Paediatric Certificates Information Booklet

Paediatric Certificates Information Booklet Page 1 of 26 1

NZAS Paediatric Certificates Contents 1. Overview... 4 2. Obtaining a Paediatric Certificate... 7 2.1 Applying for a Paediatric Certificate... 7 Option A: Audiologists with Provisional or MNZAS membership... 7 Option B: Fast Track Process for Overseas Audiologists with Paediatric Experience... 7 2.2 Paediatric Certification Requirements... 7 Paediatric Certification Activities... 8 Acquiring Clinical Skills Checklist... 9 Portfolio Chart reviews... 9 On-site Peer Review... 9 Fees and charges:... 10 3 Maintaining a Paediatric Certificate... 10 3.1 Maintenance Requirements... 11 4. Appealing a Chart Review or Peer Review... 12 5. Inactive Membership... 12 Appendix A: Application Form... 14 Appendix B: Acquiring Clinical Skills Checklist... 15 Appendix C: NZAS Peer Reviewer Paediatric Certificates Checklists... 19 Appendix D: Log Book for Paediatric Certification Activities... 30 2

Glossary ABR Auditory Brainstem Response APC Annual Practising Certificate CCC Clinical Certificate of Competency CEPs - Continuing Education Points DHB District Health Board ENT Ear Nose and Throat Specialist HAB Paediatric Habilitation MNZAS Member (Full) of the New Zealand Audiological Society NZAS New Zealand Audiological Society VRA Visual Reinforcement Audiometry 3

1. Overview The Purpose of Paediatric Certificates is to provide a structured peer review process for MNZAS members who are currently working in paediatric audiology to ensure clinical competency. This will ensure a uniform standard of care across is achieved across the country, which will benefit both patients and clinicians. Paediatric certificates also enhance opportunities for all audiologists to further their continuing education in the field of paediatrics, such opportunities and benefits are listed below in Table 1. Table 1: Summary of Benefits New skills Up-skilling Collaboration Confidence for the audiologists and DHBs Increased patient outcomes Benchmarking for the paediatric audiology services Protection for audiologists and the NZAS Ability to identify gaps and inequities around the country Efficient clinical practices Improved relationships with paediatric and ENT teams Reduced risk to the patients, the audiologists, and the DHBs Reduced complaints made by patients Reduced subjectivity in interpretation of results Reduced isolation for small DHBs Paediatric certificates cover the following three areas. Each certificate is achieved independently. An audiologist can hold one, two or all three of these certificates. These are defined below: - Visual Reinforcement Audiometry (VRA) Certificate The audiologist is the lead clinician who performs testing on infants or developmentally delayed children using visual reinforcement audiometry. The certification process reviews the audiologist s ability to; follow protocols, accurately determine true responses, follows the cross-check principle and integrate the findings to make a management plan With VRA testing the distractor does not need to hold a VRA certificate. Auditory Brainstem Response (ABR) Certificate The audiologist can accurately and efficiently diagnose the hearing status of the patient using electrophysiological recordings. These are typically performed on sleeping new-born babies, however can also be performed on hard to test children under general anaesthetic. This certification process reviews 4

the audiologist s ability to perform and analyse ABR results, both for threshold seeking tone-bursts and ANSD. This also reviews how the cross-check principle is followed to integrate the findings and make a management plan. Paediatric Habilitation (HAB) Certificate The audiologist manages the habilitation process for children diagnosed with a hearing loss from the ages of 0-5 years (developmental age). The certification process reviews the audiologist s ability to correctly diagnose the hearing loss; select, program and verify appropriate hearing aids using real-ear measure verification and age appropriate testing, follows the cross-check principle, integrates findings and makes a management plan. Note: It is not possible to hold the HAB certificate without the VRA certificate. A summary of the process for all three certificates is shown in the diagram on the following page. 5

Figure 1: Paediatric Certification Process OPTION A Provisional or full members Register interest to complete a paediatric certificate with nominated supervisor OPTION B Register interest to complete a paediatric certificate including attached letter from country of origin Obtain a mentor who holds the relevant certificate and become familiar with the UNHSEIP Diagnostic and Amplification protocols Collect paediatric hours for each certificate OBTAIN CCC (if provisional member) Submit completed log (hours and clinical skills) post obtaining CCC Submit chart for review Unsatisfactory chart May be recommended a mentor if support necessary Complete one Satisfactory chart per certificate Resubmit second chart Satisfactory on-site peer review (direct observation) by MNZAS Peer Reviewer Paediatric Certificate Awarded Maintain both MNZAS- CCC and each certificate per CEP cycle: - Maintain paediatric hours - Onsite peer review (by other individual holding the relevant certificate) - Maintain CEPs 6

2. Obtaining a Paediatric Certificate Only full members of the New Zealand Audiological Society (MNZAS) are eligible to hold a New Zealand Audiological Society (NZAS) Paediatric Certificate. A provisional or full member can register interest for one or more paediatric certificates. 2.1 Applying for a Paediatric Certificate Process for obtaining paediatric certification Option A: Audiologists with Provisional or MNZAS membership 1. Register interest and organise a supervisor who holds the relevant certificate (Appendix A) 2. Collect evidence of hours of approved Paediatric Certificate activities and supervised skills checklist Successfully obtain CCC (if provisional member) then continue the processes below 3. Submit chart(s) for review, 4. Following successful completion of portfolio apply for an on-site peer review by an NZAS peer reviewer NB. The grand-parenting option is no longer available as this ended at December 2017 Option B: Fast Track Process for Overseas Audiologists with Paediatric Experience This would typically apply to an overseas audiologist who is eligible for the fast track process to their CCC. The paediatric certificates cannot be obtained without successfully obtaining your CCC. The candidate will: 1. Have a letter from employer in country of origin confirming the candidate has a minimum of 80 hours experience in the relevant area (ABR, VRA, Paediatric Habilitation) that were accrued within the previous three years. 2. Register interest and organise mentorship from an audiologist holding a paediatric certificate in the relevant area(s) to assist in orientation to New Zealand systems. 3. Familiarise themselves with the Diagnostic and Amplification protocols which are part of the National Policy and Quality Standards, Universal New-born Hearing Screening and Early Intervention Programme. 4. Submit chart(s) for review. Exception could be made to include a chart from the country of origin in some cases. 5. Have an onsite peer review with an NZAS peer reviewer 2.2 Paediatric Certification Requirements There are four requirements Paediatric Certification Activities (Hours) 7

Acquiring Skills checklist Portfolio of chart(s) On-site peer review Paediatric Certification Activities A minimum of 80 hours of paediatric certification activities need to be logged in each clinical area relevant to the paediatric certificate being sought. These hours may be logged before and/or after completion of your CCC. The log book for this can we found in Appendix D. The vast majority of these hours will be made up of direct at the elbow supervision, as this provides a facilitated learning experience to introduce new clinicians to this area of clinical work. Hours include direct supervision, clinical case discussions and other supplementary activities as shown in the table below. Table 2: Paediatric activities Activity Description Minimum Required Direct Supervision Clinical Case Discussions Includes at- the-elbow and in the-building supervision performed by another clinician who holds a paediatric certificate in that area. Remote supervision via an internet service is acceptable Time spent with another clinician who has their paediatric certificate in that area: - Phone calls, emails - Face to face discussion - Skype/Zoom etc. discussion 70 8 Chart Review Time spent with another clinician who has their Required paediatric certificate: Checking charts i.e. ABR trace reviews, HAB (no minimum requirement) printouts 100% chart review by supervisor Note the separate requirement for chart review Below NZAS Paediatric Up-skilling Days As organised by the Paediatric Technical Advisory Group Recommended (no minimum requirement) Online Paediatric Lectures Online courses must be paediatric or have relevance to paediatric practise. They must have learning outcomes, and at least two postcourse questions that attendees need to answer. Optional (no minimum requirement) 8

Case Presentation Hours spent creating and conducting a presentation for: Case conferences within the department or workplace (e.g. hospital with ENT) - Regional meetings - International meetings Optional (no minimum requirement) Note: The main topic of the activity determines which certification the hours will count towards. For example: One hour online lecture which is half about VRA and half about paediatric hearing aids could contribute half an hour towards the VRA certificate and half an hour towards the Hearing Aid Habilitation certificate. Acquiring Clinical Skills Checklist The audiologist must submit a completed skills checklist for each certificate. The skills checklist can be found in Appendix B. Your supervisor must sign off each competency on five occasions. These are key skills which will be reviewed at the on-site peer review. You need to be confident and well-practiced in each of these competencies and must closely follow the UNHSEIP Policy and Quality Standards: Diagnostic and Amplification protocols. Portfolio Chart reviews The audiologist will submit one chart per paediatric certificate type. The contents of the chart should fulfil the portfolio requirements seen in Appendix C. The charts will be submitted and verified by an NZAS approved peer reviewer who will ensure the chart meets the competencies listed in Appendix C. If an audiologist is working in more than one paediatric field, they can submit one patient chart to fulfil the requirements of any number of certificates. For example, one single chart may include ABR, VRA and HAB and therefore be counted as a chart for each of the three certificate areas. All charts must be complex cases showing a hearing loss; conductive, sensorineural or ANSD. The hearing aid charts must show the use of real ear measures. The type of hearing aid in the chart needs to be one that can have real ear measures performed on it (i.e. not a bone conduction hearing aid). They must also have a case from a child which has required VRA for testing. On-site Peer Review The audiologist will need to successfully complete a direct observation peer review by a NZAS approved peer reviewer. This will be arranged following completion of a successful chart portfolio. Peer reviews are performed by NZAS paediatric certificate peer reviewers. Criteria used by peer reviewers can be found in Appendix C. These checklists should be revised in preparation for the on-site peer review. The audiologist should also be very familiar with the UNHSEIP Policy and Quality Standards: Diagnostic and Amplification protocols for the provision of audiologic assessment and amplification which can be downloaded from the UNHSEIP diagnostic and amplification guidelines link on the NZAS website. The NZAS approved peer reviewer will attend the audiologist s clinic (it can be held at another clinic if this suits both the candidate and peer reviewer) for direct clinical observation in each certificate. The candidate will be expected to book patients where the candidate can demonstrate the clinical skills of each certificate. These skills are listed in the marking schedules attached to the document. 9

Notes: * If time does not permit a separate distraction assessment), then assessment of distracting may not be formally reviewed on the day. ^ If Click ABR testing skills are unable to be reviewed in the ABR onsite peer review, test, then these skills may be discussed on the day following the appointment. Alternatively, they may be reviewed at a later date using skype or video recording. # Assessment of Hearing aid fitting (including Real ear measures (REMs), an RECD measurement and aided speech testing) need not be a new fitting but could be a follow-up appointment where real-ear measures are required. Please note if you use a follow up appointment for the peer review, the reviewer must be able to see all the criteria from the onsite review checklists in Appendix C. Fees and charges: DHB audiologists: The Directors of Allied Health on behalf of DHB s nationally have agreed that NZAS peer reviewers will be released with full pay from their normal duties at their home DHB to perform peer reviews at other DHBs. However, their travel and accommodation costs must be covered by the DHB they are visiting to provide the peer review. This may also apply where a private provider is contracted to a DHB to provide paediatric services. Private Providers/independent practitioners/ministry of Education audiologists: Fees have been determined by the Executive Council as follows (inclusive of travel costs): One certificate = $600 Two or more certificates = $1200 3 Maintaining a Paediatric Certificate Once an audiologist has been awarded a paediatric certificate, they are required to complete the following over a three-year period (each NZAS CEP cycle) in order to maintain both their CCC and paediatric certificates: - Paediatric activities to maintain competence (see Table 3). Maintenance of CEP points (Please see the CEP section of the NZAS website for details on this). Demonstrate competence through an on-site peer review This can be done by another audiologist who also holds a paediatric certificate. The peer reviewer can be internal or external to the candidates place of work. This review is sufficient for the peer review for the NZAS annual practising certificate, and a second adult peer review is not needed. The peer reviewer cannot be the same individual for two consecutive CEP cycles. Only one peer review, in any chosen area, is required to satisfy the requirements when multiple certificates are held 10

3.1 Maintenance Requirements On-going activities to maintain competence An MZNAS-CCC who holds a paediatric certificate must complete 60 hours of direct patient contact, for each certificate held, over the three-year CEP cycle. It is up to the audiologist to record these on-going maintenance hours. They must produce this evidence on request if audited. Table 3: On-going activities Activity Description Minimum Required Direct patient contact Includes any hours of testing in the specialised area of paediatric testing. 60 Direct Supervision NZAS Paediatric elearning Module Time spent with another clinician who has their paediatric certificate: Checking charts i.e. ABR trace reviews Discussing results or cases This could be face to face, on the phone or via email or internet connection. Successful completion of the NZAS paediatric elearning module (ABR, VRA and HAB when available). ABR requires 100% chart review. Case discussion for other areas is encouraged but has no minimum requirement. 1 per certificate as available The NZAS requires 3 hours for the peer review as a requirement to renew the Annual practising certificate (APC). If an individual only holds one paediatric certificate, it is allowable to make up the 3 hours with appointment types which reflect their main area of work. These are some of the examples of activities which earn CEPs and have a paediatric focus: - 1. NZAS Paediatric Up-skilling days 2. Online Paediatric Lectures 3. Case Presentations a. Case conferences within the department b. Case conferences outside of the department (with ENT, paediatrics, education sector) c. Regional meetings d. International meetings On-site Peer Review The audiologist will need to successfully complete a direct observation by an audiologist who holds a paediatric certificate in the area being reviewed within the CEP cycle. The peer reviewer can be internal 11

or external to the individual s place of work (this requirement differs from the NZAS requirements for an adult peer review). An individual cannot be peer reviewed by the same person for more than two consecutive CEP cycles. That peer reviewer will use the form found in the CEP section of the NZAS website along with the checklists found in Appendix C. Only one onsite peer review is required to maintain a paediatric certification which may be in any one or a combination of the three areas which audiologist may hold. Continuing Education Points (CEPs) The CEPs requirements found on the CEP section of the website must be fulfilled in order to maintain both the audiologist s APC and their paediatric certificates. Those holding any number of paediatric certificates need to acquire no more CEPs than an audiologist solely holding their CCC. Please review the information on this part of the website for further details. 4. Appealing a Chart Review or Peer Review Applicants who have an unsuccessful chart review or peer review will be provided details on specific aspects that require improvement. If there is dispute regarding the result of an on-site peer review a different peer reviewer will be assigned for a second on-site review to offer a second opinion. Please note on-site peer review results are discussed by the peer review panel prior to the decision being made. 5. Inactive Membership According to the constitutional rules of NZAS membership, any member may become inactive for any length of time. In order to re-activate paediatric certificates, the audiologist must do the following: - a. Audiologist fulfils the criteria for the on-going activities to maintain competence (Section 3.1 of this information booklet) in the 3 years prior to the date of returning from their inactive status Organise a supervisor to oversee work upon immediate return to work Undertake a peer review in any chosen area of practice in order to fulfil the APC requirements b. If the audiologist does not fulfil the criteria for the on-going activities to maintain competence (Section 3.1 of this information booklet) in the 3 years prior to the date of returning from their inactive status, they must follow the normal procedure required by NZAS to reactivate their CCC and the following to reactivate their paediatric certificate: Organise a supervisor to oversee work upon immediate return to work Complete the paediatric e-learning materials on the NZAS website Complete a successful peer review by an NZAS peer reviewer for each of the certificates to be reactivated Read and familiarise themselves with the current version of the UNHSEIP diagnostic and amplification protocols. 12

5.1 Returning to work prior to completing the re-activation process You must reactivate your MNZAS full membership first. While completing the aforementioned tasks the audiologist may organise a supervisor responsible for their clinical work, who holds a paediatric certificate in the area/s of the certificate(s) to be reactivated. The audiologist may then commence clinical work in those areas under your supervisor s guidance. It is recommended that initially direct at the elbow supervision takes place until the audiologist and supervisor agree to another arrangement, such as in the building or chart sign off. No formal paperwork is required for this; however, it is recommended this be discussed and approved by the employer and/or manager prior to return to work. 13

Appendix A: Paediatric Certificate Application Form Name Email Employer Please complete the boxes below to apply for the appropriate certificates by placing a ticking under the Apply for column for the relevant certificates. Option A Option B (Overseas) Paediatric Habilitation Visual Reinforcement Audiometry (VRA) Auditory Brainstem Response (ABR) Apply for Apply for My supervisor/mentor is: Supervisor/Mentor Signature: Date: Signed (Candidate): Date: For Option B (Overseas) I have attached a letter from my employer confirming 80 hours in the previous 3 years in each area applied for. By sending this form into the NZAS you are giving NZAS consent to share information about the outcome, or progress through, the paediatric certificate process with your employer and the NSU. 14

Appendix B: Acquiring Clinical Skills Checklist Along with the Log of Paediatric Certification Activities you and your Supervisor (or any audiologist holding the relevant certificate) must complete this Acquiring Clinical Skills Checklist. The supervisor must initial and date each box to indicate he/she has observed this skill and has approved your competency. These competencies can be achieved across multiple cases. All boxes must be filled before this checklist is submitted to NZAS. Your supervisor may observe these competencies during the provisional membership period or once full membership is attained. When you submit these with your Log book to the NZAS administration, you must have successfully obtained your CCC. 15

VRA Acquiring Clinical Skills Checklist Competency Observed by Supervisor (Initialled and Dated) 1 2 3 4 5 Clinician facilitates session in a professional and efficient way Essential case history obtained and appropriate follow-up questions (reflecting appropriate clinical reasoning) Clear explanation of test procedures Manages test session: proceeds to next test when appropriate with reference to case history information Performs otoscopy safely and integrates findings (e.g. wax, grommets) into test battery Distraction: appropriate for developmental level of child, able to realise when under or over distracted, good rapport Presentation: follows protocol, determines thresholds in a timely manner, confident in directing distractor. Screened to 20 db HL at 500, 2000 and 4000 Hz or thresholds obtained as required. 1000Hz tested as required. Performs MLV speech testing and results interpreted correctly Bone conduction is performed if thresholds are equal to or greater than 25 db HL Performs and accurately interprets tympanometry Performs and accurately interprets acoustic reflex testing Performs and accurately interprets DPOAE testing An appropriate cross-check is performed Results of different assessments are integrated to inform diagnosis and management recommendations Parents/caregivers are informed of the result accurately in a clear and logical manner Case is managed appropriately including referral for further testing or medical management Appropriately communicates results with family, giving parent/caregivers opportunity to respond and ask questions Has access to appropriate and relevant resources to support explanation (brochures, booklets, familiar sounds audiogram) 16

ABR Acquiring Clinical Skills Checklist Competency Observed by Supervisor (Initialled and Dated) 1 2 3 4 5 Clinician facilitates session in a professional and efficient way Appropriate decisions about test order with consideration of baby s state, including cursory otoscopy if appropriate Case history obtained and follow-up questions (reflecting clinical reasoning) asked in reasonable timeframe Clear explanation of test procedures Correct parameter settings are used^ Sensible test setup and positioning of baby, transducers and cables Obtain low and balanced impedances <5kΩ routinely (preferably 1-3kΩ) Follows protocol for initial test ear Follows protocol making for frequency order Appropriate threshold seeking technique (repeatability and growth) Solves interference issues Distinguish the difference between noise and a true response Appropriate placement and maintenance of bone vibrator position Perform bone conduction testing appropriately Can perform and interpret a click ABR to check for ANSD Performs and interprets tympanometry, if abandoned documented why Performs and interprets acoustic reflex, if abandoned documented why Performs and accurately interprets DPOAE testing An appropriate cross-check is performed Parents/caregivers are informed of the result accurately/clearly and logically giving parent/caregivers opportunity to respond and ask questions Case is managed appropriately including referral for further testing or medical management Uses appropriate and relevant written resources to support explanation (brochures, booklets, familiar sounds audiogram) 17

HAB Acquiring Clinical Skills Checklist Competency Clinician facilitates session in a professional and efficient way Observed by Supervisor (Initialled and dated) 1 2 3 4 5 Case history obtained and follow-up questions (reflecting clinical reasoning) asked in reasonable time frame Clear explanation of appointment proceedings Performs otoscopy safely and integrates findings for real ear measure and test battery (e.g. wax, grommets) Tympanometry is performed and taken into consideration for fitting Accurate and recent audiogram is used for hearing aid fitting (including separate ear AC and BC thresholds.). Minimum of two points in each ear Selects appropriate hearing aids and can justify choice Uses appropriate prescription formula and can justify its use Uses a safe technique to insert probe tube Measures RECDs. If not achievable justification of average RECD is documented. Justification for type of RECD is given (e.g. insert versus ear-mould) Feedback is controlled without long term gain reduction (if gain is reduced, it is for a maximum of two weeks with a plan in place to overcome the under-aiding (i.e. Refer to CI, order more powerful aids or order new ear moulds). Test-box or on-ear real ear measures are recorded and meet targets # Verification (SII) Graph is used and understood The hearing aid setting are chosen appropriately (e.g. noise control setting, microphone modes, and automation of these). Tamper-proofing if required Age appropriate aided speech testing is performed Appropriate follow up questions and counselling addressed with family Case is managed appropriately including referral for further testing or medical management Considers RMHA/FM for child and in selection of hearing aids Appropriate questionnaire is performed LittleEars, PEACH, etc Care and maintenance instruction provided clearly to family Parents/caregivers are informed of the result accurately/clearly/logically giving parent/caregivers opportunity to respond and ask questions Uses appropriate and relevant written resources to support explanation (brochures, booklets, familiar sounds audiogram) # Meeting target guidelines can be found on the paediatric certificate section of the NZAS website 18

Appendix C: NZAS Peer Reviewer Paediatric Certificates Checklists Chart Review Checklists Evidence documented (E) No Evidence seen in chart (N) Partial Evidence in chart (P) On Site Peer Review Checklist (NZAS Peer Reviewer) Clinically Safe (C) Marginal (M) Needs further development (FD) Not observed (NO) 19

Chart Visual Reinforcement Audiometry (VRA) E = Evidence documented N= No Evidence seen in chart P= Partial Evidence in chart Criteria Rating Essential case history obtained and appropriate follow-up questions (reflecting appropriate clinical reasoning) Screened to 20 db HL at 500, 2000 and 4000 Hz or thresholds obtained as required. 1000 Hz tested as required; if testing abandoned reasoning is documented Documented MLV speech testing and results are interpreted correctly; if testing abandoned reasoning is documented Documented bone conduction testing if thresholds are equal to or greater than 25 db HL; if testing abandoned reasoning is documented Documented otoscopy and includes results in interpretation of test results (e.g. wax, grommets) Documented and accurately interprets tympanometry; if testing abandoned reasoning is documented Documented and accurately interprets acoustic reflex testing; if testing abandoned reasoning is documented Documented and accurately interprets DPOAE testing; if testing abandoned reasoning is documented Results of different assessments are integrated to inform diagnosis and management recommendations, this is well documented Case is managed appropriately including referral for further testing or medical management where necessary; this is well documented Clear and concise written report to the GP and/or the referrer when appropriate Comments 20

Chart Auditory Brainstem Response (ABR) Testing E = Evidence documented N= No Evidence seen in chart P= Partial Evidence in chart Criteria Rating Essential case history obtained with appropriate follow-up questions: UNHSEIP results entered, babies state of health noted, responsiveness to sound, etc. All ABR parameter settings are included for each result (from equipment printout including test date and masking if used). All test printouts are kept in file (including immittance, DPOAEs, ABR traces); if testing is abandoned reason for this is documented ABR test frequency selection is in line with current diagnostic protocols and accurate ABR thresholds are chosen in an efficient manner. Bone conduction is performed when AC thresholds are elevated; if testing abandoned the reason is documented Where AC and BC thresholds are elevated, click ABR results are displayed and labelled appropriately to allow interpretation of ANSD if present; if testing is abandoned reasoning is documented ABR traces have been audited Results of all assessments are summarised and integrated to inform diagnosis, and this is clearly documented Case is managed appropriately in line with the current diagnostic and amplification protocols, referral for further testing or medical management is noted, i.e., ORL, AODC, and DND form completed. A report is included that summarises the results of all testing in an easily understood format and sent to all appropriate parties; parents/caregivers, new-born hearing co-ordinator (if necessary), ORL, AODC etc. Comments 21

Chart Paediatric Habilitation (HAB) E = Evidence documented N= No Evidence seen in chart P= Partial Evidence in chart Criteria Rating Essential case history obtained and appropriate follow-up questions: UNHSEIP results entered, babies state of health noted, responsiveness to sound etc. An accurate and recent audiogram is used for the hearing aid fitting (including separate ear AC and BC thresholds) with a minimum of two points in each ear, if not there is justification and future planning in place to obtain this Selects appropriate hearing aids, if not justification is documented Uses appropriate prescription formula, if not justification is documented Tympanometry is routinely performed in appointments where audiometric and real ear measures are performed, if not there is a clear and reasonable justification as to why it has not been performed Measures RECDs bilaterally routinely. If not achievable a decision and justification of averaged or other ear RECD is documented. Type of RECD measure (e.g. insert versus earmould) is documented. RECD curve and table of numbers should be printed on file. Test-box or on-ear real ear measures are recorded. Printouts in file, with documentation of type of measure insert versus ear-mould. These meet targets appropriately # The hearing aid settings are chosen appropriately (e.g. noise control settings, microphone modes, automation of microphone modes etc). The hearing aid settings need to be printed from the computer and included in the chart for the purposes of the chart review Tamper-proofing is appropriate for age, and documented in the file Appropriate aided speech testing is performed Appropriate referrals have been or will be made from this appointment (including AODC, ENT, CI if appropriate) Considers the need for RMHA/FM compatibility for child and in selection of hearing aids Appropriate questionnaires have been performed LittleEars, PEACH etc Care and maintenance instruction is documented in file Documents the counselling provided to the family on hearing loss, hearing aids, amplification and other Appropriate written material given to family; (getting started booklet, familiar sounds audiogram, mild/unilateral hearing loss handout, information on how to access batteries etc.) Documentation of family/whanau questions or concerns and how these are addressed 22

Data logging is recorded from the software and discussion with family regarding use is noted. If datalogging appears unrealistic or low a plan to improve this should be included A formal report can be included however it is not essential. If a report is not included please include a summary paragraph of the case that outlines the results so far and the goals of the subsequent appointments Comment 23

On Site Visual Reinforcement Audiometry (VRA) (Observation and Discussion) Clinically Safe (C) Marginal (M) Needs further development (FD) Not observed (NO) Criteria Case 1 Case 2 Case 3 Clinician facilitates session in a professional and efficient way Essential case history obtained and appropriate follow-up questions (reflecting appropriate clinical reasoning) Clear explanation of test procedures Manages test session: proceeds to next test when appropriate with reference to case history information Performs otoscopy safely and integrates findings (e.g. wax, grommets) into test battery Distraction*: appropriate for developmental level of child, able to realise when under or over distracted, good rapport Presentation: follows protocol, determines thresholds in a timely manner, confident in directing distractor. Screened to 20 db HL at 500, 2000 and 4000 Hz or thresholds obtained as required. 1000Hz tested as required. Performs MLV speech testing and results interpreted correctly Bone conduction is performed if thresholds are equal to or greater than 25 db HL Performs and accurately interprets tympanometry Performs and accurately interprets acoustic reflex testing Performs and accurately interprets DPOAE testing An appropriate cross-check is performed Results of different assessments are integrated to inform diagnosis and management recommendations Parents/caregivers are informed of the result accurately in a clear and logical manner Case is managed appropriately including referral for further testing or medical management Appropriately communicates results with family, giving parent/caregivers opportunity to respond and ask questions Has access to appropriate and relevant resources to support explanation (brochures, booklets, familiar sounds audiogram) KEY *may not be observed if clinician uses an assistant for this role 24

Comments: Case 1 Case 2 Case 3 25

On Site Auditory Brainstem Response (ABR) (Observation and Discussion) Clinically Safe (C) Marginal (M) Needs further development (FD) Not observed (NO) Criteria Clinician facilitates session in a professional and efficient way Case 1 Case 2 Case 3 Appropriate decisions about test order with consideration of baby s state, including cursory otoscopy if appropriate Case history obtained and follow-up questions (reflecting clinical reasoning) asked in reasonable timeframe Clear explanation of test procedures Correct parameter settings are used^ Sensible test setup and positioning of baby, transducers and cables Obtain low and balanced impedances <5kΩ routinely (preferably 1-3kΩ) Follows protocol for initial test ear Follows protocol making for frequency order Appropriate threshold seeking technique (repeatability and growth) Solves interference issues Distinguish the difference between noise and a true response Appropriate placement and maintenance of bone vibrator position Perform bone conduction testing appropriately Can perform and interpret a click ABR to check for ANSD^^ Performs and interprets tympanometry, if abandoned documented why Performs and interprets acoustic reflex, if abandoned documented why Performs and accurately interprets DPOAE testing An appropriate cross-check is performed Parents/caregivers are informed of the result accurately/clearly and logically giving parent/caregivers opportunity to respond and ask questions Case is managed appropriately including referral for further testing or medical management Has access to appropriate and relevant written resources to support explanation (brochures, booklets, familiar sounds audiogram) KEY ^ Software access to parameter settings may be discussed with clinician ^^ If not able to be performed during testing session will be discussed following appointment 26

Comments: Case 1 Case 2 Case 3 27

On Site Paediatric Habilitation (HAB) (Observation and Discussion) Clinically Safe (C) Marginal (M) Needs further development (FD) Not observed (NO) Criteria Clinician facilitates session in a professional and efficient way Case history obtained and follow-up questions (reflecting clinical reasoning) asked in reasonable time frame Clear explanation of appointment proceedings Performs otoscopy safely and integrates findings for real ear measure and test battery (e.g. wax, grommets) Tympanometry is performed and taken into consideration for fitting Accurate and recent audiogram is used for hearing aid fitting (including separate ear AC and BC thresholds.). Minimum of two points in each ear Selects appropriate hearing aids and can justify choice Uses appropriate prescription formula and can justify its use Uses a safe technique to insert probe tube Measures RECDs. If not achievable justification of average RECD is documented. Justification for type of RECD is given (e.g. insert versus ear-mould) Feedback is controlled without long term gain reduction (if gain is reduced, it is for a maximum of two weeks with a plan in place to overcome the under-aiding (i.e. Refer to CI, order more powerful aids or order new ear moulds). Test-box or on-ear real ear measures are recorded and meet targets # Verification (SII) Graph is used and understood The hearing aid setting are chosen appropriately (e.g. noise control setting, microphone modes, and automation of these). Tamper-proofing if required Age appropriate aided speech testing is performed Appropriate follow up questions and counselling addressed with family Case is managed appropriately including referral for further testing or medical management Considers RMHA/FM for child and in selection of hearing aids Appropriate questionnaire is performed LittleEars, PEACH, etc Care and maintenance instruction provided clearly to family Parents/caregivers are informed of the result accurately/clearly/logically giving parent/caregivers opportunity to respond and ask questions Has access to appropriate and relevant written resources to support explanation (brochures, booklets, familiar sounds audiogram) # Meeting target guidelines can be found on the paediatric certificate section of the NZAS website Case 1 Case 2 28 Case 3

Comments: Case 1 Case 2 Case 3 29

Appendix D: Log Book for Paediatric Certification Activities Week ending (date) VRA Activity and Hours Achieved Candidate s signature Supervisor s signature By sending this form into the NZAS you are giving NZAS consent to share information about the outcome, or progress through, the paediatric certificate process with your employer and the NSU. 30

Week ending (date) Paediatric Habilitation Activity and Hours Achieved Candidate s signature Supervisor s signature By sending this form into the NZAS you are giving NZAS consent to share information about the outcome, or progress through, the paediatric certificate process with your employer and the NSU. 31

Week ending (date) ABR Activity and Hours Achieved Candidate s signature Supervisor s signature By sending this form into the NZAS you are giving NZAS consent to share information about the outcome, or progress through, the paediatric certificate process with your employer and the NSU. 32