You’re Going Where? Through a community partnership, University of South Dakota faculty and students travel hundreds of miles to deliver audiology services to children who would otherwise never receive them. Academic Edge
Academic Edge  |   July 01, 2014
You’re Going Where?
Author Notes
  • Jessica J. Messersmith, PhD, CCC-A, is an assistant professor in the Department of Communication Sciences and Disorders at the University of South Dakota. She is an affiliate of ASHA Special Interest Group 9, Hearing and Hearing Disorders in Childhood.
    Jessica J. Messersmith, PhD, CCC-A, is an assistant professor in the Department of Communication Sciences and Disorders at the University of South Dakota. She is an affiliate of ASHA Special Interest Group 9, Hearing and Hearing Disorders in Childhood.×
Article Information
Hearing Disorders / Professional Issues & Training / Academic Edge
Academic Edge   |   July 01, 2014
You’re Going Where?
The ASHA Leader, July 2014, Vol. 19, 32-33. doi:10.1044/leader.AE.19072014.32
The ASHA Leader, July 2014, Vol. 19, 32-33. doi:10.1044/leader.AE.19072014.32
After several hours in the car, we were finally there: Hot Springs, a remote small town on the edge of Pine Ridge Reservation in South Dakota. The anxiety, excitement and fear crept over me as I thought about what awaited us. The next day I, a fellow audiology supervisor, and two AuD students from the University of South Dakota would meet and work with families of children with cochlear implants at our first USD Cochlear Implant Outreach Clinic. But, unlike the children I typically see, these children had received little, if any, follow-up care post-CI activation.
Given the challenges the families of these children face, finding time to travel eight to 10 hours for CI services ranks low on their hierarchy of priorities. Financial difficulties compound the problem. This windswept, sparsely populated part of the Dakotas has long been economically depressed, with the counties in the reservation in the bottom third of the nation’s poorest, and with unemployment rates of up to 80–90 percent.
Clearly, these families could not overcome their travel difficulties to deal with their hearing challenges, so we decided to take our services to them. And, while meeting their need for care, we’d simultaneously meet our students’ needs for experience providing services.
Getting started
Those of you interested in launching a similar program may wonder how we did it. After I joined USD in 2009, we launched the CI clinic at USD. As the on-campus clinic grew, I heard from outreach consultants at the South Dakota School for the Deaf about a need for services in the Pine Ridge area. However, they and families in the area expressed concern about the large cross-state distance. So in the fall of 2011, I proposed collaborating with SDSD to provide services there.
After brainstorming our plan, the first step was gaining support of the stakeholders: the children’s school districts, the children’s families, and administrators at SDSD and USD. We worked through the SDSD to identify families and school districts across the western half of South Dakota, from the northern ranch lands to the southern Badlands of the reservation. Funding would come from the children’s insurance (typically Medicaid or the Indian Health Service), SDSD and, to some extent, school districts (for children’s transportation). After we secured stakeholders’ support, we established a clinic site at a community center. We later moved to an audiologic suite in the Rapid City Area Schools, one of the districts we serve. (Actually, if you have the correct portable equipment you could do this in any location that meets privacy and noise level requirements.)
Our equipment packing list is long and specific because we provide multiple specialized services, including CI evaluation, programming and troubleshooting; pediatric diagnostic evaluations; electrophysiologic testing; and hearing aid evaluation, programming and troubleshooting. We travel twice a year, in the fall and spring.
Seeing results
We’ve made five trips since starting the program two years ago, with each one involving more patients and services. On our first trip, only two of six scheduled families showed up for their appointments. However, during our last trip this past spring, we saw 30 children in two and a half days. We have expanded our services to include hearing aid servicing, evaluations for CIs and osseo-integrated devices, and pediatric diagnostic testing. We sought to fill a void for these families—and the growth of the clinic, I believe, indicates that we are meeting that goal.
The program also benefits our students, who see firsthand the conditions they read about in textbooks. In addition to earning clinic hours, they’ve worked with children with cortical deafness, CHARGE syndrome and severe craniofacial abnormalities. About half the patients we see have co-occurring conditions, some of which have not been diagnosed. Many students have said that the experience was difficult, yet more rewarding and educational than any other in their academic career.
And there is no denying the benefits to the children: During our first trip we meet a preteen with an inspiring spark and an equally inspiring wit, but whose situation broke my heart. She has a volatile home life and, despite receiving a cochlear implant early, couldn’t communicate through verbal or sign language. She had not been using her CI consistently, and it had failed to provide optimal sound. We programmed her device appropriately and now she is consistently wearing it. But she had gone such a long time without appropriate sound that she had missed the critical window for auditory, speech and language development. She needs a form of communication, and it is likely not going to be verbal. We are now exploring augmentative and alternative communication devices.
Another family we’ve been working with has a baby with unilateral deafness. This baby was identified early, and through a team effort of USD, SDSD and Denver Ear Associates, will receive a CI this summer. We’ve built this family a support network with an SDSD outreach consultant, a local speech-language pathologist and mentor families. We’ve also prepared them for the challenges that lie ahead and have identified ways to ensure appropriate follow-up care with me and the surgeon in Denver. We hope our efforts will pay off, and the baby will have opportunities to hear that would otherwise have been unavailable.
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July 2014
Volume 19, Issue 7