Developing Future Pediatric Audiology Leaders: The LEND Experience The nationwide LEND Program prepares audiologists to treat children with both hearing loss and autism or other developmental disabilities. All Ears on Audiology
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All Ears on Audiology  |   November 01, 2017
Developing Future Pediatric Audiology Leaders: The LEND Experience
Author Notes
  • Jackson Roush, PhD, is an audiologist and professor in the Division of Speech and Hearing Sciences at the University of North Carolina–Chapel Hill and director of the North Carolina LEND Program at the Carolina Institute for Developmental Disabilities. He is an affiliate of ASHA Special Interest Group 10, Issues in Higher Education. jroush@med.unc.edu
    Jackson Roush, PhD, is an audiologist and professor in the Division of Speech and Hearing Sciences at the University of North Carolina–Chapel Hill and director of the North Carolina LEND Program at the Carolina Institute for Developmental Disabilities. He is an affiliate of ASHA Special Interest Group 10, Issues in Higher Education. jroush@med.unc.edu×
  • Ben Kaufman, MSW, is senior manager, Maternal and Child Health Technical Assistance, at the Association of University Centers on Disabilities, supporting all 52 LEND programs. He serves on the National Association for Hearing and Speech Action (NAHSA) Board of Directors. bkaufman@aucd.org
    Ben Kaufman, MSW, is senior manager, Maternal and Child Health Technical Assistance, at the Association of University Centers on Disabilities, supporting all 52 LEND programs. He serves on the National Association for Hearing and Speech Action (NAHSA) Board of Directors. bkaufman@aucd.org×
Article Information
Hearing Disorders / Audiologic / Aural Rehabilitation / Special Populations / Autism Spectrum / All Ears on Audiology
All Ears on Audiology   |   November 01, 2017
Developing Future Pediatric Audiology Leaders: The LEND Experience
The ASHA Leader, November 2017, Vol. 22, 18-21. doi:10.1044/leader.AEA.22112017.18
The ASHA Leader, November 2017, Vol. 22, 18-21. doi:10.1044/leader.AEA.22112017.18
When Regina Escano began her graduate studies in audiology at the University of Washington-Seattle (UW), she didn’t realize how many children with congenital hearing loss had complex challenges related to multiple disabilities.
But that soon changed through her involvement in UW’s Leadership Education in Neurodevelopmental and Related Disabilities (LEND) program, one of 52 sites across the country preparing a health care workforce to address the needs of underserved children with autism spectrum disorder and other developmental disabilities (ASD/DD).
“Prior to my LEND training I had limited exposure to the world of special needs and was surprised to learn that children with developmental disabilities are an underserved population for hearing care,” says Escano.
Her LEND experience continued as a fourth-year extern in the LEND program at Boston Children’s Hospital, where she worked with children, their family members and other professionals under the guidance of pediatric audiologists. Now an audiologist at George Washington University, Escano looks back on her LEND experience as a “game-changer.”
“I collaborate on a daily basis with physicians and other health care providers, as well as administrators and professionals from a variety of disciplines,” Escano says. “LEND training helped me develop strong teamwork skills such as active listening, effective communication and out-of-the-box problem-solving. I attribute a lot of my passion and success to LEND.”

“Prior to my LEND training, I had limited exposure to the world of special needs.”

The LEND experience
LEND programs are funded for five-year cycles on a competitive basis under the federal Autism Collaboration, Accountability, Research, Education, and Support (CARES) Act and administered by the Maternal Child Health Bureau (MCHB). Funding ranges from about $500,000 to $1 million per year, depending on the number of trainees and disciplines represented by qualified faculty.
The funding enables faculty to allot time for teaching, clinical education and mentorship, and provides administrative support. Most trainees receive either a stipend, tuition reimbursement or another allowable form of compensation, including travel to professional conferences.
Growing leaders
LEND prepares graduate-level health care trainees and fellows to lead efforts to improve the health of infants, children and adolescents with ASD/DD.
LEND also includes family members and people with disabilities as full participants. They navigate the same curriculum, but focus on expanding their knowledge and advocacy skills to benefit the broader community. Programs increase awareness of ASD/DD, reduce barriers to screening and diagnosis, promote culturally and linguistically competent delivery of evidence-based interventions, and encourage systems-level, change-oriented thinking (see sources below).
Each LEND program is unique, based on location and identified community needs. LEND faculty (leaders from their respective disciplines who are typically employed by the host university/hospital, though sometimes affiliated with clinical or community partnership sites) facilitate classroom learning and involve trainees in interdisciplinary clinics, research and community leadership projects.
All LEND programs emphasize integration with state and local agencies and community-based organizations (CBOs). For example, the Boston Children’s Hospital LEND, where Escano completed her fourth-year externship, partners with area CBOs that serve specific cultural and ethnic groups. Trainees complete a specified number of hours at these sites and collaborate with organizational leadership to design targeted projects.
Pediatric audiology specialization
Audiology has been a core discipline in LEND since its inception (see sources below). Beginning in 2009, MCHB’s Division of Services for Children with Special Health Care Needs provided supplemental funding to 10 LEND programs as part of Universal Newborn Hearing Screening and Intervention. This funding supports pediatric audiology trainees’ work on screening, treatment and follow-up for infants and young children who are deaf or hard of hearing.
The LEND audiology supplements were re-competed (MCHB put out a notice for a funding opportunity with specific guidance, and programs were encouraged to submit applications) in 2016, and MCHB expanded the number of five-year awards to 12 programs (see list below), this time with a focus on children who have ASD/DD in addition to hearing loss. The goal is to increase the number of pediatric audiologists with the interdisciplinary preparation needed to serve these children (see sources below). Now in their second year, the 12 grantees address these goals through a variety of educational approaches, some with trainees in their first three years and others as part of a fourth-year externship.
LEND training initiatives include:
  • Seminars related to hearing loss and ASD/DD.

  • Collaborations with state Early Hearing Detection and Intervention (EHDI) programs and parent groups.

  • Observation and participation in telehealth audiology services.

  • Involvement in planning and delivery of conferences and symposia.

  • Pediatric rotations with collaborative centers.

  • Participation on interdisciplinary teams that evaluate children with hearing loss and ASD/DD.

In addition, the majority of program trainees attend the EHDI Annual Meeting, where they connect with students from other sites and participate in a pre-meeting workshop designed specifically for LEND trainees.
Each year, the pediatric audiology supplement supports more than 50 long-term (more than 300 hours) trainees and fellows. Their presence affects hundreds of LEND participants from other professional disciplines. It also benefits family members and self-advocates, who acquire greater knowledge of pediatric audiology’s vital role in screening, diagnosis and management of hearing loss in children.
Statewide resource
In addition to workforce preparation and leadership training, LEND programs serve as resources in their respective states, providing continuing education and technical assistance, among other benefits.
Examples include:
  • Utah Regional LEND audiology trainees and faculty have made significant contributions to the state’s Cytomegalovirus (CMV) Public Health Initiative, creating training content and public service announcements. They also partnered with the state’s Indian Health Advisory Board to ensure the cultural appropriateness of CMV and newborn hearing screening outreach materials for traditionally underrepresented communities.

  • North Carolina LEND audiology trainees collaborated with EHDI staff in the Division of Public Health to conduct a statewide analysis of EHDI outcomes for 12 newly created geographic regions. Through this process, they helped determine strengths, challenges and opportunities for EHDI program development. The activity included hosting a statewide EHDI stakeholder meeting, conducting focus groups and analyzing data.

Collectively, these LEND programs form a diverse network to assist children with special health care needs and their families. They share best practices, develop shared products and strengthen workforce development efforts across disciplines. To find the LEND program in your state or territory, visit the Association of University Centers on Disabilities website and click on “Find Network Members” on the home page.
LEND Programs with Pediatric Audiology Supplements
  • University of Colorado

  • University of Connecticut

  • Boston Children’s Hospital

  • Kennedy Krieger Institute (Baltimore, Maryland)

  • Wayne State University (Michigan)

  • University of North Carolina–Chapel Hill

  • Albert Einstein College of Medicine (New York)

  • Oregon Health and Science University

  • University of South Dakota

  • University of Utah

  • University of Washington–Seattle

  • University of Wisconsin–Madison

Sources
Association of University Centers on Disabilities. (2017, August 28). About LEND. Retrieved from https://www.aucd.org/template/page.cfm?id=473.
Association of University Centers on Disabilities. (2017, August 28). About LEND. Retrieved from https://www.aucd.org/template/page.cfm?id=473.×
Gallaudet University Office of Research Support and International Affairs. (2014, September). Regional and national summary report of data from the 2013–2014 annual survey of deaf and hard of hearing children and youth [Report]. Washington, DC: Research Support and International Affairs.
Gallaudet University Office of Research Support and International Affairs. (2014, September). Regional and national summary report of data from the 2013–2014 annual survey of deaf and hard of hearing children and youth [Report]. Washington, DC: Research Support and International Affairs.×
HRSA, Maternal and Child Health. (2017, August 28). Pediatric audiology competitive supplement to leadership education in neurodevelopmental and related disabilities (LEND). Retrieved from https://mchb.hrsa.gov/fundingopportunities/?id=e9ba7da7-a73f-4aa4-aa10-214c75aa3f45.
HRSA, Maternal and Child Health. (2017, August 28). Pediatric audiology competitive supplement to leadership education in neurodevelopmental and related disabilities (LEND). Retrieved from https://mchb.hrsa.gov/fundingopportunities/?id=e9ba7da7-a73f-4aa4-aa10-214c75aa3f45.×
Szymanski, C. A., Brice, P. J., Lam, K. H., & Hotto, S. A. (2012). Deaf children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42(10), 2027–2037. [Article] [PubMed]
Szymanski, C. A., Brice, P. J., Lam, K. H., & Hotto, S. A. (2012). Deaf children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42(10), 2027–2037. [Article] [PubMed]×
Wiley, S., St. John, R., & Lindow-Davies, C. (2017). Children who are deaf or hard of hearing PLUS. A Resource Guide for Early Hearing Detection and Intervention. Retrieved from http://infanthearing.org/ehdi-ebook/2017_ebook/6%20Chapter6ChildrenPLUS2017.pdf.
Wiley, S., St. John, R., & Lindow-Davies, C. (2017). Children who are deaf or hard of hearing PLUS. A Resource Guide for Early Hearing Detection and Intervention. Retrieved from http://infanthearing.org/ehdi-ebook/2017_ebook/6%20Chapter6ChildrenPLUS2017.pdf.×
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FROM THIS ISSUE
November 2017
Volume 22, Issue 11