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
xvii
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.
xviii
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.