title: Factors influencing speech and language outcomes of children with early identified severe/profound hearing loss: Clinician-identified facilitators and barriers.
abstract: OBJECTIVE
  Early identification of severe/profound childhood hearing loss (HL) gives these children access to hearing devices and early intervention to facilitate improved speech and language outcomes. Predicting which infants will go on to achieve such outcomes remains difficult. This study describes clinician identified malleable and non-malleable factors that may influence speech and language outcomes for children with severe/profound HL.
  
  
  METHODS
  Semi-structured interviews were conducted with six experienced auditory verbal clinicians. A collective case study design was implemented. The interviews were transcribed and coded into themes using constant comparative analysis.
  
  
  RESULTS
  Clinicians identified that, for children with severe/profound HL, early identification, early amplification and commencing auditory-verbal intervention under 6 months of age may facilitate child progress. Possible barriers were living in rural/remote areas, the clinicians' lack of experience and confidence in providing intervention for infants under age 6-months and belonging to a family with a culturally and linguistically diverse (CALD) background.
  
  
  CONCLUSIONS
  The results indicate that multiple factors need to be considered by clinicians working with children with HL and their families to determine how each child functions within their own environment and personal contexts, consistent with the International Classification of Functioning, Disability and Health (ICF) framework. Such an approach is likely to empower clinicians to carefully balance potential barriers to, and facilitators of, optimal speech and language outcomes for all children with HL.
authors.affiliation: The Shepherd Centre , Newtown, Sydney , Australia.
authors.forename: Anne Nivelles
authors.initials: AN
authors.lastname: Fulcher
authors.forename: Alison
authors.initials: A
authors.lastname: Purcell
authors.forename: Elise
authors.initials: E
authors.lastname: Baker
authors.forename: Natalie
authors.initials: N
authors.lastname: Munro
mesh_terms: D000367:Age Factors; D002663:Child Language; D002983:Clinical Competence; D003466:Cultural Characteristics; D004185:Disability Evaluation; D019988:Children with Disabilities / Q000523:psychology / Q000534:rehabilitation*; D042241:Early Diagnosis; D061345:Early Medical Intervention / Q000379:methods*; D006297:Health Services Accessibility; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis* / Q000523:psychology / Q000534:rehabilitation*; D006801:Humans; D007223:Infant; D018730:Infant Behavior; D007407:Interviews as Topic; D019986:Persons with Hearing Disabilities / Q000523:psychology / Q000534:rehabilitation*; D011237:Predictive Value of Tests; D011379:Prognosis; D036301:Qualitative Research; D012111:Residence Characteristics; D019035:Rural Health Services; D012720:Severity of Illness Index; D013066:Speech-Language Pathology / Q000379:methods*
keywords: Children; hearing impairment; outcome