Senate Committee recommendations for the hearing impaired

Hi - as I refer to these recommendations and this report so much, I thought I'd put the Executive Summary here for your perusal. It is interesting to note in the Criminal Justice Section(repeated at the top for quick reference), that none of the recommendations have been adhered to, even though statistics are shocking, eg. 95% of Indigenous Alice Springs inmates have a hearing loss and ear disease.
 
I'm not sure that the state government departments(in every state) realize that they are disciminating against the hearing impaired on such a vastly, mammoth scale.
 
Today I was appalled to read the regurgitated opinions of one new, young, non-indigenous NT lawyer(government funded) validated on an NT government website (which shall remain nameless), suggesting that hearing impaired people are more criminally-inclined than others - how freakin extraordinary - an advocate lawyer who breaches the discrimination act! Luckily, his ignorant claims excuse decades of crappy legal defenses, the abject shortage of interpreters, and the cost of re-investigating for wrongful convictions - so his opinions must be ok then...what a stooge.
 
PS Kids with long-term chronic glue ear are over-represented as victims and offenders and usually, both, simultaneously, and giving evidence as a victim, or a witness, is just as fraught with difficulty as it is for the accused. Quick collar, huh?
 
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Criminal Justice



Recommendation 27 (chapter eight)
 
The committee recommends that the Department of Health and Ageing work closely

with state and territory jurisdictions to develop and implement a national plan which:

(a) provides resources to conduct hearing assessments for all Australians

serving custodial sentences who have never received such an assessment,

including youths in juvenile detention; and

(b) facilitates prisoner access to those hearing assessment; and

(c) encourages a high level of participation in those hearing assessments; and

(d) makes the findings of the hearing assessments available to the public

(within privacy considerations).


Recommendation 28 (chapter eight)



The committee recommends that the relevant ombudsman in each state and territory

conduct an audit of Australians serving custodial sentences, including youths in

juvenile detention, and consider whether undiagnosed hearing impairment may have

resulted in a miscarriage of justice and led to any unsafe convictions.


Recommendation 31 (chapter eight)



The committee recommends that guidelines for police interrogation of Indigenous

Australians in each state and territory be amended to include a requirement that a

hearing assessment be conducted on any Indigenous person who is having

communication difficulties, irrespective of whether police officers consider that the

communication difficulties are arising from language and cross-cultural issues.


Recommendation 32 (chapter eight)



The committee recommends that the National Judicial College of Australia work with

state and territory jurisdictions to develop and deliver accredited professional

development programs for judges, lawyers, police, correctional officers and court


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officials on the effects of hearing impairment on Indigenous engagement with the

criminal justice system, and effective evidence-based techniques for engaging

effectively with people with a hearing impairment in courtroom environments.


Recommendation 33 (chapter eight)



The committee recommends that hearing loops are available in interview rooms and

public counters of all police stations, and in all courtrooms, and that loop receiver

devices be made available for people without hearing aids.


Recommendation 34 (chapter eight)



The committee recommends that correctional facilities in which greater than 10 per

cent of the population is Indigenous review their facilities and practices, and improve

them so that the needs of hearing impaired prisoners are met.
EXECUTIVE SUMMARY



One in six Australians suffers from some degree of hearing loss. By 2050 this is

forecast to grow to one Australian in four. Hearing health is a mainstream health issue

which touches the lives of most Australians in one way or another, yet as a public

health issue it is not ranked as a national health priority. Australians with hearing loss

must live with the paradox that their disability is so prevalent in our community, and

yet suffers from a generally low level of awareness and understanding.

One message above all others came through from the evidence before this inquiry, and

this message forms the title of this report: Hear Us. It is the message to a hearing

society from people with a hearing loss who live the terrible isolation and frustration

that is often their daily lot. It is the message to governments and funding bodies from

the many volunteer support and representative groups who advocate to improve the

lives of people with a hearing impairment. It is the message to program administrators

from hearing health practitioners working within systems that need an overhaul. It is

the message from researchers striving to advance our understanding of the causes of

hearing loss, and the technologies that can improve the lives of future generations. It is

the message from Indigenous Australians, for many of whom hearing loss is so

pervasive it has become a normal and accepted part of growing up.

The forecast increased prevalence of hearing loss among Australians is largely driven

by our ageing population. However over a third of all people with hearing loss

acquired their impairment through preventable means. Workplace hearing damage is

often associated with industrial work sites where people work with noisy machinery.

A large proportion of rural workers and farmers suffer from acquired hearing loss,

though the prevalence is falling among younger farmers.

Hearing loss can also be caused by diseases and disorders, including middle ear

infections, growths in the ear canal and Meniere's Disease.

People exposed to acoustic shock can also suffer permanent hearing damage. The

committee heard that armed services people who have been exposed to artillery

explosions have been susceptible to acoustic shock in the past, as have call centre

workers experiencing unexpected loud noise through telephone headsets.

There is a widespread concern in the community about the effects of personal music

players on hearing loss, especially among young people. Whilst the proof that

personal music players cause permanent hearing loss is ambiguous for now, expert

opinion is that the potential is there if devices are played loud enough and over a long

enough period of time.

The costs of hearing loss to Australia were estimated at $11.75 billion in 2005, which

represented 1.4 per cent of Australia's then Gross Domestic Product. The largest

element of this cost, at over half the total, was lost wages and productivity among


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people with a hearing loss. The value to the nation of retaining or re-engaging people

with a hearing loss in the workforce is thus huge.

The committee heard that hearing loss can affect people's physical health and

emotional wellbeing. The economic cost of low workforce participation has been

noted, but at the core of this lies the personal distress for individuals who stop

working in their forties because they can no longer hear, or who work in jobs far

below their capacity because their employers do not support them as well as they

might.

For children who are diagnosed with hearing loss within the first six months of life,

the chances are good that, with appropriate intervention and support, they will acquire

good communication skills and be well equipped to engage with the world. For

children whose hearing loss is not picked up at birth, or who acquire hearing loss later

in life – a much greater number – their chances are more uncertain. Much will depend

on when they are diagnosed, the choices their parents make, and the support they

receive from school and from healthcare professionals.

The single issue most raised by submitters to the inquiry was that of eligibility to

Australian Hearing services, and especially the cut off age of 21 years. At a time in

their lives when they are studying, or not yet established in their careers, young

Australians find themselves without the excellent care they have received to date, and

often without the means to replace that care, or their hearing devices, in the private

sector.

The costs of hearing loss to individual people can be very high, particularly for those

who fall outside the eligibility criteria for Office of Hearing Services program support.

Expenses include hearing aids at between $3,000 and $10,000 a pair, cochlear implant

speech processors at between $8,000 and $12,000, batteries and maintenance, and

special assistive devices such as flashing fire alarms and doorbells. Hearing aids and

processors can need replacing every three to five years.

The committee heard from many submitters that the level of cover available for

hearing devices from their private health insurers was minimal.

The cost of hearing aids has generated the establishment of hearing aid banks in most

states and territories. These facilities recondition second hand hearing aids and make

them available to people who cannot afford new aids.

Hearing assessment and support services are more difficult to access in regional and

remote parts of Australia. Hearing care providers have trouble attracting and retaining

qualified practitioners in these areas. People who need to travel to larger centres for

audiological services are not eligible for Patient Assisted Travel Schemes.

Universal screening for newborns, a Council of Australian Governments initiative due

for implementation by the end of 2010, was widely applauded by submitters to the

inquiry. However the access to hearing screening for school aged children is more

patchy, even though the benefits to the child and to society of early diagnosis,


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intervention and ongoing engagement with hearing health professionals are well

known.

There is a level of concern among consumers of hearing health services that some in

the hearing industry are more interested in selling hearing aids than improving the

lives of the hearing impaired. Representatives of the private hearing aid industry told

the committee that unless they sell top-ups to government hearing aid vouchers, their

businesses are not financially viable. The Department of Health and Ageing has

amended eligibility for its voucher program so that it is better targeted toward those

with the highest need.

Around 24 per cent of all Australians who would benefit from a hearing aid have one,

which is comparable with international standards. There is an issue around the extent

to which people use these hearing aids, however, with up to 30 per cent of hearing

aids sitting in the bedside drawer unused, or not used as much as they could be.

Cochlear implants have been a great innovation for many people with hearing loss,

with take-up expected to grow as the technology improves and widens user eligibility.

The cost of the clinical aspects of implants are met from public funds, but for many

people the cost of replacing speech processors must be met privately.

The committee heard about the research currently underway in hearing health, and

about the gaps in the research field. Many researchers called for a national database

that can facilitate follow up from the national newborn screening initiative. More

research is needed around: the effects of recreational noise on permanent hearing loss;

Occupational Noise Induced Hearing Loss; the relationship between health and

hearing impairment; the effects of ototoxicity; and Meniere's Disease.

There is a place in Australia for a large-scale hearing health awareness-raising and

education campaign. Such a campaign could have three aims: to target high-risk

groups about preventable hearing loss; raise the general level of community awareness

about hearing loss issues; and promote access to support and resources for people with

a hearing loss.

There is a crisis in Indigenous ear and hearing health in Australia. Indigenous people

suffer ear disease and hearing loss at up to ten times the rate of non-Indigenous

Australians, and arguably the highest rate of any people in the world. The rate of

middle ear infection (otitis media) among Indigenous Australians far exceeds the level

that the World Health Organisation describes as 'a massive public health

problem…which needs urgent attention'.

The root causes of such a high prevalence of otitis media are the home environmental

conditions associated with poverty – overcrowded housing, poor nutrition, poor

sanitation and passive smoking.

The consequences of early onset hearing loss can be devastating for Indigenous

Australians. Their capacity to access education – arguably the best way out of the

poverty cycle - is limited. The classroom facilities are often inadequate. Teachers and


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school leadership may be untrained to manage hearing loss in the classroom, or even

unaware of the scale of the problem among Indigenous children. The momentum to

demand improvements is slowed by a widespread acceptance among families and

communities that chronic ear disease among Indigenous children is a normal part of

growing up.

The extent of hearing loss among Indigenous Australians in custody is unknown,

though informed estimates provided to the committee suggest that the incidence may

be very high indeed. The implications for Indigenous Australians who may have been

convicted and incarcerated with an undiagnosed hearing loss could be most profound.

Evidence was presented to the committee about a relationship between hearing

impairment and a person's engagement with the criminal justice system. For

Indigenous people with a hearing loss, whose first language - if they have one - is not

English, this relationship can be disastrous. Engagement between Indigenous people

with a hearing loss and police can spiral into confrontation, as police mistake deafness

for insolence, or for cultural or language communication difficulties.


Inquiry recommendations by theme



This report, along with its recommendations, is structured around the terms of

reference for the inquiry. These terms of reference provide a suitable framework for

the conduct of the inquiry, and for presenting its findings. However the

recommendations of the inquiry, when taken as a whole, can be usefully grouped into

categories which reflect the priorities for hearing health as this committee sees them:

education, criminal justice, access and services, awareness and research, and hearing

loss among young people. The committee believes it is useful to re-present the inquiry

recommendations here under these categories.


Access and services




Recommendation 2 (chapter four)



The committee recommends that the Department of Education, Employment and

Workplace Relations engage with state and territory jurisdictions, and with

employment and hearing loss peak bodies, to develop a 10 year strategy to better

support, engage and retain hearing impaired Australians in the workforce. The

strategy should be made publicly available, and detail annual performance targets and

the level of resources committed to achieving them.


Recommendation 4 (chapter five)



The committee recommends that eligibility for the Australian Government Hearing

Services Voucher Program be extended to include all Australians, subject to eligibility

and a means test.


Recommendation 5 (chapter five)



The committee recommends that former child clients of Australian Hearing remain

eligible for Australian Hearing support until the age of 25. This eligibility is to be


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subject to a means test. Former child clients of Australian Hearing who do not meet

the means test are to have the option to access Australian Hearing support on a feefor-

service basis until the age of 25.


Recommendation 6 (chapter five)



The committee recommends that state and territory governments expand eligibility for

Patient Assisted Travel Schemes to include support for people accessing audiological

services.


Recommendation 7 (chapter five)



The committee recommends that the Commonwealth provide funding to expand

services for hearing impaired children in rural and remote areas through e-technology

based program such as that developed by the Royal Institute for Deaf and Blind

Children.


Recommendation 9 (chapter five)



The committee recommends that the Audiological Society of Australia develop and

make available to its members resources and professional development that promotes

better understanding about the impact a diagnosis of hearing loss can have on people,

and which provides resources and techniques for counselling and supporting people at

the time of diagnosis.


Recommendation 11 (chapter five)



The committee recommends that the Office of Hearing Services engage with

representatives of the hearing aid manufacturing and distribution industry, private

providers of hearing health services, and hearing health consumers to investigate:

(a) the relationship between the voucher program, top-ups and the financial

viability of private health services; and

(b) whether extending the capacity to audiologists to bulk bill Medicare

directly for clinical services would have any impact on the financial

viability of private health services (i.e. would it ameliorate the need to

push 'top-ups' to stay viable?); and

(c) that the findings of these investigations be made publicly available for

the consideration of all hearing health stakeholders.


Recommendation 12 (chapter five)



The committee recommends that the Office of Hearing Services review its policy with

regard to the replacement of damaged, lost or obsolete cochlear implant speech

processors for eligible clients over 21 years of age, and if possible align it with the

replacement policy for eligible clients less than 21 years of age.


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Recommendation 13 (chapter five)



The committee recommends that the public counters in all government service

shopfronts be accessible to people with a hearing impairment through the provision of

hearing loop technology. The committee recommends that the Office of Hearing

Services coordinate a project which sets targets toward that end for all government

agencies, at all levels of government, and that these be publicly reported upon.


Recommendation 26 (chapter eight)



The committee recommends that the Department of Health and Ageing make the

changes to Medicare necessary to enable specialists and practitioners to receive public

funding support for ear health services provided remotely via ear telehealth.


Education and learning




Recommendation 3 (chapter four)



The committee recommends that the Department of Education, Employment and

Workplace Relations engages with state and territory education systems, higher

education providers of training for teachers of children with hearing impairment, and

major stakeholders (including the Royal Institute for Deaf and Blind Children and

parent representative bodies), to develop and implement an agreed national

qualification standard for teachers of children with hearing impairment. This standard

is to be benchmarked against international best practice.


Recommendation 8 (chapter five)



The committee recommends that the Council of Australian Governments extends its

commitment for universal newborn hearing screening to include a hearing screening

of all children on commencement of their first year of compulsory schooling. Given

the crisis in ear health among Indigenous Australians, the committee believes urgent

priority should be given to hearing screenings and follow up for all Indigenous

children from remote communities on commencement of school.


Recommendation 10 (chapter five)



The committee recommends that education providers develop professional standards

for interpreters working in educational environments. These standards should be based

on existing standards, such as the National Accreditation Authority for Translators and

Interpreters paraprofessional level accreditation, or the National Auslan Interpreter

Booking and Payment Service / Australian Sign Language Interpreter's Association

Deaf Relay Certification.


Recommendation 21 (chapter eight)



The committee recommends that the Department of Education, Employment and

Workplace Relations and Department of Health and Ageing jointly establish a task

force to work across portfolios and jurisdictions on a plan to systemically and

sustainably address the educational needs of hearing impaired Indigenous Australian

children.


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Recommendation 22 (chapter eight)



The committee recommends that Australian Hearing be enabled under the

Australian

Hearing Services Act 1991


to supply and maintain sound field systems for classrooms

in all new classrooms, and in all existing classrooms where there is a significant

population of Indigenous children.


Recommendation 23 (chapter eight)



The committee recommends that the Department of Health and Ageing work with the

Department of Education, Employment and Workplace Relations to develop a

program with Australian Hearing to:

(a) supply and maintain sound field amplification systems and acoustic

conditioning in all new classrooms, and in all existing classrooms where

there is a significant population of Indigenous children; and

(b) report publicly on where sound field amplification systems and acoustic

conditioning are installed to assist parents in making informed choices

about schools for their children.


Recommendation 24 (chapter eight)



The committee recommends that education providers ensure that teacher induction

programs for teachers posted to schools in Indigenous communities emphasise the

likelihood that hearing impairment among their students will be very high. Induction

programs for these teachers must include training on the effects of hearing health on

education, and effective, evidence-based teaching strategies to manage classrooms

where a majority of children are hearing impaired.


Recommendation 25 (chapter eight)



The committee recommends that the Department of Education, Employment and

Workplace Relations work with jurisdictions to develop accredited professional

development programs for teachers and school leaders on the effects of hearing health

on education, and effective evidence-based teaching strategies to manage classrooms

with hearing impaired children.


Awareness-raising and research




Recommendation 14 (chapter six)



The committee recommends that the national data set and register for neonatal hearing

screening, currently under development by the Neonatal Hearing Screening Working

Group on behalf of the Australian Health Minister's Advisory Council, be expanded to

include a national database which can:

(a) track children through neonatal hearing screening, diagnosis and

intervention;

(b) record and report cognitive, linguistic, social and emotional

development outcomes of children diagnosed at birth with a hearing

loss; and


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(c) be expanded in future years to track all children diagnosed with a

hearing impairment later in life.


Recommendation 16 (chapter six)



The committee recommends that Australian Governments continue to prioritise and

fund research into occupational noise exposure. The focus of research should be

informed by the results of the ‘

Getting heard: effective prevention of hazardous

occupational noise


’ project, currently being undertaken by Safe Work Australia, and

include investigation into the effectiveness of current legislation in limiting

occupational noise exposure. Research should continue to develop understanding

about the design of workplace equipment, hearing protection, and the long-term

effects of acoustic shock and acoustic trauma.


Recommendation 17 (chapter six)



The committee recommends that Australian Governments prioritise and fund research

into the reasons for the under use of hearing aids, and develop practicable strategies

for hearing health practitioners to help overcome the under use in the community.


Recommendation 18 (chapter six)



The committee recommends that the Department of Health and Ageing work closely

with Safe Work Australia to investigate the relationships between ototoxic substances

and hearing impairment, and the possible implications for workplace safety practices.


Recommendation 19 (chapter six)



The committee recommends that the Department of Health and Ageing works with

Meniere's Australia to identify opportunities for research into the prevalence of the

Meniere's disease in Australia, rates of diagnosis, options for treatment and personal

management, and the socio-economic impact of the disease, including on the

employment and lifestyles of those affected.


Recommendation 20 (chapter seven)



The committee recommends that the Department of Health and Ageing provides

funding for Australian Hearing to develop, in close consultation with major hearing

health stakeholders, a national hearing health awareness and prevention education

campaign. This campaign should have three dimensions. It should:

(a) target those at highest risk of acquired hearing loss (including employers

and employees in high-risk industries, farmers and rural workers, and

young people) to improve their knowledge about hearing health and

change risky behaviours;

(b) raise the level of awareness about hearing health issues among the

broader Australian population to help de-stigmatise hearing loss; and

(c) promote access to support services for people who are hearing impaired.


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Recommendation 29 (chapter eight)



The committee recommends that the Department of Health and Ageing:

(a) provide funding and resources to manage a national biennial Indigenous ear

health conference; and

(b) make the outcomes of those conferences publicly available to assist

researchers and practitioners in the field of hearing health.


Recommendation 30 (chapter eight)



The committee recommends that the Department of Health and Ageing work with

state and territory health agencies to provide funding to support the continuation,

promotion and expansion of the Ear Health Infonet.


Criminal Justice




Recommendation 27 (chapter eight)



The committee recommends that the Department of Health and Ageing work closely

with state and territory jurisdictions to develop and implement a national plan which:

(a) provides resources to conduct hearing assessments for all Australians

serving custodial sentences who have never received such an assessment,

including youths in juvenile detention; and

(b) facilitates prisoner access to those hearing assessment; and

(c) encourages a high level of participation in those hearing assessments; and

(d) makes the findings of the hearing assessments available to the public

(within privacy considerations).


Recommendation 28 (chapter eight)



The committee recommends that the relevant ombudsman in each state and territory

conduct an audit of Australians serving custodial sentences, including youths in

juvenile detention, and consider whether undiagnosed hearing impairment may have

resulted in a miscarriage of justice and led to any unsafe convictions.


Recommendation 31 (chapter eight)



The committee recommends that guidelines for police interrogation of Indigenous

Australians in each state and territory be amended to include a requirement that a

hearing assessment be conducted on any Indigenous person who is having

communication difficulties, irrespective of whether police officers consider that the

communication difficulties are arising from language and cross-cultural issues.


Recommendation 32 (chapter eight)



The committee recommends that the National Judicial College of Australia work with

state and territory jurisdictions to develop and deliver accredited professional

development programs for judges, lawyers, police, correctional officers and court


xxii


officials on the effects of hearing impairment on Indigenous engagement with the

criminal justice system, and effective evidence-based techniques for engaging

effectively with people with a hearing impairment in courtroom environments.


Recommendation 33 (chapter eight)



The committee recommends that hearing loops are available in interview rooms and

public counters of all police stations, and in all courtrooms, and that loop receiver

devices be made available for people without hearing aids.


Recommendation 34 (chapter eight)



The committee recommends that correctional facilities in which greater than 10 per

cent of the population is Indigenous review their facilities and practices, and improve

them so that the needs of hearing impaired prisoners are met.


Recreational hearing loss among young people




Recommendation 1 (chapter two)



The committee recommends that the Department of Health and Ageing work with the

appropriate agencies and authorities to devise recreational noise safety regulations for

entertainment venues. Specifically, where music is expected to be louder than a

recommended safe level, that the venues be required to:

(a) post prominent notices warning patrons that the noise level at that venue may

be loud enough to cause hearing damage; and

(b) make ear plugs freely available to all patrons.


Recommendation 15 (chapter six)



The committee recommends that the Australian Government fund the National

Acoustic Laboratory to undertake longitudinal research into the long-term impacts of

recreational noise, particularly exposure to personal music players.