Rethinking access to pediatric hearing and speech care

For young children, timely access to support can shape their future. At Hearing & Speech Nova Scotia (HSNS), the Preschool Accessibility Innovations Project (PAIP) is reimagining how care is delivered, so more children, families, and caregivers receive timely access to care—no matter where they live.

“We know that the first 2,000 days of a child’s life are critical for brain development across language, emotion, and learning,” says Sharon Walker, Director of Pediatric & Autism Hearing and Speech Services. “If kids are waiting too long for assessment or intervention, we risk missing that window.”

Supported by $1.4 million in funding from the Department of Health and Wellness, the PAIP team began by taking a phased approach: increasing clinical capacity, scaling up existing service models, and introducing flexible, family-centred options across the province. That meant hiring new staff, expanding audiology and administrative support, and offering services in the evenings, on weekends, and even in community locations like libraries or playgrounds.

Instead of every child waiting for a spot on their local clinic’s list, HSNS introduced a more provincial lens. “Virtual care and flexible scheduling helped us create options,” says Sharon. “Some families prefer weekends. Others need in-person support. Some can travel to another site, others can't. This is about meeting people where they are.”

The project uses a continuous quality improvement model—Plan, Do, Study, Act—to test and refine ideas based on real feedback. “In some zones, virtual evening appointments didn’t work—but Saturday mornings did,” says Sharon. “We listen, we pivot, and we try again.”

The impact is clear: wait times are decreasing, equity is improving, and staff feel empowered to innovate. “Our team has been energized. We’re doing things we’ve wanted to do for a long time and are seeing real results for the families we serve,” says Sharon.

As the project enters its next phase, HSNS is continuing to pilot remote audiology services, expand early language programming, and, with more funding, aims to design culturally responsive care with communities. Team Lead roles were introduced to support mentorship, leadership, and process development across clinical and support roles.

“We’re building a system that adapts to families, not the other way around,” Sharon reflects. “By listening, learning, and evolving together, we’re creating something stronger for the future.”