Infant Hearing Program

Hearing Screening Regional Trainer
Training Guide

TRAINING GUIDE OVERVIEW

Goals and Objectives

The Infant Hearing Program (IHP) identifies babies born deaf or hard of hearing and provides services to these children and their families to support language and early literacy development so they are ready to start school. IHP provides universal newborn hearing screening in hospitals and community settings, audiology assessment and hearing aid selection, monitoring for those babies born at risk of early childhood hearing loss and services to support language development in infants and preschool children who are deaf or hard of hearing.

This guideline was developed to assist local implementation of a standardized approach to the IHP training process with the newAccuScreen hearing screening equipment across Ontario. Province-wide guidelines and protocols facilitate consistent, high quality training and standardize services for children and families throughout the province, promoting effectiveness, equity and efficiency of services, no matter where or by whom such services are provided.

Types of Training Sessions

There are three types of sessions that Regional Trainers can use to facilitate learning for effective use of the AccuScreen equipment and to foster quality interactions with children and families. Each training session has many unique features.

  1. New Screener Training

This *two hour training module for new screeners provides a thorough understanding of IHP. It includes a detailed introduction to the AccuScreen: Automated Distortions Product Otoacoustic Emissions (ADPOAE) and Automated Auditory Brainstem Response (AABR) screening equipment,the screening manual and forms,hands on practice using ADPOAE and AABR screening equipment and communicating with parents

  1. Introducing the AccuScreen In-service Training

This *30 minute in-service is for those experienced in hearing screening. It includes the following: a review of IHP,review of changes in technology and hands on practiceusing ADPOAE and/or AABR screening equipment and communicating with parents

  1. IHP AccuScreen and Program Review:

The length of this training session is dependent on the depth of material to be covered. Thissession is intended for screeners who need further support. It focuses on their individual needs which could include: understanding of hearing high risk factors; ADPOAE and/or AABR screening equipment, probe selection and insertion techniques,understanding errors and troubleshooting,local infection control procedures, communicating with parents and/or documentation of screening results.

*Note: These are approximate times for training and may need to be adjusted according to the Regional Trainer and the needs of the trainees.

Understanding Perspectives and Motivation

Key to the success of training is to assess the individuals to be trained, evaluate their needs and motivatetrainees to implement the program in theirscreeningenvironment i.e. neonatal intensive care unit, community setting etc. Hearing Screening involves a unique interaction with children and families at a critical time when parents are building their initial bond with their newborn. Before the Ontario IHP started, the average age of identification of hearing loss in children was between 2-4 years of age. Since the program started, the majority of infants with hearing loss are being identified by 4 months of age and a plan for communication development is in place by 6 months of age. Hearing Screeners are responsible for the critical first step in identifying which infants require follow-up.

Motivations may differ based on the circumstances of the screeners.New hearingscreeners may be motivated because they are starting a new position or are eager to work with families.In-service training sessions may have traineesmotivated by the use of the new equipment, orby wanting tomake a difference in the lives of children and families through early identification. Screening Review sessions may have traineeswho are motivated to improve screening or to better understand IHP.

To understand what motivates others, we need to consider whatwe find motivating. Common motivating factors include: financial (money), autonomy (desire to be self-directed), mastery (desire to get better at a skill), or purpose (making a difference). In each training session it is vital to tap into what motivates your trainees. In some cases there will be experienced hearing screeners. Ask them to share some experiences where they feltinspired, motivated or made a difference in the life of someone else. Hearing screeners have the opportunity to master the skill of hearing screening. It is a purposeful activity that helps with early identification and impacts families. Each interactionis also an opportunity to make a connection with a family; to encourage continued monitoring of speech and language development, to observe potential red flags i.e. to discuss any parental concerns related to hearing, speech and or language issues and to provide external support or resource contacts. It is also an opportunity to provide controlled concern. If a parent, for example, appears anxious the screener should attempt to reduce the intensity of the “refer result’. If the parent appears unconcerned the screener should stress the importance of follow-up. If you can motivate hearingscreeners through training they will be more self-directed to master hearing screening. Any adult learnerneeds to be engaged in the learning process and recognized for the knowledge they have.This can contribute to and enhance the training process.

Types of Learners

People differ in the way they learn most effectively. There are many different categorizations of learning styles including the following: auditory, visual, reading/writing or kinesthetic (listening, watching, note taking and doing). Individuals may express a preference for a particular style of teaching or training. Many factors may underlie style preferences, including personality, cognitive ability, educational back ground, and cultural background. While scientific evidence of the effectiveness of teaching or training styles in this area is limited, a valid inference appears to be that presenting well-organized materials in multiple modalities allows the participant to engage using their preferred learning style. This is likely to increase a participant’s level of engagement. Just as there are individual learning style preferences, so people also learn at different rates. It is important to observe your trainees, be flexible and adjust your presentation delivery styles and pace to match their needs.

Types of Materials

Adultslearn best when presentations incorporate several modalities. The training materials must be diverse to have the greatest chance of appealing to all trainees. There are a variety of IHP materials including the following:the Screening Manual, Power Point presentations, videos, Quick Tips, and forms to encourage trainee engagement. It is the role of the trainer to monitor the trainees and ensure the materials are presented in a manner that is understood by the entire group. In addition to the activities and materials provided by IHP, you should consider including some of the following: group discussions, role-playing exercises, scenario or case study examples, games and individual coaching,Power Point presentations, videos with engaging activities, scenarios and group discussions. Provide plenty of opportunity to apply what was learned through hands on practice with infants and individual coaching.

When preparing presentation materials, print copies for trainees so they can record their thoughts and comments. Ensure you have sufficient supplies as well as extras incaseadditional trainees are able to attend the last minute. Also be sure to e-mail a link to the Mount Sinai AccuScreen Training Page prior to training so trainees can preview materials and prepare at their leisure. An electronic copy of all IHP Regional Trainer training materials listed below can also be found on the Mount Sinai AccuScreen Training Page.

Material List

  • AccuScreen-Ensure the carrying case is complete with the AccuScreen, docking station, probe cable, electrode cable, electrode self-test tool, probe tips, eartips (adult tips, and at least two different sizes, including a tree tip for infants), electrodes, and skin wipes.
  • Screening Supplies -Have screening forms, IHP brochures, hand sanitizer and local infection control materials (may include gloves and cleaning disinfecting wipes) available for each training session.
  • IHP Screening Manual -Each screener must read, understand and follow the IHP protocol and procedures outlined in the Screening Manual.
  • Power Point presentation and Agenda -Appropriate training session materials for desired presentation; New Screener Training, Introducing the AccuScreen In-Service or IHP AccuScreen and Program Review.
  • Quick Tips -This is a resource guide of key reference material regarding hearing screening.
  • IHP Screening Training Videos - These include the following six videos:

1. TheAccuScreen:Performing ADPOAE and AABR screens;

2. Examples of connecting the probe tip and eartips;

3. Probe positioning;

4. Techniques to calm a baby;

5. Communicating with parents; and

6. Using quality tests for troubleshooting.

  • Supporting Documents–These include the following:

1.Return Merchandize Authorization (RMA) form (please see Appendix A) to exchange or replace equipment under warranty to Genie Audio (please refer to the Power Point presentation noted in the Material List above for Genie Audio contact information);

2.Invoice Tracking (form to record tests completed that is submitted to the regional IHP to reimburse for services provided); and

3.Log Sheet (location specific form to communicate which babies were screened).

  • Audio Visual Aids - Laptop, projector and speakers if needed.
  • Participant Incentives - promotional items (pens, lanyards, retractable badge reel clips, personal hand sanitizers) or other.

Public Speaking Anxiety

Even skilled Regional Trainers may sometimes feel anxiety before a training session. Finding methods to reduce anxiety will make you feel more comfortable and improve the quality of your training. With time and practice, public speaking becomes easier. As familiarity with content, materials and potential participant questions increases, comfort levels also increase. Always plan to arrive early to allow for time to calm your nerves and set the stage for learning as trainees arrive.

Techniques to calm your nerves

Physical / Mental / Emotional
  • Take a few deep breaths
  • Take a break
  • Drink water
  • Exercise before and or after
/
  • Co-facilitate with an experienced presenter to get comfortable
  • Be prepared
  • Expect the unexpected
  • Recite a mantra or use visual imagery
/
  • Relying on team for support
  • Get support from colleagues
  • Remember “I don’t need to know everything”
  • Use humorto relieve tension

SETTING THE STAGE FOR LEARNING

Phases of Learning

  1. Preparation: In order to best prepare your trainees, allow time for them to review the materials prior to trainingbyproviding materials at least one week in advance. Include the Agenda to outline the time and topics as well as the request to the Regional Trainer to have babies available to screen directly following the training session.

Arrive at least 15 minutes early to check in with your contact, locate the space you will be using for training, and set up an environment conducive to learning i.e. position chairs to that all trainees can see you. The ideal situation would be a separate roomwithoutenvironmental distractions. Nursing stations are often busy and not conducive to focused attention or quiet enough to reliably screen an infant.A quieter location is preferred.

Setting the Stage for Learning

As trainees arrive, introduce yourself and try to remember their names. It may be helpful to have names written down or have a sign in sheet to remind you. If traineesare not familiar with the environment provide an orientation e.g. location of nearest exit, washroom etc. It is also helpful to assess your trainees’ knowledge through a show of handsabout topics such as if theyhave performed hearing screening before, or learned about it in school, etc., and what their screening environments are.Try and determine their needs and how to best facilitate their learning. This can be done informally as they arrive. Asking groups of three or more if they have any basic ground rules they think would be best conducive to their learning. Turning phones to silent or agreeing to stay present for 20 minutes are basic requirements to reduce interruptions. This is their time and you are there to help them get what they need to be able to provide the best possible service to children and families. Outline some goals for the training and write them down for everyone to see and refer to if needed.

If time allows, try an activity to get to know your trainees better. Ask them to think about something new they learned yesterday (or as needed further back). Have them write down what they learned, how they learned it, why they learned it, and what made it memorable. Then have the group reflect on what their learning needs are for today. Ask the group to share some of their thoughts.

  1. Presentation/Information: This phase involves the initial encounter of new knowledge. Use the IHP agenda to monitor time allowances. Review thePower Point and touch on key points from the notes section. Present the materials of the selected training session (may include: the basics of ADPOAE and/or AABR, screening protocol and procedures, risk factors, troubleshooting, communicating with parents, techniques that have worked when screening and sharing ideas within the group). Engagetrainees through questions and discussions. Mix styles of presentation with different types of materials to appeal to a variety of learning needs and styles.
  2. Practice: This phase involves thetrainees’ integration of new knowledge into practice. Have the group practice using the ADPOAE and/or AABR on each other; ask questions to help trainees reflect on learning and problem solving. After screening to get a pass result, have trainees make noises while screening to get a refer result or errors messages.Using the IHP brochures, provide example scripts from each brochure, and have trainees practice communicating with parents. Encourage participation and sharing of experiences while practicing communicating with parents. Provide your own examples of interactions to give trainees an idea of potential scenarios with parents and caregivers.

Have a broken probe available to teach trainees how to recognize inconsistencies when screening and troubleshoot to determine when equipment is broken. Encourage group discussion and facilitate self-directed problem solving during hands on practice with equipment. Provide sensitive feedback and allow for reflection and integration of new techniques. Work in small groups and provide individual coaching as needed. Use the knowledge base of the group when appropriate to ask for ideas of what others have done in similar scenarios or case studies.

  1. Performance: The final phase is the application of new knowledge. Continue to fine tune techniques with demonstrations and examples. Give positive reinforcement for accomplishments, and ensure traineesknowledge and self-esteem is respected. This is also an opportunity to discuss organizational and environmental changes (i.e. moving to a quieter room) in regard to when and where the screening will occur. As a Regional Trainer it is important to provide ongoing coaching and feedback for techniques observed and any areas for improvement.

CHALLENGES IN TRAINING

There may be times when challenges arise i.e. such as low attendance, a shortened time for training etc.Consider the group or individual, the scope of the issue and potential solutions.

Standing Concerns

Sometimes trainees who have conducted hearing screening before may have standing concerns. Respect their knowledge; ask which aspects of screening have presented challenges for them and if they have found anything that has helped ease the challenge. There are many moments in screening where challenges can arise, the most common are: probe positioning, settling a baby, errors with the equipment or screening, and giving refer results. Brainstorm potential solutions and try to create a shift in their perception of the issue to one that they can help solve. Many solutions are within our scope, there may however be times when we need to redirect to management for support. Listen to concerns, validate feelings and issues as they arise and direct to the appropriate resources to assist in problem solving issues beyond your scope. Always be courteous, patient and respectful.

Participant Disengagement

Maintaining awareness about your audience is the best way to ensure your training is effective. Regular eye contact and general body language are great cues to indicate if learners are engaged. Trainees who are interested and ready to learn will often make eye contact, take notes, and remain engaged. Trainees who are distracted may be focused on the time, their own personal device, or have other obstacles that inhibit their ability to learn or perform their duties. If you experience a group obstacle i.e. individuals who look distracted, it is likely time to switch activities, comment or ask a question to assess the trainees’ needs. If you have a one to one training session and the screener is disengaging try using different modalities and ask them how they learn best or if there may be another way they would like to explore the material.The biggest obstacle however is an individual who does not see that the presentation as beneficial or that hearing screening is something they want to do. A discussion about what they feel would help may be the best route. Check to see if any solutions are easy to implement. Record any challenges on your reflective practice form and discuss them with your supervisor for ideas and support.