Background and aims

Australian Hearing has been using a formalized procedure, the Client Oriented Scale of Improvement (COSITM), to document client's goals/needs and measure improvements in hearing ability in adult clients for some time. One of the greatest advantages of the procedure has been to promote a greater focus on the client's individual needs when designing their rehabilitation program.

The COSI, although very useful for adult clients, has some drawbacks for use with children. The goals/needs of children are likely to be much more diverse than those of adults, making it much more difficult to utilize the "Degree of Change" and "Final Ability" Scales of the COSI. The Client Oriented Scale of Improvement for Children (COSI-C) has been designed to try to incorporate the basic design of the COSI with some changes to make it more useful for paediatric clients.

The Parent/Child Letter 

A letter is sent to the parent or child prior to the appointment, to encourage them to think about needs and goals for the coming program.

Goals for Different Age Groups

A list of possible goals and strategies to achieve these is included for each age group. It is not intended that these be given to parents who may find them limiting and inappropriate for their individual child. It is intended that they may be used as a guideline or prompt for audiologists in the initial stages of using the procedure, however the lists are NOT exhaustive and audiologists should use their creativity and expertise to come up with innovative goals for individual children and their families.

• Goals for promoting hearing in infants

• Goals for promoting hearing in toddlers

• Goals for promoting hearing in preschoolers, primary and secondary school children

How to use the form

Download COSI-C^TM  Questionnaire

The audiologist and family agree on one or more goals, and possible strategies to achieve these from discussions with the family. These are recorded in the spaces provided.

The date for the goals to be reviewed should also be recorded in the space provided. This may be the same for each goal, or may be different. It may be possible to have the date the same as that for the next appointment, or it may be that the goal needs to be reviewed before then. For example, if the goal is for a child to manage the controls of the hearing aid by themselves, it may be appropriate for this to happen over a 6-month period. However, if the goal is to obtain a good fitting mould which prevents feedback the date for review will be much sooner.

At the review date the degree of change is recorded and if the goal hasn't been achieved the audiologist should discuss with the family and decide whether: -

1. The current strategies are working but they need more time. A new date to be reviewed should be recorded next to the goal.

2. The current strategies need to be changed. Record the new strategies and the new date to be reviewed next to the new strategy, or if there is not room rewrite the goal, new strategies, and new date to be reviewed. If the goal is rewritten indicate in the "goal achieved" column next to the original goal that although the goal has not been achieved it has not been forgotten.

3. The goal is unreachable, no longer a priority for the parents, or no longer valid. If this is the case, indicate in the "goal achieved" column that although the goal has not been achieved it no longer needs to be reviewed further.

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