Background 

The term ‘deaf’ and ‘hearing loss’ have been used in this briefing to describe all levels of hearing loss in children, including a partial or total loss of hearing. This includes those who may describe themselves as having a ‘hearing impairment’. 

Auditory verbal therapy (AVT) is a specialist programme that equips parents and caregivers with mechanisms to support their deaf child in developing listening and spoken language. It is one of several approaches that uses hearing technology to aid in this development. 

AVT focusses on supporting children to learn how to make sense of the sound they receive through technology like cochlear implants and hearing aids. AVT is delivered by teachers of the deaf, speech and language therapists and audiologists who have undergone additional post-graduate training. 

AVT is usually delivered to children under five years of age. It aims to ensure that deaf children develop age-appropriate language by the time they start school.  

Further information on AVT is provided by Auditory Verbal UK, a charity that is calling for every family with a deaf child to have the option to access AVT through publicly funded services in their local area. In a report published in 2022 (PDF, p6) the charity stated that the evidence base for the effectiveness of the AVT approach is growing with more research being published every year. They reported that research shows “strong evidence” in favour of the use of AVT for the development of linguistic skills (see: How Effective Is Auditory-Verbal Therapy (AVT) for Building Language Development of Children with Cochlear Implants? A Systematic Review). 

Auditory Verbal UK also provides training for those seeking to become a certified Auditory Verbal Therapist. In September 2023 Auditory Verbal UK updated their Auditory Verbal Therapy Position Paper. 

Further information 

There are more than 50,000 deaf children in the UK and it is estimated that around 7,200 are under the age of 5 (see Auditory Verbal UK’s position paper on AVT). Even though deafness is not a learning disability, there is a significant attainment gap facing deaf children during their time at school (The educational outcomes of deaf children in England, Education Policy Institute, March 2023). 

Provision of auditory verbal therapy 

Local authority duties 

Under section 17 of the Children Act 1989, local authorities in England have a duty “to safeguard and promote the welfare of children within their area who are in need…by providing a range and level of services appropriate to those children’s needs.” A child is defined as in need if they are disabled and the Act says a child is considered disabled if they are deaf. 

The Act further requires local authorities to provide services designed to minimise the effect on disabled children of their disabilities and give disabled children the opportunity to lead lives which are as normal as possible (Schedule 2, paragraph 6). 

Local authorities are responsible for determining what services to provide for children in need. Generally, families do not have the right to insist on a certain type of support being provided. 

Local authorities have a duty to publish information about the support available  in the area for disabled children and children with special educational needs. This should be set out in a ‘local offer’ available on the authority’s website. 

The National Deaf Children’s Society notes states that “in some cases, local authorities will provide funding to help [a] child access AVT.”  

The government has said that audiology services are commissioned locally “and the responsibility for meeting the needs of non-hearing children lies with National Health Service commissioners.”  

Special educational needs provision 

The Children and Families Act 2014 provides the statutory basis for the system for identifying children and young people (age 0-25) in England with special educational needs (SEN), assessing their needs and making provision for them.  

The statutory Special Educational Needs and Disability (SEND): Code of practice sets out detailed information on the support available for children and young people aged 0 to 25 under the 2014 Act. 

In March 2023 the Conservative government published its SEND and Alternative Provision Improvement Plan, setting out a mission for more children and young people to have their needs met effectively in mainstream settings. 

The then government said in the plan it would fund up to 5,000 early years staff to gain an accredited Level 3 (A level or equivalent) early years SENCo qualification to support the early years sector, with training running until August 2024. 

The Improvement Plan also announced the introduction of ‘Early Language Support for Every Child’ (ELSEC) pathfinders. ELSEC is a two-year workforce development programme to fund improved early identification and support for children and young people with speech, language and communication needs within early years and primary school settings. 

In response to a PQ on 13 December 2024, Labour minister, Stephen Morgan, said the Department for Education (DfE) was continuing to work with NHS England on the pathfinders. He also said the department was publishing guidance resources and tools for SEND in the early years, including a dedicated tool for communication and interaction. Other departmental policies he outlined included: 

Further background can be found in the Library briefing Special Educational Needs: support in England

NHS audiology services 

Audiology services in England are commissioned by NHS integrated care boards (ICBs), who are responsible for meeting the needs of children with hearing loss.  

A Commissioning Services for People with Hearing Loss framework was published by NHS England (NHSE) in July 2016 to support NHS commissioners to provide consistent, high quality and integrated care.  

In 2019, with input from the National Deaf Children’s Society, NHSE produced Joint Strategic Needs Assessment Guidance (PDF) for commissioners and providers who support children and young people with hearing loss. NHSE’s 2023 Paediatric Hearing Services Improvement Programme recommended that all NHS trusts should be working towards the United Kingdom Accreditation Service’s (UKAS) Improving Quality in Physiological Services (IQIPS) accreditation 

In response to a PQ about Paediatric audiology services in November 2024, the government said all 140 paediatric audiology services across England were reviewed as part of the Paediatric Hearing Services Improvement Programme. It said individual cases will be reassessed and, where appropriate, children recalled for reassessment and onward referral to clinical services as necessary (see PQ 10930 6 November 2024). 

Parliamentary material 

Parliamentary questions 

Audiology: Children 

21 October 2024 | UIN 9230 

Asked by: James Wild 

To ask the Secretary of State for Health and Social Care, what steps he is taking to increase access to (a) Auditory Verbal therapy for deaf children whose families want them to learn to listen and speak and (b) other early and effective support to develop language and communication for deaf children. 

Answering member: Stephen Kinnock | Department of Health and Social Care 

NHS Audiology services, including support for non-hearing children, are locally commissioned, and the responsibility for meeting the needs of non-hearing children lies with local National Health Service commissioners. 

NHS England is supporting the integrated care boards (ICBs) to make informed decisions about the provision of audiology services so that they can provide consistent, high quality, and integrated care to non-hearing children. In 2019, NHS England, with input from the National Deaf Children’s Society, produced a guide for commissioners and health and local authority providers which supports non-hearing children and young people, which is available at the following link: 

https://www.england.nhs.uk/wp-content/uploads/2019/11/what-works-chswg-guide.pdf

The Department recognises the need to improve access to therapies generally. Since September 2020, all eligible allied health profession students have received a non-repayable training grant of a minimum of £5,000 per academic year. NHS England and the Department for Education are also working in partnership to co-fund £10 million for nine Early Language Support for Every Child pathfinder sites over two years, starting from September 2023, to provide early identification, targeted, and universal support for children with speech, language, and communication needs in both early years and primary school settings, and more timely referrals for specialist support if required. 

NHS England met with Auditory Verbal UK (AVUK) last year and discussed the need for more higher-level research evidence for the intervention and to develop evaluations of impact. AVUK was also invited to join the Chief Scientific Officer’s Audiology stakeholder group. 

Audiology: Children 

14 October 2024 | UIN 5964 

Asked by: Mrs Sharon Hodgson 

To ask the Secretary of State for Health and Social Care, what steps his Department is taking to (a) help the NHS and local health services can maximise investment in (i) new-born hearing screening, (ii) cochlear implants, (iii) hearing aids and (iv) other hearing technology and (b) use Auditory Verbal therapy to maximise such interventions. 

Answering member: Stephen Kinnock | Department of Health and Social Care 

National Health Service audiology services, including the provision of therapies for people with hearing loss, are locally commissioned, and the responsibility for meeting the needs of people with hearing loss lies with local NHS commissioners. 

In July 2016, NHS England published Commissioning Services for People with Hearing Loss: A Framework for Clinical Commissioning Groups, which supports integrated care boards in making informed decisions about what is good value for the populations they serve and to assist in providing more consistent, high quality, integrated care. NHS England also published specific guidance on newborn hearing screening in 2016, Newborn hearing screening programme (NHSP) operational guidance, which supports healthcare professionals and stakeholders delivering and managing newborn hearing screening programmes in England. 

We also expect commissioners to follow guidance from the National Institute for Health and Care Excellence (NICE). In 2018, the NICE issued the guidance, Hearing loss in adults: assessment and management, which aims to improve hearing loss services, including the provision of hearing aids. 

Specialised ear surgery, such as cochlear implantation, is commissioned directly by NHS England as a specialised service. In NHS England’s specialised commissioning specification, Cochlear implantation services for adults and children, updated in May 2023, Auditory Verbal Therapists are recognised as part of multi-disciplinary teams able to provide rehabilitation services, alongside a range of other health professionals. 

Debates 

SEND Provision and Funding 

11 January 2024 | House of Commons | 743 cc477-525 

Auditory Verbal Therapy 

12 December 2023 | Westminster Hall | 742 cc232WH-239WH 

Special Educational Needs and Disabilities: Specialist Workforce 

22 March 2023 | Westminster Hall | 730 cc94WH-117WH 

Press and stakeholder material 

Westminster Hall debate briefing: Provision of Auditory Verbal therapy (PDF), Auditory Verbal UK

Sisters take language therapy fight to MPs, BBC News, 17 October 2024 

Families call for investment in early support for deaf children, Belfast Telegraph, 7 October 2024 

Deaf young people meet Members of the Senedd to challenge perceptions and call for investment in Auditory Verbal therapy, Auditory Verbal UK, 1 October 2024 

Deaf young people share their stories with MSPs, including First Minister Humza Yousaf, in The Scottish Parliament, Auditory Verbal UK, 8 March 2024 

Auditory Verbal therapy: supporting deaf children to thrive at school and beyond, Children’s Commissioner for England, 28 February 2024 

More than 6,500 children on waiting list to see speech therapist, STV News, 16 January 2024 

MPs debate increasing access to Auditory Verbal therapy in Parliament, Auditory Verbal UK, 12 December 2023 


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