Comprehensive Program Development: The Ottawa Model

Early identification of hearing loss in children without early intervention offers little advantage to the child and family. Audiology and habilitation together constitute the pillars of comprehensive care for children who have hearing problems. This was the principle by which the Audiology Service at the Children's Hospital of Eastern Ontario (CHEO) in Ottawa, Canada, was established in 1974 and this concept has continued to guide the evolvement of all programs in the Audiology Service. Audiology is an allied health service in a 150-bed pediatric hospital providing care for children from birth through to 18 years of age. The hospital is a publicly funded regional center for pediatric health care, servicing a population of approximately 200,000 children, in two Canadian provinces, Eastern Ontario and Western Quebec. The Audiology Service is responsible for all diagnostic hearing services and for speech and language intervention for children who are diagnosed with hearing impairments. The hospital is the only publicly funded facility providing pediatric audiology services. Private audiologists in the community may assess children age 5 and over but usually refer the child to the hospital if there is a hearing problem requiring management. Health services are covered under provincial health insurance, therefore any insured child may access the service. All initial referrals to the hospital are made by a physician. Departmental statistics show that the number of patient visits range from 5000 to 6000 annually. Clinical staff currently include 5.8 full-time equivalent audiologists and 2.0 equivalent full-time auditory-verbal therapists. (Equivalent full-time is defined as 37.5 paid hours per week.) In addition, there is a 0.4 equivalent full-time Audiology assistant assigned primarily to the evoked potentials testing program. The mandate of the Audiology Service is to provide diagnostic hearing assessments for children and habilitative care for those who are diagnosed with a hearing problem. The Audiology Service also participates in research projects and teaching. Diagnostic program components include conventional audiometry, and auditory brain stem response audiometry. Rehabilitative services include the selection and fitting of amplification, cochlear implant assessment and follow-up, and auditory-verbal therapy. Therapy is offered to all preschool children who receive amplification and to children of all ages who receive a cochlear implant. There is a close liaison with many other clinical services in the hospital, particularly the Ear Nose and Throat (ENT) Clinic, which is located adjacent to the Audiology Clinic. An estimated 60% of the diagnostic patient visits are referred by the