Evaluation of the 3-year Auditory Verbal Therapy (AVT) program 2017-2021

Authors: Christina Schiøth, Maria Hallstrøm, Ingibjörg Sigtryggsdóttir, Stella Dyrberg and Sara Maria Cordtz.

This is an English translation of the evaluations’ summary. The complete evaluation report (in Danish) can be downloaded here:  

Summary

The vast majority of children with hearing loss and deaf children today have the potential to develop hearing with hearings aids or cochlear implants (CI). But advanced hearing technology is insufficient on its own. The children need early intervention in form of highly specialized rehabilitation with Auditory Verbal Therapy (AVT) to ensure development of spoken language.

AVT is a well-documented rehabilitation intervention, with the purpose of preparing the parents, in the best way possible, to strengthen the impaired auditory area in the brain of their child with hearing loss.

In AVT, the parents - who are the children’s primary language models - are being taught by AVT-therapists in specific auditory techniques and strategies, which they can apply in the family’s everyday life, to ensure the development of the child’s hearing and spoken language.

The goal of AVT is for the child to achieve age-equivalent spoken language skills at the level of their peers with typical hearing before starting school.

In 2017, the 3-year AVT-program temporarily became part of the Danish healthcare system standard treatment, when a total of DKK 38.3 million was allocated from 2017-22 on the Finance Act for the implementation of a 3-year AVT-program for the 0–5-year-old children with hearing loss. Three audiology clinics in Denmark have offered AVT in the period (Aarhus University Hospital, Odense University Hospital and Rigshospitalet in Copenhagen) and only children with severe hearing loss and bilateral hearing loss have been included in the AVT-program.

A partnership between the audiology clinics and Decibel - The national association for children and young people with hearing loss – have recently completed an evaluation of the AVT-program.

In the AVT-program, 84% of the children acquire age-equivalent spoken language after 3 years of AVT (previously only 30%). Thus, the AVT treatment means that the children can be fully included in the school system, in the labor market etc. This means obvious great individual and societal gain.

This summary of the evaluation contains the main results as well as several recommendations for how the program from 2023 and onwards can be permanently anchored for the benefit of both the children with hearing loss of the future, their families, and for society as a whole.

Recommendations

If the AVT treatment is not made permanent, there will be no similar alternative offer for children with hearing loss in Denmark. The consequences are far-reaching, both individually and socially, as the children will not become speech and language age-appropriate and thereby lose the opportunity to be included on normal terms. Based on the evaluation, the following 6 recommendations are put forward:

• The 3-year AVT treatment must be continued and permanently anchored in the health care system.

• AVT treatment should include all children with hearing loss and be offered geographically close to the children (this means that more audiology clinics will offer AVT).

• The high quality of AVT treatment must continue to be ensured through training and capacity requirements.
• An overall plan for the group of children must be prepared and a nationwide monitoring must be established.
• More knowledge needs to be produced and gathered about children who do not benefit sufficiently from the AVT treatment.
• Enhanced cooperation between the AVT centers and the municipalities.

Economy going forward

As part of the evaluation of the AVT-program, calculations have been made of the cost of implementing the AVT treatment permanent. Overall, the costs will amount to 14 million yearly. There will be more than 800 children in AVT treatment every year corresponding to a price of DKK 16,000 per child per year. In addition, a health economic analysis shows that society will achieve a gain of more than DKK 350,000,000 per year as a result of the AVT treatment. It shows quite clearly that it can pay to invest in the children's future.

The complete socio-economic analysis can be downloaded here (in Danish): 

The most important results of the AVT-program

Successful implementation

The AVT intervention has been extended from the previous one year to three years and successfully implemented in the three audiology departments at Aarhus University Hospital (AUH), Odense University Hospital (OUH) and Rigshospitalet (RH) in Copenhagen. Thus, it has been proven that the 3-year AVT treatment works well in clinical practice.

Far more children than previous get AVT

360 children and their parents have received a 3-year highly specialized AVT intervention in close interaction with the additional audiological treatment of children's hearing loss.

Age-appropriate spoken language can be achieved in 3 years

84% of the total group of children achieve age-equivalent spoken language after three years with AVT. Previously, only 30% achieved age-equivalent spoken language.
92% of children from Danish-only speaking families achieve age-equivalent spoken language.

The families complete all 3 years with AVT

87% of the families have completed all three years of the AVT-program.

The parents are satisfied

83% of the parent’s experience that their expectations for the intervention have been met.
87% of parents experience that they can use what they have learned in the AVT-program to enhance their child's language development in the future.
Through the process, 93% of parents are satisfied or very much satisfied with the program.

Quality improvement in the rehabilitation intervention

27 audiologists have been trained in the AVT method and have thereby raised the quality of rehabilitation of children with hearing loss.

In addition to the above, we have worked with challenges in the following areas:

• Defined inclusion criteria being too narrow
• Drop-out of families due to the large distance to the AVT centers
• Monitoring the speech and language development of bilingual children
• Cooperation between the AVT centers and the municipalities

 

 

Copenhagen, February 2022

On behalf of the steering committee of the AVT-program

Stella Dyrberg

Director, Decibel - The national association for children and young people with hearing loss

Translated Copenhagen, June 2022 by Mette van Amerongen, SLT consultant, Decibel - The national association for children and young people with hearing loss