As I approach twenty years in the profession of Speech-Language Pathology, I have come to realize that we need new definitions for at least two terms: counseling and rehabilitation. Because I've spent my career specializing in aural habilitation and working directly with young children with hearing loss and their families, these terms have a very specific meaning for me.

Too often, when an infant is newly diagnosed with hearing loss, the "counseling" that occurs by the audiologist is typically informational in nature. That is, the audiologist shares information on the degree of hearing loss, explains how to understand the audiogram, discusses possible hearing technology, and, in some cases, rightly or wrongly recommends communication methodology and intervention programs. In my experience, most parents tell me that they just couldn't process all of this information. In fact, many have told me that once the diagnosis was rendered, they didn't hear a word the audiologist said after that moment.

In my opinion, all professionals working with parents in these situations, especially audiologists, speech-language pathologists, and early interventionists, must balance the informational counseling with more emotional counseling. Granted, I realize that we're not psychologists or family counselors, and I'm not advocating that anyone go beyond their training or scope of practice. However, we can do more to be "in the moment" when the diagnosis is given. Parents need emotional support, and frankly, they won't be able to fully process what has happened and make informed decisions until they've had the chance to absorb the diagnosis. Many parents do go through those stages of grief that we've all read about or experienced first-hand in our own lives. Personally, I prefer to view this as a process of ongoing adaptation. Some parents may deny there's a hearing loss and get angry before eventually accepting the diagnosis. Ultimately, however, we must help them adapt to this new situation that they find themselves in.

Unfortunately, very few university training programs in Audiology, Speech-Language Pathology, or Deaf Education provide adequate training in how to help parents to positively deal with the emotional issues that inevitably will come with a diagnosis of permanent hearing loss in their child. As concerned practitioners, we must advocate for more training in university programs at the pre-service level, and we must seek out opportunities that allow us to be more effective at emotional counseling.

Similarly, the term "rehabilitation" has come to mean different things to different people. Within the practice of Audiology, there seems to be a general view that an individual is "rehabbed" at the moment the hearing technology is prescribed and placed on his or her ear(s). For those of us who work with young children with hearing loss to assist them in developing their listening, speech and language, the fitting of the hearing technology is really the starting point.

Unfortunately, I've also seen speech-language pathologists who, after one or two sessions, dismiss the child from intervention. The parents are given a few activities to do at home and are told to return in a few months for a follow-up appointment to measure progress. I've also seen a consultative approach implemented with only occasional visits with the child and family. The parents are left trying to figure out on their own how to facilitate communication. In almost all cases, these intervention models wouldn't be an appropriate treatment approach for a child with hearing loss. The referring audiologist and parents should be educated consumers of the services that are provided.

We all can agree that children with hearing loss need access to well-fit and appropriate hearing technology to maximize their communication outcomes; however, the key to their success is everything that happens afterward. The audiologist continues to play a vital role, and for progressive pediatric audiologists, they are making appropriate recommendations that will connect the parents to early intervention services and/or speech-language pathologists who have the necessary background, knowledge and training to continue to enhance communication.

For infants and toddlers with hearing loss, the intervention most likely will be developmental in nature, and the goal should be to train the parents in how to facilitate listening, speech and language -- if spoken language is the goal. Parents should leave each session with specific information and strategies that foster overall development and communication in their child.

A strong pediatric audiologist will monitor the child's hearing loss and provide guidance to the parents in case additional or different technology -- such as cochlear implants -- will be needed. Thankfully, I've had the opportunity to work with excellent pediatric audiologists and speech-language pathologists, and I applaud those who go beyond the call of duty to ensure the success of all of the children and families they are serving.

For children with hearing loss, rehabilitation -- or more accurately habilitation -- isn't one point in time but rather consists of ongoing and overlapping developmental and communicative processes. We must move away from believing that simply placing the hearing technology on the child completes our role. Instead, we should support a continuum of care and work to make sure that a range of individualized services is available to the child and family. We can start by redefining and broadening our definitions of counseling and rehabilitation. For parents of the newly diagnosed child, receiving the hearing technology marks the beginning of the journey. Professionals must do more to ensure that families have a detailed roadmap that will guide them through the scenic byways as well as the occasional detours that are bound to happen along the way!