FEATURE

The Growth of AV in Ontario: We Have Indeed Come a Long Way!

AV in Ontario

A reflection by Anita Bernstein

Director of Therapy and Training Programs

This year, 2009, marks the 15th year of my association with the VOICE organization.

It has indeed been a stimulating and rewarding journey as I have had the opportunity

to work alongside dedicated professionals, determined parents, and inspiring young

people with hearing loss. Upon reflection, I am keenly aware of how much I have

learned from VOICE children and their families and the impact they have had on me

as a professional. I am definitely a better therapist today!

During this period I witnessed the steady evolution of supports and services for children with hearing loss who are learning to listen and speak. The result of consistent and focused efforts of the VOICE organization can be seen throughout Ontario with the increased visibility and access to auditory-verbal (AV) intervention. Ontario is one of the provinces which leads the way in early identification of hearing loss, immediate audiological services, access to state-of-the-art hearing technology, funded auditory-verbal therapy for preschoolers, and the largest concentration of trained and certified professionals who are skilled in the delivery of auditory-verbal intervention.

Fifteen years ago, children with hearing loss were being identified at the average age of 2.5 years and parents stumbled over the auditory-verbal approach. Today AV is a funded communication option which families may choose for their babies when they are identified with a hearing loss through Ontario’s universal infant hearing screening program in operation since 2001.

In the past 15 years there have been monumental advances in hearing technology which have included sophisticated digital hearing aids, miniaturized FM systems and cochlear implants. Fifteen years ago the Ontario government allowed for fewer than 12 cochlear implants per year in each of the three pediatric implant centres. Now the Hospital for Sick Children, alone, receives well over 80 per year. The other centres’ numbers have increased as well, partly due to bilateral implantation. The technology has undergone tremendous development of both internal and external components, processing capacity, and a widening of the group of individuals with hearing loss who can benefit from cochlear implants. No longer are implants cumbersome body-worn systems but are now small enough to be worn behind the ears of a one year old baby. The auditory-verbal approach has gained greater recognition as it is the recommended intervention for children who become cochlear implant recipients, and for most children it is one of the criteria examined prior to the candidacy decision.

Over the past decade, as greater numbers of children who are deaf or hard of hearing learn to listen and speak enter and succeed in their neighbourhood schools, VOICE advocacy efforts has intensely impacted school boards and the ministry of education and the terms “auditory-verbal approach” and“auditory-verbal therapy” have materializing in special education documentation (such as references to auditory-verbal therapists as paraprofessional resource staff in The Special Education Plan Standards document.)

In the past 15 years, The VOICE AV program has continually expanded to keep pace with the changing Ontario landscape and the needs of the growing numbers of children with hearing losses who are learning to listen and speak. Since 1994, when I joined the VOICE team, the therapy program has grown from AV intervention provided to 25 families by four therapists to its current caseload of over 100 children receiving services province-wide from 18 VOICE Auditory-Verbal therapists.

The shortage of skilled and certified AV professionals has been of great concern to VOICE and the AV Training and Mentoring program was developed in an effort to ameliorate this situation. In the early 90s the focus of the program was to ensure that every VOICE chapter had access to local AV therapy by a certified professional. Now 15 years later, the ministry of education has recognized the outstanding outcomes of children who have learned to listen and speak through an AV approach and VOICE’s expertise in training such professionals. As a consequence, the ministry has provided VOICE with funding to train teachers of the deaf, towards certification as auditory-verbal educators, in 13 school boards throughout Ontario.

VOICE has worked closely with York University to ensure that AV courses were entrenched in the curriculum of the Teacher of the Deaf Program. VOICE therapists have provided continuing education courses for teachers of the deaf and hard of hearing who were interested in developing their AV skills. Over the last 15 years more than 60 professionals have attended these additional qualification courses and at least 15 of them are now certified AV therapists teaching in Ontario school boards.

Children with hearing losses require the collaboration of a dedicated team to help them realize their potential to learn to listen and speak. In Ontario, VOICE families and professionals have developed a strong coalition over the years which has laid the foundation for the development of highly regarded AV intervention and training programs. Ontario is the only province with such rich programs and we serve as a model for
other provinces as well as for other countries.

In spite of the obvious benefits of AV therapy, we face a continuous battle to demonstrate its benefits to funding bodies. Government ministers come and go. Bureaucrats at all levels are often indifferent to programs affecting less than 5% of the population. Delisting of audiological services for school-age children, underfunding of the provincial infant hearing program and school services for deaf and hard of hearing students,
the closing of clinical AV programs at the Credit Valley Hospital and the Learning to Listen Foundation at the North York Hospital demonstrate that the battle is not won and the challenges remain.

Ontario would be a very different province today, if VOICE were not here to ensure that services are in place to support children with hearing loss who are learning to listen and speak. I look forward to continuing my work with the dedicated VOICE team in developing programs and services which give deaf children a voice for life.