Slide 1

J Bruce Tomblin, University of IowaMary P Moeller, Boys Town National Research HospitalForging Successful Research Collaborations to Study Outcomes in Communication Disorders

Supported by NIDCD R01 DC0095601Goals of PresentationDiscuss process of identifying gaps in research related to children with mild to severe hearing lossDescribe development of multi-center, multi-disciplinary grant to address gapsSummarize progress of project to dateReview collaborative strategies leading to effective team function

2Project BackgroundNIDCD working group (12/2006) Identify research gaps (mild-severe HL)Current State of Knowledge:Research Methods (outcomes)Language & LiteracyPsychosocial DevelopmentPerceptual ProcessingSpeech Recognition & ProductionEar & Hearing, December, 2007February 20, 2009Boys Town National Research Hospital3BackgroundMost outcome studies focus on children who are deaf Reduced body of literature concerning children with mild to severe HLSample sizes are small or mix D/HH children Lack of control of amplification histories/audibilityFew studies attempted a population sampleVaried measurement strategies; earlier generation technologiesNeed to understand sources of individual difference in outcomes

February 20, 2009Boys Town National Research Hospital4Summary of Research on Speech OutcomesDelays in babble onset increase with increasing hearing loss (Carney, 1996)Some children at risk for slow transitions from babble to word productions (Moeller, et al., 2007)Consonant repertoire differences-e.g., fricatives (McGowan, et al, 2008; Moeller, et.al, 2007)Generally intelligible speech as they mature (Wallace, et al, 2000)Number & type of phoneme errors increase with increased severity of loss (Elfenbein, et al, 1994)Substitution of fricatives & affricates most common

5Summary of Research on Language OutcomesVaried findings related to vocabulary developmentEarly lexicon delayed (Mayne, et al, 2000, Kiese-Himmel & Reeh, 2006)Delayed at school age (Davis, et al, 1986; Wake, et al, 2004)Not delayed at school age (Plapinger & Sikora, 1995; Wolgemuth, et al, 1998)Bimodal distribution of performance (Gilbertson & Kamhi, 1995)Less efficiency in Novel Word Learning (Pittman, et al, 2005) Prolonged lexical access (Jerger et al, 2006)Delays in morphology (McGukian & Henry, 2007; Brown, 1984; Norbury, et al, 2001)3 person singular, past tense markers delayed in preschoolers with mild-moderate HLGrammar understanding comparable to peers with NH (Briscoe, et al, 2001; Gilbertson & Kamhi, 1995)Few studies address narrative skills, discourse and verbal reasoning or intervention

6Language for Social Purposes

Unpublished data from Dr. A. Sedey (Colorado), analysis of 725 assessments from 352 children, ages 6 mo - 6 years, mild to profound*Age when 2/3 of group passed itemFebruary 20, 2009Boys Town National Research Hospital7Importance of Classroom Social ExperiencesLack of Peer AcceptanceAcademic Self ConceptInternalizing SymptomsAcademic PerformanceBottom line: Promotion of positive relationships with peers contributes not only to social development, but emotional and cognitive (learning/academic)Flook, Repetti & Ullman, 20058Psychosocial Effects on LearningQuality of social relationships tied to academic progress (Flook, et al, 2005)Learning with friend vs. classmate impacts (Newcomb & Bagwell, 1995):Conflict managementDeductive reasoningProblem solvingExploration

February 20, 2009Boys Town National Research Hospital9Summary of Research on Psychosocial OutcomesSome reports of difficulties participating in collaborative learning (Power & Hyde, 2002)School age mainstreamed students (53/143 mild-mod)1/3 regarded as well-integrated with NH peers30% go along with activities without significant role in planning or executionImpact on establishing friendships (Davis, et al, 1986)School age mild to mod-severe (n = 40)Half expressed concerns about making friends or social acceptanceLower on expressing emotions/resolving conflict (Maxon et al, 1991)

February 20, 2009Boys Town National Research Hospital10Effects of Moderate HL on FQoLHind & Davis, 2000 (ages 3 -11 yrs; X = 8 years) *

**

n = 223February 20, 2009Boys Town National Research Hospital11Conclusions on Speech, Language, Psychosocial Consistent findings that children with mild to severe HL are at risk for delays in phonology and morphologyVaried patterns of results for vocabularyLimited understanding of factors contributing to individual differences in outcomesNeed for comprehensive study of outcomes in new generation of children to include psychosocial and family measures

12In Children with Mild to Severe Hearing LossLiteracy Outcomes13LiteracyLiteracyLiteracy refers to a socio-cultural activity of meaning construction using printed text. Meaning construction occurs both during comprehension and writing .Literacy provides the means to access and effect information sources via print.Reading, spelling, punctuation, cursive, keyboarding are skills that serve literacy.14Literacy and Hearing LossResearch on individual differences in reading development have demonstrated that spoken language skills are highly predictive of subsequent reading (literacy) skills.Children with severe to profound hearing loss have very poor levels of reading and children with CI experience demonstrate much better performance.We do not know how much hearing is necessary for adequate language and literacy development. We can hypothesize that literacy skills may be limited in children with mild to moderate hearing to the extent that it impacts on language.15Model of Hearing and ReadingAveragePure ToneThresholdLanguage(mediator) ReadingHearing Aid(moderator)Development 16ReadingGough: Reading is making sense of print through recognizing words.Reading consists of getting words off the page and then understanding those words.Simple view of reading: Reading involves decoding times comprehension.Decoding: Going from orthographic form to lexical activation. Comprehension: understanding the literal and implicit information in the passage (same as in listening).

1718Reading ComprehensionLanguage ComprehensionWord RecognitionLanguage KnowledgeTextSentence form & meaningVocabularyPhonologyDecoding SkillsPhonological ProcessingNaming SpeedPhonicsOrthographic knowledgeConcepts about printWorld Knowledge18Component Literacy SkillsFoundationsLanguagePhonological ProcessingPhonological AwarenessPhonological MemoryLexical Naming SpeedKey Literacy SkillsReadingSpellingWritingGlobal Literacy IndicatorAcademic Achievement

19Research on Literacy Outcomes of Children with Mild to Severe Hearing LossFocus on literature that distinguishes between HH children with mild to severe losses and those who have severe to profound losses.Most research aggregates HH and DeafISI Web of Science SearchReading or LiteracyHard of Hearing or Hearing ImpairedChildrenNot Deaf, Severe or Profound, Cochlear ImplantReading or Literacy Outcome (not teaching)18139 920Summary of Research on Literacy OutcomesPhonological ProcessingGilbertson & Kamhi (1995) and Bristoe et al. (2001) showed poorer phonological awareness, phonological memory in children with HI than controls. Gibbs (2004) did not find differences.Word ReadingBess, Dodd-Murphy and Parker (1998) and Most et al. (2006) found poorer word reading in mild HI children.Bristoe et al. (2001) and Gibbs (2004) did not find poorer word reading in HI children.

21Summary of Research on Literacy OutcomesReading ComprehensionDavis, et al. (1986) and Blair et al. (1985) found HI children to be below hearing normsBristoe et al. (2001) found normal reading levels.Academic AchievementKodman (1963), Blair et al. (1985), Davis et al. (1986), and Bess et al. (1998) reported poorer general academic achievement via test and/or parent report.22Conclusions on LiteracyLiteracy outcomes in mild to moderate HI children have been neglectedThere are good theoretical reasons to predict poorer performance in these children.The evidence is weighted in support of poorer performance particularly in PP and reading comprehension, but some of the best and more recent studies show less support. All of these studies do not take into account the childs hearing aid fitting and use.23Bruce TomblinUniversity of IowaOutcomes Research in Children with Hearing Loss24Taxonomy of Outcomes ResearchHealth Services Focused Outcomes StudiesAddress questions concerning the services provided for a health condition.Person/Disease Focused Outcomes StudiesAddress questions concerning the individual or disease group including groups with risk exposures.25Health Services Outcomes Research in Medicinea term originally used to describe a particular line of health services research that focused on identifying variations in medical procedures and associated health outcomes. Youngs MT, Wingerson L. The 1996 medical outcomes & guidelines sourcebook. New York (NY): Faulkner & Gray, Inc.; 1995.Outcomes research in this context reserves the term for studies of efficacy, effectiveness, and negative consequences of clinical procedures.

26Health Services Outcomes DesignsRandomized Clinical Trials (RCT)Focus is on evaluation of new treatments.Random assignment of cases to treatment and control arms.Controls can be alternate treatments, placebo, treatment as usual or no treatment. Efficacy and EffectivenessEfficacy: treatment effect under ideal conditionsEffectiveness: treatment effect in real world conditions.Outcome measuresProvider Oriented Outcomes: Laboratory markers of disease, complications and side effects. Patient Oriented Outcomes: Functional Satisfaction, Quality of Life, Return to Work.

27Health Services Outcomes Research (Patient Outcomes Research Teams or POTS)Focused on evaluation of existing practices (preventive, diagnostic, and treatment).Observational rather than experimental. Systematic analysis of clinical records to document procedures, provider characteristics, patient characteristics.Gather functional, perceived health, and quality of life outcomes data and associate these with practices as measures of effectiveness.

28Person Oriented Outcomes ResearchOutcomes research can be found in a wide variety of disciplines concerned with human development (psychology, education, sociology, child psychiatry, communication sciences and disorders, epidemiology)The research questions in these studies are more concerned with issues having to do with what happens to cases (natural history) rather than on service provision:Developmental features of the condition itself (course, recovery, stability).Co-morbidities associated with developmental disorders.Consequences of developmental or sensory disorders (education, occupation, quality of life).

29Features of Person Centered Outcomes ResearchUse of longitudinal designs.Often a comparison group is incorporated.Unaffected group - controlPopulation sample cohortDesigns are all descriptive, correlational or quasi-experimental, thus there is no true independent variable.Methods Time A (diagnosis), Time B (Outcome)Multiple observations Growth curve analysis (HLM, latent growth analysis, growth mixture models)Path and Structural Equation modelingHazard Survival analysis (time to event such as death)30Testing Causation in Longitudinal DesignsPerson centered studies have come to focus on processes that contribute to outcomes.Intervening variables between Mediators variables or conditions that are necessary aspects of the causal chain from initial condition to outcomeModerators variables that are not necessary causal elements but that interact with mediators. Protective factorsVulnerability factorsQuestions: Risk-resilience in developmentWhat factors contribute to star performance despite initial hearing status?Methods of path analysis (regression) and structural equation models (latent variables) employed. 31Path-Like ModelingInitial Health StateMediatorOutcomeModerators Protective VulnerabilityDevelopment 32SummaryThe concept of what is an outcome study varies by discipline.Outcome studies can be focused on clinical services and/or child characteristics.Those concerned with clinical services may be wise to consider incorporating notions from person centered research such as moderators into their designs.33Team BuildingPutting together a collaboration

34It Started with an NIH FOAPurpose. This Funding Opportunity Announcement (FOA) solicits longitudinal research applications from institutions/organizations to investigate outcomes in young children with mild to severe hearing loss. Applications must be multidisciplinary and have a primary focus on determining the impact of intervention, child, and family factors on communicative, educational and social development outcomes in young children with mild to severe hearing loss.

35

ChallengeBuild an orchestra from scratch.Where the orchestra writes the music as well as plays it. Starting with a duet

?36Principles and Constraints for Team PrinciplesEach team member contributes a particular skills to the team.Some members roles involve more leadership than others, but every individual has an important contribution that needs to be respected.Team members need to be able to work well with others.ConstraintsMultiple sites will be needed and therefore some redundancy in functions and roles will occur across sites.One site will provide the general research infra-structure.37Skills NeededResearch Methods and DesignHealth Outcomes Research ExpertiseLongitudinal Research ExpertisePopulation/epidemiologic samplingMeasurement of pediatric hearingMeasurement of pediatric hearing managementUnderstanding of educational treatments and challenges of children and families with mild to moderate HI.Measurement of outcomesHearing, speech, language, literacy, psycho-social, family38Skills NeededOperational Infrastructure *Project Manager ***BudgetsPersonnelDay to day operationsCommunicationsIRBComputer and Data ManagerData AnalysisRecruitment and RetentionFront Line Research Assistants

39Research SkillsLongitudinal Health Outcomes Research ExpertiseBruceTomblin (Longitudinal Design, Outcomes of CD)Jane Pendergast (Longitudinal Analysis, Epidemiology) Jake Oleson (Biostatistics, Hearing Loss)Measurement of Pediatric Hearing Loss and Management (Audiology)Pat StelmachowiczPat RoushRuth BentlerLenore Holte

40Methods SkillsOutcomes MeasurementMary Pat Moeller Bruce TomblinMelody HarrisonSandie Bass-Ringdhal John Knutson (Psychology)Educational Treatment and FamilyMary Pat MoellerMelody HarrisonJohn Knutson

41Operational SkillsInfrastructureProject ManagerMarlea OBrienData Base and ComputerRick ArenasData AnalysisJake Oleson

Front Line Data CollectionAudiologyBeth Walker (Iowa)Meredith Spratford (Boys Town)Shana Jacobs (UNC)Speech, Language, BehaviorThomas Page (UNC)Lauren Berry (Boys Town)Emilie Sweet (Boys Town)Connie FergusonMarcia St. Clair42Challenges and SolutionsCompromising Personal ViewsAllowing all to voice opinions and then arriving at a group decision.Keeping goals of the research as the determining factorMaintain honest open interchanges no hidden agendas.CommunicationVideo Conferences monthlyFace-to-Face yearlyWeb based collaboration site (Share Point)43Challenges and SolutionsRestraining competition among subgroups and sites and minimizing personal egosOverall strategy: Channel competition and egos toward the project.Create a single identity that transcends sitesAttempt to build team interactions that cross-sites.Make the goals of the project paramount. Its not about you.Project leaders need to work to counter cliques and back stabbing. 44Research Design & Methods

45AimsTo describe the characteristics of:children and familiesintervention services factors associated with service variations

To characterize:developmental, behavioral and familial outcomescompared to normally-hearing age mates with similar backgrounds

To explore:how variations in child and family factors and in intervention characteristics relate to functional outcomesWe have 3 primary aims in this project

The first is descriptive --- what are the characteristics of the children & families & what factors are associated with variations in service delivery

In the second aim, we will measure broad child and family outcomes & compare those outcomes to a cohort of typically-developing children

Finally, we will explore how variations in child, family & intervention factors contribute to functional outcomes.46Target PopulationMild to Severe Hearing Loss PTA of 25-75 dB HL (500, 1k, 2k, 4 kHz)

Children who have one of the following types of HL:High Frequency Sensorineural Permanent Conductive MixedAuditory Neuropathy

Speaks English and has at least one primary caregiver that speaks English in the home

Age at entry: 6 months to 6 years, followed annuallyThis slide describes our target population of children

-Hearing losses 4 freq PTA of 25-75 dB HL-Children with minimal HL, permanent conductive and AN will be included-One primary caretaker must speak English with the child

Children will enroll across the age range from 6 months to 6 years, 11 mos

Most children will be tested annually, around their birthdays.Participants & General Design400 children with mild to severe hearing loss enrolled at age 6 mo to 6 years.150 children with normal hearing sampled from same communities. Children followed for 3 years+.Retrospective data prior to enrollment obtained by history.

Accelerated Longitudinal DesignWe are attempting to gather a population sample by enrolling 400 children with hearing loss from a 5-state area (IA, NE, KS, MO, NC).

The design is an accelerated longitudinal design - At whatever age the child enrolls, he or she is followed from that point for 3 consecutive years (so if you enter at 3, we follow you through 6 years).

We are inviting families to nominate a neighbor or peer, as a way to control for SES in our control/comparison group.

Combines retrospective and prospective methods48RecruitmentSampling FrameAll children in Iowa, Nebraska, Eastern Kansas/Missouri and North Carolina with mild to severe permanent bilateral hearing lossSampling MethodRecruit children who have been identified viaRefer from Newborn Hearing ScreeningChildren identified in EHDI via follow up clinicsChildren identified via audiology or medical service providers.Children identified through school screeningContact MethodReturn of post card in flyer or telephone contactFlyers will come to Iowa for processingTelephone contact is made by the appropriate the regional research group

Phases of Enrollment 50Aim 1: Background characteristics

Characteristics of childHearingUnaided hearing at each ageAided SIIEtiology Speech Perception HealthBirth history General healthMiddle ear problemsCharacteristics of FamilyNumber of siblings SESEducationOccupationIncomeNeighborhood/CommunityIntervention ServicesHistoryNewborn hearing screening statusAge of initial hearing loss diagnosisAge and nature of initial hearing interventionEducational service receiptAt Study Entry (baseline)Hearing aid and fitHearing aid functionAfter Study EntryHearing aid fit and functionHearing aid useEducational service receipt

This slide shows some of the background characteristics that will be measured ---including.the child, family and the intervention services

A unique aspect of this study is the measurement of the interventions for example, we will use the Verifit procedures to objectively determine the adequacy of the hearing aid fitting for each child. We will also monitor consistency of use and device function

Dosage, consistency and level of specialization in early intervention will be monitored over the course of the longitudinal study.Aim 2: Developmental and familial outcomes Speech Production Articulation Speech IntelligibilityLanguageUnderstanding and use ofsyntaxvocabularynarrative discoursemorphological useSocial reasoning (Theory of Mind)AcademicSpellingReading comprehensionWord recognitionMathVerbal reasoning

Psychosocial behavioral/cognitiveCognitive reasoningSocial behaviorTeacher reports

Family outcomesParentingQuality of life/ Family LifeSatisfaction of service delivery

Outcomes will be measured in a comprehensive manner.

The accelerated longitudinal design allows us to gather data on infant behaviors, as well as those of school age children (academic, psychosocial, etc).

We will also measure Family outcomes, such as satisfaction with services and impact of the childs HL on Family QoL. 52Aim 3: How variation in intervention and family background influence outcomes

This slide represents Aim 3 our effort to understand how variables interact to influence outcomes. With an N of 400, we should be able to understand the collective influence of variables, using statistical methods like SEM. To explore how variations in child and family factors and in intervention characteristics relate to functional outcomes

DATA COLLECTION AND MANAGEMENTCentralized Data EntryEach site will have access to a web based data entry systemEnrollment dataAudiological data (Audman)Test data entered at item levelScheduling and tracking of participants will be managed via web based communication systemWeb Based Service Provider SurveysService providers will enter data on a secure web site

During this first year of the grant, we have developed a lot of the infrastructure, including a shared data entry site at the U of Iowa.

WE have developed web-based service provider surveys on a secure web site. Service providers including Aud, SLP & educators. Separate surveys have been created.54DATA COLLECTION AND MANAGEMENT

55Centralized Data EntryCentralized Data EntryEach site will have access to a web based data entry systemEnrollment dataAudiological data (Audman)Test data entered at item level

56Centralized Data Entry

Automated entry & score checking57DATA COLLECTION AND MANAGEMENT

Development of new assessment protocols Infant vocalization interviewChecklist for hearing aid useFamily and service provider surveysNarrative assessments (power point)Elicitation of morphemes (new DVD)

Examples: Infant Vocalization InterviewNew Protocol Development59Item 1-4

Item 2-3

gatuhba

Item 2-6

Jargon or jabberbababadehdehdada

Item 2-7

Imitates, but far offGetting closerVery close

Similarly we ask parents if the baby imitates--- they say yes, and end of story.

This type of scale will allow us to use parental feedback to determine how closely the child is able to approximate the parents model. Examples: Morphology ElicitationNew Protocol Development64Elicitation of morphological endings

Past Tense +ed65Hearing Aid ChecklistSituationNever (0)Rare (1)Sometime (2)Often (3)Always (4)N/ACarPre-School/SchoolDay CareMeal TimePlaying AloneBook SharingPlaygroundPublic (store, zoo)Put an X in the boxes below to indicate how consistently your child uses HAs in the situations listed:66Hearing Aid ChecklistAre there any particularly challenging times or situations for you or the child for keeping the hearing aid(s) on?Has your child been without her/his hearing aid(s) for an extended period of time (>7 days) in the past year? ____Yes ____NoIf yes, please estimate how long your child was without hearing aid(s)___8-14 days ___15-21 days ___22-30 days ___1-2 months ___2-3months ___3-6 months ___6-12 months ___>12 monthsWere one or both ears affected? ____One ear ____Both earsWhat prevented your child from wearing her/his hearing aid(s)?____Ear infection____Ear pain (ex: swimmers ear, sore spot in ear)____Hearing aids were damaged and needed repair____Hearing aids were lost and needed replacement____Earmolds needed to be replaced due to loss, damage or child growth____Other, please specify: ____________________________________67DATA COLLECTION AND MANAGEMENTTelephone Survey of ParentsOne person will be administering a questionnaire concerning home and parental informationModified NEILS family surveysWeb Based Service Provider SurveysService providers will enter data on a secure web siteAudiologistPrimary EducatorSLPChildren will be seen for testing once annually; 6 months after their visit, parents will be interviewed over the phone

We have hired a parent to conduct these interviewsthey will focus on home and intervention details. 68Quality ControlAll protocols are documented with respect to administration and scoring.One lead person in speech/language and one in audiology serves as trainer across all sites.Questions over the protocol or scoring will be discussed and resolved via SharePoint.The lead SLP will visit each site periodically to check for conformity to the protocolItem level data will be double entered and summary scores will be computed automatically.

69RETENTION STRATEGIESConsistent communication with familiesProvision of reports to families & providers (with permission)Website with information for families www.uiowa.edu/~ochl/index.htmlVarious greetings/small prizes sent between appointments

70Goal: Exploratory study of relationship of amount of parental talk and child language outcomesLENA Supplement71LENA Device72

72Research Plan: LENASample environments of:Nine 12-month olds (3 at each site)Nine 24-month olds (3 at each site)Nine 36-month olds (3 at each site)Record 16-hour samplesOne time per month x 12 monthsStandard analyses + acoustic analysesLinguist Mark VanDam coordinating

73Doing Research on an Industrial ScaleHow are we doing?74GoalsForm Research TeamDevelop ProtocolLocate and Recruit Participants400 Children with HL150 Children with NHGather Longitudinal Data over Three YearsMaintain Quality Control in Protocol and DataAnalyze DataPublish 75ScheduleIRB/StaffingProtocol Dev.TrainingRecruitmentData CollectionData AnalysisPublication6/081/096/091/106/101/116/111/126/121/1376Recruitment and TestingNumber of Children Recruited =195Qualified165Disqualified 30Number of Children Tested79Average Age3 years, 1 mo.1 -6.5 years

77

7879aCompleted elementary school bCompleted junior high cReceived General Education Diploma (high school equivalence) dCompleted high school eCompleted 1 or more years of technical/vocational school fCompleted technical/vocational school gCompleted 1 or more years of university/college hBachelors degree iCompleted 1 or more years of graduate school jMasters degree kCourse work completed for PhD, but no dissertation; Law degree without bar; Medical degree without internship completed l Ph.D.; Law degree with bar; Medical degree with internship completed 80Audibility

Right 20.74 (15.9)Left 27.64 (26.5)

Right 67.38 (17.14.)Left 70.78 (16.75)81

82First Looks at OutcomesRelationships between aided and unaided audibility andEarly language developmentLater speech development

83

84

85ConclusionsStudy design and recruitment is on trackData collection is progressing wellDue to the use of an accelerated longitudinal design we currently lack large numbers at any particular age.It is going to be important to have good measures of hearing aid use in order to accurately measure hearing aid fit effects.86Some finals thoughts on overcoming challenges of multi-center studiesCollaboration87Think about your experiences on a team (past or recent)Can you recall two aspects of team function that led to successful results?Can you recall two aspects of team function that were barriers to success?What strategies did your team implement to overcome barriers?88Developing Functional TeamsFocus on ResultsHold one another accountableCommitEngage in ConflictDevelop TrustLencioni (2002) The Five Dysfunctions of a Team89Developing Trust

Regular communication frameworkGround rules for inclusive communicationStrengths-based management

Members of Trusting TeamsOCHL StrategiesLencioni (2002) Admit weaknesses and mistakesAsk for help/inputGive benefit of doubtOffer feedbackAppreciate skills

90Managing ConflictExtract ideas of all (and give them equal weight)Solve real problems quicklyMinimize politics and artificial harmony

Teams that Engage in ConflictOCHL StrategiesLencioni (2002) Team coordinator supports problem/gap identificationDelegate & discussRecruit outside expertiseEncourage all voices

91OCHL Strategies for Developing CommitmentClear focus on the project goalsLack of territoriality across sitesSharing of tasks across sitesAlign priorities by valuing the unique and collective experiences of the three sites

92AccountabilityExperience success of effortsChart & amend their courseMeet deadlinesShare the work and the success

Teams that hold each other accountableOCHL StrategiesInvestment in quality controlInvestment in project trackingStrengths-based management for efficiency

93OCHL TEAM MEMBERSUniversity of IowaJ. Bruce Tomblin, Ph.D. (Co-PI)Rick Arenas (IT)John Knutson, Ph.D.Sandie Bass-Ringdahl, Ph.D. Marlea OBrien, Program CoordinatorRuth Bentler, Ph.D.Connie Ferguson, M.S., CCC-SLPWendy Fick (data entry)Marcia St. Clair, SLP ExaminerLenore Holte, Ph.D.Elizabeth Walker, M., M.A., CCC-A/SLPAmanda Murray, M.A.Jacob Oelson, Ph.D. (biostatistics)Jane Pendergast, Ph.D. (biostastics)BTNRHMary Pat Moeller, Ph.D. (Co-PI)Patricia Stelmachowicz, Ph.D.Meredith Spratford, Au.D.Lauren Berry, M.S., CCC-SLPEmilie Sweet, M.S., CFYMark VanDam, Ph.D.University of North Carolina-Chapel HillMelody Harrison, Ph.D.Patricia A. Roush, Au.D.Shana Jacobs, Au.D.M. Thomas Page, M.S., CCC-SLP 94

A study funded by the National Institutes of Hearing National Institute on Deafness and Other Communication Disorders (NIH-NIDCD)

We are so excited to see you!

_____________________________has been scheduled for a visit at __________________ for the OCHL project on _______ at _______. Your visit will be with ___________________. Please allow ________________ for this visit.

If_______________________________ uses any of the following devices or aids, please make sure they are included in the items you bring with you. Hearing Aids Glasses FM Systems

The following would also be benefi cial if available: Additional hearing aid batteries School paperwork including: testing results, hearing results, and IEP/IFSP

Please call _______________ to reschedule if your child is ill or his/her hearing aids are not working.

Merry SpratfordBoys Town National Research HospitalCenter for Childhood Deafness555 North 30th StreetOmaha, NE 68131