Everyone, I'm Xiaoying, producer of Soundbites and your webinar host. I'd like to begin by acknowledging the traditional owners of the land on which I am presenting from today, the Camarie Girl people of the Greater Oral Nation and the collective land where we're all attending the meeting from and also pay my respects to past, elders and present and extend that respect to any Aboriginal and Torres Strait Islander people in the virtual meeting we're all in today. So what are the experiences of Aboriginal caregivers in supporting their children's hearing health and language development? And what are their experiences of audiology and speech pathology services? Welcome to the season finale of Soundbites 2022. Today we have a very special panel discussion with four highly regarded Aboriginal and Torres Strait Islander health care workers and researchers. We're very fortunate today also that Tony can join us today. And we didn't even have time to change and update our slides. So I'll leave the suspense to the presenters introduction coming very soon. And I'm sure many of you already know Tony. The panel will be moderated by Isabel O'Keefe. OK, so without any more further ado, I would like to hand over to Isabel. Thanks so much, Ayanne. So I'll briefly introduce myself and then hand over to other members of the panel to introduce themselves. But thank you so much for coming today. And I want to thank particularly the Hearing Australia First Nations team who have actually rescheduled a meeting to come along today. So thanks so much to all of you who are here today. So for those of you who don't know me, I'm Isabel O'Keefe. I'm joining from the lands of the Gadigal people of the Eora Nation. And I pay my respects to their elders, past and present, and extend respect to all Aboriginal and Torres Strait Islander people attending today. And all those who we've worked with, including the caregivers in this study who provided such important insights and the Aboriginal research leadership team who provided oversight for this study. And we're really fortunate to have two members of that team here today, Tony and Tremaine, who I'll hand over to in a minute. So I'm a non-Indigenous researcher with a background in linguistics and musicology. And I first developed an interest in Aboriginal languages, music and culture during my primary school years where I grew up at Pukajah on the Ananguupitindada Yankindadada lands in Central Australia. For my PhD research, I worked with communities in Western Arnhem Land to document languages and songs of that really multilingual region. And I've also worked with some Aboriginal linguists and educators in Northwestern New South Wales to work on language revitalisation projects. I joined NAL about two years ago. And before that, I'd worked for about six months with Hearing Australia on the Plum and Hats project with other presenters here today and other NAL researchers, including Sam Harkus, Carmen Kulm, Viv Marne, and we're a republic health researcher, Michelle Kennedy, who also assisted with this study that we're going to discuss today. It's been fantastic to work with such a multidisciplinary team with a range of different expertise and experience. And I've learnt so much from all of them, including you, Tony and Tremaine. So I'll hand over. Tremaine, would you like to introduce yourself and then Tony and then Megan? Yeah, my guys, my name is Tremaine Rinkmore, proud of our dream man from Davao, currently sitting at Newcastle. So I like to acknowledge the Awoabical people where I'm meeting today by my respects to elders, past, present and future. So currently I'm an Aboriginal health practitioner. I work across seven mainstream general practices in the Newcastle area. And I guess I'm working in eHealth research now for the last two years with the University of Newcastle and the HMRI. We're sitting at the moment. Because I've been in Aboriginal health now for 10 years, first started at the, excuse me, first started at the AMS in Tamworth and then relocated to Newcastle in 2018. Excuse me, sorry. And yeah, I've been fortunate enough to be with the Hearing Australia and NAL team for the past couple of years now in some eHealth research and looking forward to talking to you guys today. Thanks, Tremaine, Tony. Hi, everyone. I'd also like to acknowledge the traditional custodians of the land on which I'm zooming in on meeting with you today. That will be what we call war in my country and pay my respects to the oldest past president emerging and for mob that will be joining, perhaps joining us today as well. So I'm Tony Matten. I'm a Cammy Pingle woman from the Warramite Nation. I've worked in Aboriginal health for a fair while. I'm not going to tell you how long because it'll give away how old I am. And I want you to all think that I'm young and deadly. So yeah, I'm not going to say that. So I started my career as an Aboriginal health worker and I'm currently working in two different places. So the PHN as a commissioning coordinator, but more recently as a researcher in health research. I've worked on a couple of different studies, particularly around caregivers, perspectives, young people and also supporting Kelvin Kong and his research on the store and forward. So thanks. And I do hope that you enjoyed it. Thanks to Megan. Hi, everyone. I'm Megan Ward. I'm an audiologist. I'm studying on Aetical Country. And so I'm a pediatric audiologist with hearing Australia, or I was for most of my working career. I started doing outreach work for the First Nations unit in hearing Australia about 13, 14 years ago and have done a lot of work in the Northern Territory in remote communities and in Sydney, Urban and some regional communities as well. I was lucky enough to start working on the Plum and Hats project about three or four years ago. Many of you will know. And now I work for NAL and I get to work on these wonderful projects with fantastic people. I'm going to hand back to Isabel now and she's going to just give a brief overview of the of the background and of this study. Thanks so much, Aron. Yes, I'll just I'll try to keep this nice and brief so we can get into a bit more of the kind of conversation. But just wanted to give you some background about the study. So we know that there's high rates of the Titus media and related conductive hearing loss among young Aboriginal and Torres Strait Islander children.  So early intervention is really key. So our study focused on the importance of caregiver perspectives in informing this early intervention, ensuring family centred and culturally safe provision and care. So we aim to explore the perspectives of Aboriginal caregivers of young children with hearing problems on how they support their children's hearing health and language development and on their experiences with audiology and speech pathology services. So we had oversight from an Aboriginal research leadership team that included Tremaine and Tony and was led by Waroturi Research Michelle Kennedy. And we really aim to privilege the voices and experiences of Aboriginal caregivers. The study had ethics approval from human research ethics committees of the original Health and Medical Research Committee of New South Wales, Menzies Top End and Hearing Australia. Interviews were conducted with caregivers using the yarning method, meaning that the interviews were relaxed and informal conversations between researcher and participants with relationality is key. And participants were really encouraged to share stories of their lived experience and the way that they wanted to. So the interviews started with social yarning to establish those relationships and then research topic yarning to explain the research. And once caregivers had had the opportunity to ask any questions and provide consent, the rest of the interview was audio recorded. And these were then transcribed and analysed qualitatively using a reflexive thematic analysis approach. So we had five interviews in an urban New South Wales community that were conducted by Dr. Michelle Kennedy. And three interviews were conducted with Aboriginal caregivers into remote NT communities by non-indigenous researchers. Me and Jodi Kell assisted with one of those. Jodi and I both non-indigenous, but we've got we've had long term relationships with these communities that we did the brief interviews in. We have an understanding of the local language ecologies or contexts and some basic competence in local languages. We had planned to employ a community based Aboriginal research assistant in the NT, which would have been fantastic. However, unfortunately, they weren't available during this time due to work, family and other commitments. So all of the participants were all caregivers of one or more Aboriginal Torres Strait Islander children aged 12 years or under who had hearing problems and they're recruited through the researchers and social networks to ensure that there was kind of rich data around ear health and hearing journeys. They needed to have at least experience with one allied health service. So either audiology or speech pathology. And the participants included five mothers and three grandmothers. And many of the participants or their families worked in health or education contexts. But to protect the identities of participants, the communities are not named as well. So in terms of some of the main themes and then we'll be able to get into this conversation, the two main things that we really identified in the data were that caregivers are and really have to be proactive in seeking support and also in supporting their children at home. And the second one was that ear health and hearing pathways are complex. They're difficult to navigate and difficult to access at times. So one lovely quote that kind of talks about that that proactivity is from a participant in the NT who said, I used to tell them is the hearing service, get this done for my kids so they can hear and speak well in the future. And in terms of the complexity of systems, the participant from New South Wales said, we came home from the hospital. It was after an acute ear infection. We never heard back. No one followed us up. We kept asking, kept talking to our local Aboriginal controlled community health organization. We finally got an appointment with the NT. Lots was really confusing. Then we had to speak to the speech pathologist who said, you have to get a referral. So we went back to our Aboriginal controlled health organization to get a referral. Then we were able to get it through NDIS because one of the children had an NDIS plan. So you can see there's so many different parts of that journey. So, Megan, are you able to just start with outlining a few of from that data, some of the ways that we found that caregivers were proactive? And then I'll hand over to Tonya and Tremaine. Oh, there was they were proactive in so many ways and had to be. OK, so in seeking medical help, so hearing tests, speech pathology, referrals to NT treatment, but that it just kept going on and on and on. And that's the nature of ongoing ear disease, unfortunately. I love this quote. I think it really highlights this. This is from one of the New South Wales parents. So after about the 10th ear infection, I started to look for other GPs in the area. Tried probably another two and just was told it's just daycare, daycare germs. They'll get used to it once he turns one. So that that mum was really conscious that it was not just daycare germs. And she just had to keep going and going and going. So not only was she dealing with being dismissed. And that was a common thing that kept coming up that these caregivers were dismissed by professionals, I'm afraid. But also that she she shopped around and she went where she thought she'd be listened to. And then they the caregivers were proactive in that they then helped other families. So she goes on to say, we've had friends that have had their kids in similar situations and both my husband and I are like, this is what you have to do. Like, this is how you get it quicker. And we've been able to help advocate for them to make sure that they don't go through what we went through as well. And that that's, you know, so it's that building on community that's really helped. Tony and Tremaine, do you want to add to that? Yeah, I guess that's, you know, the main thing about, you know, our caregivers is there's not like a direct sort of pathway for them.   But being proactive, I guess, me and Tony collectively yesterday or the day before we actually got a phone call from a colleague or a friend, basically. And we're saying, this is what's happening with our child. What do we do? So it's definitely a big thing is that they're being proactive and they've got to do this for themselves. And that's a bit of a shame, really. Yeah, you get any more thoughts to add to that, Tony, either from what you read with these caregivers or all from your own experiences? You guys, can we, OK? I'm sorry. I think, I think sometimes that always the first on to the family, if there is possibly a way to do it, but if a parent likes to go to the GPs, raise them all. That parents like to go to the GPs and think it's very important for clinicians to understand that there's a perfectly good reason that we can make the solution a little bit more, rather than just trying to see if that will come in at the same time. So I understand that there should be for the parents to take responsibility for the parents to take the child. But if they're constantly there, I think clinicians need to stop and think about this. It's something that we might need to take into consideration. They're not coming here for no reason, right? So, yeah, that's what I would. Yeah, thanks for that, Tony. Unfortunately, your audio was a little bit crackly, but yeah, thanks for reflecting. I know you was talking about how, yeah, there is that sort of responsibility of parents, but the onus is kind of constantly on parents. And I know that that's something that's come out, I think, in the other research that you're involved in with Sam and Megan on the urban hearing pathways, just that the onus was always on parents. And so that idea of clinicians needing to listen, especially when parents are having to come back over and over. And hopefully Tony's IT will be OK. Megan, I know we had some discussions as we were going through the data as well about things that we found particularly striking. Could you reflect on one of those things that you found quite striking? Yes, it was. I expected caregivers to talk about wait times and about the difficulties they had in just getting appointments and getting tests and treatments. But what I was really what I was really found quite compelling was how proactive the parents were in what they had to do at home in supporting their child. So a lot of the parents talked about dealing with the child's frustration, nurturing the child's language and speech development. So, you know, having to talk louder, having to one parent beautifully talked about having making sure that the child used their voice and asked for things and just didn't just use gesture and pointing. Another talked about having to make sure that all the daycare stuff understood that their child needed to have their attention and needed to be tapped on the shoulder, need to talk to directly, need to be talked to at their level. So I thought it was so they were working really hard to. Really hard to support their kids in a number of ways and not just their kids, as we've said before, but the kids in the community. Yeah, I remember there were so many examples where they were looking out for other families and other other kids and saying, oh, your kid might have something similar. Yeah, to main or Tony, do you have any reflections on that or things that you either found striking in these interviews or the kinds of things that you've seen caregivers being so proactive with that's really struck you? I think it's, you know, pretty much the same. I mean, it's it's it's interesting before doing ear health research and looking into these sort of things that, you know, you kind of you kind of feel like your GP and your nurses and all that should know what to do. So it's really striking to find that, yeah, in the amount of times parents had to be proactive, parents had to push the envelope to get a referral to an ENT or or a speech or whoever it might be. Yeah, so that that to me was like, oh, wow, I didn't realize, you know, how I guess broken this sort of pathway is, especially for our young kids, you know, like, and then not only that, like, to have our parents and our carers at home trying to get their own strategy in place on how to communicate with their kids. Or, you know, I think it's it's just really a reflection on what Megan said. But that really, really comes to you when you when you're reading this data, you know, and it's, yeah, I just thought there'd be a better pathway. I thought there'd be a better, better understanding from the health professionals and and GPs into that. So I guess that's my little bit on that. Tony, how's your sound going? Did you have any other thoughts or want to try to see how your sound's going? I'm not sure if you can hear me and I do apologise. But look, I'm just supporting everything that both Trayn and Megan have said. So, yeah, that kind of leads nicely onto a bit of a discussion about the other theme, about the complexity of pathways. Megan, can you give us a brief overview of some of the complexity of your health and hearing pathways that caregivers discussed in the interviews? Yeah, I keep I keep thinking about this. And part of it is just that disease is a complex condition, OK, because it's it's. It's not just the the condition that we're faced with or that the the GPM might be faced with when the family turns up. It's the long term ramifications and and how it's impacting on the child and will keep impacting on the child. So it is a complex condition. And, you know, what's what's the most important thing for a parent? And so. But it's it's I think it's made more complex than it has to be because of how maybe health services work in, you know, who do you go to for your hearing tests and then who do you go to for the GP? And then how do you get to the E&T? And families might see an E&T at an AMS. But if they want grommet surgery, they then have to deal with the state health system in the hospital system, which is a different system. So it's a different weighting list. I'm I'm going to quote use a quote again. And this is once again from a New South Wales parent. I booked in to see a private E&T at that point just to get another review because I think it was like another huge weight to see the E&T specialist who comes back to the archo. I can't remember how long the weight was, but it was just too long. I just wanted to get on top of it before he started school and all that jazz. So it's it's another level of anxiety that parents have and that it's ongoing. Yeah, I mean, I think we. And just how fragment I was struck by how fragmented the services are and maybe how fragmented the advice that parents get.  And then it's, well, OK, but how do I help much help today? Yeah, thanks for that, Megan. So yeah, that really came out in a lot of those caregiving to use that the multiple and fragmented services, the long wait times, which we know about and that kind of lack of clear messaging to around ear health and hearing. Did you have any more thoughts on some of those issues around complex pathways, Tremaine? I guess one of the main complex about the pathway is the wait time, you know, like you know, why you could come comes in with ear infection or or some any reason why you decide to go to your GP first. Sometimes they can sort of fix it and, you know, it might put a bandaid on it for a month or, you know, a couple of weeks or something like that. And then come back and it's it's a reinfection of the ear again. Or, you know, and then they do the same thing.  So I guess being in this space, I knew, well, I know, I know I need to get an anti-referral. I know I need to get these processes in place. But it's just about, you know, they don't really there isn't a clear pathway for it. Like it'd be nice if I have one ear infection and you get a referral to an anti or something like that. I know I probably bulk up the wait list. But it's important that our kids get looked at early, you know, I think when we done one of the studies, it was like, they're not getting their hearing aids or something until like they were seven. Like that's a big, big, long time.  So they've missed out on all this early education, which we know is so important for our young people and the development that they're not hearing properly. They're so far behind already. It's just that's that's really, you know, a downfall and on what's going on at the moment. But yeah, complexity is definitely wait times as well. Yeah, I heard there's years from from people and patients that I've talked to that have been on the wait list for years before they can see any anti or get the surgery or, you know, there's just then, like I mean, we're saying there's different levels to it as well. Like, you know, you can go to a GP, you know, the antibiotic and fix that ear infection and that clears up great. But then what's the wait time to go in to get a hearing test?  It just makes it really complex. Yeah. Yeah, that definitely came out. I think there was one parent who talked about their child being on the wait list since he was born and he's now four. So for that was for anti surgery. Yeah. Can you explain a little bit to by the Tony, if your sound is working or remain if Tony's sound isn't working so well, just how it can even for urban families in New South Wales, it can be really difficult to access and navigate pathways as well. I guess working in the Newcastle area at the moment, like then I always just go back to pathways. But it's, you know, the whole lot of it, really. Like it's so, so hard for our families to know what to do. And if they haven't had their kids go through it before or, you know, have an auntie or an uncle that put their nephews and nieces through it or whatever that family member might be to you. Then there's just unknown for you, you know. So unless you've got, like I said, someone in that health space or, you know, a family member or a friend that's had problems with ears or they're hearing before that you can sort of call upon and go, hey, what do I do? What do I do next? Because I am just going to a GP. This is what's going to this is the referral. Well, this is the late time. You know, what are things that we can do? So even though places like Newcastle, you think they've got a lot of a lot of services here, it's still just the same. You know, like I just, I don't know. I don't know what to say about it, but it's just a bit frustrating at times, especially when, you know, it is so important for our young followers and young mob, you know. Yeah, definitely. And you worked both at Aboriginal Medical Services and Mainstream Services. Do you think the pathways have been easier for families in one or the other? Or it can depend a lot on local services and pathways. I think. Look, in in the like the AMS that I've worked at, it's really good because we have visiting any specialists that come there. But in saying that, there's, you know, they might be there once every month or once every two months or three months. It depends on the funding they've got for for the AMT specialist to come out and then obviously the entities are scheduled stuff like that. So. For for a part of it, I believe the AMS is a bit better because they got that direct link to it to an entity. They know that pathway a lot better. But in the other sense is, you know, if they're only there once every month, once every two or three months, you know, and they're only there for a day, they might see 20 kids, but they might be a hundred waiting, you know, like so in that sense, it's a bit the other way as well. And I'm working in a mainstream practice. It's I'm just finding it that I guess lack of knowledge of the pathway and what they should be doing is is, you know, as hard. So I guess I guess they're both for pros and cons to it. Yeah, but if I could, I'd love it. It's easier with the AMS, but then it depends on the entire schedule and their funding and stuff like that. To say a specialist earlier than inviting a longer time on a public wait system or something like that. Fantastic. And that, yeah, definitely came out. Some of those interviews, too. I think, yeah, King of is saying that the AMS had really helped them navigate that. But sometimes those wait times or if they missed it, you know, especially during COVID, that was extra challenges as well, they said. Megan, so I think when we originally started the study, we were asking kind of specifically about audiology and speech pathology services, but given that, you know, we were using these yarns, parents really chose what they wanted to talk about. And they really wanted to talk about this whole pathway rather than just audiology and speech pathology. Can you explain, I guess, as an audiologist yourself a bit about how it's really helpful as a clinician to understand caregivers' perspectives on the whole pathway? Yeah, yeah, I mean. Yeah, as an audiologist, you know, my focus is hearing. But it's. I was reminded by these parents how important it is that. You know, parents might come in and their focus might be on how the child's speaking or the child's balance or how that they're storing at night or their behaviour. So, you know, to find out what their concern is and really listen. And it sounds really simple and straightforward, but I think it's a really good reminder to us all that we have to do it. And, you know, in a busy clinic, when you're aware that there's people in the waiting room, you're kind of trying to get through as many people as you want, as you need to. But. So spending, taking that time to really listen to the parent and work out and put, you know, that they're really stressed out about it. They might have waited a long time for this appointment. They don't know what to expect. And and just to go, oh, you know, the hearing's OK today. Or, oh, yeah, I'll see you in three months and we'll keep an eye on it. It's like it's it's not enough. Yeah, we need to be more proactive in in communicating with the other people in the pathway and helping parents navigate. Yeah, there was that fantastic quote from one parent.  And she kind of reflected that perhaps it's part it's because it's part of it's just one part of the hearing journey. He says, like, all this emotional build up that's already happening. And she said, you're like, oh, bugger, this is just like another kind of thing that's happening. And then you have to see another specialist and they have to ask more questions. And she goes on to say, I guess every part happens in a siloed section. There isn't that kind of continual understanding and respect of what the patient or family is actually going through. And I thought that was, yeah, such a kind of strong quote about how, you know, these these little parts of the pathway and and sometimes, you know, the families are having to do with this whole thing, but clinicians might be only seeing them at one point. So it's, yeah, I remember we've had some discussions about how helpful that is then to keep them in mind. That's it. And then of course, there might be other healthy shoes and other kids and, you know, a whole lot of other stuff that happen. So caregivers, I think, again, part of their proactivity, but also just suggestions around both what would help them and what would help them with the whole pathways. They had a range of recommendations that they've provided throughout these interviews. Some are kind of more easily implementable, as well as others that are kind of around large systemic changes. I think that there might be another is there an echo or is there something that one of these things was around caregivers really wanted family centred and culturally safe care. They wanted explanations from services, both when booking and during appointments. They wanted some more information, including leaflets, maybe an app, community meetings to provide more information about OM, about hearing loss and about those local pathways. They wanted support and intervention before children start school. That quote that Megan read before and health systems and services that were less siloed and partnering with other sectors, so including partnering with education, partnering with disability services or other community services. And something that I found particularly striking because we've been working on another project to do with ear checks, there a number of caregivers said they really wanted regular ear health and hearing checks in primary care. So might reflect on a few of those. But Tremaine, could you have a talk about what family centred and culturally safe care might look like or does the best practice? I guess with that, you know, like just to be feeling like you're an actual person to be acknowledged that, you know, I know I'm from an Aboriginal man and that I'm just going to get the same respect from no matter who I go to.  It can be Aboriginal staff. It can be something in your your clinic or your practice that that shows that, you know, you acknowledge and that you accept Aboriginal people for who they are and you just treat them the same as you would anybody else. You know, it's a lot of I always tell it to the GPs that are coming through and training, you know, the young guys just treat them. They're a normal person, you know, you don't have to treat them any differently. Always explain things that you're talking about. Don't just use medical jargon and stuff like that. Always in my in my own practice, you know, always explain what what this means.  And this is why this is good or this is why this is bad. You know, and this is what we're going to do to fix it all. Just the explanation to it as well. And not just the acknowledging that, you know, they don't know everything that they need to and they just a simple, simple answer. But yeah, I think and being, I guess, family centred is acknowledging that, you know, Aboriginal culture is not just the one person.  So to be aware of, you know, family dynamics and connection to community and country and stuff like that, that's that's what I see as, you know, being family centred and culturally safe for any person that comes into your practice or your clinic or whatever. Yeah, fantastic. Yeah, that picked up a lot of things that that caregivers had really spoken about as well and wanting that respect and feeling somewhere that was comfortable and it reflected on the differences of going to a local AMS, where there were things that make them feel really welcome. Whereas other things were a bit, yeah, clinics seem to be kind of sterile. Yeah, fantastic. The other that had been a question from an audience member beforehand as well about what some of the barriers might be for Aboriginal people receiving good audiological services or, I guess, I mean, that could be extended to good care in this ear health and hearing space. Do you have any reflections on that? Or, Tony, feel free to jump in if you think your audio is going to work. OK. Or you can feel free to pop things in the chat as well. Tony, it's such a pity the audio wasn't great because you've got some great things to say. Oh, that sounds much better. I'm back. I've moved around till I found a really quiet space there because my earphones just didn't want to work. Look, I think just perhaps a couple of barriers to think about would if people are in rural and remote areas. And I say that here in Newcastle, though we're sort of centered in the middle of a regional space, there are areas around here that can be a little bit difficult for people to get transporting. So you've got to think about how people might be able to access some of these services. So transport can be a really big issue. And then you've got to think about, you know, families taking time off work to actually get there if they're from, you know, one family source of incomes and there might be only one driver in the in the family. So that all sort of needs to be considered and that type of stuff. Yeah, that's probably one of the biggest things when I talk to a lot of different families. And if I think about particular my community, like the community that I'm from from Carilla, there's one bus in and out. GPs, there's a couple of GPs, there's a couple of other visiting services, but people have still got to travel, you know, 20 minutes in a car to the local where they can access some audiology services or other services. But if they don't have a car, how are they going to get there? As I said, there's a bus that leaves at time in the morning and then we'll come back in the afternoon. So I think sometimes that really needs to be taken in consideration. Yeah, thanks. And that really does pick up what a number of caregivers talked about in the interviews to that, yeah, needing to travel both New South Wales caregivers and also NT caregivers having to travel often quite long distances. Definitely. Yeah. Well, the other thing is about, you know, parents are having to tell their story their story three or four different times. That becomes a really tiring for parents if they have to constantly tell people the same thing 20 times. In the end, the parents go, you know, what's the they'll keep going. But yeah, I think it's really important that when parents are telling you something, you open your ears and listen, because they're not saying it for the sake of it. Yeah, that's fantastic. And we'd almost finished up on that, because I know we have to get to some question times. But I just wanted to ask, I ask you, Tremaine, about why you think so, well, first of all, I just said a quick kind of promo for next year. A group of researchers, both from now and a working group and an expert panel and other researchers we've been collaborating with, we've been working on another study developing evidence based and consensus recommendations about the components and timing of ear checks of ear health and hearing checks in primary health care and that that there's going to be a sound bites, a whole sound bites on that next year. And we can ask them more about that or the sound bites team. But I think Tremaine, you were on the working group for that. Can you just kind of very briefly, before we open to questions, just say how you think ear health and hearing checks in primary health care could be really important for caregivers and how it would help them in the ways they have to be proactive or helping them navigate pathways? Oh, yeah, I guess when we're looking at that, you know, like. I guess one of the things I always think about is if we have regular checks and regular screens and stuff like that, we might be able to pick these things up earlier. So the whole, I guess, getting a. Whole checklist on doing hearing checks and when it should be done, stuff like that is going to be really, really important. Hopefully, you know, like we can do this. I don't even know the timing on it, but if we do it every, you know, three months or something like that, we're going to be on top of it.  That needs to be put off and put off if we have these consistent checks and and hearing screening and tests and stuff like that. We just got this is just. Punching information on that one child on hay at, you know, three months they were at this level. Then six months there at this level, nine months are at this level. Like if they've decreased or improved, what happened in those those three months? Or, you know, it might not be three months. It might be a month or six months, whatever it is. But, you know, what's happened in there? What what's the change that you guys have done? You know, I've just been knowing your infection the last six months and hearing is really picked up for now. Or we've had surgery and the grommets are working and all this stuff. So I guess, yes, it's important to have a more consistent hearing check that everyone can go off that we don't have to speak. I guess question. Yeah. Yeah, fantastic. And I think the number of caregivers that said, I think that would have really helped them not having to be so proactive because they would be these regular checks in place. I think that that would have helped them kind of pick it up early rather than having to keep pushing themselves to get it done. Fantastic. I'm aware of the time. So I just want to to finish up. I just wanted to finish with another quote from a New South Wales caregiver because there were just so many fantastic quotes. We could have just sat here and read quotes. They're amazing. At this point is quite striking. She said, if I was a doctor or a boss or something, I'd probably go to a head meeting and say, you know, this needs to change and this needs to happen and this isn't good enough. But I'm not a doctor and people aren't going to listen to me because I'm just one mum. So we really assured her that we were listening and that we would be continuing to listen and working for change. And so we really thank all of you for listening today as well. And we look forward to ongoing discussions. So we'd be really happy to take some questions I've been sort of seeing in the background some things coming through in the chat. And you're very welcome to email us or the soundbites team to stay in touch so we can be in contact. And we're currently working on a paper to write up these results so we can let you know when that's out as well. Thank you so much. And I think Shalya and you will pull out some questions for us. Is that right? Yes, hello. Thank you so much for those insights. So, yes, the questions are popping up now before we go through them. I just want to let everyone know that keep the questions and comments coming because we can keep them at the end of the chat and all our panellists can see them so we can address them to you individually, even if we don't get to them today. And thank you so much for pushing through some technical issues that we might be having as well, but we didn't let any of that stop us. So well done, everyone. OK, so we have a question from Amanda Leach. What do parents say about prevention strategies, early detection and and treatment in brackets, antibiotics in primary health care? That's a great question. Do you want to jump in me? It's a tricky question. Now, that could be a whole sound bites. Yeah, there were mention of or the frustration of repeated antibiotics and several of the parents talked about. The long term, their anxiety about the long term you know, the problems with a child beyond antibiotics. Other parents talked about introducing nose blowing regimes and getting those reinforced by the child care, hand washing. Other parents, particularly ones in the Northern Territory, talked about being really careful where their kids swam. So it was, yeah. I mean, we I'd like to go into that more with parents and carers. It would be really interesting. But when it was touched on, it was quite interesting that the scope of what they came up with. So is that does that address your question? And I guess and I guess to Amanda, just to say that that I guess that wasn't a main focus around prevention strategies, because we were talking particularly to parents who already have had to travel a fair way along the pathway. So, yeah, that it definitely came up a little bit. Some of the things parents tried to do to seek prevention or to seek things becoming more of a problem. But certainly, yeah, we hadn't asked a lot of detailed questions about that. So hopefully that's that covers it enough from just from what we have. Yeah. Thank you. And another question from Sarah Murphy from Western Australia. She says hi to the team. She's asking, are you looking at linking here in screening or ear checks into the MBS 757 15 to encourage their completion in primary care settings, both Aboriginal community controlled health, the organizations and mainstream? We may have to wait for the sound bites for ear check. But no, but no, I think there there's been lots of discussion about how to link it with lots of different checks. And I think that was something that caregivers even spoke about as well. How can we link this to this check or link it to vaccinations or link it to when a child is in for something else? Tremaine or Tony, do you have any other thoughts on that? I was just going to say, Tremaine may have a wealth of knowledge around this, considering that during what about race conducting our research is something that Tremaine did. So Tremaine, I'm going to leave that. I think that's a great question for you to answer. I guess linking ear health checks into the 715 is something that I already do. So it is bigger than just the the practitioner doing it. I know that it's the nacho guidelines for 715s. I'm pretty sure they're including the hearing into it now, but in saying that it is very open, if that's the right word, it's just not as detailed as what it should be. So I know when I do a 715 hearing check, you know, like you've got the OM6 questionnaire you can do for older kids. You've got Plumman hats checklists that we can do for younger kids. There's a lot more than just asking how the hearing is going. Because I know before I even done any sort of ear health research that my knowledge on hearing was how you think your hearing is going on. And then you get parents saying, oh, you don't that missing sometimes. I just select you here and we'll shrug it off and we'll say that. And, you know, like they just don't really focus on it. But with certain and specific questions, you know, we get a bit more detail in, especially like the Plumman hats. So under sevens we do that for, you know, it asks like when it's quiet, what does the kid do? And when it's loud, does the kid answer you more? And, you know, can they hear sounds outside when they when you're talking to them in a different room? Do they can they hear you and understand you and these sort of things? Like I found that really, really effective in my hearing screening for a seven one five for especially for our young kids. So, yeah, it's definitely I'd love to see it linked into it fully, you know, into an actual template and and all these new checklists that I guess we're going to try and recommend in the future when we should do the hearing screen hearing checklists and stuff. I hope that answers your questions. Fantastic. Thanks, Tramaine. Thank you. And we do have a few more questions come through where people are thinking of ways to to change this to support the pathway. So one from Paul Hickey, thinking could additional training and clear guidelines for scopes of practice assist to cut through pathways and ensure in the in the right place ensure actions in the right place at the right time assist some families and also he listed out some ways that an audiologist could be able to better facilitate and be a facilitator of that pathway to make it easier. Well, that's a huge question. Tramaine, do you want to take the first bit and then Megan to take the audiology bit? Something was around training for for pathways. Yeah, I guess, you know, it would be beneficial if there were training around specific pathways for hearing health. You know, even in my training, there's not much about it. You know, we get to look. Yeah, know how to look into, you know, our scope and look in the drum and see if it's healthy or not healthy. But for what next and what pathways happen is not really known. I know with the GPs that come through a training. For instance, I've got one young follower at the moment that's, you know, in his last term of his GP practice. We're doing an ear health clinic now together, but he said he's only done one one day of the training. So you look at that for a GP who's done who's done five years in university and this is probably his third year out and he's only done one day. You know, so you can sort of see the barrier right there. So absolutely additional training, clear guidelines, you know, it'd be immensely helpful. And even then, like, even the referrals to an ENT, like, why does that got to go through a GP?  Because that's that's another thing, you know, like. But you know, you can get sick and then it's a week or two weeks or three weeks before you get to see a GP.  I'm trying to catch it next time.  And, you know, same sort of process goes into place as well. So I had a meeting. I mean, I've been, I think, I think all audiologists have been wanting to be able to refer straight to ENTs for years. So, yeah, it is very frustrating. I guess the second part of your question, Paul, is that the the pathways vary so much, not just from state to state, but everywhere from region to region across the country. So I guess developing no local knowledge of where families can go and local. I guess local, I'm trying to think of a really good word, but but local contacts. So, you know, people who who can help navigate. So if you're a visiting audiologist, it's it's if you can map ties with people who are in a position to help families navigate and know what's around.  But if speech pathology waitlist is six months in that community, then it's it's you're just adding another stress to that family. So knowing those things is is really important. Thank you so much for those. Those answers as well. And maybe just the last one, if we can squeeze it in. Eugenie is wondering, could a AHP Australian Health for practitioner professional be assigned to case manage a child or a family through this pathway? And this is to address the how we have to explain things a million times to to all these different people. What are thoughts on that? I was going to have to remain on that one again. I should be talking about Aboriginal health practitioner there, I think it's a case managed year. And I think in some places, there are kind of your health coordinators and things. I don't know if you're a tiny bit to speak about that. Yeah, I guess, you know, like there could be any health coordinator that we go through. And, you know, that would be good for each practice, maybe to have. Practicality of it, I'm not sure it's really possible right now. But definitely some practices could definitely put an AHP on and assign just to you and hearing and, you know, create that that link between GP to hearing Australia or an audiologist and the ENT specialists and stuff like that. I think it would have been definitely telling your story a hundred times by having someone that sort of case manages it. Yeah, but I guess I guess I just think about the wait list here in Newcastle and stuff like that, how many people that would be and, you know, how many per person that would be for the AHP is as a large number. But in an ideal world, yeah, absolutely. It would be awesome to have that to help out and have that pathway there. So, unfortunately, it is time for us to to wrap up. So very big thank you to all our panellists today for such an insightful discussion and also just like the the caregivers being proactive and persistent and families being persistent. We are also observing the team here being very persistent on the on the research and our actions and our findings trying to understand and change for the better. So on behalf of now Soundbites production team, thank you for joining our webinar. Thank you for all the panellists and attendees and the production team and see you all next year.