Pilbara Ear Health Model of Care

Pilbara Ear Health

Model of Care

INCLUDING

Pilbara Ear Health & Hearing
Best Practice Workforce Guidelines

Peta Monley & Jay Krishnaswamy
Editors
Telethon Speech & Hearing

Government of Western Australia
Department of Health
WA Country Health Service

This project proudly supported by Chevron Australia

Pilbara Ear Health Model of Care

Pilbara Ear Health Model of Care including Pilbara Ear Health and Hearing Best Practice Workforce Guidelines

Peta Monley & Jay Krishnaswamy (Eds.). Telethon Speech & Hearing, Perth WA

Telethon Speech & Hearing
36 Dodd Street, Wembley
Western Australia 6014

Copyright © 2015 by Peta Monley and Jay Krishnaswamy, Telethon Speech & Hearing.
The copyright owners give permission for sections of this document to be copied for use in the prevention and remediation of ear disease.
Sections that can be copied are marked with the publication reference.

Suggested citation
Monley, P., & Krishnaswamy, J. (Eds.). (2015). Pilbara Ear Health Model of Care including Pilbara Ear Health and Hearing Best Practice
Workforce Guidelines. Perth, Western Australia: Telethon Speech & Hearing.

This document can be viewed at: http://www.tsh.org.au/resources/publications

ISBN: 978-0-9953908-0-5
ISBN: 978-0-9953908-1-2 (eBook)

Contributors and Participants to the Pilbara Ear Health Model of Care

In alphabetical order by surname.

Dr Aanand Acharya, ENT Consustant
Margaret Abernethy, Director Population Health, WA Country Health Services – Pilbara
Linda Bacich, Program Officer – Outreach in the Outback, Rural Health West
Sue Beath, Manager Aboriginal Education, Pilbara Education Regional Office, Government of Western Australia, Department of Education
Melinda Benson, Community Nurse Manager WA Country Health Service, Government of Western Australia
Erin Bourne, Social Investment Team Lead, Chevron Australia
Angie Boyes, Practice Manager, Wickham Primary Health Care Centre
Paula Bridges, Associate Principal – Visiting Teacher Service, School of Special Educational Needs – Sensory, Government of

Western Australia Department of Education
Gemma Brooks, Health Promotion Officer, WA Country Health Services
Hannah Cauchi, Program Officer – Outreach in the Outback, Rural Health West
Nila Cecconi, Manager-Outreach in the Outback, Rural Health West
Shane Coleman, Customer Service Officer, Telethon Speech & Hearing
Rebecca Corbett, WA Country Health Service, Government of Western Australia
John De Satge, Screener, Telethon Speech & Hearing
Jennifer Duggan, Manager Ear Health, Telethon Speech & Hearing
Deanna Exeter, Public Health Manager, WA Country Health Services – Pilbara
Adam Faulkner, Manager, Australian Hearing
Deborah Gayton, Service Development and Contract Manager, WA Country Health Service
Jo Halpin, CEO, Pilbara Health Network
Winsome Henry, Program Manager, Pilbara Health Network
Joan Hicks, CEO Mawarnkarra Health Service Aboriginal Corporation
Paul Higginbotham, CEO, Earbus Foundation of WA
Maureen Jackson, Primary Health Care Representative, Medicare Local – Kimberley Pilbara
Douglas Josif, Clinical Services Director, Medicare Local – Kimberley Pilbara
Alison King, ASPHIA Specialist, Australian Hearing
Dr Yuriko Kishida, Research Coordinator, Telethon Speech & Hearing
Jay Krishnaswamy, Head of Hearing Services, Telethon Speech & Hearing
Donna Lawrence, Clinical Leader – Psychology, Telethon Speech & Hearing
Geraldine Le, Paediatric Audiologist, Australian Hearing
Clinical Assocate Professor Deborah Lehmann, Principal Research Fellow, Telethon Kids Institute
Belinda Leksas, Manager – Program Development, Telethon Speech & Hearing
Rod Mapstone, Social Investment Advisor, Chevron Australia
Professor Terry McManus, Ear Nose and Throat Surgeon
Peta Monley, CEO and Audiologist, Telethon Speech & Hearing
Dr Philip Montgomery, Regional Medical Director, WA Country Health Services – Pilbara
Gemma Nickolai, Coordinator Health Enhancement, WA Country Health Service, Government of Western Australia
Dannielle O’Hara, Ear Health Co-ordinator Pilbara, Telethon Speech & Hearing
Dr Julie Owen, Regional Coordinator, Rural Health West
Chris Pickett, CEO, Medicare Local – Kimberley Pilbara
Clare Reid, Marketing and Communications Officer, Telethon Speech & Hearing
Kirsten Richardson, Manager, Australian Hearing
Sam Rigg, Social Investment Advisor, Chevron Australia
Brett Robertson, General Manager, Ear Science Institute of Australia
Debra Royle, Manager-Outreach in the Outback, Rural Health West
Amelia Scheele, Pilbara Ear Health Coordinator, Telethon Speech & Hearing
Sharon Safstrom, Ear Science Institute of Australia
Paula Schneider, Educational Audiologist, School of Special Educational Needs – Sensory, Government of Western Australia,

Department of Education
Sarah Seymour, Government and Stakeholder Relations Officer, Telethon Speech & Hearing
Dr Rob Starling, Chief Information Officer, Medicare Local – Kimberley Pilbara
Kathleen Stoop, Manager Ear Health and Audiologist, Telethon Speech & Hearing
Victoria Stroud, Research Officer, Telethon Kids Institute
Shanthi Thuraisingam, Acting Primary Health Manager, WA Country Health Services – Pilbara
Steve Watson, Principal, School of Special Educational Needs – Sensory, Government of Western Australia Department of Education
Lauren White, Manager, Australian Hearing
Associate Professor Cori Williams, Deputy Head, School of Psychology and Speech Pathology, Curtin University

©Monley, P., & Krishnaswamy, J. (Eds.). (2015). Pilbara Ear Health Model of Care including Pilbara Ear Health and Hearing Best Practice
Workforce Guidelines. Telethon Speech & Hearing, Perth WA. 

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Pilbara Ear Health Model of Care

Abbreviations

AMS Aboriginal Medical Service

AH Australian Hearing

AHW Aboriginal Health Worker

BBC Breath, Blow Cough

DNA Did Not Attend

DOE Department of Education

ENT Ear Nose & Throat Specialist

ESIA Ear Science Institute of Australia

MP Medical Practitioner

NBHS Newborn Hearing Screening

IWG Interagency Working Group

KPML Kimberley-Pilbara Medicare Local

OHS Office of Hearing Services

OM Otitis Media

PEHC Pilbara Ear Health Coordinator

PHN Primary Health Network

NP Nurse Practitioner

RHW Rural Health West

SSENS School of Special Educational Needs Sensory

TS&ES Therapy, Support and Educational Services

TSH Telethon Speech & Hearing

WACHS West Australian Country Health Service

WAMPET West Australian Education & Training for General Practitioners

©Monley, P., & Krishnaswamy, J. (Eds.). (2015). Pilbara Ear Health Model of Care including Pilbara Ear Health and Hearing Best Practice
Workforce Guidelines. Telethon Speech & Hearing, Perth WA. 

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Pilbara Ear Health Model of Care

Table of Contents

Abbreviations��������������������������������������������������������������������������������������������������������������������������������������� iii
Hearing Loss������������������������������������������������������������������������������������������������������������������������������������������ 4
Hearing Loss in Australia�������������������������������������������������������������������������������������������������������������������� 5
Otitis Media�������������������������������������������������������������������������������������������������������������������������������������������� 5
Risk Factors and Effects of Hearing loss������������������������������������������������������������������������������������������� 6
Profile of the Pilbara���������������������������������������������������������������������������������������������������������������������������� 7
Development of the Pilbara Ear Health Model of Care��������������������������������������������������������������������� 8

Otitis Media Model of Care�������������������������������������������������������������������������������������������������������������� 8
Pilbara Ear Health Network – Hearing Health Report������������������������������������������������������������������ 8
Collaborative Partnership – Chevron Australia, WACHS and Telethon Speech & Hearing�������� 9
Pilbara Ear Health Model of Care – 10 Principles of Best Practice�����������������������������������������������11
1: Target priority populations�������������������������������������������������������������������������������������������������������11
2: Focus on prevention�����������������������������������������������������������������������������������������������������������������11
3: Coordinate well – no duplication and work together – right care, right patient, right time,

right team, right place������������������������������������������������������������������������������������������������������������� 12
4: Use primary health care approach – early diagnosis and effective treatment�������������������� 12
5: Use specialists well – audiologists, speech pathologists, MPs, ENTs��������������������������������� 12
6: Appropriate access to hearing aids and sound field amplification��������������������������������������� 13
7: Therapy, support and educational services (TS&ES) – to address developmental and

educational delay due to hearing loss������������������������������������������������������������������������������������ 13
8: Research, evaluation and surveillance – for quality improvement��������������������������������������� 13
9: Workforce planning����������������������������������������������������������������������������������������������������������������� 14
10: Support and encourage specialist training���������������������������������������������������������������������������� 14

©Monley, P., & Krishnaswamy, J. (Eds.). (2015). Pilbara Ear Health Model of Care including Pilbara Ear Health and Hearing Best Practice
Workforce Guidelines. Telethon Speech & Hearing, Perth WA. 

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Pilbara Ear Health Model of Care – Work Plan������������������������������������������������������������������������������� 15
1: Target priority populations������������������������������������������������������������������������������������������������������ 15
2: Focus on prevention���������������������������������������������������������������������������������������������������������������� 17
3: Coordinate well – no duplication and work together – right care, right patient,
right time, right team, right place������������������������������������������������������������������������������������������� 19
4: Use primary health care approach – early diagnosis and effective treatment�������������������� 20
5: Use specialists well – audiologists, speech pathologists, MPs, ENTs��������������������������������� 22
6: Appropriate access to hearing aids and sound field amplification��������������������������������������� 23
7: Therapy, support and educational services (TS&ES) – to address developmental
and educational delay due to hearing loss����������������������������������������������������������������������������� 24
8: Research, evaluation and surveillance – for quality improvement��������������������������������������� 25
9: Workforce planning����������������������������������������������������������������������������������������������������������������� 26
10: Support and encourage specialist training���������������������������������������������������������������������������� 27

Pilbara Ear Health & Hearing Best Practice – Workforce Guidelines������������������������������������������ 29
HEALTH WORKERS........................................................................................................................ 29
CHILD CARE WORKERS................................................................................................................. 33
AGED CARE WORKERS.................................................................................................................. 37
TEACHERS...................................................................................................................................... 41
MEDICAL AND NURSE PRACTITIONERS...................................................................................... 45
AUDIOLOGISTS................................................................................................................................ 49
EAR NOSE AND THROAT SURGEONS........................................................................................... 53
OTHER SPECIALIST SERVICES – Paediatricians, Psychologists, Other Health
Professionals............................................................................................................................ 57
REMEDIATION PROVIDERS – Teachers of the Deaf, AV Therapists, Speech Pathologists,
Occupational Therapists, Psychologists................................................................................. 61

References������������������������������������������������������������������������������������������������������������������������������������������� 65

Appendices������������������������������������������������������������������������������������������������������������������������������������������ 69

©Monley, P., & Krishnaswamy, J. (Eds.). (2015). Pilbara Ear Health Model of Care including Pilbara Ear Health and Hearing Best Practice
Workforce Guidelines. Telethon Speech & Hearing, Perth WA. 

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Pilbara Ear Health Model of Care

Hearing Loss

The World Health Organization reports that 360 million people worldwide have
disabling hearing loss (World Health Organization, 2014). Hearing loss can cause life-
long difficulties, including a profound effect on communication, socialisation, literacy,
education and the ability to obtain employment (World Health Organization, 2014).
The WHO estimates that half of all cases of hearing loss can be prevented through
primary prevention and that a large percentage of people living with hearing loss
can benefit from early identification and intervention, and appropriate management
(World Health Organization, 2014) .

The most important factor in minimising the impact of hearing loss on a child’s development
and educational achievements is early detection and intervention (Cole & Flexer, 2007). Early
identification and management of hearing loss through newborn hearing screening programmes
can improve the linguistic and educational outcomes for the child (Ching et al., 2013). Screening
for otitis media and hearing loss at day-care centres, kindergartens and primary school can
also be effective for early identification and management of hearing loss (Bhatia, Mintz, Hecht,
Deavenport, & Kuo, 2013; Fitzpatrick, Whittingham, & Durieux-Smith, 2014; McPherson &
Driscoll, 2014).
As sensory input (e.g., seeing and hearing) is a major contributor to a child’s brain development
and learning (Allen, 1992), hearing loss can adversely affect various developmental domains, and
can lead to delay in language, academic, and social – emotional development, even if the degree
of loss is mild (Access Economics, 2006; Durieux-Smith, Fitzpatrick, & Whittingham, 2008;
Yoshinaga-Itano, Johnson, Carpenter, & Brown, 2008). A combination of high quality newborn
hearing screening, the audiological diagnostic process, fitting of amplification and individualised
early intervention services is essential to maximise outcomes of children with congenital hearing
loss (Yoshinaga-Itano, 2014).
Studies on the prevalence of acquired hearing loss across the life span have shown a trend of
increase in hearing loss with age (Chou, Dana, Bougatsos, Fleming, & Beil, 2011). Due to the
gradual onset and progressive nature of age-related hearing loss it is often an overlooked health
concern. Adult-onset hearing loss is typically diagnosed and managed several years post onset
and may lead to multiple negative consequences, including social isolation, poor quality of life,
reduced independence and effects on employment (McMahon et al., 2013). Recent research has
found an association between hearing loss and decline in cognitive ability, and an increased risk
of dementia in adults (Crain, 2014; Lin & Albert, 2014; Lin & Resnick, 2011). The more severe the
hearing loss is, the higher a risk of dementia (Crain, 2014).

©Monley, P., & Krishnaswamy, J. (Eds.). (2015). Pilbara Ear Health Model of Care including Pilbara Ear Health and Hearing Best Practice
Workforce Guidelines. Telethon Speech & Hearing, Perth WA. 

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Pilbara Ear Health Model of Care

Hearing Loss in Australia

Hearing loss affects 1 in 6 Australians and it is predicted that the prevalence will
increase to 1 in 4 by 2050 (Access Economics, 2006). As hearing is one of the primary
means to communicate with others, impairment in hearing can have a significant
negative impact on various daily activities and quality of life at any stage of life
(Access Economics, 2006; Olusanya, Neumann, & Saunders, 2014).

There are two major types of hearing loss in childhood, sensorineural or conductive (Access
Economics, 2006). Research suggests that 1-2 babies in every 1,000 are born with permanent
hearing loss (WA Department of Health, 2014) and that conductive hearing loss was also found to
be a common diagnosis among infants referred through screening. Aboriginal and Torres Strait
Islander infants had significantly higher referral rates due to middle ear pathology and showed
poor resolution of middle ear pathology over time (Aithal, Aithal, Kei, & Driscoll, 2012).
Indigenous Australians experience some of the highest levels of ear disease and hearing loss
in the world, with rates up to ten times more than those for non-Indigenous Australians (Burns
& Thomson, 2013). For Indigenous children in particular, hearing loss is widespread and much
more common than in the broader Australian population (Jervis-Bardy, Sanchez, & Carney, 2014;
YienMPrugsawan, Hogan, & Strazdins, 2013).
In 2005, almost two-thirds of Australians aged over 70, and nearly half of Australians aged from
61 to 70 presented with hearing loss (Access Economics, 2006). The annual cost of earnings lost
due to workplace separation and early retirement as a result of hearing loss was estimated to be
6.7 billion.

Otitis Media

Otitis media (OM) is inflammation or infection of the middle ear, and is a common
childhood condition (Daniero, Clary, & O’Reilly, 2012). By age 4, the majority of children
will experience OM (Williams & Jacobs, 2009). OM is treatable but without appropriate
treatment, it can cause temporary or permanent hearing loss. OM and associated
hearing loss can have a negative impact on a child’s cognitive development and
educational outcomes (Williams & Jacobs, 2009).

The high prevalence of early onset, long-term otitis media (middle ear infection) and consequent
conductive hearing loss amongst Indigenous children is well documented (Aithal et al., 2012;
Burns & Thomson, 2013; Lehmann, Arumugaswamy, et al., 2008; Williams & Jacobs, 2009).
A recent study of children in Perth, Western Australia identified 30% of 408 school-aged
indigenous children as having otitis media (Timms, Grauaug, & Williams, 2012). Furthermore,
research indicates a higher incidence of middle ear disease in urban compared to regional
cohorts, with a higher incidence of middle ear disease in younger children (Burns & Thomson,
2013), and associated hearing loss (Lehmann, Weeks, et al., 2008; Timms et al., 2012).

©Monley, P., & Krishnaswamy, J. (Eds.). (2015). Pilbara Ear Health Model of Care including Pilbara Ear Health and Hearing Best Practice
Workforce Guidelines. Telethon Speech & Hearing, Perth WA. 

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Pilbara Ear Health Model of Care

Although the incidence decreases with increasing age, middle ear disease is present in
Indigenous children throughout primary school (Williams, Coates, Pascoe, Axford, & Nannup, 2009).
A study of refugees in Australia found an overall prevalence of 2.64% for chronic suppurative
otitis media in adults, which suggests that untreated otitis media can persist into adulthood
(Benson & Mwanri, 2012).
Acute otitis media may become recurrent or may lead to perforation of the ear drum. Recurrent
episodes of otitis media can lead to ‘glue ear’ (or otitis media with effusion) which results in
reversible hearing loss due to fluid behind the ear drum. When an eardrum is perforated, this
will lead to fluid draining into the external ear canal, causing chronic suppurative otitis media
(Qureishi, Lee, Belfield, Birchall, & Daniel, 2014). This condition can persist for years and may
lead to irreversible hearing loss. Other complications may include cholesteatoma, mastoiditis,
meningitis,brain abscess formation and sigmoid sinus thrombosis (Qureishi et al., 2014). In WA,
the hospitalisation rate in 2008-2010 for Indigenous people for disease of the ear and mastoid
process was 1.5 times higher than the non-Indigenous rate (Rural Health West, 2013). In the
Pilbara, the hospitalisation rate for otitis media was found to be 14.5% (Rural Health West, 2014).

Risk Factors and Effects of Hearing loss

The risk factors contributing to ear disease and hearing disorders are complex and
reflect a combination of historical, social, cultural, environmental and economic
factors (Burns & Thomson, 2013; Lehmann, Arumugaswamy, et al., 2008). As a result,
a multidisciplinary approach to primary prevention and education is key to early
identification and management of middle ear disease and hearing loss across the
age span.

Students at risk of emotional or behavioural difficulties are likely to be absent from school more
often (Zubrick et al., 2004). Students with hearing problems may demonstrate behavioural issues
in a classroom, as teacher instructions are mostly relying on auditory skills (Douglas & Flexer,
2012). Students may be less engaged at school because they have problems hearing what is
said by teachers or by peers. Better hearing can therefore assist to provide children with better
access to education that can lead to better future opportunities; hence it can help to break the
undesirable cycle. A routine ear health program, especially for younger age children is therefore
necessary (Lehmann, Weeks, et al., 2008).
A much poorer school attendance rate in Aboriginal students than non-Aboriginal students
is a serious issue in WA (Zubrick et al., 2004). A low school attendance means less learning
opportunity, leading to lower educational achievement, unhealthy social-emotional well –
being, and can result in the cycle of poor health, unemployment, poverty and social exclusion
experienced by many ATSI people (Lehmann, Weeks, et al., 2008; Zubrick et al., 2004).
It is encouraging that findings of recent research indicate reduced occurrence of ear health
problems in areas where an ear health program was routinely delivered (Monley, Kishida, &
Williams, 2014, May; Timms et al., 2012) .

©Monley, P., & Krishnaswamy, J. (Eds.). (2015). Pilbara Ear Health Model of Care including Pilbara Ear Health and Hearing Best Practice
Workforce Guidelines. Telethon Speech & Hearing, Perth WA. 

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Pilbara Ear Health Model of Care

Profile of the Pilbara

The Pilbara is a remote and isolated region representing 20% of Western Australia’s
land mass and covering 508,000 square kilometers, including offshore islands, and
located 1,480 kilometers from Perth (Rural Health West, 2012). It has the Indian
Ocean to the West and the Northern Territory to the East. There are two major towns,
Karratha and Port Hedland, with smaller towns of Roebourne, Newman, Marble Bar,
Onslow, Tom Price, and Nullagine. There are approximately 67,500 residents in the
Pilbara (Pilbara Development Commission/REMPLAN, 2015) with a large fly-in/fly-
out population of about 30,000 people who mostly reside in Perth. The Pilbara has a
higher proportion of resident males, 56% compared to the state average of 51%. The
Aboriginal population represents approximately 16% of the population with a higher
proportion of females and younger people.

The region is serviced by major airports at Karratha, Port Hedland and Newman with many
charter flight services available. The two major roads are the Great Northern Highway and the
North West Coastal Highway and transport within the Pilbara is mainly by private vehicle with 4
wheel drive recommended for travels to ‘off road’ remote locations.
The region is divided into West and East Pilbara and health services delivered accordingly with
most of the region’s population residing in the West.
Mining is the major economic activity in the Pilbara with significant reserves of iron ore, crude
oil and natural gas. Peaks in mining activity stretch the ability of local health services to meet
demand (Rural Health West, 2012).

©Monley, P., & Krishnaswamy, J. (Eds.). (2015). Pilbara Ear Health Model of Care including Pilbara Ear Health and Hearing Best Practice
Workforce Guidelines. Telethon Speech & Hearing, Perth WA. 

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Development of the Pilbara Ear Health
Model of Care

Effective delivery of health services in the Pilbara requires a unique approach to meet the needs
of the population. In regards to the delivery of ear health services the major challenges are the
high incidence of otitis media, especially in Aboriginal children, access to specialist services,
especially tertiary medical and remediation services, and high staff turn – over across both the
local health and education sectors.

Otitis Media Model of Care

The Western Australian Government released the Otitis Media Model of Care in January 2013 (WA
Department of Health, 2013). This comprehensive guideline provided a blueprint for WA health
regions to use to develop a model of ear health care that best met the individual requirements of
each region. The major recommendations were:
• To target priority populations;
• To use a coordinated approach (right care, right patient, right time, right team, right place);
• To utilise a three pronged approach of prevention, primary health care and specialist care.

Pilbara Ear Health Network – Hearing Health Report

Further work was carried out in the Pilbara through a collaboration between the Pilbara
Health Network and the WA Country Health Services (WACHS) (Leidwinger, 2013). This report
recommended the establishment of Cloud based data sharing for better service coordination.
The use of approved treatment protocols for the management of otitis media. Improved
understanding by all health providers of otitis media, speech and language development, and the
impact of hearing loss on educational outcomes. Training to improve the confidence of health
workers managing otitis media. The use of more Nurse Practitioners to relieve the pressure on
General Practitioners. There was an emphasis on all health practitioners checking the ears of
all Aboriginal children at every contact and the introduction of hearing checklists especially for
children under 4 years of age. The appointment of a Pilbara Ear Health coordinator and ongoing
training and working together opportunities.

©Monley, P., & Krishnaswamy, J. (Eds.). (2015). Pilbara Ear Health Model of Care including Pilbara Ear Health and Hearing Best Practice
Workforce Guidelines. Telethon Speech & Hearing, Perth WA. 

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Pilbara Ear Health Model of Care

Collaborative Partnership – Chevron Australia,
WACHS and Telethon Speech & Hearing

Chevron Australia partnered with Telethon Speech & Hearing in 2011 to deliver ear health
programs in West Pilbara to Aboriginal school aged children. Chevron community partnerships
aim to build community capacity and leave a lasting legacy. This partnership was expanded,
following extensive community and stakeholder engagement in 2013, to include all people in
West Pilbara with a focus on children under 4 years of age and Aboriginal people. The focus of
the program also shifted from a medical model to one of prevention and delivering services in
partnership with local providers and building and strengthening local provider capacity.
With Chevron’s support and a partnership with WACHS, the first Pilbara Ear Health Model of Care
interagency meeting was held in Karratha in December 2013. The purpose of this meeting was
to collectively develop the Pilbara Ear Health Model of Care which reflected the needs of people
in the Pilbara and would be delivered with the support of all agencies. Four further meetings
were held in 2014. The result of the first two meetings was the agreement by all agencies on the
principles of best practice and the development of a work plan to implement these. The third
meeting developed a set of Guidelines for all health practitioners, workers and teachers, based
on the 10 best practice principles, and the fourth meeting developed the referral pathways for all
providers. The fifth meeting finalised the Pilbara Ear Health Model of Care, including the Pilbara
Ear Health & Hearing Best Practice Workforce Guidelines (PEHMC). The interagency group
became the Pilbara Hearing Interagency Group (PHIG).
The role of PHIG is to implement the Pilbara Ear Health Model of Care, work plan, and be the
advisory body to the Pilbara Aboriginal Health Planning Forum. PHIG will meet regularly to
achieve these objectives.
The Pilbara Ear Health Model of Care, including the Pilbara Ear Health & Hearing Best Practice
Workforce Guidelines (PEHMC) is a comprehensive approach based on best practice principles
for at risk populations. The development of the PEHMC was only possible with the significant
contribution by many. It is an example of collective partnerships working together to deliver best
practice in ear health care, in a Pilbara specific manner, to improve the hearing outcomes for all
persons living in the Pilbara.

©Monley, P., & Krishnaswamy, J. (Eds.). (2015). Pilbara Ear Health Model of Care including Pilbara Ear Health and Hearing Best Practice
Workforce Guidelines. Telethon Speech & Hearing, Perth WA. 

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Pilbara Ear Health

Model of Care

10 Principles of Best Practice

10 Principles of Best Practice Pilbara Ear Health Model of Care

Pilbara Ear Health Model of Care –
10 Principles of Best Practice

These principles for ear health apply to all persons in the Pilbara and form the framework for
best practice.

1: Target priority populations

a) Focus on early diagnosis and Children ‘At Risk’ for hearing loss
b) All Aboriginal children and in particular children 0-4 years
c) Children in child care centres
d) Aboriginal Adults
e) Adults over 50yrs

2: Focus on prevention

a) Support local activities that address the social determinants of poor ear health: –
i. Reducing crowded housing and improving environmental health
ii. Reducing the prevalence of smoking and encouraging adults not to smoke
around children
iii. Improving food security and encouraging breast feeding
iv. Improving access to clean water and encouraging good hygiene practices
v. Work with Day Care staff to encourage practices that reduce the incidence of
otitis media
vi. Implement strategies and work practices that address the issues created by
geographical isolation
vii. Work cooperatively to reduce educational and social disadvantage

b) Engage in Ear Health Promotion Activities that: –
i. Target mothers and carers especially those with children 0-5 yrs
ii. Include children 5 years plus to encourage self-responsibility and future role models
iii. Use intermediaries to channel ear health promotion such as MP or health workers
and reinforce at every contact
iv. Localise National or State programs to be Pilbara relevant
v. Are culturally relevant and community-driven
vi. Coordinate with other public health prevention programs to address diseases with
similar epidemiology and aetiology

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10 Principles of Best Practice Pilbara Ear Health Model of Care

3: Coordinate well – no duplication and work together – right
care, right patient, right time, right team, right place

a) Establish a system to allow shared easily accessible patient data
b) Engage a Pilbara Ear Health Coordinator
c) Encourage the practice of care coordination by all participants – don’t lose individuals

and their families in the system
d) Encourage the practice of operational service coordination – all agencies working

together
e) Engage in strategic coordination to monitor National and State programs and access

funding opportunities

4: Use primary health care approach – early diagnosis and
effective treatment

a) Early diagnosis and effective treatment of acute OM
b) Early diagnosis of children with sensorineural losses and the application of early

intervention services
c) Monitor children with recurrent acute OM
d) Coordinated management of CSOM ‘runny ears’ in the primary care setting
e) Testing for and provision of hearing aids and sound field amplification to ensure children

with hearing loss can hear at school
f) Developmental rehabilitation in communities, school, health care settings for children

affected by hearing loss
g) Early diagnosis of adults with sensorineural losses and referral for appropriate

rehabilitation

5: Use specialists well – audiologists, speech pathologists,
MPs, ENTs

a) Ensure a regular visiting schedule and good notification to local services of visiting dates
b) Educate for appropriate referrals and the following of correct referral pathways
c) Utilise web based, Telehealth and online resources and therapy
d) Encourage the use of appropriate checklists
e) Ensure all visiting specialists leave behind easy to follow care plans
f) Utilise local providers to manage the care plans
g) Work to have ENT surgery in safe environments as close to home as possible

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12

10 Principles of Best Practice Pilbara Ear Health Model of Care

6: Appropriate access to hearing aids and sound field
amplification

a) Support visits by the Federal Government’s Australian Hearing who provide fully
subsidised hearing aids to persons 0-26 years of age and Aboriginal Australians
50 years and older

b) Support local and visiting providers who are registered with the Office of Hearing
Services (OHS) to provide fully subsidised services to pensioners and veterans

c) Support local and visiting services that provide private fee for service hearing aids
to adults

d) Work with the School of Special Educational Needs Sensory (SSENS) to ensure
appropriate sound field systems in schools

7: Therapy, support and educational services (TS&ES) –
to address developmental and educational delay due
to hearing loss

a) Support early identification of speech and language delay
b) Utilise web based, Telehealth and online resources and therapy to supplement local

providers
c) Support local teachers address educational delay due to hearing loss
d) Support visiting Teachers of the Deaf
e) Work with local and visiting Paediatricians and other Specialist for early identification of

other factors impacting on general delay

8: Research, evaluation and surveillance – for quality
improvement

a) Engage in practices that evaluate the effectiveness of prevention, screening and
treatment programs

b) Use the data collected to guide future program planning and investment
c) Set up practices that allow for the collection of prevalence data

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13

10 Principles of Best Practice Pilbara Ear Health Model of Care

9: Workforce planning

a) Introduce strategies that address the high turnover of staff in the Pilbara
b) Work with Medicare Locals, Specialist Colleges and tertiary education sector to support

the education, recruitment and retention of staff
c) Train Nurse Practitioners who can diagnose and prescribe treatment for OM
d) Engage in strategies to ensure access to Medical Practitioners, Audiologists,

e.g. Telehealth

10: Support and encourage specialist training

a) That is local, relevant and encourages culturally appropriate and safe practices
b) That supports the Pilbara Ear Health Model of Care
c) That supports the agreed Pilbara protocols for OM management

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14

Pilbara Ear Health

Model of Care

Work Plan

Work Plan Pilbara Ear Health Model of Care

Pilbara Ear Health Model of Care – Work Plan

1: Target priority populations

Target Population How

All Aboriginal Increase access to screening, early diagnosis, and follow up programs
children and in for children at risk of or with ear health conditions.
particular children
aged 0-4 years All health service providers should have regular child health
surveillance programs in place e.g. newborn hearing screening,
Children in child Aboriginal child health schedule, Aboriginal child health checks and
care centres the capacity to offer screening and opportunistic assessments.

Increase access for school-aged children to participate in school entry
ear health screening, and offer opportunistic screening when carers/
teachers have concerns.

Work closely with child care centres, child and parent centres,
playgroups and other groups provided by non-government
organisations to access all children who may require screening
and assessments.

Work closely with schools and education liaison officers to ensure
children not attending school are offered screening and assessments.

Ensure all health service staff are appropriately skilled to undertake
ear health screening and assessments and have access to appropriate
equipment.

Increase access to remote communities for Audiology and ENT
assessments.

Increase access to paediatric audiology booths suitable for children
less than 3yrs.

Ensure all service providers working with children and their families
are aware of health services providers in the Pilbara, what they do and
how to access them.

Map location of child day care centres and number of children
attending.

Local health service providers develop screening and follow-up
programs for children in full-time child care in collaboration with
carers and community.

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Work Plan Pilbara Ear Health Model of Care

Target Population How

Early diagnosis of Continue to provide and monitor Pilbara newborn hearing screening
Children ‘At Risk’ program. Aim for a screening rate of 98% of eligible screens.
for hearing loss
Introduce Hearing Checklists for all service providers, particularly for
Aboriginal Adults children 0-4yrs.

Adults over 50yrs Implement Aboriginal child health schedule.

Implement Aboriginal child health checks.

Develop clinical guidelines for health service providers and ensure
referral processes to specialist services e.g. audiology assessment,
audiology treatment (including hearing aids), speech therapy, MP, ENT
are made available.

Assess current specialist services to determine if complex diagnostic
services can be provided in the Pilbara rather than children needing to
be sent to Perth.

Increase access to hearing screening of Aboriginal adults through
PEHC, AMS, TSH and develop KPIs.

Work to address cultural issues of non-acceptance of hearing loss
rehabilitation.

Work with Australian Hearing to ensure coordinated referral
procedures for those adults requiring hearing aids.

Implement adult health checks and ensure ear health and hearing
problems are assessed.

Encourage screening programs in nursing homes.

Support visiting private and OHS hearing services.

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Work Plan Pilbara Ear Health Model of Care

2: Focus on prevention

Focus on Prevention How

Social Determinants Encourage local Government, local agencies and health service
providers, who have environmental officers, to address issues such as
Crowded Housing/ rubbish in gated and non-gated communities.
environmental
health Advocate with Dept. of Housing on over-crowding issues.

Support culturally appropriate housing.

Social Determinants Support implementation of brief interventions for alcohol and smoking
in communities.
High smoking
prevalence Develop community awareness and provide primary education
regarding the links between smoking and OM.

Support funded Quit Smoking strategies.

Social Determinants Develop community awareness and primary education on the
importance of breastfeeding.
Low Food security /
poor nutrition Support strategies that develop school/community gardens.

Improve food access in remote communities.

Encourage and support School feeding programs – breakfast clubs.

Social Determinants Support access to swimming pools in remote communities.

Lack of clean water Support community awareness education and primary health

– poor hygiene promotion – clean faces, clean hands, BBC Programs.

Social Determinants Support education programs about OM prevention.
Day Care
Support community awareness education and primary health
promotion – clean faces, clean hands, BBC Programs.

Social Determinants Increase access to remote communities for specialist services,
Geographical Audiology, Speech Therapy and ENT.
Isolation
Ensure ear health services are coordinated with other visiting services
i.e. dental, eye health to improve attendance rates and the community
is aware of visit dates.

Health Promotion Provide advice to expectant parents on importance of good ear health.

Target parents Develop ear health promotion strategies which can be offered in
(mothers and community, playgroup, and kindergarten settings.
fathers) carers
especially those with Encourage immunisation.
children 0-5 yrs
Encourage parents and carers to access health services and have
children assessed, treated and followed up.

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Work Plan Pilbara Ear Health Model of Care

Focus on Prevention How

Health Promotion • School based preventive programs e.g. clean faces and hands, BBC.
• Utilise existing school newsletters for community education.
Include children • Education programs using pictures and gestures.
5 years plus • Access to older children who can role model and encourage

younger children about importance of good ear health.
• Focus on kids’ behaviour, change and reducing stigma on hearing

aids.
• Utilise existing resources and education from Australian Hearing.
• Develop methods to support hearing with children at home.

Health Promotion Work with community on developing local resources.

National or State
programs must be
localised, culturally
relevant and
community driven

Health Promotion Co-ordinate with other programs e.g. eye health, dental health,
Immunisation programs and across agencies and share information.
Coordinate with
other public health
prevention programs
to address diseases
with similar
epidemiology and
aetiology

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18

Work Plan Pilbara Ear Health Model of Care

3: C oordinate well – no duplication and work together –
right care, right patient, right time, right team, right place

Coordinate Well How

Care Coordination Perform an audit of current client management systems in use to
Shared easily establish accessibility of data across service providers.
accessible data
Investigate the development of a single state-wide database with
Care Coordination internet portal (possibly Cloud based).
Pilbara Ear Health
Coordinator/s Design consent and referral form to allow data access by all providers.

Care coordination Investigate the application of electronic health records – national
Don’t lose e Health Record.
individuals and
their families in the Chevron funded West Pilbara coordinator and the WACHS funded East
system Pilbara coordinator to work together.

Care coordination • Support children and their families to access locally based and
Strategic visiting services.
coordination
• Inform communities about locally based and visiting services.
• Ensure clinical pathways are followed.
• Ensure follow up and continuity of care.
• Be responsible for clinical database and management.

Keep all Government and non-Government engaged – through
Aboriginal Planning Forum.

Keep all funding agencies informed of the progress/gaps in the Model
of Care to target funding.

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Work Plan Pilbara Ear Health Model of Care

4: U se primary health care approach – early diagnosis and
effective treatment

Primary Health Care How
Approach
• Introduce Hearing Checklists for all service providers, particularly
Early diagnosis and for children 0-4yrs.
effective treatment
of acute OM • Ensure health service providers are using clinical care guidelines
for management of OM.
Monitor children
with recurrent • Ensure clinical pathways for treatment and follow up are adhered to.
acute OM
Coordinated Ensure assessment for high risk status – Aboriginal, siblings with
management of history of OM, attending fulltime day-care.
CSOM ‘runny ears’
in the primary care Ensure all high risk children receive an examination of outer ear, ear
setting canal and ear drum using otoscope.

Ensure assessment of compliance and mobility of eardrum using
pneumatic otoscopy (skill dependent) and/or tympanometry.

Ensure health service staff are appropriately skilled and trained to
deliver screening and assessment using a consistent protocol.

Health Service providers to use the Australian Government, Revised
Recommendations for Clinical Care Guidelines on the Management
of Otitis Media (Middle Ear Infection) in Aboriginal and Torres Strait
Islander Populations.

Health Service providers to use the Australian Government, Revised
Recommendations for Clinical Care Guidelines on the Management
of Otitis Media (Middle Ear Infection) in Aboriginal and Torres Strait
Islander Populations.

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Work Plan Pilbara Ear Health Model of Care

Primary Health Care How
Approach

Train educators to recognise hearing loss in the classroom.

Provide information and support regarding eligibility criteria for
schools to secure additional funding for eligible children.

Testing for and Establish referral pathway for diagnostic hearing assessment and
provision of hearing onward referral to Australian Hearing.
aids and sound
field amplification Work with local schools and communities to develop classroom
to ensure children management strategies.
with OM can hear at
school Distribute visiting schedule for ear health services and visiting
audiologists.

Provide training to educators regarding the appropriate use of sound
field amplification.

Provide training to educators regarding basic hearing aid
troubleshooting.

Developmental Coordinate a list of local resources and schedules for visiting
rehabilitation specialists with regards to paediatricians, speech-language
in communities, pathologists, psychologists and teachers of the deaf.
school, health care
settings for children Encourage the use of existing educational resources for conductive
affected by OM hearing loss to promote phonological awareness.
related hearing loss
Involve parents and encourage support groups.

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Work Plan Pilbara Ear Health Model of Care

5: U se specialists well – audiologists, speech pathologists,
MPs, ENTs

Use Specialists Well How
Audiologists
Co-ordinate a schedule of visiting audiologists to the Pilbara and
Speech Pathologists distribute to stakeholders and community services (possibly on a
MPs dedicated website).

ENTs Develop clinical pathways for eligibility criteria and referral process.

ENT surgery in safe Develop a list of locally based speech-language pathologists (including
environments as WACHS sites and private practitioners) and develop clinical pathways
close to home as for eligibility criteria and referral process.
possible
• Map MP and NP services across the Pilbara.
• Develop clinical pathways for eligibility criteria and referral process.

Distribute clinical guidelines to ensure consistency in care.

• Map visiting ENT specialist services to the Pilbara.
• Develop clinical pathways for eligibility criteria and referral

processes to specialists.

Coordinate visiting schedule and distribute to stakeholders and
community services (possibly on a dedicated website).

Coordinate referrals from all service providers to maximise efficient
use of specialist’s times.

Work closely with community resources to reduce DNA rates.

Establish eligibility criteria and referral process for minor surgery.

Establish eligibility criteria and referral process for surgery that needs
to be done in Perth.

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Work Plan Pilbara Ear Health Model of Care

6: Appropriate access to hearing aids and sound field
amplification

Hearing aids and How
sound Field systems
Support visits by the Federal Government’s Australian Hearing (AH)
Hearing Aids who provide fully subsidised hearing aids to persons 0-26 years of age
and Aboriginal Australians 50 years and older.
Sound Field
Amplification Support local and visiting providers who are registered with the Office
of Hearing Services (OHS) to provide fully subsidised services to
pensioners and veterans.

Support local and visiting services that provide private fee for service
hearing aids to adults.

Work with the School of Special Educational Needs Sensory (SSENS)
to ensure appropriate installation and use of sound field systems in
schools.

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23

Work Plan Pilbara Ear Health Model of Care

7: T herapy, support and educational services (TS&ES) –
to address developmental and educational delay due
to hearing loss

TS&ES How
Speech and
Language Delay Support the early identification of speech and language delay through
the use of questionnaires.
Educational Delay
Support web-based Telehealth and online resources.
General Delay
Promote existing providers and encourage web-based therapy to
supplement local providers.

Support local teachers in addressing educational delay due to hearing
loss by providing educational workshops.

Promote the appropriate use of sound field amplification and sound
field distribution systems.

Support educators in obtaining additional funding to support learners
with hearing loss.

Support visiting Teachers of the Deaf.

Support pediatricians and visiting specialists to rule out hearing loss
as a contributing factor to general developmental delay.

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Work Plan Pilbara Ear Health Model of Care

8: Research, evaluation and surveillance – for quality
improvement

Research, Evaluation How
and Surveillance

Conduct an audit of existing partnerships with universities to establish
research capacity in the Pilbara.

Research – • Work in partnership with universities for postgraduate research
Effectiveness topics.
of prevention,
screening and • Encourage narrative enquiry and single case studies as research
treatment tools to document successful outcomes.

Modify patient management systems to link data between screening,
diagnosis and treatment to establish outcomes.

Investigate the use of eHealth and telemedicine to collect data.

Investigate the use of the Enhanced Aboriginal Child Health Schedule
and Health Kids Check as a baseline for ear health and hearing data.

Evaluation – should Investigate the formation of a research committee that encourages
be used to guide annual reports by hearing health service providers.
future investment
Pool data across health services to establish trends and prioritise
allocation of resources.

Streamline protocols to facilitate consistent and accurate data input
regarding screening and diagnostic outcomes.

Surveillance – Perform an audit of current client management systems in use to
collection of useful establish joint data analysis opportunities across service providers.
data for prevalence
statistics Align data input across patient management systems to allow
consistent information to be exported to Excel for data analysis.

Perform biannual reviews of client management system to establish
accuracy of data input and establish the need for modification of
software.

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Work Plan Pilbara Ear Health Model of Care

9: Workforce planning

Workforce Planning How

Provide a hard copy of the Pilbara Ear Health Model of Care and
Workforce Guidelines at induction.

High turnover Provide online copy of Pilbara Ear Health Model of Care and Workforce
of staff Guidelines on service provider website.

Design simplified flowcharts to indicate clinical referral pathway and
ensure consistency of care.

Work with Medicare Partner with Pilbara Health Education, Learning and Development
Locals, Specialist Hub (WA Centre for Rural Health).
Colleges and tertiary
education sector Rural Health West (RHW) – programs to support MP and their families.

KPML – training workshops and familiarisation.

Ongoing discussion with tertiary training institutions regarding
requirements.

Train Nurse Support training programs for Nurse Practitioners.
Practitioners who
can diagnose and Encourage increased engagement with Aboriginal Health Practitioners
prescribe treatment for effective service delivery.
for OM
Engage in ongoing discussion with tertiary training institutions
regarding the required number of graduates to meet community needs.

Strategies to ensure Investigate the use of Telehealth and Tele-audiology.
access to Medical
Practitioners, Coordination of services and triage via eHealth to maximize efficient
Audiologists use of visiting MPs and audiologists.

Investigate the use of mobile clinics to provide ‘on doorstep’ access.

Support training programs.

Training for MPs, Engage in ongoing discussion with tertiary training institutions
ENTs, Audiologists regarding the required number of graduates to meet community
needs.

Encourage increased engagement with Aboriginal Health Practitioners
for effective service delivery.

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Work Plan Pilbara Ear Health Model of Care

10: Support and encourage specialist training

Specialist Training How

Local and relevant Investigate the option of online training modules to up-skill local
health professionals.
Up skilling MPs
ENTs Create supervision and volunteer opportunities for medical and allied
health students.

Provide support regarding cultural awareness and culturally safe
health care.

Investigate opportunities to extend invitation to annual retreats at
Karijini, to Pilbara providers.

Partner with Pilbara Health Education, Learning and Development
Hub (WA Centre for Rural Health).

Provide up skilling workshops regarding ear health.

Training in the use of the Pilbara Model of Ear Health Care plan.

Agreed Pilbara Protocols for OM management plan.

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27

Pilbara Ear Health & Hearing

Best Practice

Workforce Guidelines

best practice workforce guidelines

HEALTH WORKERS

(Aboriginal health worker and/or practitioner; remote area nurse; child, school or
1. Target priority populations

KNOW WHO IS ‘AT RISK’ FOR HEARING LOSS
All Aboriginal children and/or in particular children 0-4 years; babies who ‘pass’
onset or progressive loss (eg. TORCH, family history of hearing loss, see Append
adults over 50 years of age.
ADHERE TO AGREED PILBARA HEARING SCREENING PROTOCOL (APPENDIX 2)

Children 0-4 years School Aged Child

• Administer Hearing and • Complete school entry asses
Communication Milestones Screening
Questionnaire (Appendix 3) • Conduct an audiometric hear
screening (Appendix 7 for scr
• Conduct otoscopy protocol.)

• Use 0-4 years Child Health Schedule • Conduct otoscopy
Questionnaire
• Conduct tympanometry if tra
(See Appendix 8)

Normal findings and Abnormal results or Normal findings and Abnormal
no concerns about concern about the no concerns about concern ab
hearing. hearing. hearing. hearing.

Ongoing surveillance • Refer to MP/NP Ongoing surveillance • Refer to
for those ‘At Risk’ and or to AMS if acute for those ‘At Risk’ and or to AM
on request for others. infection present on request for others. infection
(Appendix 4) then (Append
to audiology then to a
(Appendix 5 and (Append
Appendix 6). Appendi

• Refer non-acute • Refer no
cases to audiology cases to
(Appendix 5 and (Append
Appendix 6). Appendi

©Monley, P., & Krishnaswamy, J. (Eds.). (2015). Pilbara Ear Health Model of Care including Pilbara Ear Health and H

Pilbara Ear Health Model of Care

r community health nurse.)

’ the Newborn Hearing Screening but are ‘At Risk’ for late
dix 1); children in child care centres; Aboriginal adults;

)

dren Adults over 50 years

ssment • Conduct an audiometric hearing
ring screening (Appendix 9 for screening
reening protocol) or administer Hearing
Questionnaire (Appendix 10)
ained
• Conduct otoscopy
• Conduct tympanometry if trained

results or Normal findings and Abnormal results or
bout the no concerns about concern about the
hearing. hearing.

o MP/NP Surveillance in 12 • Refer to MP/NP HEALTH WORKERS
MS if acute months for those ‘At if acute infection
n present Risk’ and on request present (Appendix
dix 4) for others. 4) then to audiology
audiology (Appendix 5).
dix 5 and
ix 6). • Refer non-acute
on-acute cases to audiology
o audiology (Appendix 5).
dix 5 and
ix 6).

Hearing Best Practice Workforce Guidelines. Telethon Speech & Hearing, Perth WA. 

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best practice workforce guidelines

HEALTH WORKERS HEALTH WORKERS HEALT

2. Focus on prevention 3. Coordinate Well 4. Use Pr
Appro

Be a significant provider Work together to ensure Suppor
of agreed prevention no duplication of services ENT/Au
education information – right care, right patient,
right time, right team, • Use ear
• See Appendix 11 for Ear Health right place directed
promotion information.
• Support individuals to attend • Support
• Support all activities that promote appointments. as presc
overall good health.
• Support the coordination of • Reinforc
Be a mentor for parents, visiting services. parents
grandparents, teacher’s
aids and anyone who • Maintain records to help facilitate • Support
wants to help out with information sharing and reduce ear heal
prevention service duplication.
• Provide
• Target mothers and carers Understand and follow NP/ ENT
especially those with children agreed referral pathways
0-5 yrs. (see previous page)

• Include children 5 years plus to
encourage self-responsibility and
future role models.

• Use materials and support
programs that are culturally
relevant and community-driven.

• Coordinate with other public
health prevention programs to
address diseases with similar
epidemiology and aetiology.

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Pilbara Ear Health Model of Care

LTH WORKERS HEALTH WORKERS

rimary Health Care 5. Use specialists well
oach

rt care plans (MP/ Support attendance at
udiologist) specialist appointments

wash, tissue spears as • Support families to attend clinics
d. to reduce Did Not Attend (DNA)
t the taking of medication rate.
cribed.
ce post-operative care with • Send reminders the day before a
clinic.
and guardians.
t cultural liaison between • Ensure carers are travelling
lth programs and families. with the child to the specialist
support for Audiology/MP/ appointment.
T clinics as requested.
• Identify and use services that can
provide transport to facilitate
attendance.

Build confidence in the
use of Telehealth

• Embrace the use of Telehealth if
available (Appendix 12).

HEALTH WORKERS

Hearing Best Practice Workforce Guidelines. Telethon Speech & Hearing, Perth WA. 

30

best practice workforce guidelines

HEALTH WORKERS HEALTH WORKERS HEAL

6. Appropriate access to 7. TS&ES 8. Quali
hearing aids and sound
field amplification

Have a basic Understand and follow Suppor
understanding of hearing agreed referral pathways evaluat
aids, cochlear implants for therapy, support and surveill
and sound field operation education services improve

• See Appendix 13 for information • Refer to Speech Pathology, • Obtain c
about hearing aids. Occupational Therapy and other required
remediation services by following
• See Appendix 14 for information the required referral guidelines • Use agr
about cochlear implants. (See Appendix 18). form.

• See Appendix 15 for information • Provide
about sound field systems. Ear Hea
gaps and
Understand referral (Append
process to, and services
of Australian Hearing
and School of Special
Educational Needs
Sensory (SSENS)

• See Appendix 16 for information
about Australian Hearing

• See Appendix 17 for information
about SSEN-S.

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Pilbara Ear Health Model of Care

LTH WORKERS HEALTH WORKERS

ity Improvement 9. Workforce Planning

rt research, Engage in training
tion and opportunities to keep
lance for quality skills relevant and up to
ement date

consents and collect • Contact Pilbara Ear Health
d data. Coordinator (Appendix 19 for
eed common consent contact details).

feedback to the Pilbara HEALTH WORKERS
alth Coordinator about
d duplications in services 10. Specialist Training
dix 19 for contact details).

Support and encourage HEALTH WORKERS
specialist training

• Be an informal provider of
training.

• Provide mentoring and training to
new staff.

• Engage in Aboriginal cultural
awareness training along with
other relevant PD.

Hearing Best Practice Workforce Guidelines. Telethon Speech & Hearing, Perth WA. 

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best practice workforce guidelines

CHILD CARE WORKERS

1. Target priority populations

KNOW WHO IS ‘AT RISK’ FOR HEARING LOSS
All Aboriginal children and in particular children 0-4 years. C
ADHERE TO AGREED PILBARA HEARING SCREENING PROTO

Children 0-4 yea

Administer Hearing and
Communication Milestones
Screening Questionnaire
(Appendix 3)

No concerns about Possible h
hearing identified loss identi
on Questionnaire or Questionn
raised by parents or concerns r
guardian. parents or
Surveillance in 6
months for those ‘At • Arrange
Risk’ and at any time at your C
there is a concern Centre o
about the hearing. AMS (Ap
and App

• Refer to
(Append
Appendi

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Pilbara Ear Health Model of Care

Children in child care centres
OCOL (APPENDIX 2)

ars

hearing CHILD CARE WORKERS
ified on
naire or
raised by
r guardian.
e screening
Child Care
or refer to
ppendix 4
pendix 5).
o audiology
dix 5 and
ix 6).

Hearing Best Practice Workforce Guidelines. Telethon Speech & Hearing, Perth WA. 

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best practice workforce guidelines

CHILD CARE CHILD CARE CHILD
WORKERS WORKERS
WORK
2. Focus on prevention 3. Coordinate Well
4. Use P
Appro

Encourage, educate and Understand and follow Suppor
support agreed health agreed referral pathways ENT/Au
care practices to reduce (See previous page)
ear disease • Support
• Discuss with parents or guardians as presc
• See Appendix 11 for Ear Health referrals to screening and parents
promotion information. audiology appointments, after
obtaining consent.
• Support all activities that promote
overall good health. • Use the Pilbara Ear Health
Coordinator for support (See
• Implement Breath Blow Cough Appendix 19 for contact details).
protocols, and hand washing for
all children.

• Introduce songs and games
around hygiene and ear health.

©Monley, P., & Krishnaswamy, J. (Eds.). (2015). Pilbara Ear Health Model of Care including Pilbara Ear Health and H

D CARE Pilbara Ear Health Model of Care
KERS
CHILD CARE
Primary Health Care WORKERS
oach
5. Use specialists well
rt care plans (MP/
udiologist) Support early
identification of speech
t the taking of medication and language delay
cribed, and approved by
s or guardians. • Understand normal childhood
speech and language development
(See Appendix 20).

• Should there be any speech and
language development concerns,
discuss with parents and
guardians and obtain consent to
refer to speech pathology services
(See Appendix 18).

CHILD CARE WORKERS

Hearing Best Practice Workforce Guidelines. Telethon Speech & Hearing, Perth WA. 

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best practice workforce guidelines

CHILD CARE CHILD CARE CHILD
WORKERS WORK
WORKERS
7. TS&ES 8. Qualit
6. Appropriate access to
hearing aids and sound
field amplification

Have a basic Understand what therapy, Suppor
understanding of hearing support and educational evaluat
aids, cochlear implants services are available surveil
for children with hearing improv
• See Appendix 13 for information problems
about hearing aids. • At enrol
• See Appendix 18 for allied health about ch
• See Appendix 14 for information services available in the Pilbara.
about cochlear implants. • Obtain a
regardin

• Ensure
Newbor
been fol
(where n

• Look in
records
ongoing
any iden
Appendi
guardia
follow u
chart ab

©Monley, P., & Krishnaswamy, J. (Eds.). (2015). Pilbara Ear Health Model of Care including Pilbara Ear Health and H

D CARE Pilbara Ear Health Model of Care
KERS
CHILD CARE
ty Improvement WORKERS

9. Workforce Planning

rt research, Engage in training
tion and opportunities to keep
llance for quality skills relevant and up to
vement date

lment capture information • Contact the Pilbara Ear Health
hildren’s ear health. Coordinator to arrange training
and record any information (See Appendix 19 for contact
ng associated conditions. details).
all children have had their
rn Hearing Screening and CHILD CARE
llowed up appropriately WORKERS
necessary).
the child’s ‘baby book’ 10. Specialist Training
s to see if the child requires
g surveillance in view of Support and encourage
ntified risk factors (See specialist training
ix 1) and ensure parents or
ans have complied with the • Be an informal provider of
up. If not, refer as per flow training.
bove.
• Provide mentoring and training to
new staff. CHILD CARE WORKERS

• Engage in Aboriginal cultural
awareness training along with
other relevant PD.

Hearing Best Practice Workforce Guidelines. Telethon Speech & Hearing, Perth WA. 

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best practice workforce guidelines

AGED CARE WORKERS

1. Target priority populations

KNOW WHO IS ‘AT RISK’ FOR HEARING LOSS
Aboriginal adults, adults over 50 years of age.
(Australian adults with hearing loss – 50% of 50 year olds, 60
80% of 80 year olds, 90% of 90 year olds.)
ADHERE TO AGREED PILBARA HEARING SCREENING PROTO

Adults over 50 ye

• Administer Adult Hearing
Questionnaire (Appendix 1

No concerns about Possible he
hearing identified loss identifi
on Questionnaire or Questionna
raised by resident or concerns r
their family. resident or
Surveillance in 6
months for those ‘At • Arrange
Risk’ and at any time at your
there is a concern Centre
about the hearing. (See Ap
and App

• Refer to
(See Ap

©Monley, P., & Krishnaswamy, J. (Eds.). (2015). Pilbara Ear Health Model of Care including Pilbara Ear Health and H

Pilbara Ear Health Model of Care

% of 60 year olds, 70% of 70 year olds,
OCOL (APPENDIX 2)

ears

10)

earing AGED CARE WORKERS
fied on
aire or
raised by
r their family.
e screening
Aged Care
or AMS
ppendix 4
pendix 5).
o audiology
ppendix 5).

Hearing Best Practice Workforce Guidelines. Telethon Speech & Hearing, Perth WA. 

37

best practice workforce guidelines

AGED CARE AGED CARE AGED
WORKERS WORKERS
WORK
2. Focus on prevention 3. Coordinate Well
4. Use P
Appro

Encourage, educate and Understand and follow Suppor
support agreed health agreed referral pathways ENT/Au
care practices to reduce (see previous page)
ear disease • Support
• Discuss with residents and as presc
• Only use tissue spears to clean families referrals to screening resident
ears. This will prevent ear drum and audiology appointments, after
perforations or damage to the ear obtaining consent. • Provide
canal. required
• Use Pilbara Ear Health Cordinator
• Keep water out of ears. for support. (see Appendix 19). • Arrange
from ea
audiolog
fitting o

©Monley, P., & Krishnaswamy, J. (Eds.). (2015). Pilbara Ear Health Model of Care including Pilbara Ear Health and H

Pilbara Ear Health Model of Care

D CARE AGED CARE
WORKERS
KERS
5. Use specialists well
Primary Health Care
oach

rt care plans (MP/ Support attendance at
udiologist) specialist appointments

t the taking of medication • Support residents to attend clinics
cribed and approved by especially for Fly-in-Fly-out
ts MP/NP or ENT. specialist services.
e post-operative care when
d. • Provide consulting space in the
e to have wax removed aged care facility to support ‘on
ars by MP/NP to support door step’ services.
gy assessments and the
of hearing aids. • Ensure carers or family are
travelling with the resident to the
specialist appointment.

• Identify and use services that can
provide transport to facilitate
attendance.

• Understand what services are
available for older Australians to
obtain hearing aids and devices
(see Appendix 21).

AGED CARE WORKERS

Hearing Best Practice Workforce Guidelines. Telethon Speech & Hearing, Perth WA. 

38

best practice workforce guidelines

AGED CARE AGED CARE AGED
WORKERS WORK
WORKERS
7. Rehabilitation 8. Qualit
6. Appropriate access to
hearing aids and sound
field amplification

Have a basic Understand the Suppor
understanding of hearing importance of older evaluat
aids, cochlear implants Australians using surveill
functioning hearing aids improve
• See Appendix 13 for information
about hearing aids. • There is a relationship between • Keep re
dementia and deafness in older needs o
• See Appendix 14 for information Australians.
about cochlear implants. • Share in
• Maintaining contact with the world to ensur
Be able to carry out minor through hearing is important care.
repairs for good mental functioning and
health.
• See Appendix 13.

©Monley, P., & Krishnaswamy, J. (Eds.). (2015). Pilbara Ear Health Model of Care including Pilbara Ear Health and H

D CARE Pilbara Ear Health Model of Care
KERS
AGED CARE
ty Improvement WORKERS

9. Workforce Planning

rt research, Engage in training
tion and opportunities to keep
lance for quality skills relevant and up to
ement date

ecords about the hearing • Contact the Pilbara Ear Health
of residents. Coordinator to arrange training
nformation with new staff (see Appendix 19 for contact
re continuity of quality details).

AGED CARE
WORKERS

10. Specialist Training

Support and encourage AGED CARE WORKERS
specialist training

• Be an informal provider of
training.

• Provide mentoring and training to
new staff.

• Engage in Aboriginal cultural
awareness training along with
other relevant PD.

Hearing Best Practice Workforce Guidelines. Telethon Speech & Hearing, Perth WA. 

39

best practice workforce guidelines

TEACHERS

(Inc. Aboriginal Education Workers, Aboriginal Teacher Aids an

1. Target priority populations

KNOW WHO IS ‘AT RISK’ FOR HEARING LOSS
All Aboriginal children and in particular children 0-4 years
ADHERE TO AGREED PILBARA HEARING SCREENING PROTO

School Aged Child

• Understand Hearing loss i
Classroom and the commo
(Appendix 22)

No concerns about Possible h
hearing identified identified o
or raised by parents raised by p
or guardian and no guardian o
behaviour issues. problems.
Surveillance in 6
months for those ‘At • Arrange
Risk’ and at any time with sch
there is a concern nurse, A
about the hearing. other pr
availabl
school (
and App

• Refer to
(Append
Appendi

©Monley, P., & Krishnaswamy, J. (Eds.). (2015). Pilbara Ear Health Model of Care including Pilbara Ear Health and H