved in promoting the early diagnosis of otitis media in Aboriginal and Torres Strait Islander children by enabling families, primary health and early educators to be able to identify young children at risk with the aim to reducing the impact of ear disease.
Vivienne Marnane is a researcher in the Communication Sciences Department at the National Acoustic Laboratories, located on Wattamattagal land in Sydney. She has Bachelor of Applied Science (Speech Pathology) and Master of Epidemiology qualifications. Since 2007 she has been involved in research primarily investigating the impact of early identification and intervention, and the factors that affect short and long term outcomes for paediatric populations with hearing loss. She is passionate about research that empowers and drives real world impact, whether it be at the individual level or at a policy level.
Caroline Jones is a Professor in the MARCS Institute for Brain, Behaviour and Development at Western Sydney University. Caroline's research interests are in children's speech and language development, cultural and linguistic differences and effective ways of measuring and supporting communication. Caroline has worked with Aboriginal people in research in NSW and NT for more than 25 years to co-design and produce language documentation and associated language teaching and learning materials including two published dictionaries (Ngarinyman, Darkinyung languages). In current work Caroline has been leading research teams to develop two short vocabulary checklists (approved MacArthur-Bates adaptations) for measuring and monitoring communication development in children aged 0–3 years: the OZI-SF (short form Australian English Communicative Development Inventory) and the ERLI (Early Language Inventory), the latter codeveloped with Aboriginal parents and coresearchers.
Eugenie Collyer is a linguist based in Katherine, NT, a traditional meeting point of Jawoyn, Wardaman and Dagoman people. She completed an Honours Degree in Linguistics at Monash University in 2006 and began work in Katherine as a community based linguist with Diwurruwurru-Jaru Aboriginal Corporation, supporting maintenance and documentation of endangered languages. She subsequently worked as an interpreter trainer with NT Aboriginal Interpreter Service then with the MARCS Institute, Western Sydney University, supporting development of the ERLI – an early vocabulary parent reporting checklist. She is currently Project Manager for Communities for Children Facilitating Partner, at The Smith Family, supporting delivery of key prevention and early intervention services to vulnerable children and families of the Katherine Region.
Chantelle Khamchuang is an Aboriginal woman from the Dharug community in Sydney. Chantelle works in the Badanami Centre for Indigenous Education at Western Sydney University. Chantelle is due to complete Honours in Psychology at end of 2020 at Western Sydney University.
Kelvin Kong (BSc, MBBS(UNSW), FRACS) hails from the Worimi people of Port Stephens, NSW, Australia. He completed his Bachelor of Medicine, Bachelor of Surgery at the University of NSW in 1999 and began his surgical training at St. Vincent's Hospital in Darlinghurst, completing resident medical officer and registrar positions at various Hospitals in NSW. Along the way, he has been privileged in serving the urban, rural and remote community. Kelvin qualified as the first Aboriginal Fellow of the Royal Australasian College of Surgeons (RACS), in 2007, now practising on Awabakal Country in Newcastle. He feels lucky to have a very broad practice in ORL, including community clinics, primary health care, outreach, a private practice and a commitment to research. He has also been humbled to partake and serve in various roles with a variety of government, NGO's and private sector groups. His pride and strength is his family.