Jane B. Seaton - Cheryl DeConde Johnson - Educational Audiology Handbook (2021)

Educational
Seaton
Johnson
Educational Audiology Handbook, Third Edition, offers a roadmap for audiologists who work in schools or other providers who
support school-based audiology services. As the gold standard text in the field, the handbook provides guidelines and blueprints for
creating and maintaining high-quality educational audiology programs. Educational audiologists will also find guidance for achieving
full integration into a school staff. Within this comprehensive and practical resource, there are a range of tools, including assessment
guidelines, protocols and forms, useful information for students, families, school staff, and community partners, as well as legal and
Audiology
reference documents.
New to this Edition:

• All chapters revised to reflect current terminology and best practices
• A new feature called “Nuggets from the Field” which offers practical information from experienced educational audiologists
currently working in school settings
• Revised and updated chapter on legislative and policy essentials third
Handbook
edition
• Latest perspectives on auditory processing deficits
third
• Contemporary focus on student wellness and social competence
• Expanded information and resources for access to general education
• Updated perspectives on hearing loss prevention
• New information on the development of remote audiology practices edition
• Materials and recommendations to support interprofessional collaboration
Educational Audiology Handbook

• Updated and more comprehensive technology information with multiple handouts and worksheets
• Resources for students in all current learning environments
• Expanded focus on coaching to support students and school staff Cheryl DeConde Johnson _ Jane B. Seaton
Cheryl DeConde Johnson, EdD, has an extensive history of advocacy for children and youth who are deaf and hard
of hearing and their families. Through her many roles as an educational audiologist, early intervention specialist, deaf
and hard of hearing program administrator, deaf education and audiology consultant with the Colorado Department
of Education, author, and university instructor, she continues to provide consultation, program evaluation, and
training globally through her practice, the ADE-vantage (Audiology Deaf Education). Cheryl is also a co-founder of
Hands & Voices. She is most proud of her grown daughter who describes herself as sometimes deaf and sometimes
hard of hearing and from whom Cheryl continues to be enlightened. Cheryl now shares her time between Leadville,
Colorado, and Green Valley, Arizona.
Jane B. Seaton, MS, consultant in audiology and communication disorders, has spent more than 40 years working
with families and children with significant hearing and listening challenges. She developed and administered a model
regional educational program for deaf and hard of hearing students and has professional experience in the field
of pediatric and educational audiology in university, pubic health, hospital, and public school settings. Ms. Seaton
received an undergraduate degree from Northwestern University, a Master’s degree from the University of Michigan,
and continued her post-graduate education at the Universities of Akron, Washington, and Georgia. She has been
an invited speaker and writer in the field of educational audiology and continues to serve as an early intervention
specialist and stakeholder for Georgia’s Early Hearing Detection and Intervention program.
www.pluralpublishing.com
Educational
Audiology
Handbook THIRD
EDITION
Plural_Johnson_FM.indd 1 2/25/2020 4:55:37 AM

Editor-in-Chief for Audiology
Brad A. Stach, PhD

Educational
Audiology
Handbook THIRD
EDITION
CHERYL DECONDE JOHNSON, EDD JANE B. SEATON, MS

5521 Ruffin Road
San Diego, CA 92123
e-mail: information@pluralpublishing.com
Web site: https://www.pluralpublishing.com
Copyright © 2021 by Plural Publishing, Inc.
Typeset in 10/12 Times LT Std by Achorn International

Printed in the United States of America by Integrated Books International
All rights, including that of translation, reserved. No part of this publication may be reproduced, stored in a retrieval
system, or transmitted in any form or by any means, electronic, mechanical, recording, or otherwise, including
photocopying, recording, taping, Web distribution, or information storage and retrieval systems without the prior
written consent of the publisher.
For permission to use material from this text, contact us by

Telephone: (866) 758-7251
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Every attempt has been made to contact the copyright holders for material originally printed in another source. If any
have been inadvertently overlooked, the publishers will gladly make the necessary arrangements at the first opportunity.
Library of Congress Cataloging-in-Publication Data
Names: Johnson, Cheryl DeConde, author. | Seaton, Jane B., author.

Title: Educational audiology handbook / Cheryl DeConde Johnson, Jane B. Seaton.
Description: Third edition. | San Diego, CA : Plural Publishing, Inc., [2021] | Includes bibliographical
references and index.
Identifiers: LCCN 2019051643 | ISBN 9781635501087 (paperback) |
ISBN 9781635501094 (ebook)
Subjects: MESH: Hearing Disorders | Child, Exceptional | Education of Hearing Disabled |
School Health Services | Persons With Hearing Impairments | Audiologists | Professional Role
Classification: LCC RF290 | NLM WV 271 | DDC 617.8—dc23
LC record available at https://lccn.loc.gov/2019051643

Contents
List of Appendices xv
Preface xix
Contributors xxiii
SECTION I Educational Audiology Practices
CHAPTER 1 Legislative and Policy Essentials 3

Legislation and Policies 7
Key Legislation 8
Key Initiatives and Events in Deaf Education 16
Inclusion 16
The Deaf Child Bill of Rights 17
Early Hearing Detection and Intervention 17
The National Association of State Directors of Special Education 17
The Council for Exceptional Children, Division for Communication,
Language, and Deaf/Hard of Hearing 18
Legislative Initiatives 18
Summary 18
Suggested Readings and Resources 19
Appendices 20
CHAPTER 2 Roles and Responsibilities of Educational Audiologists 31

Roles of Educational Audiologists 33
Educational Audiologists as Service Coordinators 33
Educational Audiologists as Instructional Team Members 34
Educational Audiologists as Consultants 34
Educational Audiologists in Schools for the Deaf 34
Responsibilities of Educational Audiologists 35
Identification 35
Assessment 37
Habilitation 37
Hearing Loss Prevention 38
Counseling and Coaching 38
Amplification, Cochlear Implants, and Other Assistive Technology 38
Ethical Considerations 39
Educational Audiology Service Delivery Models 39
School-Based Audiology Services 39
Contracted Audiology Services 40

vi Contents
Combined School-Based and Contractual Agreement 41

Telepractice 41
Establishing and Expanding Educational Audiology Services in the Schools 42
Reimbursement for Educational Audiology Services 42
Dispensing Personal Hearing Instruments 42
Cerumen Management 43
Support for Early Hearing Detection and Intervention 43
Training for Educational Audiologists 44
Summary 45
Appendices 47
CHAPTER 3 Partnering With Families With Janet DesGeorges 57

Positive Attitudes 59
Rapport 59
Respect 59
Trust 60
Effective Communication 60
Informational Guidance 62
Quantity of Information 63
Types of Information 63
Parent-to-Parent Communication 65
Parent Involvement 66
Committee/Task Force Work 67
Classroom Support 67
Parent Activities 68
Difficult Situations 68
Parent/School Disagreement Over Individualized Education
Program Services 69
Request for a Specific Brand of Amplification 69
Influence of Private Provider on School Services 69
Families That Have Difficulty Being Involved 70
Differing Opinions on Communication Modality 70
Summary 71
Appendices 72
CHAPTER 4 Hearing Screening and Identification 79

State Hearing Screening Mandates 81
Screening Requirements in Private Schools, Charter Schools,
and Other Nontraditional Education Settings 82
Purposes of Hearing Screening and Identification Programs 82
Professional Guidelines 83
Age Considerations 83
Prevalence Considerations 84
Resources for Hearing Screening and Identification Programs 85
Personnel and Time 85
Scheduling Considerations 85

Contents vii
Screening and Identification Program Considerations 85

Early Childhood 85
School-Age Children and Youth 87
Screening and Identification Procedures 88
Visual Inspection 89
Auditory Brainstem Response 89
Otoacoustic Emissions 89
Pure-Tone Audiometry 90
Tympanometry 92
Behavioral Observation 93
Screening and Identification Protocols 93
Infants and Young Children 93
School-Age Children and Youth 93
Hearing Screening and Monitoring Children Who Cannot Respond to Traditional Measures 96
Screening Personnel 96
Audiologists 96
Speech-Language Pathologists 96
Parent Volunteers, School Nurses, and Paraprofessionals 97
Training of Support Personnel 97
Screening Equipment and Maintenance 97
Screening Equipment 97
Equipment Maintenance/Calibration 98
Infection Control 98
Screening Environment 99
Location of the Screening Room 99
Noise Levels 99
Other Factors 99
Organization of Screening and Identification Programs 99
Scheduling of the Screening 100
Activities Prior to the Screening 100
Activities During the Screening 100
Follow-Up Procedures 101
Follow-Up Screening for Middle Ear Conditions and Medical Referrals 101
Referrals for Audiological Evaluations 101
Educational Screening 101
Data Management and Reporting 102
Determining the Effectiveness of Hearing Screening and Identification Programs 102
Data from Screening Program 102
Sensitivity and Specificity 102
Cost Effectiveness 103
Summary 103
Appendices 104
CHAPTER 5 Assessment 111

The Cross-Check Principle in Educational Audiology 113
Basic Assessment of Hearing 113

viii Contents
Case History 113

Otoscopy and Visual Inspection 114
Behavioral Assessment 114
Physiological Assessment 116
Modifications for Special Populations 118
Pure-Tone Modifications 118
Speech Modifications 120
Monitoring Hearing Sensitivity 121
Types of Monitoring 121
Schedules for Monitoring 121
Additional Audiometric Information and Functional Hearing Assessment 121
Speech Recognition for Sentences and Phrases 122
Speech Perception in Noise Testing 123
Listening in Noise 123
Speech Recognition With Visual Support 124
The Functional Listening Evaluation 124
Auditory and Listening Development Skills 125
Audiometric Assessment Considerations Without a Sound Booth 125
Cultural Considerations 125
Assessment of the Educational Effects of Hearing Status 127
The Classroom Listening Assessment 127
Use of Teacher Checklists 128
Interpretation of Audiological Information 129
Need for Comprehensive Evaluation 130
Communication of Assessment Results 130
Audiograms 131
Written Reports 131
Teacher Letters 131
Letters to Physicians or Other Professionals 131
Telephone or Personal Conferences 132
E-mail, Texting, and Web-Based Communication 133
Documentation 133
Privacy Issues 133
Personal Vulnerability and Safety 133
Summary 135
Appendices 136
CHAPTER 6 Auditory Processing Deficits With Lisa R. Cannon 179

Auditory Processing Deficit Basics 181
Terminology and Definitions of Auditory Processing and Auditory Processing
Deficits and Disorders 181
Criteria for Determination of an Auditory Processing Disorder 182
Practice Guidelines: The Role of the Audiologist and Other Professionals 182
APD and Other Disorders 183

Contents ix
An Educational Model of Auditory Processing 184

APD and Multitiered Systems of Support 184
Implementing a School-Based APD Program 185
Step 1. Developing the APD Team and Philosophy 185
Step 2. Referral and Screening 185
Step 3. Assessment for APD 187
Step 4. Eligibility for Services 193
Step 5. Intervention 194
Summary 196
Appendices 199
CHAPTER 7 Classroom Acoustics and Other Learning Environment Considerations 219

Learning Environments and At-Risk Students 221
Listening and Learning Challenges 221
Lighting and Learning Challenges 223
At-Risk Students 224
Universal Design for Learning 224
Properties of Classroom Acoustics 226
Noise 226
Signal-to-Noise Ratio 226
Reverberation 226
Inverse Square Law and Critical Distance 227
Classroom Acoustics and Speech Perception 228
Effects of Noise on Speech Perception 228
Effects of Reverberation on Speech Perception 229
Combined Effects of Noise and Reverberation on Speech Perception 229
Effects of Classroom Acoustics on Teachers 229
Classroom Acoustics Standard 230
History and Development of the Standard 230
Current Standard Status 230
Classroom Audio Distribution Systems 231
Conformance and Tolerance Verification 231
Standard Adoption 231
Classroom Acoustics Resolutions and Guidelines 234
Measuring Classroom Acoustics 235
Classroom Observation 235
Instrumentation and Software Programs 236
Classroom Noise Measurements 236
Classroom Reverberation Measurements 236
Estimating Critical Distance 237
Role of the Educational Audiologist 237
Management of the Learning Environment 237
Summary 240
Appendices 242

x Contents
CHAPTER 8 Hearing Instruments and Remote Microphone Technology

With Erin C. Schafer 255
Rationale for Hearing Instruments and Remote Microphone Technology 257
Recent Trends and Regulatory Considerations 257
Regulations 258
The Role of Case Law 258
Professional Practice Standards and Scope of Practice Considerations 258
The Responsibility of Public Education 260
Keeping Up with Technological Advancements 263
Equipment and Space Requirements 263
Assessment of Hearing Instrument and Remote Microphone Technology in Children and Youth 263
Candidacy and Candidacy Considerations 264
Device Selection Considerations for Remote Microphone Technology 265
Personal Hearing Instruments and Remote Microphone Technology Options 271
Hearing Aids 274
Cochlear Implants 275
Remote Microphone Technology 276
Implementation and Management of Hearing Technology 282
Fitting and Verification 282
Orientation and Training 283
The Usage Plan 283
Validation 283
Monitoring and Equipment Management 284
Strategies to Implement the American Academy of Audiology Hearing Assistance
Technology Guidelines 288
Other Assistive Technologies 291
Summary 291
Appendices 292
CHAPTER 9 Case Management and Habilitation 311

Planning Case Management and Habilitation 312
The Importance of Service Coordination 312
Facilitating Effective Case Management 313
Implementing Audiological Habilitation 314
Direct Services 314
Indirect Services 317
Services for Special Populations 323
Students With Unilateral Hearing Conditions, Single-Sided Deafness, or Minimal Hearing Loss 323
Students With Auditory Processing Deficits and Auditory Neuropathy Spectrum Disorder 324
Students With Multiple Learning Challenges 324
Students Using Cochlear Implants 325
Early Hearing Detection and Intervention 326
Inclusion 327
Summary 328
Appendices 330

Contents xi
CHAPTER 10 Supporting Wellness and Social-Emotional Competence

With Carrie Spangler 363
A Wellness Perspective 365
Social-Emotional Development 367
Bullying and Victimization 370
Skills and Strategies for Students to Address Wellness and Social Competence 371
Self-Determination Skills 371
Self-Advocacy Skills 371
Counseling Strategies 375
Reflective Listening 376
Self-Assessment 376
Extending Conversations and Coaching 377
Networking for Students 377
Peer Mentors and Role Models 379
Referring for Additional Services 379
Summary 380
Suggested Reading 380
Appendices 381
CHAPTER 11 Developing Individual Plans 403

The Special Education Process 405
Step 1: Identification: Concern About the Child 406
Step 2: Referral to Special Education and Assessment 409
Step 3: Determination of Eligibility 410
Step 4: The Individualized Education Program Meeting 414
Step 5: Review and Revision of the Individualized Education Program 416
Due Process Procedures 416
The Educational Audiologist’s Role in the Special Education Process 418
The Individualized Education Program 419
Consideration of Special Factors: Communication Considerations 421
Services, Placement, and Least Restrictive Environment Considerations 422
Services for Parents 422
Transition Planning 423
Individualized Education Program Goal Development 424
Section 504 Plan 426
The Services Plan 427
The Individual Family Service Plan 428
Eligibility Criteria 428
Purpose of the Individual Family Service Plan 429
Individual Family Service Plan Requirements 429
The Role of Case Law 431
Summary 431
Appendices 432

xii Contents
CHAPTER 12 Prevention of Noise-Induced Hearing Loss

and Tinnitus in Youth With Deanna K. Meinke 447
Epidemiology Estimates of Noise-Induced Hearing Loss in Youth 448
Epidemiology of Noise-Induced Tinnitus in Youth 449
Rationale for Hearing Loss Prevention Targeting Youth 449
Public Health Role for Audiologists 451
Raising Public Awareness in the School Setting 451
Noise Awareness and Prevention Programs 451
Education to Prevent Noise-Induced Hearing Loss 452
Dangerous Decibels 453
Hearing Screenings for At-Risk Individuals 453
Advocating for Public Policies 454
Challenges and Future Directions 454
SECTION II Collaborative Practices and Program Effectiveness
CHAPTER 13 Supporting the Educational Team With Carrie Spangler 459

Formal Inservice 461
Preparation 461
Presentation 465
Follow-Up 467
Continuing Contact With Participants 467
Coaching and Mentoring 468
Educational Coaching 468
Coaching for Educational Audiologists 469
Mentoring 470
Summary 470
Appendices 472
CHAPTER 14 Educational Considerations for Students Who Are Deaf or Hard of Hearing 481
Critical Issues in Deaf Education 483
Accountability and Oversight 483
Communication and Communication Access 484
Quality Instruction 485
Evidenced-Based Practices 487
Students Not Eligible for Special Education 488
Maintaining Teacher of the Deaf and Related Service Provider Positions 488
Parent and Family Engagement 488
Early Hearing Detection and Intervention and Early Childhood Education 489
Technology 489
Deaf Versus Hard of Hearing 489
National Association of State Directors of Special Education: Ten Essential Principles
for Effective Education of Deaf and Hard of Hearing Students 490
What Is Research Saying? 491

Contents xiii
Legislative Initiatives in Deaf Education 492

Language Acquisition and Literacy Accountability 492
Deaf Child’s Bill of Rights 492
Hearing Aid Insurance 493
Educational Assessment 493
Transition Planning 494
Best Practice Considerations for Educating Children and Youth Who Are Deaf or Hard of Hearing 495
Know Your Students 495
Adopt Program Standards 496
Conduct a Program Review 496
Identify Evidence-Based and Consensus-Based Practices 496
Utilize Progress Monitoring 497
Incorporate Expanded Core Curricula 497
Utilize Deaf and Hard of Hearing Peers and Role Models 497
Engage Parents and Caregivers 497
Summary 500
Suggested Reading 500
Appendices 501
CHAPTER 15 Collaborative School–Community Partnerships 519

Establishing and Maintaining Relations With Community Resources 521
Identifying and Interfacing With Community Resources 521
Identifying Resources Through a Community Survey 521
Potential Community Partners 522
Updating the Community Resource Survey 525
Marketing and Advocacy for Educational Audiology Programs 525
Increased Name Recognition 526
Broadened Visibility of Services 526
Increased Knowledge of Program Outcomes 526
Internal Marketing 526
External Marketing 527
Developing and Fostering Creative Collaborative Efforts 527
Information and Materials to Share 527
Facilitating Interprofessional Collaboration 530
Fostering Creative Community Collaboration 532
Legal and Ethical Issues 534
Summary 534
Appendices 536
CHAPTER 16 Program Development, Evaluation, and Management 551

Program Development 553
Laying the Foundation 553
Needs Assessment 554
Planning 555

xiv Contents
Program Evaluation 558

Assessment of Existing Audiology Services 558
Planning for Improvement 562
Implementation of New Services 562
Measuring Effectiveness 563
State Model Evaluation Systems 564
Program Management 566
Annual and Monthly Scheduling 566
Day-to-Day Scheduling 566
Office Support 566
Data Management 568
Forms 568
Budget and Finances 568
Facilitating Meetings 568
Challenges 568
Summary 570
Suggested Reading and Resources 570
Appendices 571
CHAPTER 17 Reflections and Future Directions With Sarah Florence 575

Emerging Themes 576
The Educational Audiologist as an Integral Member of the Multidisciplinary Team 576
The Emphasis on Accountability, Specific Student and Program Outcomes, and
Use of Cost-Effective Strategies to Address Critical Issues 576
Societal Factors 577
Promoting Hearing Loss Prevention as a Social Health Problem 577
Remote Audiology Services 577
Remote Educational Audiology Services Model 577
Remote/Onsite Hybrid Model 578
Remote Support of Onsite Educational Audiologists 578
Service Considerations 578
Remote Technology Tools 578
Summary 579
References 581
Index 595

List of Appendices
1. Legislative and Policy Essentials

1–A omparison of Pertinent Areas of the Individuals With Disabilities Education Act (IDEA) Part B,
C
Section 504, and the Americans With Disabilities Act (ADA) (Text) 20
1–B omparison of Pertinent Part B and Part C Individuals With Disabilities Education Act (IDEA)
C
Requirements Related to Children and Youth Who Are Deaf or Hard of Hearing (Text) 23
1–C Summary of Laws Pertaining to Persons Who Are Deaf or Hard of Hearing (Text/Online) 29
1–D ey Individuals with Disabilities Education Act (IDEA) Regulations Pertaining to Audiology and
K
Deaf Education Services (Online)
2. Roles and Responsibilities of Educational Audiologists

2–A Educational Audiology Association: Supporting Students who are Deaf and Hard of Hearing:
Shared and Suggested Roles of Educational Audiologists, Teachers of the Deaf and Hard
of Hearing, and Speech-Language Pathologists, Checklist (Text/Online) 47
2–B Part C Roles of Audiologists in Early Hearing Detection and Intervention (Text) 51
2–C Educational Audiology Association: Educational Audiology Scope of Practice (Text) 53
3. Partnering With Families

3–A Resources for Parents of Children Who Are Deaf or Hard of Hearing (Text/Online) 72
3–B Family Needs Interview for Families of Children Who Are Deaf or Hard of Hearing (Text/Online) 75
3–C Childhood Hearing Loss Question Prompt List for Parents (Text/Online) 77
4. Hearing Screening and Identification

4–A State Hearing Screening Laws for Children in Schools (Text) 104
4–B HEAR Checklist (Text/Online) 109
4–C Record of Ear and Hearing Problems (Online)
4–D Basic Hearing Problems Questionnaire for Students With Developmental Delays (Text/Online) 110
4–E Preparation Checklist for Preschool and School Hearing Screening (Online)
4–F Parent Notification Letter for Hearing Screening (Online)
4–G Class Hearing Screening Results Record Forms (Online)
4–H School Hearing Rescreening/Referral List (Online)
4–I Sample Teacher Notification of Screening Results (Online)
4–J Sample Parent Notification of Screening Results—Pass (Online)
4–K Sample Parent Notification of Screening Results—Recheck (Online)
4–L Sample Parent Letter to Refer Child for Further Audiological Evaluation (Online)
4–M Sample Medical Referral Letter and Return Medical Referral Form (Online)
4–N Sample Medical Referral Form (Physician) (Online)
5. Assessment
5–A Audiology Case History (Text/Online) 136
5–B Familiar Sounds Audiogram (Text/Online) 138
5–C Sample Audiogram (Text/Online) 139
xv

xvi List of Appendices
5–D Word Recognition in Quiet and Noise for Normally Developing Children (Text) 142
5–E Speech Audibility Audiogram for Classroom Listening (Text/Online) 143
5–F Adaptations for Assessing Children/Youth Who Are Blind/Visually Impaired (Text/Online) 144
5–G Common Functional Outcome Measures for Listening Performance (Text) 146
5–H The Functional Listening Evaluation (Text/Online) 150
5–I Classroom Participation Questionnaire—Revised (Text/Online) 155
5–J Auditory Problems Self-Checklist (Text/Online) 160
5–K Relationship of Hearing Loss to Listening and Learning Needs (Text/Online) 161
5–L ichigan Department of Education—Low Incidence Outreach Educational Impact
M
Matrix for Students Who Are Deaf or Hard of Hearing (Text/Online) 170
5–M General Teacher Letter (Text/Online) 174
5–N Ordering Information for Selected Assessment Products (Text) 177
6. Auditory Processing Deficits

6–A Auditory Processing Deficit Screening Questionnaires (Text/Online) 199
6–B Referral for Auditory Processing Assessment (Text/Online) 201
6–C Auditory Processing Case History (Text/Online) 202
6–D Auditory Processing Assessment Resources (Text) 205
6–E Supplemental and Multidisciplinary Tests of Auditory Processing (Text) 207
6–F Auditory Processing Assessment Profile (Text/Online) 210
6–G Accommodations and Modifications Checklist for Auditory Processing Deficits (Text/Online) 212
6–H Computer-Based Auditory Training Programs (Text) 214
6–I Instructional Interventions for Students With Auditory Processing Deficits (Text/Online) 216
6–J A Multitiered Model of Auditory Processing Deficit Interventions (Text) 218
7. Classroom Acoustics and Other Learning Environment Considerations

7–A Classroom Acoustics Screening Survey Worksheet (Text/Online) 242
7–B sing the Student, Environments, Tasks, and Tools Framework to Identify Assistive Technology
U
and Interpreting Services for Students Who Are Deaf or Hard of Hearing (Text/Online) 248
7–C Resources (Text) 250
8. Hearing Instruments and Remote Microphone Technology

8–A Student Amplification Listening Evaluation (Text/Online) 292
8–B Pediatric Amplification Listening Evaluation (Text/Online) 295
8–C Personal Amplification Monitoring Plan (Text/Online) 299
8–D Instructions for Hearing Aid Checks (Online)
8–E Instructions for Cochlear Implant Checks (Online)
8–F Instructions for Osseointegrated Bone Conduction Implant Checks (Online)
8–G Instructions for Personal Remote Microphone System Checks (Online)
8–H Hearing Technology Monitoring Chart (Online)
8–I The Ling Six Sound Check (Text/Online) 300
8–J Tips to Enhance Remote Microphone Use (Text/Online) 302
8–K emote Microphone Hearing Assistance Technology Implementation
R
Worksheet: In-School Form (Text/Online) 303
8–L emote Microphone Hearing Assistance Technology Implementation Worksheet:
R
Out-of-School Form (Text/Online) 307

List of Appendices xvii
9. Case Management and Habilitation

9–A Form to Facilitate Collaboration Between Teacher/School Provider and Physician (Text/Online) 330
9–B Auditory and Tactile Assessment and Curricula (Text) 331
9–C Listening Development Profile (Text/Online) 332
9–D Teaching Strategies and Classroom Activities for Selected Listening Difficulties (Text) 335
9–E Parent Letter on Speechreading (Text/Online) 338
9–F Speechreading Resources for Children (Text) 339
9–G Classroom-at-a-Glance: Observation Checklist (Text/Online) 340
9–H Reduced Hearing and Recorded Speech (Text/Online) 342
9–I Functional Auditory Performance Indicators (FAPI) (Text/Online) 343
9–J Language and Communication (Text/Online) 359
9–K Early Auditory Skill Development for Special Populations (Text/Online) 360
9–L Auditory Response Data Sheet (Text/Online) 362
10. Supporting Wellness and Social-Emotional Competence

10–A Self-Determined Learning Model of Instruction (Text/Online) 381
10–B Resources for Social-Emotional Development and Social Competence (Text) 383
10–C Student Accommodations Notification Templates (Text/Online) 386
10–D Hearing Notification Card (Online)
10–E udiology Self-Advocacy Checklists (Teacher Forms) and “I Can”
A
Self-Advocacy Checklist (Student Form) (Text/Online) 390
10–F Overview of Ida Counseling Tools for Children, Youth, and Young Adults (Text) 396
10–G Ten Tools for Developing Self-Efficacy With Hearing Loss (Text/Online) 398
10–H Guide to Setting Up Student Support Groups (Text/Online) 400
11. Developing Individual Plans

11–A I ndividualized Education Program/Section 504 Checklist: Accommodations and Modifications
for Students Who Are Deaf or Hard of Hearing (Text/Online) 432
11–B Individualized Education Program Team Responsibilities for the Educational Audiologist (Text/Online) 434
11–C Communication Considerations Worksheet (Text/Online) 435
11–D PARC: Placement and Readiness Checklists for Students Who Are Deaf or Hard of Hearing (Online)
■■ General Education Inclusion Readiness Checklist
■■ Interpreted/Transliterated Education Readiness Checklist
■■ Captioning/Transcribing Readiness Checklist
■■ Oral + Manual Instruction Access Checklist
■■ Placement Checklist for Children Who Are Deaf or Hard of Hearing: Preschool/Kindergarten
■■ Placement Checklist for Students Who Are Deaf or Hard of Hearing: Elementary
■■ Placement Checklist for Students Who Are Deaf or Hard of Hearing: Secondary
11–E Checklist for ADA Services (Text/Online) 438
11–F Sample Section 504 Plan (Text/Online) 439
11–G Case Law Summary (Text) 441
13. Supporting the Educational Team

13–A Inservice Outlines (Text) 472
13–B Inservice and Hearing Simulation Resources (Text) 476
13–C Sample Index Card Handouts (Text/Online) 478
13–D Inservice Evaluation Form (Text/Online) 479
13–E Sample Coaching Concept Organizer (Text) 480

xviii List of Appendices
14. Educational Considerations for Students Who Are Deaf or Hard of Hearing
14–A Colorado Individualized Education Program Communication Plan (Text /Online) 501
14–B Assessment Terminology (Text) 503
14–C Summary of Psychoeducational, Language, and Communication Assessments (Text) 505
14–D ational Association of State Directors of Special Education (NASDSE) Implementation: Deaf
N
and Hard of Hearing Program and Service Review Checklist (Text/Online) 512
15. Collaborative School–Community Partnerships

15–A Sample Community Resource Survey Form (Text/Online) 536
15–B Service Clubs That Support Programs for Persons With Disabilities (Text) 538
15–C Sample Cover Letter to Community Resources (Text/Online) 539
15–D Community Education and Marketing Resources (Text) 540
15–E School and Community Survey of Educational Audiology Services (Text/Online) 542
15–F Sample Survey: Educational Audiology Services (Text/Online) 544
15–G Marketing/Advocacy Outcomes Log (Text/Online) 545
15–H EARS—School Contract Template (Text) 546
15–I Implant Center/School/Therapist/Parent Information Exchange Form (Text/Online) 547
15–J Characteristics That Foster Successful Collaboration (Text) 549
16. Program Development, Evaluation, and Management

16–A Self-Assessment: Effectiveness Indicators for Audiology Services in the School (Online)
16–B Goal Prioritization Worksheet (Online)
16–C Long-Range Planning Form (Online)
16–D Logic Model Planning Form (Online)
16–E1 Educational Audiology Workload Analysis Form (Text) 571
16–F Recommended Outcomes and Evidence for Educational Audiology Tier 1 Services (Text) 573
Instructional Materials (Online)

Basic Syllabus
Chapter Learning Objectives
Chapter PowerPoint Slides
Chapter Discussion Questions

Preface
It has been 22 years since the first edition of the Educational esteem, and self-determination skills are all precursors to
Audiology Handbook was published and eight years since becoming effective self-advocates. While we recognize that
the second edition. We are older, not sure if we are wiser, it is the right of each person to determine how they would
but we hope to have threaded throughout this third edition like their hearing status referenced (e.g., deaf, hard of hear-
traditional practices with additional evolving practices that ing, hearing impaired, hearing loss), we have used terminol-
we feel are necessary to strengthen educational audiology ogy that refers to hearing levels or differences rather than
services. “losses” whenever possible and appropriate. Lastly, we are
As in the past, this handbook focuses on the practice of very excited to endorse remote audiology services. We think
audiology within the educational environment. We recog- some form of this model is in the future of most every edu-
nize that audiology practice settings, job descriptions, and cational audiologist’s practice.
employment conditions vary from state to state and district
to district. However, we believe that educational audiolo-
gists are indispensable. In order to fulfill our role as advo- Handbook Use Considerations
cates for students, educational audiologists should be con- The number of printed appendices (and the length of the
sistent and participatory members of the multidisciplinary book) has been reduced by moving forms and some proto-
team whether that is in-person and/or remote. As a member cols and handouts to the online PluralPlus companion web-
of the team, responsibilities should be discussed and shared site. Many of the online forms have been formatted so that
to ensure all relevant and necessary services are provided, you can modify them to add your logo or school informa-
particularly those related to access to communication and tion. Materials available on the companion website are noted
learning in the classroom. in the Table of Contents and Chapter Contents.
The handbook also has many links to resources at other
websites. We guarantee that they all worked at the time of
New and Updated Content production. However, URLs change frequently, and we
This edition of the handbook includes information on leg- know this is frustrating. If a link does not work, try entering
islation, and guidelines and procedures for educational au- the first part of the link to get to the desired entity’s home
diologists and related professionals serving deaf and hard page and then search for a document.
of hearing students in all learning environments. We are
grateful to our contributing authors who have offered new
perspectives on the topics of family partnerships (Janet Support for Educational
DesGeorges), auditory processing deficits (Lisa Cannon),
Audiology Coursework
remote microphone technologies (Erin Schafer), wellness
and social competence and support for the educational team A new feature of this Handbook edition is that it is designed
(Carrie Spangler), prevention of noise-induced hearing loss to serve as a textbook for educational audiology and other
(Deanna Meinke), and tele-audiology practice (Sarah Flor- related coursework. The companion website contains a
ence). In addition, Krista Yuskow, among others, have pro- basic syllabus, and learning objectives, discussion questions,
vided practical nuggets for everyday application of various and PowerPoint slides for each chapter. We hope to provide
components of educational audiology services. students in AuD and other related programs (speech-language
Look for this icon throughout the text indicating Nug- pathology, deaf education) with an appreciation for the prac-
gets from the Field: Overall, we have tried to emphasize tice of audiology in educational settings as well as the im-
the importance of improving outcomes for all children with portance of teamwork and parent involvement when serving
auditory deficits, particularly with the increasing diversity students who are deaf or hard of hearing.
in student demographics, performance, and learning envi-
ronments. We also hope to move the focus on disability or
deficits to wellness and promote a positive perspective of Acknowledgments
hearing and processing “differences” in order to align with In addition to our author contributors, we would like to rec-
school efforts to promote social-emotional well-being in ognize the students who contributed chapter page artwork.
all students. We believe that our students’ identities, self- They are:
xix

xx Preface
Allison, Mogadore, OH cons! The connections you make are long lasting and
Anec, Edmonton, Alberta, CA you learn a great deal along the way about the impact
Ben, Athens, GA of hearing loss on the lives of children and families. I
Billy, Mogadore, OH say give it a go . . . it is definitely worth trying!”
Jaxen, Denver, CO “27 years and counting. I love this career although
Nikayla, Edmonton, Alberta, CA there are days I don’t like the ‘job’ very much. Every
Sara Madeleine, Colorado Springs, CO job has plus and minuses but I wouldn’t trade the irrita-
Sophia, Greeley, CO tions in this position for any other one! I took the leap
Izabela, Justin, Rupert, Katie, & Emmy, Ohio high school after working in the medical side of things since 1999.
students I now work in the 0–5 program including the preschool.
I often would call my mom or a friend for months after
Finally, we would like to acknowledge the spirit and
starting having to talk about how much I love my job! I
work of all audiologists, especially those who devote their
am sure they were sick of hearing it. I also share space
careers to working in the schools. The politics and resource
with the 2 audiologists that work in the public schools
limitations in education are challenging and require our con-
and work closely with 2 university audiologists. We all
stant vigilance. However, the gratification of working with
have sat and talked about how lucky we were to have
students, parents, teachers, and other school professionals,
landed our gigs! Go for it, it is so worth it profession-
and our ability to be involved in the lives of the children for
ally and personally.”
such a critical part of their development yields countless
rewards; perhaps why so many of us remain in our positions “There are headaches, frustrations, and challenges,
throughout our careers. We close with the following remarks, but the rewards of seeing the impact of what you do
taken from the Educational Audiology Association List- in the lives of both the child/family and in the school
serve, in response to a query for reasons to motivate gradu- environment . . . is worth every minute. I have worked in
ate students in audiology about careers in educational audi- many different roles as an audiologist (clinical, private
ology. They describe why we love what we do. practice, early intervention, and now in education) and
I have no regrets. I love my job and hope to be here
for many years to come. I think back to grad school
“LOVE my job . . . nothing better than watching a kid do
when Kris English told me I would be an educational
well and knowing you had a part in it. I don’t get sum-
audiologist and I told her, “I don’t think so!” Looking
mers off . . . but I still LOVE my job . . . even after
back (several years later), I remember the phone call to
24 years and lots of admin headaches and parent
Kris after I moved here and started as an educational
pains . . . . .”
audiologist admitting, “OK, you were right . . . this is
“There will be headaches with any job. What I can tell you exactly where I should be. (Thanks Kris)”
is that working with kids in schools is so rewarding over
“I have been an audiologist with an ENT, an audiolo-
time. You may not realize day to day the impact you can
gist with a non-profit speech and hearing center, and now
have on a child’s life but you will and you will find out
an audiologist in a large school district. My favorite has
as they grow and flourish and succeed. . . . and later in
been the school setting . . . hands down! I enjoy the chal-
your life, some of those very kids will find you and tell you
lenges, the interaction with the kids, and the camaraderie
that. . . . . and when that happens, any challenge I have
within the special education department. And I cannot
had with a parent or an administrator just melts away. . . .”
tell a lie . . . I enjoy these summers with my own kids!!”
“I just came in contact less, than 2 weeks ago, with a
“I am a dual certified/licensed, SLP/A. I worked in the
36-year-old hearing-impaired guy who is now a coun-
public school arena for 34 years spending 1/2 time
selor for the deaf and hard of hearing. . . . . I saw his
doing SLP and 1/2 time doing Ed Aud stuff. I retired
name on his office door. . . . . . it was the same ‘little boy’
from the school district five years ago and they kept me
I had worked with in the preschool deaf program from
on, on a consulting basis, to continue to function as the
1975–1978. . . . . . . wow, what a feeling. So, unless you
Ed Aud for however long they will tolerate me. Despite
can search inside yourself and find a really great reason
the ups and downs, I wouldn’t trade those 34 years for
to not work in the schools with kids, then do it!!”
anything. And now, I still love my time ‘in district’ once
“As an educational audiologist for 20 some years, I per week. Of course, I don’t tell that to the Special Ed.
wasn’t really all that surprised to hear the words, ‘Can Director because I need to maintain an aura of inde-
you believe I get paid to do this?,’, come out of my pendence. Headaches and fighting with parents and ad-
mouth as I was working with an AuD intern!” ministrators come with any job in our related fields. It’s
“The job is SO rewarding and offers complete job satis- up to you to “educate and demonstrate” (stolen from a
faction overall. I truly believe the pros far outweigh the rather well-known stuttering officionado in NYC) to the

Preface xxi
uninitiated, in a way that produces the best results for do my job better. If you feel a sense of frustration in a
our hearing-impaired charges, and results in optimal standard clinical setting because you are locked out
outcomes.” of knowing the middle and end of the pediatric ‘story,’
“For me educational audiology has always been about then educational audiology is for you.”
the opportunity to learn as much as I can about pe-
diatric hearing loss impact across a broad spectrum Cheryl DeConde Johnson and Jane Seaton
of domains, which hopefully has in turn helped me to November, 2019

Contributors
Lisa R. Cannon, AuD, CCC-A Erin C. Schafer, PhD

Educational Audiologist, Denver Public Schools Associate Professor
Audiology Coordinator, Colorado Department of Education Department of Audiology and Speech-Language Pathology
Denver, Colorado University of North Texas
Chapter 6 Denton, Texas
Chapter 8
Janet DesGeorges
Executive Director, Hands & Voices Carrie Spangler, AuD, CCC-A
Boulder, Colorado Lead Educational Audiologist
Chapter 3 Summit Educational Service Center
Cuyahoga Falls, Ohio
Sarah Florence, AuD Chapters 10 & 13
Educational Audiology Coordinator, University of North
Texas Krista Yuskow, AuD, R. Aud
Educational Audiology Consultant: Onsite and Remote Educational Audiology Consultant
Services Inclusive Learning–Edmonton Public Schools
Conifer, Colorado Edmonton and Wood Buffalo Regional Collaborative
Chapter 17 Service Delivery
University of Alberta, Guest Lecturer
Deanna K. Meinke, PhD, CCC-A Edmonton, Alberta
Professor Chapter Nuggets and Student Artwork
Audiology and Speech-Language Sciences
University of Northern Colorado
Co-Director of Dangerous Decibels
Greeley, Colorado
Chapter 12
xxiii

SECTION I
EDUCATIONAL
AUDIOLOGY PRACTICES
Plural_Johnson_Ch01.indd 1 2/25/2020 3:25:52 AM

CHAPTER 1
Legislative and Policy
Essentials
Chapter 1
CONTENTS
Key Legislation
Legislation and Policies
Key Initiatives and Events in Deaf Education

Inclusion ■ The Deaf Child Bill of Rights ■ Early Hearing Detection and Intervention ■ The National
Association of State Directors of Special Education ■ The Council for Exceptional Children, Division for
Communication, Language, and Deaf/Hard of Hearing ■ Legislative Initiatives
“Lisn Pls” to what I need to hear in my classroom.

4 Chapter 1
CONTENTS (Continued )
Summary
Suggested Readings and Resources
Appendices
1–A Comparison of Pertinent Areas of the Individuals With Disabilities Education Act (IDEA) Part B, Section
504, and the Americans With Disabilities Act (ADA) (Text)
1–B Comparison of Pertinent Part B and Part C Individuals With Disabilities Education Act (IDEA) Requirements
Chapter 1
Related to Children and Youth Who Are Deaf or Hard of Hearing (Text)
1–C Summary of Laws Pertaining to Persons Who Are Deaf or Hard of Hearing
(Text/Online)
1–D Key Individuals With Disabilities Education Act (IDEA) Regulations Pertaining to Audiology and Deaf
Education Services (Online)
KEY TERMS ■■ Major limitations of the Individuals with Disabilities

Education Act (IDEA) are that individual states have a
Statutes, regulations, Individuals with Disabilities Education great deal of latitude in their interpretation of the provi-
Act (IDEA), Section 504, Americans with Disabilities Act sions and that the federal government lacks significant
(ADA), effective communication under ADA, accommoda- consequences in its accountability system.
tions, modifications, equal access, special communication ■■ All students with reduced hearing or other auditory dis-
factors orders must be represented on the Individualized Edu-
cation Program (IEP) team by a specialist in hearing/
deafness. (“specialist” may be defined by each state’s
KEY POINTS plan but is usually a teacher of deaf and hard of hear-
ing students, an audiologist, or sometimes a speech-
language pathologist who can interpret test results and
■■ A growing number of students with reduced hearing
make appropriate recommendations.)
and other auditory deficits are not being served through
■■ While many students have more opportunity because of
special education.
the increased accountability, additional legislation, and
■■ To staff school audiology services at the American
other education initiatives of the past decade, there is
Speech-Language-Hearing Association (ASHA) and Ed-
still much work to do to ensure the required and recom-
ucational Audiology Association (EAA) recommended
mended practices are implemented at the local school
level of one audiologist for every 10,000 students, 3,785
level in the intended manner.
more audiologists are needed in the schools.
Educational audiology represents one of the most chal-
lenging yet rewarding practice areas of our profession. The
challenge is in reconciling the sheer numbers of children
The first definition of Educational Audiol- and their diverse needs with sufficient audiology full-time
ogy was proposed by Berg and Fletcher in equivalent (FTE) positions, support, equipment, and re-
1976 as an outcome of the 1965 Babbidge sources to meet those needs. The reward is the opportunity
Report: to make a difference in children’s lives every day. What are
Educational audiology seeks to isolate the parame- some of the challenges facing audiologists in educational
ters of hearing impairment, to identify the deficien- settings?
cies rising from hearing disabilities, to relate these
to the unique characteristics of individuals, and to ■■ A large in-school population—about 50,580,000 chil-
develop educational programs specifically for hard- dren prekindergarten through grade 12 in the United
of-hearing children. (Berg, 1976, p. 30) States based on 2016 enrollment data reported by the
National Center for Education Statistics (https://nces
.ed.gov/programs/digest/d17/tables/dt17_201.10.asp).

Legislative and Policy Essentials 5
■■ A large out-of-school population including children special education. These students are in general educa-
who are birth through age 2 years, children attending tion classrooms and often do not have Section 504 plans
community-based preschools, and students who are or other formally identified accommodations.
incarcerated or in special facilities. From these popula- ■■ Many unserved students that did not meet eligibility for
tions, children with reduced hearing must be identified, services under the Individuals with Disabilities Educa-
and appropriate services must be provided. tion Act (IDEA) when they transitioned from early in-
■■ A growing number of students with reduced hearing tervention and thus lack monitoring or follow-up until
and other auditory deficits who are not served through they have difficulty or fail in general education programs.
Chapter 1
TABLE 1–1 Number of Full-Time Equivalent Audiologists Employed by States and Audiologist-to-Student Ratios During the
1991–1992, 2006–2007, and 2016–2017 School Years
1991–1992 2006–2007 2016–2017 2016–2017

FTE FTE FTE Audiologist to
State Audiologists1 Audiologists2 Audiologists3 Student Ratio
Alabama 8 21 10.66 1:69,034
Alaska 4 3 5.9 1:22,525
Arizona 16 63 47.83 1:23,561
Arkansas 4 4 2.85 1:172,737
California 51 198 124.41 1:50,440
Colorado 31 54 58.8 1:15,480
Connecticut 15 No data No data
Delaware 2 13 12 1:11,433
D.C. 4 3 2 1:43,150
Florida 47 60 54.5 1:51,719
Georgia 39 26 36.4 1:48,755
Hawaii 3 1 1 1:188,500
Idaho 10 4 3.62 1:80,967
Illinois 48 36 31.64 1:64,434
Indiana 14 15 21.6 1:48,153
Iowa 58 50 42.51 1:12,000
Kansas 19 22 23.12 1:21,648
Kentucky 4 7 5 1:139,200
Louisiana 15 22 20 1:36,184
Maine 11 24 9.86 1:18,124
Maryland 25 29 32.1 1:27,763
Massachusetts 7 5.86 1:162,270
Michigan 20 14 21.66 1:69,474
Minnesota 26 52 37.32 1:23,395
(Continues )

6 Chapter 1
TABLE 1–1 (Continued )
1991–1992 2006–2007 2016–2017 2016–2017

FTE FTE FTE Audiologist to
State Audiologists1 Audiologists2 Audiologists3 Student Ratio
Mississippi 9 1 4.87 1:100,103
Missouri 13 16 11.6 1:78,931
Montana 4 4 2.83 1:51,767
Nebraska 3 7 3.22 1:98,851

Chapter 1
Nevada 3 6 7.52 1:62,633
New Hampshire 1 3 .91 1:197,473
New Jersey 44 51 35.2 1:39,347
New Mexico 21 35 18.11 1:18,758
New York 21 105 118.46 1:23,231
North Carolina 32 77 73.41 1:21,409
North Dakota 3 4 2 1:56,300
Ohio 26 93 39.47 1:43,276
Oklahoma 4 5 6 1:116,200
Oregon 64 16 14.05 1:43,324
Pennsylvania 25 40 76.32 1:22,543
Rhode Island 2 0 1 1:140,700
South Carolina 17 13 15.75 1:49,041
South Dakota 3 4 .82 1:165,366
Tennessee 32 22 24.35 1:41,035
Texas 21 40 63.5 1:84,740
Utah 22 26 26.68 1: 24,561
Vermont 2 5 1.86 1:45,860
Virginia 127 66 45.7 1:28,330
Washington 0 28 29.53 1:37,071
West Virginia 5 8 7.2 1:38,736
Wisconsin 12 19 24.35 1:35,639
Wyoming 8 5 3.25 1:29,662
BIA 1 12 4.2
Total 999 1439 1272.8
Audiologist-to-Student 1:42,173 1:34,271 1:39,733

Ratio4
1
U.S. Department of Education (1994b). Sixteenth Annual Report to Congress on the Implementation of the Individuals with Disabilities Education Act, p. A-212.
2
http://www.ideadata.org, Table C-1 (Estimated Resident Population Ages 6–17 years, 2008) and Table 3–5, Audiologists Employed to Serve Children and Students
ages 3–21 Under IDEA, Part B, Fall 2006).
3
U.S. Department of Education. 40th Annual Report to Congress on the Implementation of the Individuals with Disabilities Education Act. Exhibit 45: Number of full-time
(FTE) personnel to provide related services for children and students ages 3 to 21 served under IDEA, Part B (state audiology FTE provided by OSEP to author
5.7.19).
4
Based on Pre-K to 12th-grade enrollment, National Center for Educational Statistics (https://nces.ed.gov).

■■ School districts that often do not know about students

with reduced hearing unless they have Individualized Ed- Understanding Statutes and
ucation Programs (IEPs). Therefore, these students often Regulations
must “fail” before their hearing status is revealed or con-
nected to their learning problems. The education system Statutes are laws passed by Congress (at the federal
is often “failing” these students and leaving them behind. level) and state and local legislatures. These laws
■■ An alarming shortage of educational audiologists to pro are often termed “Acts” and, at the federal level,
vide services to these students. As shown in Table 1–1, are numbered according to the Congress within
1,273 full-time equivalent (FTE) audiologists were re- which they are passed (e.g., PL 94-142 was the
ported as employed in school settings in the United 142nd public law enacted by the 94th Congress).
States in the Fall of 2016, representing an average ratio These Acts are periodically reauthorized, often with
Chapter 1
of one audiologist for every 39,733 children. By com- amendments and name changes. At the federal
parison, there were 999 FTE audiologists reported during level, the Acts are first published in the Statutes at
the 1991 to 1992 school year, yielding a ratio of 1:42,173 Large, after which they are organized by subject in
(U.S. Department of Education, 1994b). To staff school the United States Code (U.S.C.). The U.S.C. has 50
audiology services at the American Speech-Language- subject classifications called Titles in which the laws
Hearing Association (ASHA) and Educational Audi are further indexed and assigned section numbers.
ology Association (EAA) recommended level of one Title 20 is the section for education. Example: The
audiologist for every 10,000 students, 3,785 more audi- Individuals with Disabilities Education Act (IDEA) is
ologists are needed in the schools. published in the U.S.C. as 20 U.S.C. §1400, et seq.,
■■ General and special education administrators who meaning that it is in Title 20 of the U.S.C. beginning
often have limited, if any, knowledge about listening with Section 1400 (“et seq.” is a Latin abbreviation
and communication access needs of children in learning and legal term indicating the writer is citing a page
environments. and the pages that follow).
■■ Limited financial resources to provide necessary hear- Regulations clarify and explain the United States
ing assistance technology and services for each child Code. The responsible agency (e.g., the Depart-
with hearing and listening needs. ment of Education) must publish the proposed
■■ Limited time to conduct audiology services as stipu- regulations in the Federal Register to solicit comment
lated in state and federal regulations (IDEA, 2004) in- from the public. Following revision, the final regu-
cluding ensuring consistent and effective communica- lations are then published in the Code of Federal
tion access (ADA, 2008). Regulations (C.F.R.). IDEA is published in Vol
■■ A federal law that is interpreted by each state, result- ume 34, Part 300 of the Code of Federal Regula-
ing in services and programs that differ significantly tions, referred to as 34 CFR §300. There are nu-
across state lines. These services also may vary within merous sections and subsections. Within the final
states, depending on the individual school district’s unpublished regulations, commentary is included that
derstanding, commitment, and willingness to provide responds to the proposed regulations comments.
audiology services. This commentary explains the rationale for terms,
■■ Adaptation of a traditionally clinical model of audiology definitions, and requirements of the final rules and
to one that is functional, meaningful, and responsive to is very helpful when interpreting various compo-
children and youth within the educational environment. nents of the regulations.
LEGISLATION AND POLICIES

Although legislation should define public policy, ensuring
Key events, policies, and legislation that have impacted that individual rights are protected, services are provided,
audiology and the education of deaf and hard of hearing and a level of quality is maintained, it does not guarantee
children are summarized in Table 1–2.1 A basic understand- that sufficient funds are provided or that compliance is ad-
ing of the legislative process is necessary to utilize pertinent equately enforced. Advocacy groups have played a major
laws appropriately to ensure the rights of all persons with role in the interpretation and monitoring of legislative ac-
disabilities. Statutes and their accompanying regulations tions. The area of special education, having some of the
passed by the federal government usually result in state leg- most active, productive, and influential public and profes-
islation to ensure that state laws align with federal policy. sional advocacy groups in the United States, is an excellent
1
Historical events beginning in the 1960s that were chronicled in early editions of this text.

8 Chapter 1
TABLE 1–2 Key Policies and Events Impacting the Education of Children Who Are Deaf or Hard of Hearing in the United States from
the 1960s to the Present
Legislation: Non-Special Education Legislation/Policy: Special Education Events, Reports, and Publications
1960s Joint Committee on Audiology and
Education of the Deaf (1965)
The Babbidge Report (1965)
1970s Section 504 of the Rehabilitation PL 93-380, the Education of the

Act of 1973 Handicapped Amendments of 1974
PL 94-142, Education for all
Handicapped Children Act (1975)
Chapter 1
1980s PL 100-553 established the National PL 99-457, Education of the National Commission on Excellence
Institute on Deafness and Other Handicapped Act Amendments in Education: A Nation at Risk (1983)
Communication Disorders at the (EHA) of 1986 Commission on Education of the
National Institutes of Health (1988) Deaf: Toward Equality: Education of
the Deaf (1988)
1990s PL 101-336, Americans with PL 101-476, Individuals with U.S. Department of Education Notice
Disabilities Act (1990) Disabilities Education Act (IDEA) of Policy Guidance (October 1992)
PL 103-227, Educate America Act, (1990) Council of Organizational
1994 (Goals 2000) PL 105-17, Individuals with Disabilities Representatives’ proposal for a Deaf
Education Act (IDEA) (1997) Child Bill of Rights (1992)
National Association of State
Directors of Special Education
(NASDSE): Deaf and Hard of Hearing
Students: Education Service Guidelines
(1994)
The National Deaf Education Project
(1998)
2000–2009 PL 107-110, No Child Left Behind PL 108-446, Individuals with The National Agenda (2005)
(NCLB) (2001) Disabilities Education Improvement National State Leaders Summit
PL 110-325, Americans with Act, (2004) (2005–2011)
Disabilities Act Amendments Act National Association of State
(2008) Directors of Special Education
(NASDSE): Meeting the Needs of
Students who are Deaf or Hard of
Hearing Students: Education Service
Guidelines, 2nd ed. (2006)
2010–2020 Every Student Succeeds Act 2015 U.S. Department of Justice, U.S. Pepnet 2 Building State Capacity
Department of Education (2014). Summit Series (2011–2016)
Dear Colleague Letter on Effective National Association of State
Communication Directors of Special Education
(NASDSE): Optimizing Outcomes
for Students who are Deaf or Hard
of Hearing: Educational Service
Guidelines, 3rd ed. (2018)
example of how public policy can be influenced by groups has been reauthorized under different names; for example,
heralding a common cause. “No Child Left Behind” (NCLB) in 2001, followed by the
“Every Student Succeeds Act” (ESSA) in 2015. NCLB was
the first time that specific provisions were made for the in-
Key Legislation clusion of children with disabilities in the state performance
The primary education law that delineates U.S. public and accountability systems in states.
school requirements is titled the Elementary and Second- Among the various laws passed affecting special educa-
ary Education Act (ESEA), first passed in 1965. This law tion, three are the most significant:

■■ Section 504 of the Rehabilitation Act of 1973;

■■ the Individuals with Disabilities Education Act (reau- Specially Designed Instruction
thorized and amended numerous times since its incep-
tion in 1975 as PL 94-142); and Specially designed instruction means adapting, as
■■ the Americans with Disabilities Act (ADA), passed in appropriate to the needs of an eligible child under
1990, and its amendments. this part, the content, methodology, or delivery of
instruction
With time the lines between these laws and their regu-
lations have blurred. However, together they provide com- (i) T o address the unique needs of the child that
prehensive protection to all children whether or not they are result from the child’s disability; and
identified as disabled under the special education statutes. Ap- (ii) To ensure access of the child to the general
curriculum, so that the child can meet the edu-
Chapter 1
pendix 1–A summarizes the key features of each law. Specific
components that differentiate these laws include the following. cational standards within the jurisdiction of the
Title II of ADA and Section 504 are both civil rights public agency that apply to all children. (34 CFR
laws; Section 504 prohibits discrimination in entities that §300.39(b)(3))
received federal financial assistance while ADA prohibits
discrimination in any state or local government entity re-
gardless of federal financial assistance. A Section 504 plan
directly applies to a student’s services and accommodations, ■■ Simply because a child with a disability under IDEA re-
while the ADA requires equal access for all individuals ceives a free and appropriate education (FAPE) through
within these entities who may be experiencing difficulties a school district’s special education program does not
connected to broader definitions of disabilities, including necessarily mean that the situation is in compliance
students who qualify for services under IDEA. with Section 504 or ADA. IDEA provides a program
IDEA eligibility requires the existence of a disability (as designed to meet the unique needs of a child and re-
identified in the IDEA, Part B regulations2) that adversely af- lated services to assist the child to benefit from special
fects educational performance necessitating special education education,5 while ADA provides the right to effective
and related services. It is the need for specialized instruction communication access “equal to” nondisabled peers, a
that distinguishes IDEA from the services provided under higher standard than is required under IDEA.
Section 504. Section 504’s broader definition also includes
persons with disabilities3 not mentioned in IDEA or state
Section 504 of the Rehabilitation Act of 1973
education policies. Furthermore, mitigating measures, that is
how well a child performs with a hearing aid or cochlear im- This act is commonly referred to as the civil rights legis-
plant or when a sign language interpreter is provided, cannot lation for people with disabilities because it was the first
be used to mitigate disability determination. Appendix 1-C law that specifically protected the rights of persons with
summarizes basic elements of each of these pertinent laws. disabilities by prohibiting recipients of federal funds from
discriminating against “otherwise qualified individuals” (34
■■ Regarding IDEA, Section 504 regulations state: “A free CFR §104). The provisions of this law are almost identical to
appropriate public education is the provision of regu- the nondiscriminatory provisions related to race in Title VI
lar education or special education and related services of the Civil Rights Act of 1964 and to gender in Title IX of
that . . . are designed to meet individual educational needs the Education Amendments of 1972.
of persons with disabilities as adequately as the needs Section 504 prohibits entities that receive federal finan-
of persons without disabilities are met.”4 Therefore, the cial assistance from discriminating based on disability, en-
obligation to provide appropriate education may extend suring that students with disabilities are provided an equal
beyond the traditional special education programs. opportunity to access and participate in or benefit from the
■■ Because a school district is obligated to provide services aid, benefits, services, and opportunities provided to others in
(evaluations, general education, reasonable accommoda- federally assisted programs. This Act defines a disability as:
tions, related services, and related aids) regardless of eligi-
bility for special education under IDEA, the school district “any person who (1) has a physical or mental impairment
may be bound to use general education funds to provide that substantially limits a major life activity; (2) has a re-
related services and/or aids for a child with disabilities. cord of such an impairment; or (3) is regarded as having
such an impairment.”6
2
34 CFR §300.5.
3
Individuals with physical or mental impairments that substantially limit
one or more major life activities or record of such impairment or regarded
5
as having such impairment. 34 C.F.R §300.39 and §300.34.
4 6
34 CFR §104.33(b)(1). 29 U.S.C. §705(9)(B), (20)(B).

10 Chapter 1
TABLE 1–3 Patterns of Services for Students Who Are Deaf or Hard of Hearing
Percentage of
Percentage of Students With an Percentage of Students Students Without
State Individualized Education Program With a 504 Plan a Service Plan
Colorado (2005) 43 2 55
Washington (2012) 57 17 26
Iowa (2012) 54 No data available 46
Minnesota (2019) 77% DHH; 12% DHH dual diagnosis; 2% 9%/20% (EC)
Chapter 1
50% EC (20% DHH, 30% other)
Note. From personal communications: Colorado, June 1, 2005; Washington, August 5, 2012; Iowa, October 4, 2012; Minnesota, June 24, 2019.
The impact of Section 504 for students with disabilities bility is an invisible barrier to their hearing, listening, and/
continues to grow as more students receive support services or understanding of auditory information. These students
under this law. Data from the Departments of Education in typically are overlooked unless knowledgeable audiologists,
Colorado, Washington, Iowa, and Minnesota reveal patterns teachers, parents, or other individuals represent their needs
of service provision for students who are deaf or hard of in schools. Amplification systems and other classroom and
hearing (Table 1–3). Students whose disabilities do not meet communication accommodations are critical general educa-
IDEA eligibility criteria but who do require communication tion supports that can be implemented for students to pro-
access or other assistance benefit from Section 504 plans. vide accessibility without special education eligibility (see
Comprehensive assessment is required prior to eligibility Chapter 11, Developing Individual Plans, for more infor-
determination to ensure that students would not benefit from mation on Section 504, and Chapter 9, Case Management
“specialized instruction” (i.e., the distinguishing feature be- and Habilitation, for additional information about student
tween services under IDEA and Section 504). As previously support needs and services). The Office of Civil Rights at
stated, The ADA Amendments Act of 2008 expanded the the U.S. Department of Education provides comprehensive
interpretation of disability to align definitions between ADA guidance regarding students with disabilities and Section
and Section 504. In addition to the broadened definition of 504, Protecting Students with Disabilities (https://www2
“major life activities” (see text box), Section 504 eligibility .ed.gov/about/offices/list/ocr/504faq.html?exp=0).
determination must be made without the effects of mitigat-
ing measures. These measures include hearing aids, medi- The Americans With Disabilities Act (ADA)
cations, and other learned behavioral adaptations such as The ADA was enacted in 1990 to provide protection from
tutoring. Therefore, a child who wears hearing aids to access discrimination based on disability, just as the 1964 Civil
classroom communications, who receives private tutoring Rights Act prohibited discrimination based on race, sex,
to maintain A and B grades or receives extensive homework creed, and national origin. Modeled after the Rehabilitation
help is still eligible as a student with a disability under Sec- Act of 1973, the ADA replaced the word “handicap” with
tion 504. “disability” and pertains to all employers, facilities, and
Two groups for which this law has significant implica- services, not just those receiving federal funds. Covered
tions are children with minimal, mild, and unilateral hear- disabilities include physical conditions affecting mobility,
ing loss, single-sided deafness, and children with auditory stamina, sight, hearing, and speech as well as conditions
processing difficulties. For these groups, acoustic accessi- such as emotional illness and learning disorders (see text
box). The Act includes five sections (called Titles) cover-
ing employment, public services and transportation, public
accommodations and commercial facilities, telecommuni-
cations, and miscellaneous provisions. Title II of the Act
Major life activities may include but are not limited pertains to public schools, institutions of higher education,
to caring for one’s self, performing manual tasks, vocational education, and public libraries. It does not apply
seeing, hearing, eating, sleeping, walking, standing, to schools of medicine, dentistry, nursing, and other health-
lifting, bending, speaking, breathing, learning, read- related schools (these are covered under Title III). The ADA
ing, concentrating, thinking, communicating, and was amended in 2008 (ADA Amendments Act) providing an
working. expanded interpretation of disability. The disability require-
ments of ADA for schools are the same as Section 504 of the
Rehabilitation Act of 1973. Thus, the expanded definition

ADA Checklist (Johnson, 2014)

IDEA provides reasonable access to public educa-
tion through individualized services regardless of 
Does the student meet disability criteria under
costs, administrative burden, or programming re- ADA?
quired. Title II of ADA requires that the services 
Does the student attend a public preschool, el-
are not only accessible, but that they provide effec- ementary, or secondary school (including char-
tive communication that is equal to that of nondis- ter schools and magnet programs)?
abled persons, so long as they do not impose an 
Does the student require auxiliary aids and ser-
undue burden or require a fundamental alteration of vices to achieve communication that is as effec-
their programs. tive as communication for individuals without
Chapter 1
disabilities?

Are the auxiliary aids and services provided by
the school based on an appropriate assessment
of disability likely resulted in an increase in the number of and analysis in accordance with
Section 504 plans whose needs may have been previously
handled under health care plans. ■■ the method of communication used by the
The Access Board (short for the Architectural and individual;
Transportation Barriers Compliance Board) was created by ■■ the nature, length, and complexity of the
the Rehabilitation Act of 1973 as an independent federal communication involved; and
agency devoted to accessibility for people with disabilities ■■ the context in which the communication is
by ensuring access to federally funded facilities. The Board taking place?
is now a leading source of information on accessible design 
Are the auxiliary aids and services provided by
and provides technical assistance and training on accessible the school primarily based on the preferences
design, including classroom acoustics, as well as general of the student, or his/her parents/guardian, with
ADA requirements. The Board continues to enforce accessi- disabilities?
bility standards that address federally funded facilities, most 
Are the auxiliary aids and services provided in
recently the Information and Communication Technology a timely manner?
(ICT) Standards and Guidelines7 in 2018. 
Are the auxiliary aids and services provided in
such a way as to protect the privacy and inde-
Effective Communication under the ADA The U.S. pendence of the student?
Department of Justice and U.S. Department of Education
together published a policy guidance, Frequently Asked
Questions on Effective Communication for Students With
Hearing, Vision, or Speech Disabilities in Public Elementary
and Secondary Schools (2014), to address obligations of
factors to the IEP toward “leveling the playing field” for
schools to provide these services (https://www2.ed.gov
children and youth who are deaf or hard of hearing.
/about/offices/list/ocr/docs/dcl-faqs-effective-communication
-201411.pdf). This guidance describes eligibility and accom
Individuals With Disabilities Education Act (IDEA)
modations under Title II of the Americans with Disabilities
Act (ADA) and the Individuals with Disabilities Education The primary legislation for children with disabilities was
Act (IDEA) as well as important differences between the first passed in 1975 as PL 94-142. This law stated that “All
laws. children who are handicapped and in need of special educa-
tion and related services must be identified, evaluated, and
The ADA Checklist (see text box and Appendix 11–E)
assured a free appropriate public education in the least re-
summarizes some of the key communication access con-
strictive environment” (Rules and Regulations, U.S. Depart-
siderations required under Title II of ADA. Timelines for
ment of Health, Education, and Welfare, August 23, 1977).
implementing ADA accommodations create some interest-
Although there have been several reauthorizations of this
ing challenges. For example, to use a remote microphone
law since, the major principles remain the same. These prin-
system, do we wait for IDEA eligibility and the IEP to use
ciples are summarized in Table 1–4. Key changes from each
IDEA funds or fit immediately as required under ADA and
reauthorization include the following:
provide through general school funds.
The implications of this policy clarification may be the ■■ 1986: expansion to ages 3 to 5 and the addition of Part
most significant development since the inclusion of special C to address services for birth to age 3;
7
36 CFR §1193 & §1194.

12 Chapter 1
TABLE 1–4 Major Principles of PL 94-142/Individuals With Disabilities Education Act (IDEA)
Full educational opportunity (zero reject) ■■ Requires that all children with disabilities be provided with a free and appropriate
public education (FAPE)
Identification ■■ Requires a child find program to locate, identify, and evaluate all children who are
suspected of having a disability who live in the jurisdiction of each public agency
Multidisciplinary evaluation ■■ Requires a full, individual, comprehensive evaluation before placement in a special
education program
■■ Evaluation must be multidisciplinary and meet specified standards, and interpretation
must consider information from a variety of sources
Chapter 1
Individualized Education Program (IEP) ■■ Development and implementation of the IEP ensures that educational programs are
determined on an individual basis to meet the needs of students with disabilities
■■ IEP requirements specify the content, scope, timeliness for writing IEPs; participants
in the IEP meeting; parent participation; private school placements; and
accountability
Least restrictive environment (LRE) ■■ Placement of children occurs so that, to the maximum possible, children with
disabilities are educated with their typical peers
■■ Removal to special classes occurs only when the nature or severity of a child’s
disability prevents successful education in general education classes even with the
use of supplementary aids and services
■■ A continuum of alternative education services from more restrictive to less
restrictive is provided by the public agency
■■ Placement decisions are determined by the goals and objectives of the student’s IEP
and are reviewed annually
Procedural safeguards and due process ■■ Establishes and implements regulations, standards, and procedures for compliance
with all procedural safeguards, including written notice to parents of referral,
confidentiality of information, rights to independent educational evaluation, parental
consent for placement, due process hearings, and appointment of surrogate parents
when needed
■■ Ensures fairness of educational decisions and the accountability for making
decisions for both professionals and parents
■■ 1990: changed “handicapped” to “disabilities,” added services and as part of assistive technology. Consider-
assistive technology devices and services; and ing multiple sources of input, Congress responded by
■■ 1997: added consideration of special factors, assistive excluding mapping services in the statute. Because the
technology use in the home when needed to receive proposed regulations were found to be ambiguous, the
FAPE, parent training. Office of Special Education Programs of the U.S. De-
partment of Education responded in the final regulations
The most recent reauthorization of IDEA, the Individu-
with language clearly defining its intentions. Although
als With Disabilities Education Improvement Act (still re-
schools are exempt from “optimizing” cochlear implant
ferred to as IDEA), PL 108-446, was passed in 2004. Se-
functioning, including mapping and maintaining or re-
lected highlights pertaining to students who are deaf or hard
placing these devices, schools are required to continue
of hearing are summarized in the following list. Implications
to provide other services as determined by the IEP team.
of these regulations are discussed in greater depth in the
These include other related services such as speech-
chapters that correspond with the topic areas.
language therapy, support for the child’s communica-
1. Cochlear Implants8 tion development, and routine monitoring of cochlear
Prior to the 2004 statute, there had been a growing implants to make sure they are functioning properly.
number of legal decisions requiring school districts to 2. Routine Checking of Hearing Aids and Cochlear Implants9
provide mapping (programming) services for children’s School systems have always been required to ensure
cochlear implants as an audiology service under related that hearing aids worn by children in school are func-
8 9
34 CFR §300.34[b]; 34 CFR §303.12. 34 CFR §300.113.

tioning properly. The new regulations changed the pre- student’s movement from school to postschool activi-
vious wording from shall ensure to must ensure, adding ties, including postsecondary education, vocational ed-
some subtle strength to the requirement. In addition, ucation, integrated employment, continuing and adult
a new section was added that specifically addresses education, adult services, independent living, or com-
cochlear implants (see earlier). It requires schools to munity participation” (34 CFR §300.43(a)). The IEP
ensure that the external components of the cochlear im- requirements were modified requiring IEPs for youths
plant are working properly (see Appendix 11–G, De- 16 years and older to contain appropriate postsecondary
troit City School District—Michigan State Education goals as well as the transition services needed to assist
Agency 15-00085 [2015]). youths to achieve those goals.
3. Assistive Technology Used at Home10 8. Response to Intervention (RTI)15
The IEP team may determine that a child needs to use Also referred to as a Multi-Tiered System of Support
Chapter 1
his or her assistive technology (e.g., remote microphone (MTSS), the RTI/MTSS framework provides a school-
system) at home or in other settings outside of school to wide approach to address the needs of all students, in-
meet IEP goals. This regulation is particularly pertinent cluding students who are struggling learners and stu-
with preschool children who may attend school for only dents with disabilities. Generally, students are served
3 or 4 half-days per week yet participate in other lan- through this framework prior to initiation of a special
guage and learning opportunities throughout the day. education referral to ensure that the learning problem
4. Interpreting Services11 is not a result of lack of appropriate instruction. The
As an official related service, interpreting includes oral MTSS framework is considered to have a broader
and cued speech transliteration, sign language inter- scope than RTI to focus on the entire education sys-
preting, note taking and computerized transcription ser- tem to set high expectations for all students. These RTI
vices (e.g., Communication Access Real-time Transla- procedures are not intended to delay or deny initial
tion [CART], C-Print, TypeWell). Although it is unclear evaluations for children suspected of having a disability
how the highly qualified requirements of IDEA have (OSEP, 2011) and therefore may not be an appropriate
impacted interpreters, ADA provides for effective com- process for students with sensory, cognitive, or physi-
munication, meaning that communication access must cal disabilities. However, the RTI principles do have
be as effective through interpreting as a student who components that potentially benefit instruction for all
does not require accommodations. children in the general education classroom. These in-
5. Eligibility for Services12 clude access to high-quality instruction (scientifically,
Eligibility for special education and related services research-based interventions) matched to individual
does not require a child to fail. Section 300.101(c) needs, frequent monitoring procedures to identify how
states “each state must assure that FAPE is available to children are responding to these interventions, and use
any individual child with a disability who needs special of child response data to inform educational decisions.
education and related services even though the child Read more about RTI/MTSS in Chapter 6, Auditory
has not failed or been retained in a course and is ad- Processing Deficits; Chapter 11, Developing Individual
vancing from grade to grade.” Plans; and Chapter 14, Education Considerations for
6. Consideration of Special Factors13 Students Who Are Deaf or Hard of Hearing.
First added in the 1997 IDEA amendments, this regula-
Despite efforts to change terminology, the definitions per-
tion requires access to communication with peers and
taining to hearing impairment and audiology services have
professional personnel in the student’s communication
remained unchanged. Definitions of hearing impairment are
or language mode. Although a subtle wording change
explained in three categories:
from “the IEP team shall consider” to “must consider,”
this regulation is the heart of the IEP for deaf or hard of ■■ “Deaf-blindness” means concomitant hearing and vi-
hearing students. IEP teams must document how each sual impairments, the combination of which causes
provision of this section is determined. such severe communication and other developmental
7. Transition Services14 and educational needs that they cannot be accommo-
The definition of transition services emphasizes a “re- dated in special education programs solely for children
sults oriented process” aimed at improving “the aca- with deafness or children with blindness.
demic and functional achievement that facilitates the ■■ “Deafness” means a hearing impairment that is so severe
that the child is impaired in processing linguistic infor-
10
34 CFR §33. 105[a][2]. mation through hearing, with or without amplification,
11
34 CFR §300.34[c][4]. that adversely affects a child’s educational performance.
12
34 CFR §300.101.
13
34 CFR §300.324[2][iv].
14 15
34 CFR §300.43 and §300.320 [b][2]. 34 CFR §300.307, 309.

14 Chapter 1
■■ “Hearing impairment” means an impairment in hearing, requirements for assistive technology devices and
whether permanent or fluctuating, that adversely affects services.
a child’s educational performance but that is not in-
This provision addresses the importance of language
cluded under the definition of deafness in this section.16
and communication access for deaf and hard of hearing stu-
Figure 1–1 summarizes key definitions for audiology and dents. Although this regulation should be the core of the
deaf education including the Part B and Part C definitions of IEP for students with reduced hearing, IEP meetings often
audiology (subtle differences between them are underlined). default to a checklist rather than having discussion regard-
Appendix 1-B compares pertinent sections of Part B and ing the full meaning and the associated consequences for
Part C regulations and Appendix 1-D contains a one page each student. Communication considerations are discussed
handout of relevant regulations pertaining to audiology and further in Chapter 11, Developing Individual Plans.
Chapter 1
education of deaf or hard of hearing students. In addition, Major limitations of IDEA are that individual states
audiologists are included as one of several “qualified person- have a great deal of latitude in their interpretation of the
nel” for providing early intervention services. provisions and that the federal government lacks signifi-
A controversial audiology service under Part C is the cant consequences in its accountability system. Further-
dispensing of amplification devices. In most states Part C is more, performance data that pertains to students with low-
a community-based service managed under agencies other incidence disabilities such as hearing impairment/deafness
than departments of education. Therefore, if hearing aids or tend to draw little attention in the monitoring process and,
other amplification devices are necessary for a child, it may as a result, are often overlooked, or compiled with other
be a community or healthcare responsibility to determine low-incidence disability data. These problems contribute to
how they are provided to the family. While Part C stipulates the variability in services that exists among states. A review
that services are provided at no cost, hearing aids, cochlear of litigation related to special education law can be found in
implants, and bone conduction devices are generally the re- Appendix 11–G. These cases demonstrate the power of the
sponsibility of the parents. Because insurance typically has court system in interpreting regulations and consequently
not covered hearing aids (although related surgical proce- providing clarification to procedures and services.
dures for implantable devices are covered by most plans), Following a general societal pattern, the reliance on the
several states have now passed legislation requiring insur- court system to define IDEA and civil rights for children
ance coverage for hearing aids. Many states and commu- continues to escalate. Unfortunately, litigation requires par-
nities also have loaner banks and other programs that will ents who have the time, money, and perseverance to take on
provide hearing aids when other resources are not available. their local school programs. In addition, such litigation may
The National Center for Hearing Assessment and Manage- not be in the best interests of the involved children because
ment (NCHAM) (http://www.infanthearing.org) maintains their parents are often pitted against their school systems in
a list of state loaner hearing aid banks. Pertinent sections of bitter disputes rather than working together for the children.
the current rules and regulations for IDEA Parts B and C Although 2004 IDEA regulations helped reduce frivolous
(2004) are contained in Appendix 1–B. cases by placing the responsibility of paying for legal fees
For deaf and hard of hearing students, the most signifi- on the parent if a decision rules against them, parents find
cant changes to IDEA since its inception occurred with the that the legal process is often their only recourse in a dispute.
addition of “special factors” as part of the development, re- IDEA now generally requires mediation as a first step for
view, and revision of the IEP.17 Each IEP team must consider resolving problems.
the following special factors: Because the IEP is the key to ensuring that appropriate
services are provided for deaf and hard of hearing students,
■■ communication needs of the child and in the case of a
it is imperative that their IEPs be developed by individu-
child who is deaf or hard of hearing, consider the child’s
als knowledgeable about the specific communication and
language and communication needs;
educational needs of these students. Therefore, all students
■■ opportunities for direct communications with peers and
with reduced hearing or other auditory disorders must be
professional personnel in the child’s language and com-
represented on the IEP team by a specialist in hearing/deaf-
munication mode;
ness. (“Specialist” may be defined by each state’s plan but
■■ academic level; and
is usually a teacher of deaf or hard of hearing students, an
■■ full range of needs, including:
audiologist, or sometimes a speech-language pathologist
opportunities for direct instruction in the child’s lan- who can interpret test results and make appropriate recom-
guage and communication mode and mendations.) To be effective, educational audiologists need
to understand their role in the IEP process. This role is dis-
cussed in Chapter 11, Developing Individual Plans.
16
34 CFR § 300.7, 34 CFR § 300.8[b].
17
34 CFR §300.324[a].

IDEA 2004 Key Regulations Pertaining to Audiology and Deaf Education

PART B RELATED SERVICES 34CFR300.34(b) PART B ROUTINE CHECKING OF HEARING AIDS AND
Exception; services that apply to children with surgically implanted EXTERNAL COMPONENTS OF SURGICALLY IMPLANTED
devices, including cochlear implants. MEDICAL DEVICES 34CFR300.113
(1) Related services do not include a medical device that is surgically (a) Hearing aids. Each public agency must ensure that hearing aids
implanted, the optimization of that device’s functioning (e.g., worn in school by children with hearing impairments, including
mapping), maintenance of that device, or the replacement of that deafness, are functioning properly.
device. (b) External components of surgically implanted medical devices.
(2) Nothing in paragraph (b)(1) of this section— (1) Subject to paragraph (b)(2) of this section, each public agency
(i) Limits the right of a child with a surgically implanted device (e.g., must ensure that the external components of surgically
cochlear implant) to receive related services (as listed in implanted medical devices are functioning properly.
paragraph (a) of this section) that are determined by the IEP Team (2) For a child with a surgically implanted medical device who is
to be necessary for the child to receive FAPE. receiving special education and related services under this part,
(ii) Limits the responsibility of a public agency to appropriately a public agency is not responsible for the post-surgical
Chapter 1
monitor and maintain medical devices that are needed to maintain maintenance, programming, or replacement of the medical
the health and safety of the child, including breathing, nutrition, or device that has been surgically implanted (or of an external
operation of other bodily functions, while the child is transported to component of the surgically implanted medical device).
and from school or is at school; or
(iii) Prevents the routine checking of an external component of a PART B DEVELOPMENT, REVIEW, AND REVISION OF IEP,
surgically-implanted device to make sure it is functioning properly, Consideration of special factors 34CFR300.324(2)(iv)
as required in §300.113(b). The IEP Team must-
(iv) Consider the communication needs of the child, and in the case of a
PART C DEFINITION OF AUDIOLOGY 34CFR303.13(b)(2) child who is deaf or hard of hearing, consider the child’s language
(2011) and communication needs, opportunities for direct communications
Audiology services includes- with peers and professional personnel in the child’s language and
(i) Identification of children with auditory impairments, using at risk communication mode, academic level, and full range of needs,
criteria and appropriate audiological screening techniques; including opportunities for direct instruction in the child’s language
(ii) Determination of the range, nature, and degree of hearing loss and communication mode;
and communication functions, by use of audiologic evaluation (v) Consider whether the child needs assistive technology devices and
procedures; services.
(iii) Referral for medical and other services necessary for the
habilitation or rehabilitation of an infant or toddler with a disability ASSISTIVE TECHNOLOGY PART B 34CFR300.5-.6 & PART C
who has an auditory impairment; 34CFR303.13(b)(1)(i)
(iv) Provision of auditory training, aural rehabilitation, speech reading Assistive technology device means any item, piece of equipment, or
and listening devices, orientation and training, and other services; product system, whether acquired commercially off the shelf, modified, or
(v) Provision of services for the prevention of hearing loss; and customized, that is used to increase, maintain, or improve the functional
(vi) Determination of the child's need for individual amplification, capabilities of children with disabilities. The term does not include a
including selecting, fitting, and dispensing of appropriate listening medical device that is surgically implanted, or the replacement of such
and vibrotactile devices, and evaluating the effectiveness of those device.
devices. Assistive technology service means any service that directly assists a
child with a disability in the selection, acquisition, or use of an assistive
PART B - DEFINITION OF AUDIOLOGY 34CFR300.34(c)(1) technology device. The term includes-
Audiology includes- (a) The evaluation of the needs of a child with a disability, including a
(i) Identification of children with hearing loss; functional evaluation of the child in the child’s customary
(ii) Determination of the range, nature, and degree of hearing loss, environment;
including referral for medical or other professional attention for (b) Purchasing, leasing, or otherwise providing for the acquisition of
the habilitation of hearing; assistive technology devices by children with disabilities;
(iii) Provision of habilitation activities, such as language habilitation, (c) Selecting, designing, fitting, customizing, adapting, applying,
auditory training, speech reading, (lipreading), hearing maintaining, repairing, or replacing assistive technology devices;
evaluation, and speech conservation; (d) Coordinating and using other therapies, interventions, or services
(iv) Creation and administration of programs for prevention of hearing with assistive technology devices, such as those associated with
loss; existing education and rehabilitation plans and programs;
(v) Counseling and guidance of children, parents, and teachers (e) Training or technical assistance for a child with a disability or, if
regarding hearing loss; and appropriate, that child’s family; and
(vi) Determination of children’s needs for group and individual (f) Training or technical assistance for professionals (including
amplification, selecting and fitting an appropriate aid, and individuals providing education or rehabilitation services), employers,
evaluating the effectiveness of amplification. or other individuals who provide services to, employ, or are otherwise
PART B INTERPRETING SERVICES 34CFR300.34(c)(4) substantially involved in the major life functions of children with
Interpreting services includes- disabilities.
(i) The following when used with respect to children who are deaf or hard PART B DEFINITIONS 34CFR300.8(c)
of hearing: oral transliteration services, cued language transliteration [2] Deaf-blindness means concomitant hearing and visual impairments,
services, and sign language transliteration and interpreting services, the combination of which causes such severe communication and
and transcription services, such as communication access real-time other developmental and educational needs that they cannot be
translation (CART), C-Print, and TypeWell; and accommodated in special education programs solely for children with
(ii) Special interpreting services for children who are deaf-blind. deafness or children with blindness.
ASSISTIVE TECHNOLOGY 300.105(a)(2) [3] Deafness means a hearing impairment that is so severe that the child
On a case-by-case basis, the use of school-purchased assistive is impaired in processing linguistic information through hearing, with
technology devices in a child’s home or in other settings is required if or without amplification that adversely affects a child’s educational
the child’s IEP Team determines that the child needs access to those performance.
devices in order to receive FAPE. [5] Hearing impairment means an impairment in hearing, whether
permanent or fluctuating, that adversely affects a child’s educational
performance but that is not included under the definition of deafness in
this section.
Prepared by Cheryl DeConde Johnson, Ed.D., The ADEvantage. (2011)
FIGURE 1–1 Key IDEA regulations pertaining to audiology and deaf education services. (Compiled by Cheryl DeConde Johnson, EdD,
The ADEvantage, 2011.)

16 Chapter 1
The Rowley Case
The first case decided by the U.S. Supreme Court involv- stream placement because the student was performing
ing PL 94-142 involved the use of a sign language inter- well without an interpreter even though she missed a
preter by a deaf student in a mainstreamed classroom. substantial portion of what was being said in class, the
In the 1982 case, Hendrick Hudson School District Board court brought forth the argument of minimum versus
of Education v. Rowley, the Supreme Court overturned maximum services. The ruling emphasized that the inten-
previous District Court and Court of Appeals decisions tion of FAPE was not to maximize the child’s education
that had interpreted “appropriate” to mean “to maxi- program but rather to provide access to a program that is
Chapter 1
mize the potential of each handicapped child commen- sufficient to confer some educational benefit.The dissent-
surate with the opportunity provided nonhandicapped ing opinion of the Supreme Court, however, emphasized
children.” In the Supreme Court’s ruling on this case, that PL 94-142 guaranteed an equal educational oppor-
“appropriate education” was defined as a program that tunity and that the basic floor of opportunity intended to
provides “personalized instruction with sufficient support eliminate the effects of the handicap, at least to the extent
services to permit the child to benefit educationally from that the child will be given an equal opportunity to learn,
that instruction. . . . In addition, the IEP, and therefore the and that passing grades alone should not be the basis for
personalized instruction, should be formulated in accor- that opportunity.The meaning of “appropriate education”
dance with the requirements of the Act, and if the child continues to be one of the most litigated areas of IDEA,
is being educated in the regular classrooms of the pub- and sometimes the impact of the litigation does find its
lic education system, should be reasonably calculated to way into regulations. For example, the 2004 IDEA regu-
enable the child to achieve passing marks and advance lations specify that passing grades cannot be used as a
from grade to grade.” By ruling that the school did not criterion to deny FAPE. (See Chapter 11 for more discus-
have to provide a sign language interpreter for the main- sion on current FAPE and eligibility regulations.)
KEY INITIATIVES AND EVENTS As time has passed, inclusion has impacted all students
with disabilities under the tenet of LRE. Although many stu-
IN DEAF EDUCATION dents are benefiting from their education in the regular class-
room, the actual benefit derived from the general classroom
Inclusion setting by some students with disabilities remains contro-
Inclusion has changed the face of special education since versial. Many school districts now only have separate class-
the 1990s. Up to this time, many students with disabilities rooms for students with the most severe behavior problems
received the majority of their education outside of the gen- or very limited cognitive function. Therefore, most deaf and
eral education classroom in resource rooms for students in hard of hearing students are educated in general education
special education. Students were mainstreamed into general classrooms relying on a consulting or itinerant teacher of the
education classrooms when the IEP team determined that deaf/hard of hearing in combination with access technolo-
they could benefit from the general education curriculum. gies and educational interpreters across the country. The use
In contrast, inclusion places students with disabilities in the of Special Factors18 is critical to ensure appropriate opportu-
general educational classroom as members of the class as nities and services are provided.
their typical peers. They are served in either push-in (within Educational audiology has been significantly impacted
the regular classroom) or pull-out models, typically sepa- by the increased inclusion of children with auditory, language,
rated only when specific instruction or therapy cannot occur and learning problems in general education classrooms. With
within the student’s classroom. Least restrictive environment fewer students educated in small groups in resource rooms
(LRE) is the term used by IDEA rather than inclusion. LRE that can be controlled for noise and distance from the speaker,
requires that students with disabilities are to be educated in auditory learning problems have escalated. In addition to chil-
the regular classroom to the maximum extent possible and dren with reduced hearing, audiologists are fitting hearing
that removal from the regular education environment occurs assistance technology on children with normal hearing who
“only if the nature of severity of the disability is such that have other language and/or learning problems to counteract
education in regular classes with the use of supplementary the effects of noise and distance listening problems. These is-
aids and services cannot be achieved satisfactorily.”17 sues are discussed further in Chapter 7, Classroom Acoustics
17 18
34 CFR § 300.114 (a)(2)(i)(ii). 34 CFR § 300.324[2][iv].

■■ Every family of an infant with hearing loss receives cul-

turally competent family support as desired.
According to the 40th Annual Report to Congress ■■ All newborns have a “medical home.”
(U.S. Department of Education, 2018), 76.8% of ■■ State Departments of Health have effective newborn hear
deaf or hard of hearing students with IEPs receive ing screening tracking and data management systems
40% or more of their education in the regular which are linked with other relevant public health infor-
classroom. mation systems.” (http://www.infanthearing.org/about/)
The National Association of State

Directors of Special Education
Chapter 1
and Other Learning Environment Considerations; Chapter 8, The National Association of State Directors of Special Edu-
Hearing Instruments and Remote Microphone Technology; cation (NASDSE) published the first edition of the Educa-
and Chapter 11, Developing Individual Plans. tional Service Guidelines for deaf and hard of hearing stu-
dents in 1994, followed by a second edition in 2006. This
The Deaf Child Bill of Rights document has provided comprehensive information about
necessary components of programming for deaf and hard
The movement for a bill of rights for deaf and hard of hear-
of hearing (DHH) students to states and school programs
ing children emanated from the 1988 Commission on Educa-
througout the United States. The third edition, Optimizing
tion of the Deaf (COED) report, the 1992 U.S. Department of
Outcomes for Students who are Deaf or Hard of Hearing:
Education Policy Guidance, and the 1992 Council of Orga-
Educational Service Guidelines (2018), continues to provide
nizational Representatives’ (COR) proposal for a Deaf Child
current recommended practices regarding administration,
Bill of Rights. Without federal legislation, several states have
early identification and intervention, evaluation and eligibil-
enacted legislation containing many of the components of the
ity, services and placement, school access accommodations,
COR-proposed Bill of Rights. Other states have adopted com-
postsecondary transition, and personnel. Chapter 1 identifies
parable policies through their state departments of education,
12 essential principles that are necessary to understand and
and still others have proposed legislation that did not pass
optimize the education of deaf and hard of hearing students.
or are in the process of developing legislation. Regardless of
This edition includes a services review checklist to review
the means, these efforts have generally resulted in a Com-
local services in relation to the recommended practices (see
munication Plan that expands on the requirements of IDEA’s
Appendix 14–D). The guidelines may be downloaded free
Consideration of Special Factors. Chapter 14, Education Con-
from http://www.nasdse.org.
siderations for Students Who are Deaf or Hard of Hearing,
provides more information regarding Communication Plans.
Early Hearing Detection and Intervention Essential Principles to Optimize the Education of Deaf
Much of the improvement in educational outcomes of deaf and Hard of Hearing Students (NASDSE, 2018)
and hard of hearing children can be attributed to early hear-
ing detection and early intervention programs. Beginning ■■ Each student is unique.
with the Walsh Bill in 1999, the Newborn and Infant Hear- ■■ High expectations drive educational program-
ing Screening and Intervention Act, most current national ming and future employment opportunities.
and state early hearing detection and intervention (EHDI) ■■ Families are critical partners.
activities are supported by the NCHAM, a technical as- ■■ Early language development is critical to cogni-
sistance center funded by the Maternal and Child Health tion, literacy, and academic achievement.
Bureau of the Health Resources and Services Administra- ■■ Specially designed instruction is individualized.
tion (HRSA) at the U.S. Department of Health and Human ■■ Least restrictive environment (LRE) is student
Services. The goal of NCHAM is “to ensure that all infants based.
and toddlers with hearing loss are identified as early as pos- ■■ Educational progress must be carefully
sible and provided with timely and appropriate audiology, monitored.
educational, and medical intervention.” NCHAM’s research, ■■ Access to peers and adults who are deaf or
training, and technical assistance activities contribute to this hard of hearing is critical.
goal by working to achieve the following objectives: ■■ Qualified providers are critical to a child’s
success.
■■ Every child born with a hearing loss is identified before ■■ State leadership and collaboration is essential.
3 months of age and provided with timely and appropri-
ate intervention by 6 months of age.

18 Chapter 1
The Council for Exceptional Children, ongoing collaborations with other organizations, the initia-
tive currently supports ASL, English (i.e., spoken English,
Division for Communication, Language,
written English, or English with or without the use of visual
and Deaf/Hard of Hearing supplements), or both, and recognizes that parents have the
The Division for Communication, Language, and Deaf/ right to choose the language methodology they use with
Hard of Hearing under the Council for Exceptional Children their child.
(CEC-DCD) has published guidance documents including a As each state group considers its constituents and
position statement describing the critical need for teachers current needs in early childhood deaf education services,
of the deaf/hard of hearing, Teachers of Students who are collaborative efforts have resulted in several successful
Deaf or Hard of Hearing, A Critical Resource Needed for statutes that are designed to identify appropriate develop-
Legal Compliance and Code of Ethical Conduct for Teach- mental assessments and track developmental milestones of
Chapter 1
ers of Students who are Deaf or Hard of Hearing. The Code children through age 5 and up to age 8. Successful legisla-
of Conduct includes a commitment to professional practice tion provides critical clarification in areas of IDEA that are
for all personnel who are involved with educating deaf and overlooked when being applied to deaf and hard of hearing
hard of hearing infants, children, and youth. These docu- children. Furthermore, the legislation institutionalizes these
ments may be accessed at https://dcdcec.org/ policies rather than relying on the goodwill efforts of the
people in charge at the state agency and local levels. Partici-
pation in local and state efforts such as this is important to
Legislative Initiatives ensure the values of all participant groups are represented.
It is important to stay up to date with ongoing and evolving
federal and state initiatives affecting students who are deaf Cogswell-Macy
or hard of hearing. Various iterations of the Alice Cogswell and Anne Sullivan
Macy Act have been introduced in Congress since 2013.
Language Equality and Acquisition for Deaf Kids The proposed act amends the Individuals with Disabilities
Language Equality and Acquisition for Deaf Kids (LEAD-K) Education Act to require a state to identify, evaluate, and
is an ongoing grassroots state-level initiative promoting provide special education and related services to children
kindergarten readiness literacy skills for children who are who have visual or hearing disabilities (or both) regardless
deaf or hard of hearing through American Sign Language of disability category. A state must also ensure that it has
(ASL) and English as described in the LEAD_K Fact Sheet enough qualified personnel to serve children who have such
(http://www.infantva.org/documents/LEAD-K-Website-At disabilities and that a full continuum of alternative place-
-A-Glance-FAQ.pdf). This movement was founded on the ments is available to meet the needs of disabled children
premise that all children who are deaf or hard of hearing for special education and related services. The primary bill
will benefit from both languages. The basis for this assertion authors have been the Conference of Educational Adminis-
stems from research from the Visual Language and Visual trators of Schools and Programs for the Deaf (CEASD) and
Learning Center (VL2) at Gallaudet University (https://vl2 the American Federation of the Blind (AFB). Regardless of
.gallaudet.edu/research/research-briefs) stating that the lack the status of this proposed legislation, it may be considered
of early and fully accessible visual language exposure may a way to introduce desired areas of modification when the
contribute to poor reading levels in deaf children. Through next IDEA reauthorization is set.
SUMMARY vocal parents’ wishes rather than risk litigation, while other
schools resist providing requested services leaving parents
While many students have more opportunity because of the to engage in mediation or other legal recourse methods. The
increased accountability, additional legislation, and other result often is that children of vocal parents get more ser-
education initiatives of the past decade, there is still much vices than those of quiet, compliant families even though
work to do to ensure the required and recommended prac- children of the latter may be just as needy.
tices are implemented at the local school level in the in- States with strong leadership in deaf education have
tended manner. As practicing educational audiologists, we engaged in systemic reform efforts, most recently using
know that our time, finances, and administrative support the 2018 NASDSE Guidelines as an opportunity to con-
have a significant impact on the services we can deliver. sider gaps in services as well as strengths. We have learned
Another factor is the increased advocacy efforts of parents, that there are no simple answers to address the problems
made on behalf of their children. Some schools succumb to of underachievement. We have also learned that improve-

ment requires state leaders and stakeholders to roll up their efforts, and these efforts need to be designed to solve, in
sleeves, work together to find common ground, and facilitate part, some of the problems facing educators of the deaf.
system change through creative planning and commitment 8. Deaf education programs need to take greater advan-
to implementation. tage of the audiologic services available at speech and
Although most educational audiologists have much to be hearing centers. This is particularly true if the centers
proud of, as a profession, we are still wrestling with many of can offer a wide variety of services, especially diagnos-
the same issues raised in the 1965 Joint Committee Report, tic services.
“Audiology and Education of the Deaf” (Ventry, 1965), a 9. The role of the speech pathologist in dealing with the
project that was identified as a beginning to resolve the issues speech and language problems associated with deafness
at the time. Read the following summary statements from that needs to be reevaluated.
project and compare them with the list of challenges identified 10. Greater understanding, appreciation, and respect for the
Chapter 1
at the opening of this chapter. Expanding “deaf ” to “deaf and contributions made by each professional group need to
hard of hearing,” do you think we are there yet? be fostered and enhanced.
11. The final conclusion is that maximum audiologic ser-
1. There is an undeniable need for increased emphasis to vices are not currently being provided to, or utilized by,
be placed on education of the deaf in audiology training deaf children and adults. As a result, many deaf individ-
programs. There is also a need, perhaps to a somewhat uals fail to achieve their maximum potential (p. 116).
lesser extent, for increased emphasis on audiology in
teacher of the deaf training programs.
2. There is a need for clarification of the roles and respon-
sibilities of both audiologists and teachers of the deaf.
3. Interprofessional relationships need to be improved. SUGGESTED READINGS
One major method of accomplishing this is to increase
contact and communication between the practicing
AND RESOURCES
teacher of the deaf and the clinical audiologist. National Association of State Directors of Special Education.
4. The audiologist needs greater exposure, probably by (2018). Optimizing Outcomes for Students who are Deaf or
means of direct contact, to the educational and language Hard of Hearing: Educational Service Guidelines. Alexandria,
problems imposed by deafness. Teachers need to be bet- VA: Author. Available from http://www.nasdse.org
ter able to utilize audiologic information in planning an U.S. Department of Education, Office of Civil Rights (n.d.). Pro-
educational program. tecting Students With Disabilities: Frequently Asked Questions
5. The audiologists can play an important and significant About Section 504 and the Education of Children with Dis-
abilities. Available from https://www2.ed.gov/about/offices
role in an educational program for deaf children. There
/list/ocr/504faq.html?exp=0
needs, however, to be greater utilization of audiologic U.S. Department of Justice and U.S. Department of Education
personnel in such programs. (2014, November 12). Frequently Asked Questions on Effective
6. If services are to be offered to deaf clients, they must Communication for Students with Hearing, Vision, or Speech
be offered by individuals who are knowledgeable about Disabilities in Public Elementary and Secondary Schools.
problems related to deafness and who have had experi- Available from http://www2.ed.gov/about/offices/list/ocr/docs
ences with deaf people. /dcl-faqs-effective-communication-201411.pdf
7. Audiologic research has much to contribute to deaf edu-
cation, but there needs to be more cooperative research

APPENDIX 1–A
Comparison of Pertinent Areas of the Individuals With Disabilities
Education Act (IDEA) Part B, Section 504, and the Americans With
Disabilities Act (ADA)
Areas IDEA Section 504 ADA, Title II
Chapter 1
Type Education Act Civil Rights Law Civil Rights Law
Title The Individuals with Disabilities The Rehabilitation Act of 1973 Americans with Disability Act
Education Act (IDEA) (2004, of 1990 (ADA) and ADA
amendments of 2008) Amendments Act, 2008
Responsible Special education General education Public and private schools

Entity (religious schools are exempt)
Funding State, local, and federal funding (IDEA No federal funding—state and No federal funding—public
funds cannot be used with students who local school responsibility and private responsibility
are only eligible under 504)
Adlinistrator Special education director or designee Section 504 coordinator (for entities 504 Coordinator may
with 15 employees or more) oversee ADA responsibilities
Service Tool Individualized Education Program (IEP) ■■ Appropriate academic Reasonable accommodations
adjustments and legal employment
■■ Accommodations and/or practices
services
Purpose To provide federal financial assistance ■■ To protect the rights of ■■ To prohibit discrimination
to state and local education agencies to individuals with disabilities from on the basis of disability by
guarantee educational rights and benefits discrimination in programs and state and local governments
for children with disabilities including activities that receive federal in employment,
the right to a free appropriate public financial assistance from the public services, and
education, an IEP designed to meet the U.S. Department of Education accommodations
child’s unique needs, and procedural ■■ To empower individuals
safeguards with disabilities to maximize
employment, economic self-
sufficiency, independence, and
inclusion and integration into
society
Population Identifies 13 categories of qualifying ■■ Identifies students as disabled so long as she/he meets the
conditions: definition of qualified persons with disabilities (e.g., “has a physical
■■ Autism or mental impairment; has a record of such impairment; or is
■■ Deaf-blindness
regarded as having such an impairment”). An impairment that
substantially limits a major life activity includes “caring for one’s self,
■■ Deafness
performing manual tasks, seeing, hearing, eating, sleeping, walking,
■■ Emotional disturbance standing, lifting, bending, speaking, breathing, learning, reading,
■■ Hearing impairment concentrating, thinking, communicating, and working”
■■ Mental retardation ■■ Determination must be made without considerations for
■■ Multiple disability “mitigating measures”
■■ Orthopedically impairment ■■ Applies to all employers, schools and educational programs,
■■ Other health impairment nursing homes, mental health centers, and human service
programs that receive or benefit from federal financial assistance
■■ Specific learning disability
■■ Speech or language impairment
■■ Traumatic brain injury
■■ Visually impaired including blindness
20


Free Both require the provision of a free appropriate public education to eligible ■■ Addresses education
Appropriate students, including individually designed instruction in terms of accessibility
Public requirements but does
Education Requires the school to provide an IEP ■■ Requires the provision of not require individual
(FAPE) designed to meet the child’s unique regular or special education entitlement for FAPE
needs and from which the child receives and related aids and services
■■ Works in conjunction with
educational benefit (i.e., “appropriate that are designed to meet
504
education”) individual educational needs
as adequately as the needs of ■■ Public entities cannot use
persons without disabilities are employment practices that
Chapter 1
met developed in a 504 Plan discriminate on the basis
of a disability
■■ “Appropriate” means an
education comparable to
the education provided to
nondisabled students
Eligibility A student is only eligible to receive ■■ A student is eligible so long as ■■ A person is eligible so
special education and/or related services she/he meets the definitions long as she/he meets the
if the multidisciplinary team determines of qualified person with definition of qualified
that the student has a disability under disabilities. The student is not person with disabilities
one of the 13 qualifying conditions and required to need specially ■■ Mitigating measures
requires specially designed instruction to designed instruction in order cannot be used to
receive FAPE to be protected exclude a person
■■ Mitigating measures cannot be ■■ ADAAA (2008) aligned
used to exclude students ADA and 504 definitions
of disabilities
Accessibility Requires that accommodations and modifications must be made to provide Requires that public and
access to a FAPE; IEP students automatically protected under 504 and ADA private programs be
accessible to individuals
with disabilities and that
“reasonable accommodations”
are provided to students with
disabilities
Undue Size of the program and its budget, Consideration is given for the Size of the business and its
Hardship type of operation, nature, and cost of size of the program, extent of budget, type of operation,
accommodation accommodation, and cost relative nature, and cost of
to school budget accommodation
Procedural Comprehensive system of safeguards Requires notice to parents No procedural safeguards

Safeguards including written notice prior to any regarding identification, evaluation, related to special education;
change in placement and the right to and/or placement. Written notice Makes provisions for
an independent evaluation at public only required before a significant public notice, hearings,
expense change in placement is made complaint procedures,
and consequences for
noncompliance
Consent Requires written consent before initial Does not require consent, but a Consent not required
evaluation and placement school district would be wise to
do so
Evaluation, Comprehensive evaluation, services, and Requires notice, not consent, for No evaluation specified;
Services, and placement according to IDEA regulations evaluation; evaluation procedures only provision of reasonable
Placement are same as IDEA; meeting not accommodations and
required for change of placement effective communication
(Continues )

22 Chapter 1
Due Both statutes require schools to provide impartial hearings for parents or No specific due process
Process guardians who disagree with the identification, evaluation, records who disagree procedures are delineated.
with the identification, evaluation, records, or placement of students with Due process hearing can
disabilities be initiated by either party.
The court may allow the
Delineates specific requirements Requires that the parent have an prevailing party, other
opportunity to participate and be than the United States, a
represented by counsel. Other reasonable attorney’s fee
details are left to the discretion
of the school district. Policy
Chapter 1
statements should clarify specific

details
Enforcement Enforced by the U.S. Office of Special ■■ Enforced by the U.S. Office for In education, enforced by the
Education Programs, U.S. Department of Civil Rights U.S. Office for Civil Rights
Education. Compliance is monitored by ■■ State Department of Education (each federal agency has its
each state’s Department of Education, has no monitoring, complaint own 504 regulations that
Office of Special Education Programs, resolution, or funding apply to its programs)
with oversight by the U.S. Department involvement
of Education
Note. Resources included https://www.ed.gov: 504, IDEA, Title II of ADA; Wrightslaw: IDEA 2004 (2006).

APPENDIX 1–B
Comparison of Pertinent Part B and Part C Individuals With Disabilities
Education Act (IDEA) Requirements Related to Children and Youth Who
Are Deaf or Hard of Hearing
Part B, Education of Children With Disabilities Part C, Early Intervention Program for Infants and
Chapter 1
(2004) (2006) Toddlers With Disabilities (2011)
Audiology 300.34(c)(1) AUDIOLOGY includes- 303.13(b)(2) AUDIOLOGY SERVICES includes-
(i) Identification of children with hearing loss, (i) Identification of children with auditory impairments,
(ii) Determination of the range, nature, and degree using at risk criteria and appropriate audiological
of hearing loss, including referral for medical or screening techniques;
other professional attention for the habilitation of (ii) Determination of the range, nature, and degree of
hearing; hearing loss and communication functions, by use of
(iii) Provision of habilitation activities, such as language audiologic evaluation procedures;
habilitation, auditory training, speech reading, (iii) Referral for medical and other services necessary for
(lipreading), hearing evaluation, and speech the habilitation or rehabilitation of an infant or toddler
conservation; with a disability who has an auditory impairment;
(iv) Creation and administration of programs for (iv) Provision of auditory training, aural rehabilitation,
prevention of hearing loss; speech reading and listening devices, orientation and
(v) Counseling and guidance of children, parents, and training, and other services;
teachers regarding hearing loss; and (v) Provision of services for the prevention of hearing loss;
(vi) Determination of the children’s need for group and
and individual amplification, selecting and fitting an (vi) Determination of the child’s need for individual
appropriate aid, and evaluating the effectiveness of amplification, including selecting, fitting, and dispensing
amplification. of appropriate listening and vibrotactile devices, and
evaluating the effectiveness of those devices.
Cochlear 300.34 RELATED SERVICES 303.16 HEALTH SERVICES

Implant (b) Exception; services that apply to children with (c) The term does not include--
Exception surgically implanted devices, including cochlear (1) Services that are--
implants. (iii) Related to the implementation, optimization
(1) Related services do not include a medical device (e.g., mapping), maintenance, or replacement
that is surgically implanted, the optimization of that of a medical device that is surgically implanted,
device’s functioning (e.g., mapping), maintenance of including a cochlear implant.
that device, or the replacement of that device. (A) Nothing in this part limits the right of an infant
(2) Nothing in paragraph (b)(1) of this section— or toddler with a disability with a surgically
(i) Limits the right of a child with a surgically implanted device (e.g. cochlear implant) to
implanted device (e.g., cochlear implant) to receive the early intervention services that are
receive related services (as listed in paragraph identified on the child’s IFSP as being needed
(a) of this section) that are determined by to meet the child’s developmental outcomes.
the IEP Team to be necessary for the child to (B) Nothing in this part prevents the EIS provider
receive FAPE. from routinely checking that either the hearing
(ii) Limits the responsibility of a public agency to aid or the external components of a surgically
appropriately monitor and maintain medical implanted device (e.g., cochlear implant)
devices that are needed to maintain the health of an infant or toddler with a disability are
and safety of the child, including breathing, functioning properly.
nutrition, or operation of other bodily
functions, while the child is transported to and
from school or is at school; or
(iii) Prevents the routine checking of an external
component of a surgically implanted device to
make sure it is functioning properly, as required
in §300.113(b). (Continues )
23

24 Chapter 1
Sign 300.34(c)(4) INTERPRETING SERVICES 303.13(b)(12) SIGN LANGUAGE AND CUED
Language, Interpreting services includes- LANGUAGE SERVICES
Speech- (i) The following when used with respect to children Sign language and cued language services include teaching
Language, who are deaf or hard of hearing: oral transliteration sign language, cued language, and auditory/or language,
Pathology services, cued language transliteration services, providing oral transliteration services (such as amplification),
Services and sign language transliteration and interpreting and providing sign and cued language interpretation.
services, and transcription services, such as
communication access real-time translation 303.13(b)(1) SPEECH-LANGUAGE
(CART), C-Print, and TypeWell; and PATHOLOGY SERVICES include--
Chapter 1
(i) Identification of children with communication or

(ii) Special interpreting services for children who are
language disorders and delays in development of
deaf-blind.
communication skills, including the diagnosis and
300.34(c)(15) SPEECH-LANGUAGE appraisal of specific disorders and delays in those skills;
PATHOLOGY SERVICES - there is no reference (ii) Referral for medical or other professional services
to speech- language services specifically for children necessary for the habilitation or rehabilitation of
who are deaf or hearing impaired. children with communication or language disorders and
delays in development of communication skills; and
(iii) Provision of services for the habilitation, rehabilitation,
or prevention of communication or language disorders
and delays in development of communication skills.
Assistive 300.5 ASSISTIVE TECHNOLOGY DEVICE 303.13(b)(1)(i) ASSISTIVE TECHNOLOGY

Technology means any item, piece of equipment, or product DEVICE means any item, piece of equipment, or
system, whether acquired commercially, off the shelf, product system, whether acquired commercially off the
modified, or customized, that is used to increase, shelf, modified, or customized, that is used to increase,
maintain, or improve the functional capabilities of maintain, or improve the functional capabilities of an infant
a child with a disability. The term does not include or toddler with a disability. The term does not include
a medical device that is surgically implanted, or the a medical device that is surgically implanted, including
replacement of such device. cochlear implants, or the optimization (e.g., mapping) or
the maintenance or replacement of that device.
300.6 ASSISTIVE TECHNOLOGY SERVICE
means any service that directly assists a child with 303.13(b)(1)(ii) ASSISTIVE TECHNOLOGY
a disability in the selection, acquisition, or use of an SERVICE means any service that directly assists an infant
assistive technology device. The term includes- or toddler with a disability in the selection, acquisition, or
(a) The evaluation of the needs of a child with a use of an assistive technology device. The term includes--
disability, including a functional evaluation of the (A) The evaluation of the needs of an infant or toddler
child in the child’s customary environment; with a disability, including a functional evaluation of
(b) Purchasing, leasing, or otherwise providing for the infant or toddler with a disability in the child’s
the acquisition of assistive technology devices by customary environment;
children with disabilities; (B) Purchasing, leasing, or otherwise providing for the
(c) Selecting, designing, fitting, customizing, adapting, acquisition of assistive technology devices by infants or
applying, maintaining, repairing, or replacing assistive toddlers with disabilities;
technology devices; (C) Selecting, designing, fitting, customizing, adapting,
(d) Coordinating and using other therapies, applying, maintaining, repairing, or replacing assistive
interventions, or services with assistive technology technology devices;
devices, such as those associated with existing (D) Coordinating and using other therapies, interventions,
education and rehabilitation plans and programs; or services with assistive technology devices, such
(e) Training or technical assistance for a child with a as those associated with existing education and
disability or, if appropriate, that child’s family; and rehabilitation plans and programs;
(f) Training or technical assistance for professionals (E) Training or technical assistance for an infant or toddler
(including individuals providing education or with a disability or, if appropriate, that child’s family; and
rehabilitation services), employers, or other (F) Training or technical assistance for professionals
individuals who provide services to, employ, or are (including individuals providing education or
otherwise substantially involved in the major life rehabilitation services) or other individuals who
functions of that child. provide services to, or are otherwise substantially
involved in the major life functions of, infants and
toddlers with disabilities.

300.105(b) ASSISTIVE TECHNOLOGY
On a case-by-case basis, the use of school-purchased
assistive technology devices in a child’s home or
in other settings is required if the child’s IEP Team
determines that the child needs access to those
devices in order to receive FAPE.
Hearing 300.113 ROUTINE CHECKING OF 303.16(c) HEALTH SERVICES
Aid/ HEARING AIDS AND EXTERNAL The term does not include--
Chapter 1
Cochlear COMPONENTS OF SURGICALLY (1) Services that are--
Implant IMPLANTED MEDICAL DEVICES (iii) Related to the implementation, optimization
Function (a) Hearing aids. Each public agency must ensure (e.g., mapping), maintenance, or replacement
that hearing aids worn in school by children of a medical device that is surgically implanted,
with hearing impairments, including deafness, are including cochlear implants.
functioning properly.
(A) Nothing in this part limits the right of an infant
(b) External components of surgically implanted or toddler with a disability with a surgically
medical devices. implanted device (e.g. cochlear implant) to
(1) Subject to paragraph (b)(2) of this section, receive the early intervention services that are
each public agency must ensure that the identified on the child’s IFSP as being needed
external components of surgically implanted to meet the child’s developmental outcomes.
medical devices are functioning properly. (B) Nothing in this part prevents the EIS provider
(2) For a child with a surgically implanted medical from routinely checking that either the hearing
device who is receiving special education aid or the external components of a surgically
and related services under this part, a public implanted device (e.g., cochlear implant)
agency is not responsible for the post-surgical of an infant or toddler with a disability are
maintenance, programming, or replacement functioning properly.
of the medical device that has been surgically
implanted (or of an external component of
the surgically implanted medical device).
Consideration 300.324(2) DEVELOPMENT, REVIEW AND

of Special REVISION OF IEP.
Factors CONSIDERATION OF SPECIAL FACTORS.
The IEP team must
(iv) Consider the communication needs of the
child and in the case of a child who is deaf or
hard of hearing, consider the child’s language
and communication needs, opportunities
for direct communications with peers and
professional personnel in the child’s language
and communication mode, academic level, and
full range of needs, including opportunities for
direct instruction in the child’s language and
communication mode; and
(v) Consider whether the child requires assistive
technology devices and services.
Native 300.29 NATIVE LANGUAGE- 303.25 NATIVE LANGUAGE-

Language (a) Native language, when used with respect to an (a) Native language, when used with respect to an
individual who is limited English proficient, means individual who is limited English proficient or LEP (as
the following: that term is defined in section 602(18) of the Act),
(1) The language normally used by that individual, means:
or, in the case of a child, the language normally (1) The language normally used by that individual, or,
used by the parents of the child, except as in the case of a child, the language normally used
provided in paragraph (a)(2) of this section. by the parents of the child, except as provided in
paragraph (a)(2) of this section; and
(Continues )

26 Chapter 1
(2) In all direct contact with a child (including (2) For evaluations and assessments conducted
evaluation of the child), the language normally pursuant to § 303.321(a)(5) and (a)(6), the
used by the child in the home or learning language normally used by the child, if determined
environment. developmentally appropriate for the child by
(b) For an individual with deafness or blindness, or for qualified personnel conducting the evaluation or
an individual with no written language, the mode assessment.
of communication that is normally used by the (b) Native language, when used with respect to an
individual (such as sign language, Braille, or oral individual who is deaf or hard of hearing, blind or
Chapter 1
communication). visually impaired, or for an individual with no written

language, means the mode of communication that is
normally used by the individual (such as sign language,
braille, or oral communication).
Disability 300.8(b) DEFINITIONS 303.21 INFANT OR TODDLER WITH A

Definitions [2] Deaf-blindness means concomitant hearing and DISABILITY
visual impairments, the combination of which (a) Infant or toddler with a disability means an individual
causes such severe communication and other under three years of age who needs early
developmental and educational needs that they intervention services because the individual-
cannot be accommodated in special education (1) is experiencing a developmental delay, as
programs solely for children with deafness or measured by appropriate diagnostic instruments
children with blindness. and procedures, in one or more of the following
[3] Deafness means a hearing impairment that is so areas:
severe that the child is impaired in processing (i) Cognitive development.
linguistic information through hearing, with or (ii) Physical development, including vision and
without amplification that adversely affects a hearing.
child’s educational performance.
(iii) Communication development.
[5] Hearing impairment means an impairment in
(iv) Social or emotional development.
hearing, whether permanent or fluctuating, that
adversely affects a child’s educational performance (v) Adaptive development; or
but that is not included under the definition of (2) Has a diagnosed physical or mental condition
deafness in this section that –
(i) Has a high probability of resulting in
developmental delay; and
(ii) Includes conditions such as chromosomal
abnormalities; genetic or congenital disorders;
sensory impairments; inborn errors of
metabolism; disorders reflecting disturbance
of the development of the nervous system;
congenital infections; severe attachment
disorders; and disorders secondary to
exposure to toxic substances, including fetal
alcohol syndrome.
Program 300.22 INDIVIDUALIZED EDUCATION 303.20 INDIVIDUALIZED FAMILY SERVICE

PROGRAM or IEP means a written statement for a PLAN or IFSP means a written plan for providing early
child with a disability that is developed, reviewed, and intervention services to an infant or toddler with a
revised in accordance with 300.320 through 300.324 disability under this part and the infant’s or toddler’s family
that--
300.101 FAPE: CHILDREN ADVANCING (a) Is based on the evaluation and assessment described
FROM GRADE TO GRADE in Sec. 303.320;
(c) (1) Each state must assure that FAPE is available (b) Includes the content specified in Sec. 303.344;
to any individual child with a disability who needs (c) Is implemented as soon as possible once parental
special education and related services, even consent to early intervention services on the IFSP is
though the child has not failed or been retained obtained (consistent with Sec. 303.420); and
in a course or grade and is advancing from grade
(d) Is developed in accordance with the IFSP procedures
to grade.
in Sec. Sec. 303.342, 303.343, and 303.345.

Educational 300.114(a) LEAST RESTRICTIVE 303.26 NATURAL ENVIRONMENTS.
Environment ENVIRONMENT. Natural environments means settings that are natural
(2) Each public agency must ensure that or typical for a same-aged infant or toddler without a
(i) To the maximum extent appropriate, children disability, may include the home or community settings,
with disabilities, including children in public or and must be consistent with the provisions of Sec.
private institutions or other care facilities, are 303.126.
educated with children who are nondisabled;
and 303.126 EARLY INTERVENTION SERVICES IN
NATURAL ENVIRONMENTS.
Chapter 1
(ii) Special classes, separate schooling, or other
removal of children with disabilities from the Each system must include policies and procedures to
regular educational environment occurs only if ensure, consistent with Sec. Sec. 303.13(a)(8) (early
the nature or severity of the disability is such intervention services), 303.26 (natural environments),
that education in regular classes with the use and 303.344(d)(1)(ii) (content of an IFSP), that early
of supplementary aids and services cannot be intervention services for infants and toddlers with
achieved satisfactorily. disabilities are provided--
(a) To the maximum extent appropriate, in natural
environments; and
(b) In settings other than the natural environment
that are most appropriate, as determined by
the parent and the IFSP team, only when early
intervention services cannot be provided
satisfactorily in a natural environment.
Service [NOTE: There are no specific qualifications for 303.12 Early intervention service provider.
Provider/ teachers or related services providers serving students (a) Early intervention service provider or EIS provider
Qualified with disabilities who have hearing impairments.] The means an entity (whether public, private, or nonprofit)
following regulations apply to all personnel. or an individual that provides early intervention
Personnel
services under part C of the Act, whether or not the
300.156 PERSONNEL QUALIFICATIONS entity or individual receives Federal funds under part
(a) General. The SEA must establish and maintain C of the Act, and may include, where appropriate,
qualifications to ensure that personnel necessary the lead agency and a public agency responsible for
to carry out the purposes of this part are providing early intervention services to infants and
appropriately and adequately prepared and toddlers with disabilities in the State under part C of
trained, including that those personnel have the the Act.
content knowledge and skills to serve children with
(b) An EIS provider is responsible for—
disabilities.
(1) Participating in the multidisciplinary individualized
(b) Related services personnel and paraprofessionals.
family service plan (IFSP) Team’s ongoing
The qualifications under paragraph (a) of this
assessment of an infant or toddler with a disability
section must include qualifications for related
and a family-directed assessment of the resources,
services personnel and paraprofessionals that --
priorities, and concerns of the infant’s or toddler’s
(1) are consistent with any State-approved family, as related to the needs of the infant or
or State-recognized certification, licensing, toddler, in the development of integrated goals and
registration, or other comparable requirements outcomes for the IFSP;
that apply to the professional discipline in
(2) Providing early intervention services in accordance
which those personnel are providing special
with the IFSP of the infant or toddler with a
education or related services; and
disability; and
(3) Consulting with and training parents and others
regarding the provision of the early intervention
services described in the IFSP of the infant or
toddler with a disability.
(Continues )

28 Chapter 1
(2) Ensure that related services personnel 303.13(c) QUALIFIED PERSONNEL. The following
who deliver services in their discipline or are the types of qualified personnel who provide early
profession-- intervention services under this part:
(i) Meet the requirements of paragraph (b)(1) (1) Audiologists.
of this section; and (2) Family therapists.
(ii) Have not had certification or licensure (3) Nurses.
requirements waived on an emergency, (4) Occupational therapists.
temporary, or provisional basis; and (5) Orientation and mobility specialists.
Chapter 1
(iii) Allow paraprofessionals and assistants (6) Pediatricians and other physicians for diagnostic and
who are appropriately trained and evaluation purposes.
supervised, in accordance with State law,
(7) Physical therapists.
regulation, or written policy, in meeting the
requirements of this part to be used to (8) Psychologists.
assist in the provision of special education (9) Registered dieticians.
and related services under this part to (10) Social workers.
children with disabilities. (11) Special educators, including teachers of children
with hearing impairments (including deafness) and
teachers of children with visual impairments (including
blindness).
(12) Speech and language
pathologists.
(13) Vision specialists, including
ophthalmologists and optometrists.
Specially 300.39 Special education 303.13 (b)(14) Special instruction

Designed (a) General. Special instruction includes-
Instruction (1) Special education means specially designed (i) The design of learning environments and activities that
instruction, at no cost to the parents, to meet promote the infant’s or toddler’s acquisition of skills in
the unique needs of a child with a disability, a variety of developmental areas, including cognitive
including— processes and social interaction;
(i) Instruction conducted in the classroom, in the (ii) Curriculum planning, including the planned interaction
home, in hospitals and institutions, and in other of personnel, materials, and time and space, that leads
settings; and to achieving the outcomes in the IFSP for the infant or
(ii) Instruction in physical education. toddler with a disability;
(3) Specially designed instruction means adapting, as (iii) Providing families with information, skills, and support
appropriate to the needs of an eligible child under related to enhancing the skill development of the
this part, the content, methodology, or delivery of child; and
instruction— (iv) Working with the infant or toddler with a disability to
(i) To address the unique needs of the child that enhance the child’s development.
result from the child’s disability; and
(ii) To ensure access of the child to the general
curriculum, so that the child can meet the
educational standards within the jurisdiction of
the public agency that apply to all children.
Note. Prepared by Cheryl DeConde Johnson, https://ADEvantage.com (May 22, 2019).

APPENDIX 1–C
Summary of Laws Pertaining to Persons Who Are
Deaf or Hard of Hearing
Law or Regulation Main Themes Regulatory Authority
Individuals With Disabilities ■■ Free and appropriate public education (FAPE) The Office of Special
Chapter 1
Education Act (IDEA) (amended ■■ Education in the least restrictive environment (LRE) Education Programs, Office
2004) http://idea.ed.gov ■■ Individualized Education Program (IEP) of Special Education and
Rehabilitative Services, U.S.
Department of Education
Every Student Succeeds Act (ESSA) The ESSA replaced NCLB as the reauthorized U.S. Department of Education
(amended 2015); Elementary and Secondary Education Act (ESEA), the
https://www.ed.gov/essa federal law guiding public education from kindergarten
through high school. ESSA continues the focus on
accountability for all students but increases state control
and flexibility to close achievement gaps, increase equity,
improve the quality of instruction, and increase outcomes
for all students.
504 (Section 504 of the School-age: FAPE Office for Civil Rights
Rehabilitation Act of 1973) Other populations: all employers, schools and educational (OCR), U.S. Department of
http://www.ed.gov/about/offices/list programs, nursing homes, mental health centers, and Education
/ocr/docs/edlite-FAPE504.html human service programs that receive or benefit from
Subpart A: General Provisions federal financial assistance. Under Section 504, any
Subpart B: Employment Practices qualified individual with a disability1 has the right to a
Subpart C: Program Accessibility reasonable accommodation, such as services or aids, to
Subpart D: Preschool, Elementary help that individual participate in the programs or jobs
and Secondary Education offered by the federally funded employer, school, or other
Subpart E: Post-Secondary Setting organization
Subpart F: Health, Welfare, and Postsecondary:
Social Services ■■ Appropriate academic adjustments as necessary
Subpart G: Procedures to ensure that it does not discriminate based on
disability. If a postsecondary school provides housing
to nondisabled students, it must provide comparable,
convenient, and accessible housing to students with
disabilities at the same cost.
■■ The program does not have to make modifications
that would fundamentally alter the nature of a service,
program, or activity or would result in undue financial
or administrative burdens.
508 (Section 508 of the Requires federal departments and agencies that develop, Office for Civil Rights (OCR),
Rehabilitation Act of 1973, procure, maintain, or use electronic and information U.S. Department of Justice
amended 1998) https://www technology to ensure that federal employees and
.section508.gov/manage/laws members of the public with disabilities have access to
-and-policies and use of information and data comparable to those
of the employees and members of the public without
disabilities unless it is an undue burden to do so. The U.S.
Access Board, responsible for developing standards for
Information and Communication Technology (ICT), issued
final standards and guidelines effective January 18, 2018.
(Continues )
29

30 Chapter 1
Law or Regulation Main Themes Regulatory Authority
Americans With Disabilities Act Prohibits discrimination on the basis of disability including Education: Office for
(ADA) of 1990 amended 2008 standards for effective communication in employment, Civil Rights (OCR), U.S.
■■ Title II: all services, programs, public services, and accommodations; sections include Department of Education
and activities, including provided (responsible agency in parenthesis): All other areas: U.S.
to the public by state and local ■■ /TBL/Employment (Equal Employment Opportunity Department of Justice, Civil
governments, including state- Center) Rights Division, Disability
operated schools, colleges, ■■ Public Transportation (U.S. Department of
Rights Section
and universities https://www Transportation)
.ada.gov/regs2010/titleII_2010 ■■ Telephone Relay Service (Federal Communications
Chapter 1
/titleII_2010_regulations.htm Commission)
■■ Title III: places of public
■■ Design Guidelines (U.S. Access Board)
accommodation (businesses and
■■ Education (U.S. Department of Education)
nonprofit agencies that serve
■■ Health Care (U.S. Department of Health and Human
the public) and “commercial
facilities” (other businesses), Services)
including private schools, ■■ Labor (U.S. Department of Labor)
colleges, and universities ■■ Housing (U.S. Department of Housing and Urban

Development)
■■ Parks and Recreation (U.S. Department of the
Interior)
■■ Agriculture (U.S. Department of Agriculture)
Family Educational Rights and ■■ The FERPA (20 U.S.C. § 1232g; 34 CFR Part 99) is U.S. Department of Education
Privacy Act (FERPA) (1974, a federal law that protects the privacy of student Complaints: Office for Civil
regulations amended 2011) education records. The law applies to all schools that Rights, U.S. Department of
http://www.ed.gov/policy/gen/guid receive funds under an applicable program of the U.S. Education
/fpco/ferpa/index.html Department of Education.
■■ FERPA gives parents certain rights with respect to
their children’s education records. These rights transfer
to the student when he or she reaches the age of
18 years or attends a school beyond the high school
level. Students to whom the rights have transferred
are “eligible students.”
Health Insurance Portability and ■■ Improved efficiency in health care delivery by U.S. Department of Health
Accountability Act (HIPAA) (1996) standardizing electronic data interchange and Human Services
http://www.hhs.gov/ocr/privacy ■■ Protection of confidentiality and security of health Complaints: Office for Civil
/index.html data through setting and enforcing standards Rights, U.S. Department of
http://www.hhs.gov/ocr/privacy ■■ Exclusion of schools: In most cases, the HIPAA Privacy Health and Human Services
/hipaa/understanding/consumers Rule does not apply to an elementary or secondary
/index.html school because the school either: (1) is not
a HIPAA covered entity or (2) is a HIPAA covered
entity but maintains health information only on
students in records that are by definition “education
records” under FERPA and, therefore, is not subject to
the HIPAA Privacy Rule. (https://www.hhs.gov/hipaa
/for-professionals/faq/513/does-hipaa-apply-to-an
-elementary-school/index.html)
■■ Contains confidentiality exceptions
Occupational Safety and Health Requires monitoring of noise levels, noise exposure, and U.S. Department of Labor
Administration (OSHA) use of ear protection in work environments
http://www.osha.gov/
1
The categories of disability were expanded to align with ADA 2008.

Appendix 1–D
IDEA 2004 Key Regulations Pertaining to Audiology and Deaf Education

PART B RELATED SERVICES 34CFR300.34(b) PART B ROUTINE CHECKING OF HEARING AIDS AND
Exception; services that apply to children with surgically implanted EXTERNAL COMPONENTS OF SURGICALLY IMPLANTED
devices, including cochlear implants. MEDICAL DEVICES 34CFR300.113
(1) Related services do not include a medical device that is surgically (a) Hearing aids. Each public agency must ensure that hearing aids
implanted, the optimization of that device’s functioning (e.g., worn in school by children with hearing impairments, including
mapping), maintenance of that device, or the replacement of that deafness, are functioning properly.
device. (b) External components of surgically implanted medical devices.
(2) Nothing in paragraph (b)(1) of this section— (1) Subject to paragraph (b)(2) of this section, each public agency
(i) Limits the right of a child with a surgically implanted device (e.g., must ensure that the external components of surgically
cochlear implant) to receive related services (as listed in implanted medical devices are functioning properly.
paragraph (a) of this section) that are determined by the IEP Team (2) For a child with a surgically implanted medical device who is
to be necessary for the child to receive FAPE. receiving special education and related services under this part,
(ii) Limits the responsibility of a public agency to appropriately a public agency is not responsible for the post-surgical
monitor and maintain medical devices that are needed to maintain maintenance, programming, or replacement of the medical
the health and safety of the child, including breathing, nutrition, or device that has been surgically implanted (or of an external
operation of other bodily functions, while the child is transported to component of the surgically implanted medical device).
and from school or is at school; or
(iii) Prevents the routine checking of an external component of a PART B DEVELOPMENT, REVIEW, AND REVISION OF IEP,
surgically-implanted device to make sure it is functioning properly, Consideration of special factors 34CFR300.324(2)(iv)
as required in §300.113(b). The IEP Team must-
(iv) Consider the communication needs of the child, and in the case of a
PART C DEFINITION OF AUDIOLOGY 34CFR303.13(b)(2) child who is deaf or hard of hearing, consider the child’s language
(2011) and communication needs, opportunities for direct communications
Audiology services includes- with peers and professional personnel in the child’s language and
(i) Identification of children with auditory impairments, using at risk communication mode, academic level, and full range of needs,
criteria and appropriate audiological screening techniques; including opportunities for direct instruction in the child’s language
(ii) Determination of the range, nature, and degree of hearing loss and communication mode;
and communication functions, by use of audiologic evaluation (v) Consider whether the child needs assistive technology devices and
procedures; services.
(iii) Referral for medical and other services necessary for the
habilitation or rehabilitation of an infant or toddler with a disability ASSISTIVE TECHNOLOGY PART B 34CFR300.5-.6 & PART C
who has an auditory impairment; 34CFR303.13(b)(1)(i)
(iv) Provision of auditory training, aural rehabilitation, speech reading Assistive technology device means any item, piece of equipment, or
and listening devices, orientation and training, and other services; product system, whether acquired commercially off the shelf, modified, or
(v) Provision of services for the prevention of hearing loss; and customized, that is used to increase, maintain, or improve the functional
(vi) Determination of the child's need for individual amplification, capabilities of children with disabilities. The term does not include a
including selecting, fitting, and dispensing of appropriate listening medical device that is surgically implanted, or the replacement of such
and vibrotactile devices, and evaluating the effectiveness of those device.
devices. Assistive technology service means any service that directly assists a
child with a disability in the selection, acquisition, or use of an assistive
PART B - DEFINITION OF AUDIOLOGY 34CFR300.34(c)(1) technology device. The term includes-
Audiology includes- (a) The evaluation of the needs of a child with a disability, including a
(i) Identification of children with hearing loss; functional evaluation of the child in the child’s customary
(ii) Determination of the range, nature, and degree of hearing loss, environment;
including referral for medical or other professional attention for (b) Purchasing, leasing, or otherwise providing for the acquisition of
the habilitation of hearing; assistive technology devices by children with disabilities;
(iii) Provision of habilitation activities, such as language habilitation, (c) Selecting, designing, fitting, customizing, adapting, applying,
auditory training, speech reading, (lipreading), hearing maintaining, repairing, or replacing assistive technology devices;
evaluation, and speech conservation; (d) Coordinating and using other therapies, interventions, or services
(iv) Creation and administration of programs for prevention of hearing with assistive technology devices, such as those associated with
loss; existing education and rehabilitation plans and programs;
(v) Counseling and guidance of children, parents, and teachers (e) Training or technical assistance for a child with a disability or, if
regarding hearing loss; and appropriate, that child’s family; and
(vi) Determination of children’s needs for group and individual (f) Training or technical assistance for professionals (including
amplification, selecting and fitting an appropriate aid, and individuals providing education or rehabilitation services), employers,
evaluating the effectiveness of amplification. or other individuals who provide services to, employ, or are otherwise
PART B INTERPRETING SERVICES 34CFR300.34(c)(4) substantially involved in the major life functions of children with
Interpreting services includes- disabilities.
(i) The following when used with respect to children who are deaf or hard PART B DEFINITIONS 34CFR300.8(c)
of hearing: oral transliteration services, cued language transliteration [2] Deaf-blindness means concomitant hearing and visual impairments,
services, and sign language transliteration and interpreting services, the combination of which causes such severe communication and
and transcription services, such as communication access real-time other developmental and educational needs that they cannot be
translation (CART), C-Print, and TypeWell; and accommodated in special education programs solely for children with
(ii) Special interpreting services for children who are deaf-blind. deafness or children with blindness.
ASSISTIVE TECHNOLOGY 300.105(a)(2) [3] Deafness means a hearing impairment that is so severe that the child
On a case-by-case basis, the use of school-purchased assistive is impaired in processing linguistic information through hearing, with
technology devices in a child’s home or in other settings is required if or without amplification that adversely affects a child’s educational
the child’s IEP Team determines that the child needs access to those performance.
devices in order to receive FAPE. [5] Hearing impairment means an impairment in hearing, whether
permanent or fluctuating, that adversely affects a child’s educational
performance but that is not included under the definition of deafness in
this section.
Compiled by Cheryl DeConde Johnson, Ed.D., The ADEvantage. (2011)
Copyright © 2021 Plural Publishing, Inc. All rights reserved. Permission to print for clinical use is granted.
The files are NOT allowed to be hosted electronically without written permission of the publisher.
CHAPTER 2
Roles and Responsibilities
of Educational Audiologists
CONTENTS
Chapter 2
Roles of Educational Audiologists
Educational Audiologists as Service Coordinators ■ Educational Audiologists as Instructional Team Members
■ Educational Audiologists as Consultants
Educational Audiologists in Schools for the Deaf

Responsibilities of Educational Audiologists
Identification ■ Assessment ■ Habilitation ■ Hearing Loss Prevention ■ Counseling and Coaching
■ Amplification, Cochlear Implants, and Other Assistive Technology
Ethical Considerations
Educational Audiology Service Delivery Models
School-Based Audiology Services ■ Contracted Audiology Services ■ Combined School-Based and Contractual
Agreement ■ Telepractice
“I’m going with my teacher to see my educational audiologist.”
31

Establishing and Expanding Educational Audiology Services in the Schools

Reimbursement for Educational Audiology Services ■ Dispensing Personal Hearing Instruments ■ Cerumen
Management ■ Support for Early Hearing Detection and Intervention
Training for Educational Audiologists
Summary
Appendices
2–A Educational Audiology Association: Supporting Students who are Deaf and Hard of Hearing: Shared and
Suggested Roles of Educational Audiologists, Teachers of the Deaf and Hard of Hearing, and Speech-
Language Pathologists, Checklist (Text/Online)
2–B Part C Roles of Audiologists in Early Hearing Detection and Intervention (Text/Online)
Chapter 2
2–C Educational Audiology Association: Educational Audiology Scope of Practice (Text/Online)
KEY TERMS School-based audiologists are in a unique position to

facilitate and support the education of students with reduced
Educational audiologist, school-based audiologist, educa- hearing. Unfortunately, the need to have comprehensive au-
tionally significant hearing loss, specialized instructional diology services within school systems is often not obvious
support personnel (SISP), telepractice/teleaudiology, work- to administrators, teachers, and parents. These individuals
load approach may be aware of legal mandates to provide equal access and
appropriate services for deaf and hard of hearing students,
but they may seek to do so using a more traditional clinical
KEY POINTS model of audiology services. The clinical model focuses on
diagnosis of hearing levels, and intervention often is limited
■■ The roles of educational audiologists vary depending on to medical management and/or the provision of personal
other services and personnel available to assist children amplification. The importance of these services should not
within the school system. be diminished, but the educational impact of reduced hear-
■■ Educational audiology responsibilities are described in ing must be comprehensively assessed and interventions
legislation (e.g., Individuals with Disabilities Education implemented to appropriately and fully meet the individual
Act (IDEA), Section 504 of the Rehabilitation Act of needs of each student.
1973) and delineated in professional scopes of practice. To create an educational audiology position in a school
Results from case law may provide additional interpre- district or to expand existing services for deaf and hard of
tation of these responsibilities. hearing students, it is imperative that educational audiolo-
■■ Educational audiologists are critical members of educa- gists understand their role and responsibilities in the edu-
tional teams that develop and implement programs and cational system. Educational audiologists must work with
support for individual students who are deaf or hard of their school administration to define their positions and
hearing and may serve as service coordinator, instruc- to develop a plan for delivering audiology services to all
tional team member, and/or consultant. students including those with hearing and listening chal-
■■ Educational audiologists provide identification and in- lenges and those with normal hearing levels. After audiol-
tervention services as well as accommodations for stu- ogy services are in place in a school system, educational
dents with hearing and listening challenges in general audiologists should continue to advocate for their services
and special education settings. by providing evidence that illustrates their impact. With-
■■ Factors impacting delivery models for educational audi- out continued awareness of the importance of educational
ology services include number and type of schools and audiology services, these services may not be used effec-
student populations, geographic territory to be covered, tively and may eventually be reduced or eliminated. Ad-
specific needs of identified deaf or hard of hearing stu- ditionally, documenting outcomes of services provides ac-
dents, and availability and expertise of other specialized countability, a critical component for sustainability of any
instructional and support personnel. program.
32

Roles and Responsibilities of Educational Audiologists 33
This chapter addresses the following questions: gist may also be designated by the educational team as the
service coordinator for a student with reduced hearing who
■■ What are the roles of educational audiologists?
is receiving multiple special education services. In either
■■ What responsibilities do educational audiologists have
of these situations, the educational audiologist provides re-
in learning environments?
sults, interpretations, and recommendations resulting from
■■ What knowledge and skills are necessary for the prac-
routine diagnostic audiology services and functional listen-
tice of educational audiology?
ing evaluations. In addition, educational audiologists work
■■ What systems can be implemented for effective and ef-
with the general and special education teachers, the student,
ficient delivery of educational audiology services?
the parents, and other relevant school professionals to see
■■ What strategies can be used to expand and improve the
that appropriate services and classroom accommodations
effectiveness of audiology services in the schools?
are provided. As the service coordinator, the educational
audiologist is responsible for monitoring the student’s edu-
cational progress and plays a key role in facilitating changes
ROLES OF EDUCATIONAL in educational placement and/or accommodations when
changes are necessary. Service coordinator responsibilities
AUDIOLOGISTS for educational audiologists may include the following:
Chapter 2
The roles of educational audiologists vary depending on ■■ preparing teachers and other service providers to sup-
the services and other specialized instructional and support port students with a variety of hearing levels and com-
personnel that are available to assist children within the munication needs;
school system. Educational audiologists are members of the ■■ ensuring that all identified individual student services
educational team and, in addition to performing traditional (e.g., speech-language pathology, interpreting, counsel-
audiology activities described in audiology scope of practice ing) are provided in a collaborative and timely fashion;
documents and state licensure laws, may serve at various ■■ providing regular support to teachers and other school
times in any or all of the following capacities: staff;
■■ service coordinator; ■■ monitoring student progress and outcomes;
■■ instructional team member; and/or ■■ monitoring student placements and making recommen-
■■ consultant. dations for review and further assessment when needed;
■■ supporting transitions between learning environments,
grades, schools, and postsecondary education, training,
Educational Audiologists and employment; and
as Service Coordinators ■■ maintaining complete and accurate information regard-
ing potential placement options within the local educa-
When students with reduced hearing are not receiving direct
tion agency (LEA), as well as those in the applicable
special education services, such as students in general edu-
region and state.
cation with Section 504 plans, the educational audiologist
often functions as their service coordinator with responsi- A more detailed discussion on the implementation of
bilities for monitoring their educational performance and these responsibilities is provided in Chapter 9, Case Man-
managing their accommodations. The educational audiolo- agement and Habilitation.
Educational Audiologists deliver a full spectrum of hearing of the students. Educational audiologists provide evi-
services to all children, particularly those in educational dence for needed services and technology, emphasize
settings. Audiologists are trained to diagnose, manage, access skills and supports, counsel children to promote
and treat hearing and balance problems. Educational au- personal responsibility and self-advocacy, maintain stu-
diologists are members of the school multidisciplinary dent performance levels, collaborate with private-sector
team who facilitate listening, learning, and communica- audiologists, help student transitions, and team with
tion access via specialized assessments; monitor per- other school professions to work most effectively to
sonal hearing instruments; recommend, fit, and manage facilitate student learning.
hearing assistance technology; provide and recommend
support services and resources; and advocate on behalf [edaud.org (n.d.)]

34 Chapter 2
Educational Audiologists as slightly different roles and responsibilities. For example, be-
cause they function in a school setting that serves an already
Instructional Team Members
identified population of students, their role in screening and
There are many circumstances in which an educational audi- identification may be primarily one of community support
ologist functions as a member of the instructional team, pro- and collaboration with other schools or public health pro-
viding support to teachers and other staff. When a student re- grams (e.g., infant and early childhood hearing detection
ceives special education services, whether it is a program for and intervention [EHDI]). In addition, schools for the deaf
deaf and hard of hearing children or for students with other are typically structured around a Deaf culture environment,
learning challenges, the audiologist typically collaborates requiring knowledge of American Sign Language and sen-
with and provides support to the special education teacher, sitivity to communication, terminology, and identity issues
the general education teacher, other specialized instructional that may not be as pervasive in general education school
personnel, the student, and the parents. This support is fo- programs. Educational audiologists are uniquely qualified to
cused most often on assessing the hearing status, understand- guide educational teams and families in pursuing language
ing and communicating the implications of the hearing status, and learning proficiency through one or both languages used
and managing amplification and the student’s learning en- in these specialized learning environments.
vironment to ensure communication accessibility. Support Although still having a goal of maximizing audition,
Chapter 2
may also include direct habilitation, facilitating development listening, and access for deaf and hard of hearing children
of self-advocacy skills, or other services. When teachers are and youth who are able and desire to incorporate audition
not familiar with decreased hearing and its implications, the into their communication, educational audiologists working
support provided by the educational audiologist typically is in schools for the deaf may have to be creative in designing
expanded to include in-service, coaching, and consultation environments in which students are able to use and practice
with other members of the educational team. A comprehen- these skills.
sive discussion of the educational audiologist’s activities as The number of students who use cochlear implants is
a member of the instructional team is provided in Chapter 9, continuing to increase at schools for the deaf, resulting in
Case Management and Habilitation; Chapter 10, Supporting a greater potential to use listening and spoken language
Wellness and Social-Emotional Competence; and Chap- (LSL), cued speech, and other spoken language strategies in
ter 14, Educational Considerations for Students Who Are these environments. As reported by Nussbaum et al. (2017),
Deaf or Hard of Hearing. these students are ethnically, culturally, and educationally
diverse, but they have a bond stemming from their experi-
Educational Audiologists as Consultants ences with implanted devices. The educational audiologist
Educational audiologists provide consultation to all teach- is a critical resource for students in making connections
ers, including those who may not have children with identi- with others using implanted devices, as well as supporting
fied hearing challenges in their classrooms. Teacher requests students in the care and use of their implants and related
may include, but are not limited to, any of the following: assistive devices. Educational audiologists are critical team
partners with other school personnel in the development and
■■ information about a specific child’s hearing sensitivity implementation of communication strategies and accom-
or auditory processing ability; modations both within and outside of the formal classroom
■■ activities for improving their students’ listening skills; setting.
■■ information about how to integrate and reinforce spe- In residential and day schools for the deaf, there may
cific auditory skills into classroom instruction (see Uni- be increased opportunities for audiologists to provide ha-
versal Design for Learning in Chapter 7); bilitation, support, and collaboration in addition to the re-
■■ classroom presentations related to the function of the ear, sponsibilities of educational audiologists described later in
hearing disorders, hearing loss prevention, or deaf culture; this chapter and listed in Table 2–1. Communication labs
■■ information about classroom acoustics; and other similar programs provide children and youth with
■■ assistance with the use of classroom audio distribution
systems (CADS) (aka classroom amplification systems)
or other remote microphone listening technologies; or
■■ suggestions for classroom accommodations for instruc-
tion and standardized testing.
Nuggets from the Field
EDUCATIONAL AUDIOLOGISTS Educational audiologists working within schools
for the deaf should possess a strong sense of lan-
IN SCHOOLS FOR THE DEAF guage equality and be proficient in both American
Sign Language and spoken English.
Educational audiologists who work at schools for the deaf
serve in the capacities described earlier, but they often have

a very functional approach to communication development, At times, the responsibilities of educational audiologists
and these programs often combine listening skill develop- may overlap with those of other school personnel, particu-
ment, speechreading/visual communication skills, self- larly speech-language pathologists, counselors, and teachers
advocacy development, remote microphone hearing assis- of deaf and hard of hearing students. When this occurs, it is
tance technology (RM HAT), and other assistive systems important to delineate which individual has primary respon-
and technology to help students maximize their communica- sibility for each student need so that all areas are covered.
tion skills and academic outcomes. The Educational Audiology Association (EAA) has pub-
Many schools for the deaf are experiencing increased lished a comprehensive and collaborative approach to ad-
enrollment of students with additional learning challenges. dressing the needs of deaf and hard of hearing students, Sup-
Educational audiologists in this work environment must porting students who are deaf and hard of hearing: Shared
possess knowledge of a wide variety of disability categories and suggested roles of educational audiologists, teachers of
and be able to guide the educational team in determining the deaf and hard of hearing, and speech-language patholo-
which strengths and needs are hearing related rather than gists, presented in Appendix 2–A. Individual school district
a function of other cognitive, physical, or emotional needs. or agency personnel may alter the responsibility for each
These audiologists may be able to guide the dispensing au- activity unless prohibited by state licensure or professional
diologist in choosing personal amplification with features scope of practice. The checklist in Appendix 2–A contains
Chapter 2
that are functional for the student and the student’s family. the following areas: (a) audiological and equipment needs;
Finally, schools for the deaf often provide outreach (b) speech, language, auditory, and visual needs; (c) com-
support and expertise to area public school programs serv- munication—speech, language, auditory, and visual needs;
ing a variety of students who are deaf or hard of hearing. (d) academic needs; and (e) collaboration program manage-
Educational audiologists in this role provide expertise in ment needs for students who are deaf or hard of hearing.
Individualized Education Program (IEP) goal development, Each area should be discussed and student needs identified.
accommodations, and supports needed for successful main- Individual responsibility should be designated based on spe-
stream experiences. cific student needs to ensure that all relevant components of
the checklist are assigned to a team member for follow-up.
Periodic meetings should be held to discuss new students
and review existing student checklists to ensure all are re-
RESPONSIBILITIES OF ceiving the services they need. Other specialized instruc-
tional support personnel (e.g., speech-language pathologists,
EDUCATIONAL AUDIOLOGISTS educational interpreters, school psychologists, counselors,
Regardless of the roles assumed by educational audiologists, social workers) who are part of the student’s educational
there are many responsibilities they must address. Respon- team should be included as individual systems require.
sibilities outlined in the Individuals with Disabilities Edu-
cation Act (IDEA) (2004)1 include the categories of iden- Identification
tification, assessment, habilitation, prevention, counseling,
Identification of hearing status is one responsibility that is
and amplification. Assistive technology and assistive tech-
almost always a part of the educational audiologist’s role.
nology services and proper functioning of hearing aids are
Although educational audiologists generally do not perform
additional areas defined separately in IDEA2 (see Chapter 1,
population-based hearing screening services, they may be
Appendix 1–B). A more detailed list of suggested responsi-
responsible for the administration and supervision of a
bilities for audiologists who are employed in the schools is
school hearing screening program. They may also collabo-
provided in Table 2–1.
rate with community-based audiologists and other agencies
Responsibilities of educational audiologists are dis-
to facilitate the identification of infants, toddlers, and pre-
cussed in this chapter according to the following areas:
schoolers with reduced hearing and those who are at risk
■■ identification; for later-onset hearing changes. A full discussion of hear-
■■ assessment; ing identification programs is provided in Chapter 4, Hear-
■■ habilitation; ing Screening and Identification. Chapter 15, Collaborative
■■ hearing loss prevention; School–Community Partnerships, includes more infor
■■ counseling and guidance; and mation about how community systems can work together
■■ amplification, cochlear implants, and other assistive to ensure that children who are deaf or hard of hearing are
technology. identified.
1
34CFR300.34[c]1; 34CFR303.12[d].
2
34CFR300.5-.6; 34CFR303.12; 34CFR300.15[b].

36 Chapter 2
TABLE 2–1 Suggested Responsibilities of Audiologists Employed in the Schools

Identification of hearing loss
■■ Collaborate with state and local early hearing detection and intervention (EHDI) programs and other community resources to
promote awareness and implications of hearing and listening challenges, access to screening services, and awareness of and access to
programs and services to support deaf/hard of hearing children and their families.
■■ Collaborate in the establishment, administration, and implementation of programs to identify hearing and listening challenges for
children between birth and 21 years of age.
■■ Utilize screening tools that have been validated, reflect best practices, and are culturally and developmentally appropriate.
■■ Facilitate efficient transition from initial screening through diagnosis and intervention within the educational system.
■■ Assist in training and support for individuals that implement childhood hearing screening programs.
■■ Document effectiveness of screening programs through appropriate outcome measures.
Assessment
■■ Administer and interpret behavioral and electrophysiologic measures of the peripheral and central auditory systems using calibrated
equipment in appropriate acoustical environments.
■■ Provide comprehensive audiological assessments using appropriate protocols and materials that are standardized, developmentally
Chapter 2
appropriate, free from cultural bias, and in compliance with local, state, and federal education requirements.
■■ Administer and interpret results of functional listening assessments.
■■ Assist in the identification and management of students with auditory processing disorders.
■■ Provide written and verbal interpretation of audiological assessment results, functional implications, and management
recommendations.
■■ Make appropriate referrals for further audiological, communication, educational, psychosocial, and medical assessments.
■■ Provide assessment information as member of interdisciplinary teams for deaf and hard of hearing students and those with auditory
processing disorders.
■■ Assist educational team members in making referrals for additional medical care, educational assessments, and specialized audiologic
assessments if not available within the school facilities.
Habilitation and educational management

■■ Analyze classroom noise and acoustics and recommend strategies for improving acoustic accessibility in the learning environment.
■■ Select, fit, monitor, and manage amplification used in the educational environment.
■■ Collaborate in the development and implementation of evidence-based treatment plans to facilitate communication competence
using technology, auditory skill development, communication repair strategies, speechreading, and other visual communication
supports.
■■ Identify accommodations to facilitate access to education for students with hearing difficulties who are in general education settings
and/or in special education settings.
■■ Serve as a member of the Individual Family Service Plan (IFSP), Individualized Education Program (IEP), and instructional teams
responsible for the educational plans for deaf and hard of hearing children.
■■ Collaborate in the development and implementation of an appropriate 504 plan for access to general education instruction when
special education services are not recommended.
■■ Collaborate in the application of research-based protocols to measure ongoing progress and outcomes for students receiving aural
habilitation within the educational environment.
Amplification, cochlear implants, and assistive technology

■■ Select, fit, monitor, and manage personal and classroom amplification and remote microphone hearing assistance technology
(RM HAT) used in the educational environment.
■■ Maintain a collaborative working relationship with cochlear implant program audiologists, manufacturers, families, and school
personnel to facilitate appropriate referrals and follow-up for cochlear implant evaluations and/or use.
Hearing loss prevention

■■ Provide comprehensive hearing conservation curricula within the school environment.
■■ Provide for education about and access to hearing protection devices.
■■ Collaborate with other school professionals to develop materials and design activities related to hearing conservation.
■■ Provide current resources and materials for school personnel regarding state and federal noise protection standards.
(Continues )


Counseling
■■ Provide information and support to students, families, caregivers, and educational personnel related to the educational and
psychosocial aspects and impact of reduced hearing.
■■ Facilitate a school-based learning and social environment that fosters communication access for deaf and hard of hearing students.
■■ Provide information and coaching to assist deaf and hard of hearing students in their development of self-advocacy and self-
determination skills.
■■ Facilitate communication among families of deaf and hard of hearing children and youth.
■■ Provide information to educators, families, and students regarding evidence-based benefits and limitations of hearing aids, cochlear
implants, and assistive devices, as well as use and maintenance of this technology.
■■ Make appropriate referrals to address counseling needs beyond the student’s hearing loss.
Note. From Educational Audiology Association (2019), Educational audiology scope of practice; American Speech-Language-Hearing Association (2018), Scope of practice
in audiology; American Speech-Language-Hearing Association (2002), Guidelines for audiology service provision in and for schools; National Association of State Directors of
Special Education (2018), Optimizing outcomes for students who are deaf or hard of hearing: Educational service guidelines, 3rd ed.
Chapter 2
Assessment involvement in this area has increased substantially. Educa-
tional audiologists often take the lead in performing class-
A key responsibility of educational audiologists is provid-
room acoustic measurements and in disseminating informa-
ing comprehensive and educationally relevant audiology
tion on ways to improve acoustics in listening and learning
evaluations, including functional listening performance and
environments. Educational audiologists should also promote
the assessment of central auditory functioning. Although
appropriate visual access that considers lighting and posi-
traditional audiology assessment is a primary requirement,
tioning of students to reduce glare and other visual barriers
we strongly believe that the responsibility of educational
(NASDSE, 2018, p. 41). School-based audiologists should
audiologists is to perform functional assessments of listen-
collaborate with school facilities personnel, architects, tech-
ing skills and support optimal communication access. These
nology personnel, acousticians, parents, and other members
assessments should be contingent on the student’s various
of the educational team to advocate for educational facili-
learning environments and, therefore, also require an assess-
ties that meet the current American National Standards In-
ment of the auditory and visual aspects of the classroom fa-
stitute (ANSI, 2010) standards as well as universal design
cilities. Analysis of the interactions of hearing and listening
for learning (UDL) instructional practices. Issues related
abilities is critical for communication and instructional ac-
to assessment are addressed in detail in Chapter 5, Assess-
cess, and subsequent determination of accommodations and
ment; Chapter 6, Auditory Processing Deficits; and Chap
other intervention considerations. Educational audiologists
ter 7, Classroom Acoustics and Other Learning Environment
must make appropriate referrals and be able to recognize
Considerations.
and discuss the relationship of atypical hearing or a central
auditory processing issue to the student’s overall functioning
and to help determine when the hearing status or auditory Habilitation
processing concern is educationally significant. Habilitation or intervention services can include a broad
The importance of classroom acoustics has gained rec- array of direct and indirect support for students with hearing
ognition for its role in supporting learning for all children. or listening challenges. Although not all educational audi-
With the current legislative requirements for documenting ologists assume responsibility for providing direct interven-
mastery of academic material by all students, the need and tion services to deaf and hard of hearing students, educa-
opportunity for educational audiologists to increase their tional audiologists have a critical role in habilitation that
includes working with the educational team to determine the
services that are needed and to ensure that all identified ser-
What Is an Educationally vices are provided and implemented as intended. Frequently,
educational audiologists consult with other school- and non-
Significant Hearing Loss (ESHL)? school-based professionals who are providing services to as-
sist with communication access and classroom accommoda-
Any hearing level that potentially interferes with
tions and to ensure that the services are appropriate. Direct
access to classroom instruction and impacts a child
services may focus on any or all of the following:
or youth’s ability to communicate, learn, and de-
velop peer relationships. ■■ language development;
■■ speechreading and other visual communication
supports;

38 Chapter 2
■■ auditory and listening skill development; Educational audiologists must work closely with each
■■ communication strategies; child’s family to provide support and, when necessary, IEP-
■■ hearing aid orientation; based parent coaching, counseling, and training services.
■■ use and care of personal hearing instruments and hear- Family-centered early intervention now is the norm for in-
ing assistive technology; fants and toddlers in the United States, but families often be-
■■ self-determination and advocacy about hearing and come less involved in their children’s education as the years
communication access needs; and/or go on. It is important to keep parents involved because they
■■ informational counseling. have knowledge about their children that can result in a more
productive educational program with improved outcomes.
More information on implementing habilitation services
Additionally, parents often become primary case manag-
is contained in Chapter 9, Case Management and Habilitation.
ers during periods when school personnel are not available,
such as during the summer months and holiday vacations.
Hearing Loss Prevention Educational audiologists increasingly must engage and
One of the responsibilities of educational audiologists is coach families to empower them to more fully participate
educating parents, teachers, students, and school staff about in their children’s education and to use their resources to
all levels of hearing and ways to prevent hearing loss. This support their children’s communication development and
Chapter 2
education may be accomplished through in-service pro- educational progress.

grams for teachers, development and implementation of When engaging families, educational audiologists must
noise education curricula, direct instruction to students, and be sensitive to culture and norms. Families may include only
monitoring of noise levels during various school activities. a single parent, or there may be a large extended family ac
Prevention activities often have a lower priority than other tively involved with the child. There are many various so-
responsibilities, but this information is important and can cioeconomic and cultural differences, including the unique
be a means of increasing the awareness of school personnel considerations associated with Deaf culture as well as those
about all educational audiology services. More information for families from other countries. Educational audiologists
on hearing loss prevention strategies and activities is con- must be aware of various parent/family options and prefer-
tained in Chapter 12, Prevention of Noise-Induced Hearing ences regarding communication modes, programming and
Loss and Tinnitus in Youth. services, educational placements, amplification, and other
issues. It is critical to provide impartial information in a non-
judgmental manner to parents and to support their decisions.
Counseling and Coaching A final aspect of counseling is the support to school
Counseling includes support for students, parents, and personnel, including teachers, specialized instructional sup-
school personnel regarding a child’s identity including as port personnel (SISP), administrators, and paraprofessionals
a person with reduced hearing. Identity, self-esteem, emo- to ensure that appropriate educational services are delivered
tional and social development, self-determination, and self- to and accessible for each deaf or hard of hearing student.
advocacy all contribute to a student’s wellness and ability to The educational audiologist is a member of the educational
be responsible for his or her hearing and communication- team who evaluates and provides services for students with
related needs. Students need to be fully involved in the man- hearing and listening challenges. The educational audiolo-
agement of their own hearing status if positive outcomes in gist can provide information and coaching to the classroom
these areas are to be achieved. The educational audiologist teacher and other professionals who work with each student
should be a key provider of information and coaching re- regarding the implications of the hearing status, accessibil-
lated to students’ knowledge of hearing levels, amplifica- ity issues, and potential management strategies. These is-
tion, and communication challenges within school, home, sues are addressed more completely in Chapter 3, Partnering
and community environments. And when partnering with with Families; Chapter 9, Case Management and Habilita-
parents, teachers, deaf or hard of hearing mentors, and tion; Chapter 10, Supporting Wellness and Social-Emotional
other school personnel, educational audiologists can also Competence; Chapter 11, Developing Individual Plans;
contribute to the development of identity, self-esteem, self- Chapter 13, Supporting the Educational Team; and Chap
determination, and self-advocacy skills to support students ter 14, Educational Considerations for Students Who Are
in becoming better advocates for their own communication Deaf or Hard of Hearing.
needs. In addition, educational audiologists can often facili-
tate networking and group activities with other deaf and hard
of hearing peers, a critical social and emotional component
Amplification, Cochlear Implants,
of identity and overall wellness. The role of the educational and Other Assistive Technology
audiologist as a provider of wellness and counseling support The area of hearing instruments and other assistive listen-
is discussed in more detail in Chapter 10, Supporting Well- ing technology is a major responsibility for educational au-
ness and Social-Emotional Competence. diologists. The need for audiology support services in the

school environment continues to rise as the number of stu- ■■ lack of qualified personnel and/or financial resources to
dents wearing technology and the variety of personal and support services or technology; and
assistive technologies worn by students increases. Though ■■ personal and professional biases.
technology advancements may streamline the functioning
Our ethical codes can provide benchmarks for use in
of these devices, the complexity for audiologists and teach-
monitoring and evaluating the practice of audiology in the
ers is the variety of technologies they must manage, includ-
schools. Questions of ethics often have no “right or wrong”
ing hearing aids, cochlear implants, bone-anchored hearing
answers, but considering relevant ethical practice statements
systems, FM, DM, Bluetooth, streaming, and looping, as
can help guide our thinking as we provide services to stu-
well as the connectivity between these personal and assis-
dents and their families. Increased awareness of Codes of
tive devices with other classroom technologies. More in-
Ethics that impact the practice of audiology is critical for
formation about the role of educational audiologists with
both educational audiologists and other school profession-
students using cochlear implants can be found in the EAA
als responsible for administering and supervising audiology
position statement, Educational audiologists and cochlear
services in the schools. Ethics, personal belief systems, and
implants (EAA 2005). Although either clinical audiologists
bias are discussed further in Chapters 3 and 15.
or educational audiologists may make recommendations
about a student’s use of hearing aids, cochlear implants,
Chapter 2
bone-anchored hearing devices, tactile devices, and other
amplification systems, the educational audiologist is usually EDUCATIONAL AUDIOLOGY
the individual responsible for ensuring that these devices are
functioning properly and are being used correctly and appro-
SERVICE DELIVERY MODELS
priately in the classroom (American Academy of Audiology, Educational audiology services can be delivered in various
2008 EAA, 2014). The educational audiologist is also the ways within a school district. Several different models have
person who typically makes recommendations for the use been discussed over time, but most are merely modifications
of personal DM/ FM systems, classroom audio distribution of two basic models:
systems (CADS), or other remote microphone technology
and who has the responsibility for monitoring device func- ■■ school based and
tion in the learning environment. This topic is covered in ■■ contractual agreement.
more detail in Chapter 8, Hearing Instruments and Remote Both models can be used to provide effective educa-
Microphone Technology. tional audiology services in schools, and it may be possible
that a district will find it beneficial to provide services using
a combination of the two models. Neither of these models is
superior to the other, but they each have specific advantages
ETHICAL CONSIDERATIONS and disadvantages (see Table 2–2 for a comparison of the
Codes of ethics are a guide for professional behavior, and two models).
educational audiologists may practice under one or more
formal codes that have been adopted by professional orga- School-Based Audiology Services
nizations (e.g., AAA, 2018; ASHA, 2016a; Council for Ex-
In a school-based model of services, the educational audiol-
ceptional Children, Division for Communication, Language
ogist typically is a direct employee of a single school district
and Deaf/Hard of Hearing, 2018), codes attached to state
or multidistrict education agency. Most school-based audi-
licensure laws, or guidelines found within state standards of
ologists are relatively autonomous in defining their positions
practice (Seaton, 2001). Some of the areas where ethical
and are therefore able to include comprehensive educational
concerns may impact the practice of audiology in the schools
audiology services in their job descriptions. Because school-
include the following:
based audiologists are employees of school systems, they
■■ compliance with federal and state laws, regulations, and are peers of teachers and other school personnel and are per-
policies; ceived as providing services within the system rather than
■■ relations among private and educational audiologists re- as an outsider. Scheduling flexibility for consultation and
lated to the dispensing and management of technology; follow-up can also be an advantage of this model. Although
■■ issues of confidentiality; payment for school-based audiologists frequently is based on
■■ conflicts of interest; an educational salary schedule, many systems’ salary sched-
■■ restrictions on information provided to families and ules are based on education and experience, with an incre-
caregivers; ment for advanced degrees and/or professional certification.
■■ referral procedures; Benefits, such as health insurance and retirement plans, also
■■ perceived pressure to compromise recommendations are typically part of the employment package. A major dis-
for or against services and technology; advantage is that many districts assume that the school-based

40 Chapter 2
TABLE 2–2 Comparison of School-Based and Contractual Agreement Service Delivery Models
School-Based Audiology Services Contracted Audiology Services

■■ Direct employee, typically for one employer ■■ Contract employee
■■ Benefits (e.g., insurance, retirement, staff development) ■■ No employment benefits provided
similar to other school employees included ■■ Contract typically specifies number of hours and/or days per week
■■ Services are typically comprehensive based on job required
description ■■ Services may be limited by scope of contract
■■ Relatively autonomous for service and scheduling decisions, ■■ Can be difficult to anticipate and address student needs that
dependent on administrative knowledge and support require contract changes
■■ Peer of other school employees; perceived as “insider” with ■■ Considered an “outside expert”; collaboration with teachers may
increased opportunities for collaboration be challenging
■■ District typically purchases and maintains audiological ■■ Caseload can be specified in contract
equipment and related materials ■■ District usually not responsible for diagnostic audiological
■■ Overall cost to district may be less per service equipment
■■ Possible to implement when part of a regional cooperative ■■ Lower capital outlay
Chapter 2
■■ Often less cost-effective in small, rural systems with smaller ■■ Higher cost per service
student populations unless system belongs to regional ■■ May be appropriate for small, rural systems when shared services/
cooperative that employs audiologist(s) regional cooperatives not available
■■ Caseload and geographic area may be large for regional ■■ Contracts with individual systems belonging to regional educational
cooperative cooperatives may be viewed as financially inequitable and result in
■■ Unanticipated student needs may be addressed more less efficient service delivery to students than contracting through
quickly by school-based employee the cooperative
■■ Scheduling flexibility for consultation and follow-up ■■ Staff meetings and staff development may not be covered in
■■ Staff meeting attendance may be required contract
audiologist can provide services to an infinite number of services for students. This model may be more feasible for
students. This model is effective only if the audiologist’s the school district and may be the only means of obtaining
caseload is reasonable. The EAA supports a target ratio of audiology services in small or rural districts. If the contract
one full-time equivalent (FTE) educational audiologist for is comprehensive, the services provided to the students may
every 10,000 students served by the LEA or multidistrict not differ from those provided by school-based audiologists.
agency (i.e., regional cooperative). Workload factors such However, many districts limit services in their contracts so
as extensive travel time or time-intensive services (e.g., di- that most of the services related to the educational support
rect intervention; services to infants, toddlers, students with for deaf or hard of hearing students are addressed minimally,
multiple disabilities; service provision to regional or self- if at all. Also, with this model, educational audiologists often
contained programs designed for multiple students who are are viewed as “outside experts,” and their effectiveness to
deaf or hard of hearing) may result in the need for adjustment collaborate with teachers may be compromised.
of this ratio (EAA, 2009). The ASHA Guidelines for Audi- Audiologists providing contracted audiology services
ology Service Provision in and for Schools (2002) suggests should emphasize to administrators that a full range of audi-
that there should be a ratio of at least one FTE audiologist ology services is required by IDEA (2004). Differences be-
for every 10,000 children (birth through 21 years of age). A tween educational and clinical audiology services may need
number of factors, such as geographical coverage and travel to be clarified as the contract is being developed (Table 2–3).
time, numbers of students with hearing loss beyond the ex- In addition to hearing assessments, activities such as class-
pected prevalence, and secretarial, scheduling, and computer room observations, teacher collaboration, attendance at IEP
support, are identified by ASHA as time-intensive services or IFSP meetings, equipment maintenance and repair, and
that can reduce the caseload ratio of one per 10,000 students. in-service should be specified in the contract. The Suggested
and Shared Roles checklist (Appendix 2–A) is a tool to help
guide service delivery by various members of the team.
Contracted Audiology Services Guidelines for developing contracted educational audiology
A school district may choose to provide educational audiol- services have been developed by the EAA in 2012 and are
ogy services using a contractual agreement. In this instance, available online (see recommended resources at the end of
the district contracts with the audiologist to perform specified this chapter).

TABLE 2–3 Educational Audiology and Clinical Audiology Practices
Educational Audiology Clinical Audiology

■■ Identify hearing status for children and youth ■■ Identify hearing loss at earliest age in clinical/hospital settings
■■ Collaborate with local and state early hearing detection ■■ Collaborate with local and state EHDI programs regarding
and intervention (EHDI) programs regarding follow-up and screening, diagnosis, and follow-up
intervention ■■ Collaborate with community health agencies and volunteer
■■ Participate in the development and oversight of school hearing organizations to provide adult hearing screening programs
screening programs and other programs for the prevention of ■■ Administer and provide programs for the prevention of
hearing loss work-related hearing loss
■■ Assess hearing status and interpret educational implications ■■ Administer and interpret clinical case history, behavioral,
and impact of atypical results electroacoustic, and electrophysiologic measures of the
■■ Make appropriate referrals for medical attention and peripheral and central auditory, balance, and other related
management systems to detect the presence of hearing, balance, and other
■■ Collaborate with private-sector/community-based audiologists related disorders
and other professionals relative to students’ educational needs ■■ Provide cerumen management
Chapter 2
■■ Evaluate hearing abilities and auditory skill development to ■■ Evaluate, select, fit, verify, validate, dispense, and monitor
determine hearing function in various communication and performance of a variety of technology interventions for
learning settings hearing, balance, and other related disorders
■■ Counsel students, family, and educational team regarding ■■ Assist with counseling and (re)habilitative needs related to
educational impact of identified hearing loss auditory and vestibular disorders
■■ Select, fit, verify, validate, and monitor personal amplification ■■ Promote self-advocacy for personal needs or systems change
and hearing assistance technology for educational settings ■■ Provide strategies to address other related disorders (e.g.,
■■ Ensure that amplification is working properly in schools tinnitus, misophonia)
■■ Measure acoustics in classrooms and other learning ■■ Provide individual counseling and public education about the
environments benefits and/or limitations of various classes of devices and
■■ Identify instructional modifications and accommodations to technology
facilitate access to education in all school settings ■■ Provide assistance with acoustic management of large
■■ Consult with students, teachers, parents, and other relevant community meeting facilities (e.g., theaters, churches,
staff regarding hearing, amplification, and accommodation entertainment arenas)
needs ■■ Communicate with physicians, families, and referral sources
■■ Participate as a member of educational team for students with ■■ Activities typically provided in clinic and/or hospital facilities
auditory needs
■■ Provide or assist with (re)habilitative needs within learning
environment
■■ Assist with transition planning and support
Note. From AAA Standards of Practice (2012), ASHA Scope of Practice (2018), EAA Recommended Professional Practices for Educational Audiology (2009).
Combined School-Based the district. For this model to work effectively, both the
school-based and the contracted audiologist must have well-
and Contractual Agreement
articulated responsibilities, a clear understanding of what the
At times, it may be advantageous for a school district or LEA other is doing, and an ability to collaborate so that compre-
to use a combination of both school-based and contractual hensive services are provided without duplication.
agreement services. This model can be particularly useful Additional information to assist in comparing school-
when the school-based audiologist is not able to provide ser- based audiology with contractual audiology services, in-
vices to all of the students within the district or when an au- cluding strategies for estimating cost–benefit and workload
diologist with specialized skills or equipment is needed. The assessment can be found in Chapter 16, Program Develop-
contracted audiologist may provide comprehensive services ment, Evaluation, and Management.
to specified students within the district, such as those who
live in a particular geographical area or those with specific
disabilities and/or equipment needs (e.g., auditory brainstem Telepractice
assessment or cochlear implant programming). Optionally, An evolving method for the delivery of educational audi-
the contracted audiologist may provide specified services ology services is telepractice/teleaudiology/telehealth, the
(e.g., auditory processing assessments) to all students within remote delivery of services through an Internet system

42 Chapter 2
in which the audiologist delivering the service is not on- audiologists document outcomes for services provided in
site with the individual receiving the services. This type a format that is related to school district goals and objec-
of contracted arrangement has been used for remote pro- tives (e.g., classroom accommodations that have facilitated
gramming of cochlear implants used by children as well as successful performance on standardized assessments as
adults (Franck, Zerfoss, & Pengelly, 2006; Hughes, Sevier, & well as for general education classroom instruction). See
Choi, 2018) and can be an efficient alternative to multiple Chapter 16, Program Development, Evaluation, and Man-
programming appointments requiring students to leave their agement, for guidance on creating and expanding services,
school locations. Additional services delivered remotely in- workload analysis, and outcomes, and Chapter 15, Collab-
clude diagnostic testing, hearing aid fittings and equipment orative School-Community Partnerships, for information
troubleshooting, classroom observations, and coaching. on increasing awareness of and advocating for educational
Telepractice is beginning to be implemented and validated as audiology services.
a system for use in early hearing detection and intervention
(EHDI) programs as well as with local school systems for
additional auditory device services (Angley, Schnittker, & Reimbursement for Educational
Tharpe, 2017; Steuerwald, Windmill, Scott, Evans, & Audiology Services
Kramer, 2018).
Chapter 2
Educational audiologists using or considering the use A number of school systems have implemented third-party
of telepractice should familiarize themselves with current reimbursement from Medicaid for audiology as a health-
regulations involving the electronic transfer of patient in- related service provided to students under IDEA (2004).
formation (e.g., Health Insurance Portability and Account- This is permitted by the current guidelines established by
ability Act [HIPAA], Family Educational Rights and Privacy the Centers for Medicare and Medicaid Services (CMS),
Act [FERPA], see Chapter 1). For additional discussion of provided that the service is
potential benefits, limitations, trends, and research related ■■ provided to Medicaid-eligible children;
to telepractice, educational audiologists are referred to the ■■ medically necessary;
following documents: AAA (2015), Introduction to tele- ■■ delivered and claimed in accordance with all other fed-
medicine (available from https://www.audiology.org/prac eral and state regulations; and
tice_management/resources/introduction-telemedicine) and ■■ included in the state Medicaid plan.
ASHA (2014), Telepractice practice portal (available from
https://www.asha.org/Practice-Portal/Professional-Issues Although Medicaid has national guidelines, each state
/Telepractice/). In addition, Chapter 17, Reflections and Fu- has the authority to determine the type, amount, duration,
ture Directions, includes a more detailed discussion by an and scope of services; determine state eligibility standards;
educational audiologist who is currently providing school set rates of payments; and administer its own program. Edu-
services remotely. cational audiologists who bill Medicaid for their services
through a school district must be qualified as Medicaid pro-
viders in their state and must be knowledgeable about their
individual state’s current Medicaid plan. More detailed infor-
ESTABLISHING AND EXPANDING mation on Medicaid regulations and reimbursement require-
EDUCATIONAL AUDIOLOGY ments related to school services is available from the Ameri-
can Speech-Language-Hearing Association (see Resources).
SERVICES IN THE SCHOOLS
Although educational audiologists have been employed in
school systems for many years, there are still many areas in Dispensing Personal Hearing Instruments
which educational audiology services are minimal or nonex- Some school districts have limited provisions for dispens-
istent (Richberg & Smiley, 2009). A few states have adopted ing of personal hearing instruments as a part of the educa-
guidelines related to the practice of educational audiology tional audiology program as these devices must be classified
(e.g., Georgia, Colorado, Minnesota), but only Colorado’s as assistive technology. Typically, this service is undertaken
practice standards specify a caseload requirement of one to address an educational need and most often occurs when
audiologist for every 10,000 students in a school system, insurance, Medicaid, or income issues prevent a child from
as recommended by the EAA (2009) and ASHA (2002). A getting hearing aids in a timely manner. Most schools retain
workload approach that involves documenting and analyz- the instruments as school property, and depending on district
ing time spent providing educational audiology services in- policy, they may or may not go home when the student is not
cluding direct and indirect activities necessary to support attending school. We recommend that school-based audiolo-
students’ needs is preferred to a caseload approach targeting gists considering dispensing should familiarize themselves
student populations or a specific number of identified deaf with the legal and ethical implications of setting up such a
or hard of hearing students. It is imperative that educational program in their individual communities and school districts.

Cerumen Management
Although cerumen management is included in the audiolo- “Audiologists who are employed in school settings
gist’s professional scope of practice, this service typically is have an opportunity as well as responsibility to
not provided in the educational setting (see ASHA, 2016b, promote early detection and intervention of hear-
for state information). However, some cerumen removal ing loss.”
may be necessary to conduct certain assessments such as
acoustic immittance and probe-microphone measurements (EAA, 2002, p. 1)
or as part of hearing aid or HAT use. Educational audiolo-
gists who wish to consider adding cerumen management
to their practice should check with their state licensure
and certification requirements (where applicable) as well
as their employers and legal counsel to determine if there If the responsible agency for birth to 3 years of age is
are any legal requirements or restrictions that would apply. not the department of education, at a minimum, the edu-
Any educational audiologist planning a cerumen manage- cational audiologist has the responsibility to (a) collabo-
ment program also should develop a written protocol that rate with local early intervention programs and providers,
includes procedures for obtaining parental permission and (b) provide support to families during the identification and
Chapter 2
the process for making referrals to other medical profession- intervention process, and (c) serve as a member of and fa-
als when warranted. Participation in continuing education cilitator for the transition team as the child and family move
workshops or conference sessions that provide information to educational services under IDEA Part B. If the child’s
on type of equipment, instruments, and infection control in placement is to fill a federally funded slot for students with
addition to offering hands-on training in cerumen manage- disabilities or a state-funded at-risk program placement in
ment is strongly recommended for those who have not com- a regular daycare or preschool setting, the educational pro-
pleted this training in their educational program. Finally, gram is required to provide the necessary support services. If
before implementing a program in cerumen management the infant or toddler is placed in a daycare or other nonpublic
within the educational setting, professional liability cover- preschool setting, the educational audiologist should, at a
age should be discussed with the school system administra- minimum, observe the child’s functioning for relevant audi-
tion and legal counsel (Lowell & Valdes, 2010). tory information and functional listening skills and serve as
a resource for amplification equipment (both personal and
classroom remote microphone sound distribution systems),
Support for Early Hearing appropriate curricula and materials for maximizing auditory
Detection and Intervention learning, and other habilitation needs. (See Chapter 9, Case
Although it is incumbent on all educational audiologists to Management and Habilitation, for more detail concerning
be knowledgeable and supportive of early hearing detection classroom support applicable to daycare environments.)
and intervention practices in their local areas, many edu- The EAA’s position statement Early detection and
cational audiologists play a larger role in the identification intervention of hearing loss: roles and responsibilities for
and follow-up services for infants and toddlers with reduced educational audiologists (2002) identifies potential roles,
hearing. IDEA 2004 requires each state to designate a lead responsibilities, and activities for educational audiologists
agency to oversee programs and services for infants and tod- with the infant and toddler population. Also included is a
dlers with disabilities and follow the federal eligibility re- strategy for discussing communication features, as distinct
quirements that are noncategorical under Part C (see https:// from communication modes or methodologies, and the edu-
infanthearing.org/stateguidelines/index.php). Each state cational audiologist’s role in facilitating service provision
may provide further eligibility guidance so long as it meets in natural environments. Chapter 20 in the EHDI e-book
the federal requirements. As a result, educational audiology 2019 (http://infanthearing.org/earlyintervention/index.html)
services can and do vary widely between states and among describes educational audiology roles and responsibilities
districts within many states. Audiology is listed as an early under IDEA Part C. Appendix 2–B summarizes information
intervention service in the federal statute,3 and regulations for use when identifying and implementing early interven-
for audiology services under IDEA Part C4 vary slightly tion roles and responsibilities for educational audiologists
from those listed under Part B (see Table 2–4). Where the within their local communities.
designated Part C agency is the state department of educa- An additional resource document developed by ASHA
tion, roles and responsibilities may fall in line with those emphasizes three co-occurring roles for audiologists serving
described earlier in this chapter. the infant and toddler population (diagnostician, counselor,
3
20 U.S.C.§1432, Definitions (4)(E)(iii).
4
CFR §303.13 (b)(2)(i-vi).

44 Chapter 2
TABLE 2–4 Descriptions of Audiology Services Under the Individuals With Disabilities Education Act 2004
Part C §303.13 (b)(2)(i-vi) Part B§300.34(c)(1)(i-vi)

(2) Audiology services include — (1) Audiology includes—
(i) Identification of children with auditory impairments, using a t- (i) Identification of children with hearing loss;
risk criteria and appropriate audiologic screening techniques; (ii) Determination of the range, nature, and degree of hearing loss,
(ii) Determination of the range, nature, and degree of hearing loss including referral for medical or other professional attention
and communication functions, by use of audiological evaluation for the habilitation of hearing;
procedures; (iii) Provision of habilitative activities, such as language habilitation,
(iii) Referral for medical and other services necessary for the auditory training, speech reading (lip-reading), hearing
habilitation or rehabilitation of an infant or toddler with a evaluation, and speech conservation
disability who has an auditory impairment; (iv) Creation and administration of programs for prevention of
(iv) Provision of auditory training, aural rehabilitation, speech hearing loss;
reading and listening devices, orientation and training, and (v) Counseling and guidance of children, parents, and teachers
other services; regarding hearing loss; and
(v) Provision of services for prevention of hearing loss; and (vi) Determination of children’s needs for group and individual
Chapter 2
(vi) Determination of the child’s individual amplification, including amplification, selecting and fitting an appropriate aid, and
selecting, fitting, and dispensing appropriate listening and evaluating the effectiveness of amplification.
vibrotactile devices, and evaluating the effectiveness of those
devices.
and case manager or “care coordinator”) and delineates the tification; and Chapter 12, Prevention of Noise-Induced
knowledge and skills necessary for each role (ASHA, 2006). Hearing Loss and Tinnitus in Youth);
As children who are deaf or hard of hearing increasingly are ■■ services related to amplification and hearing assistive
identified and served through early intervention programs, technology (Chapter 8, Hearing Instruments and Re-
it is critical for educational audiologists to include informa- mote Microphone Technology); and
tion such as the EAA and ASHA documents in in their job ■■ counseling (Chapter 3, Partnering With Families).
descriptions and to disseminate this information to EHDI
personnel, families, and clinical audiologists in their area. Fi-
nally, educational audiologists can facilitate the IFSP process
and the transition from services under Part C to those under TRAINING FOR EDUCATIONAL
Part B by providing information regarding resources and all AUDIOLOGISTS
support options available to deaf and hard of hearing infants
and young children. The Joint Committee on Infant Hearing To be qualified for all of the responsibilities described in this
recommends including quarterly educational audiology ser- chapter, it is obvious that educational audiologists must have
vices at a minimum as part of the preschool transition plan training beyond basic audiology coursework. Early surveys
and further emphasizes that children who transition with age- routinely indicated that practicing educational audiologists
appropriate language and communicative skills should con- believed they were inadequately prepared to meet the re-
tinue to be monitored and supported (JCIH, 2019). See the sponsibilities they have in the schools, especially in areas
following chapters for more information about educational such as amplification, educational management of deaf and
audiology services for children birth through age 3 years: hard of hearing children, mainstreaming, auditory (re)ha-
bilitation, working with special populations, sign language,
■■ identification (Chapter 4, Hearing Screening and and counseling (Blair, Wilson-Vlotman, & Von Almen,
Identification); 1989; Seaton, Von Almen, & Blair, 1994; Wilson-Vlotman
■■ determination of the range, nature, and degree of hear- & Blair, 1986). Additionally, two-thirds of the respondents
ing loss (Chapter 5, Assessment); to the survey conducted by Seaton, Von Almen, and Blair
■■ referral for other services as needed (Chapter 5, (1994) stated that an externship in an educational setting
Assessment); would have been helpful.
■■ provision of aural rehabilitation and listening device In recognition of the deficiencies currently existing in
orientation (Chapter 9, Case Management and Habili- the training of educational audiologists, the EAA-approved
tation, and Chapter 8, Hearing Instruments and Remote Minimum competencies for educational audiologists was
Microphone Technology); published initially in 1994. An updated version (2009) is
■■ hearing loss prevention services (Chapter 3, Partnering available currently as a downloadable handout from http://
with Families; Chapter 4, Hearing Screening and Iden- edaud.org. These competencies focus on the knowledge,

skills, and abilities necessary to provide effective compre- The EAA also recommended that all audiologists em-
hensive audiology services in the schools. Although many ployed in the schools complete an internship in a school
of the competencies are also necessary for clinical audiolo- setting under the supervision of an educational audiologist,
gists, competency in the following areas are unique to the preferably a full-time experience lasting at least 6 weeks.
educational setting: These recommendations have been used to encourage uni-
versity training programs to include relevant curricula for
■■ educational referral, follow-up procedures, and special
educational audiologists and to inform school administrators
education eligibility requirements;
about the special knowledge, skills, and abilities of educa-
■■ evaluation of the need for, selection, and maintenance
tional audiologists.
of personal DM/FM and classroom audio distribu-
English and Vargo (2006) provide encouraging results
tion systems and other RM HAT used in educational
regarding the status of educational preparation for audi-
environments;
ologists working with school-aged children and youth. Of
■■ the structure of the learning environment, including
56 AuD programs surveyed, the majority reported their
classroom acoustics and implications for learning;
programs include learning objectives related to the rec-
■■ IFSP and IEP planning process and procedures, includ-
ommended areas, but only 45% of the programs surveyed
ing interpretation of auditory assessment results and
required a course in educational audiology. A more recent
their implications, educational options, and legal issues
Chapter 2
survey (Dillmuth-Miller, 2016) found that 30 of 71 (42%)
and procedures;
AuD programs reported offering a course in educational
■■ consultation and collaboration with classroom teach-
audiology, while the remaining programs (58%) included
ers and other professionals regarding the relationship
educational audiology topics in other courses (e.g., pediatric
of hearing and reduced hearing to the development of
audiology, aural habilitation). Another promising strategy
academic and psychosocial skills;
reported by the Colorado Department of Education de-
■■ participation in team management of communication
scribes their licensure requirements for educational audi-
treatment;
ologists that align entry-level knowledge and skills with the
■■ knowledge of the various communication approaches
IDEA definition of audiology plus an additional area of ethi-
used by deaf and hard of hearing individuals and famil-
cal conduct (https://www.cde.state.co.us/cdeprof/schoolau
iarity with American Sign Language and Deaf culture;
diologistendorsementrules). An 8-week FTE practicum or
■■ implementation of in-service training and coaching for
internship is also required for educational audiology licen-
educational staff and support personnel;
sure in Colorado, and it is hoped that other states requiring a
■■ knowledge of school systems, multidisciplinary teams,
state credential will consider this requirement. There contin-
and community and professional resources; and
ues to be a need for standardization of educational audiology
■■ knowledge of laws, regulations, and policies governing
coursework and content within AuD programs.
general and special education.
SUMMARY SUGGESTED READINGS

The roles and responsibilities of educational audiologists AND RESOURCES
in the total management of deaf or hard of hearing students American Academy of Audiology. (2004). Scope of practice.
are quite comprehensive (see Appendix 2–C). Unfortunately, Retrieved from https://audiology.org/publications-resources
administrators, other school personnel, and parents often are /document-library/scope-practice
not aware of the need for educational audiologists, and edu- American Academy of Audiology. (2012). Standards of practice.
cational audiology services frequently are not available or Retrieved from https://www.audiology.org/sites/default/files
are underused. There are many ways that educational audi- /documents/StandardsofPractice.pdf
ology services can be delivered in a school system, but it is American Speech-Language-Hearing Association. (2009). Guide-
important for us to recognize what we can do to advocate for lines for audiology service provision in and for schools [Guide-
lines]. Retrieved from https://www.asha.org/policy
our services. It is possible to enhance audiology services in
American Speech-Language-Hearing Association. (2018). Scope
the schools, but to do so takes a planned, consistent effort on of practice in audiology [Scope of Practice]. Retrieved from
the part of educational audiologists. The changes required https://www.asha.org/policy
are not easy to accomplish, but they are necessary to ensure American Speech-Language-Hearing Association. (n.d.). School-
comprehensive services for all deaf and hard of hearing stu- based medicaid services: Audiology. Retrieved from https://
dents and other children and youth with hearing and listen- www.asha.org/practice/reimbursement/Medicaid/SchoolBased
ing challenges in their educational environments. ServicesAUD/

46 Chapter 2
American Speech-Language-Hearing Association. (n.d.). Tele- Macione, M., Johnson, C. D., & Sanders, S. (2019). The role of ed-
practice Overview. https://www.asha.org/Practice-Portal/Pro ucational audiologists in the EHDI Process. In National Center
fessional-Issues/Telepractice/ for Hearing Assessment, The EHDI e-book: A resource guide
Anderson, K., & Arnoldi, K. (2011). Building skills for success in for early hearing detection and intervention. Retrieved from
the fast-paced classroom. Hillsboro, OR: Butte Publications. http://www.infanthearing.org
Davis, J. (2002). Our Forgotten Children: Hard of Hearing Pupils Madell, J. (2013, May). Educational audiology: From observation
in the Schools (3rd ed.). Washington, DC: Shhh Publications. to recommendation. AudiologyOnline, Article 11853. Retrieved
Colorado Department of Education: Standards of Practice for from http://www.audiologyonline.com/
Audiology Services in the Schools (n.d.) “Rubric for Evalu- Madell, J., & Flexer, C. (2013). Pediatric audiology: Diagnosis,
ating Colorado’s Specialized Service Professionals: Audiolo- technology and management (2nd ed.). New York, NY: Thieme
gist Simulation.” Retrieved from http://www.cde.state.co.us Medical Publishers.
/educatoreffectiveness/audsimulation Madell, J., & Flexer, C. (2018). Maximize children’s school out-
Colorado Department of Education: Standard Requirements for comes: The audiologist’s responsibility. Audiology Today,
All Colorado Initial Special Services Licenses (n.d.). Retrieved 30(1), 18–26.
from http://www.cde.state.co.us/cdeprof/licensure_ssp National Association of State Directors of Special Education
Educational Audiology Association (EAA). Retrieved from http:// (NASDSE). (2018). Optimizing outcomes for students who are
www.edaud.org/position-statements/ deaf or hard of hearing: Educational service guidelines. Alex-
Chapter 2
andria, VA: NASDSE.

■■ Educational Audiologists and Cochlear Implants (2005)
National Center for Hearing Assessment and Management
■■ Recommended Professional Practices for Educational Audiol-
(NCHAM) EHDI e-book (2019). Chapter 20: The Role of
ogy (2009)
Educational Audiologists in the EHDI process. Retrieved from
■■ Guidelines for Developing Contracts for School-based Audi-
http://infanthearing.org/ehdi-ebook/
ology Services (2012)
Northern, J., & Down, M. (2014). Hearing in children (6th ed.).
■■ Educational Audiology Association: Guidelines of the Con-
San Diego, CA: Plural Publishing.
sensus Panel on Support
Richberg, C., & Smiley, D. (2011). School-based audiology. San
■■ Personnel in Audiology (1997)
Diego, CA: Plural Publishing.
English, K. (2018). Audiologic rehabilitation services in the school Roeser, R. J., & Downs, M. P. (2004). Auditory disorders in school
setting. In Schow, R., & M. Nerbonne (Eds.), Introduction to children: The law, identification, remediation (4th ed.). New
audiologic rehabilitation (7th ed., pp. 217–246). New York, York, NY: Thieme Medical Publishers.
NY: Pearson Publishing. Schraeder, T. (2019). The 3:1 model—A workload solution. The
Johnson, C. D. (2011). A call for outcomes measurement for ASHA Leader, 34(5), 36–37.
school-based audiology services. Hearing Journal, 64(10), Tye-Murray, N. (2018). Foundations of aural rehabilitation: Chil-
30–32. dren, adults, and their family members (5th ed.). San Diego,
Johnson, C., Cannon, L., Oyler, A., Seaton, J., Smiley, D., & Span- CA: Plural Publishing. [section on school services]
gler, C. (2014). Shift happens: Evolving practices in school-
based audiology. Journal of Educational Audiology, 20, 1–15.

APPENDIX 2–A
Supporting Students who are Deaf and Hard of Hearing: Shared and
Suggested Roles of Educational Audiologists, Teachers of the Deaf
and Hard of Hearing, and Speech-Language Pathologists
(Approved by the Board of Directors of the Educational Audiology Association February 2018)
Educational audiologists, teachers of the deaf and hard of hearing, and speech-language pathologists are critical partners on the
school education team. Together, they address the needs of students who are deaf and hard of hearing and promote language and
communication access that is essential for participation and learning in today’s educational environments. The Individuals with
Disabilities Education Act (IDEA), Section 504 of the Rehabilitation Act, and the Americans with Disabilities Act (ADA) all contain
regulations pertinent to the services and accommodations contained in this guidance document.
Language and Communication Regulations (Title II and IDEA)
Chapter 2
Title II of the ADA includes the following requirements for schools:
● Communication for students who are deaf and hard of hearing must be “as effective as communication for others” [ADA Title II 28
C.F.R. §35.160 (a)(1)].
● Provision of appropriate aids and services “affording an equal opportunity to obtain the same result, to gain the same benefit, or to
reach the same level of achievement as that provided to others” [ADA Title II 28 C.F.R. §35.130 (b)(1)(iii)].
● Students who are deaf and hard of hearing should be able to participate in and enjoy the benefits of the district’s services, programs,
and activities” (DOJ-DOE p14)1.
● These requirements apply to all school-related communications, and when a public school is deciding what types of auxiliary aids
and services are necessary to ensure effective communication, it must give “primary consideration” to the particular auxiliary aid or
service requested by the person with the disability. (DOJ-DOE p27).
IDEA (2004) “Special Factors” regulations specify that schools must provide the following supports for students who are deaf or hard
of hearing [34 C.F.R. §300.324(a)(2)(iv)]:
● Opportunities for direct communication with peers in the student’s language and communication mode.
● Opportunities for direct communication with professional personnel in the student’s language and communication mode.
● Opportunities for direct instruction in student’s language and communication mode.
IDEA (2004) also requires:
● Routine checking of hearing aids and external components of surgically implanted medical devices to ensure they are functioning
properly [34 C.F.R. §300.113(a)(b)(1)]
● Audiology Services [34 C.F.R.§300.34(c)(1)]
● SLP Services [34 C.F.R.§300.34(c)(1)]
● Assistive Technology Devices and Services [34 C.F.R.§300.34(c)(15)]
● Highly Qualified Special Education Teachers [34 C.F.R.§300.18]
To assist schools in meeting the language and communication requirements above, the following checklist describes supports to be
considered for each student who is deaf or hard of hearing and those with other auditory learning needs. This checklist was developed
and field-tested with input from all three professional groups via focus group meetings and online surveys. Categories are described
as “student assurances” with activities and expected outcomes that should be addressed by the student’s team of educational
professionals, including educational audiologists (Ed. Aud), speech-language pathologists (SLP), and teachers of the deaf and hard of
hearing (TODHH). Because student needs change over time, this checklist should be completed at least annually.
1.
U.S. Department of Justice & U.S. Department of Education (2014, Nov 12). Frequently Asked Questions on Effective Communication for Students with Hearing, Vi-
sion, or Speech Disabilities in Public Elementary and Secondary Schools. http://www2.ed.gov/about/offices/list/ocr/docs/dcl-faqs-effective-communication-201411.pdf
Copyright © 2018, Educational Audiology Association www.edaud.org 1-800-460-7EAA (7322)
47

48 Chapter 2
When the student’s team is designating primary responsibility for each activity listed, the professional scopes of practice and state
licensure/certification requirements, as well as training and experience, should guide considerations for specifying responsible
personnel. Areas with direct scope of practice implications are checked.
Ed
Student Assurances: Audiological and Equipment Needs TODHH SLP Other
Aud
1. Audiological evaluations that include recommendations to enhance communication 
access and learning.
2. Diagnosis of auditory processing disorders (APD) with recommendations to manage
APD issues provided to school personnel for the classroom and to parents for out of 
school consideration.
3. Management of auditory access in all educational environments
4. Assessment of classroom acoustics with recommendations made to improve
classroom listening environments where necessary.
5. Evaluation and fitting for personal hearing instruments, classroom, and other hearing
Chapter 2

assistive technology.
6. Management of hearing assistive devices including maintenance and
troubleshooting.
7. Provision of training for school personnel and students, when appropriate, to
perform listening checks and basic troubleshooting to maintain proper functioning of
personal hearing instruments and hearing assistance technology.
8. Provision of hearing assistive technology services including educating students,
teachers of the deaf/hard of hearing, and other school personnel regarding
technology performance and expectations.
9. Use of daily listening checks to monitor functioning of hearing technology used by
students.
10. Other:
Ed
Student Assurances: Communication - Speech, Language, Auditory, Visual Needs TODHH SLP Other
Aud
11. Evaluation of current speech production skills including articulation, fluency,
voice, and resonance, as appropriate for the student’s preferred language and 
communication mode.
12. Evaluation of current language skills in the student’s preferred language and
communication mode, including:
● Comprehension, expression, and language processing in oral written, graphic
and manual modalities
● Phonology, semantics, syntax, morphology and pragmatics/social aspects of
communication
● Pre-literacy and language-based literacy skills, including phonological awareness
● Description and interpretation of specific language communication skills and
needs identified through appropriate formal and informal, standardized and
non-standardized assessments.
13. Evaluation of communication-related visual and/or auditory skills and needs as
appropriate in the student’s preferred language and communication mode.
Ed
Student Assurances: Communication - Speech, Language, Auditory, Visual Needs TODHH SLP Other
Aud

14. Implementation of an appropriate therapy plan to develop speech, language,

pragmatics, speechreading and auditory skills including strategies for generalization
in the general education classroom.
15. Self-advocacy instruction and support to enable students to advocate for their needs
with peers, school personnel and other communication partners including:
● Evaluation and inclusion of communication goals targeting identity, self-
advocacy and communication repair strategies
● Inclusion of language and communication goals related to classroom
accommodations and modifications
● Orientation and /or instruction for peers, families, and school staff regarding
communication development, the impact of hearing loss, and communication
repair strategies.
16. Services that ensure opportunities for students to develop peer-to-peer social
communication skills including:
● Facilitated support groups for children who are deaf or hard of hearing or who
Chapter 2
have other auditory disorders.
● Goals for communication repair strategies that will facilitate communication
with peers.
● Orientation to hearing peers that encourages social interactions and
communication.
17. Other:
Ed
Student Assurances: Academic Needs TODHH SLP Other
Aud
18. Evaluation of educational performance in accordance with the requirements of IDEA
330.304 (b) that includes:
• Use of a variety (no single measure) of assessment tools and strategies to gather
functional, developmental and academic information.
• Use of reliable and valid tools administered in the child’s preferred language or
other mode of communication to yield accurate information.
• Measures administered by trained and knowledgeable personnel, according to
procedures by the producers of the assessment tools.
19. Assessment that distinguishes learning issues related to hearing status from those
related to other cognitive, sensory or physical challenges.
20. Specialized academic instruction to include preview and review of academic material 
to help optimize learning.
21. Specialized instruction including expanded core curricular areas such as

communication, career education, self-determination and advocacy, social-emotional
skills, technology and family education.
Ed
Student Assurances: Academic Needs TODHH SLP Other
Aud

50 Chapter 2
22. Assessment of literacy skills conducted in the child’s preferred language and
communication mode.
23. Literacy development plans designed and implemented according to the individual
student’s needs.
24. Provision of interpreting, notetaking, captioning, transliteration, and/or voice-to-text
services to optimize access to instruction for those who require these supports.
25. Provision of optimal visual and auditory access for both assessment and instruction.
26. Other:
Collaboration Program Management Needs for Students who are Deaf/Hard of Ed

TODHH SLP Other
Hearing: Identify Individual Responsible for Coordination Aud
Chapter 2
27. Educational plans developed, reviewed, and implemented in a timely manner by

team members who have knowledge, skills, and resources related to the impact
of hearing loss/deafness on communication, access to classroom instruction and
academic performance.
28. Communication that is consistent between school-based instructional staff and other
specialized personnel (e.g., private SLPs, interpreters, audiologists).
29. IEP and 504 development and meeting participation by one or more specialists in
hearing loss/deafness to address student communication, education, access needs
and to develop a transition plan for post-secondary education/training/employment.
30. Education of students and their families regarding hearing status, communication
approaches, associated accommodations, technology options, and self-advocacy.
31. Observation of classroom and school environments that continuously evaluates

and monitors communication access, classroom acoustics, and how children are
functioning in these settings.
32. Consultation activities that ensure school personnel understand the language,
communication, social, and educational effects of hearing loss/deafness, technology
options and associated accommodations.
33. Education of students and their families about resources in the community,
financial resources (for personal hearing technology), educational resources and
opportunities to connect with other students who are deaf and hard of hearing and
their families.
34. Other:

APPENDIX 2–B
Part C Roles of Audiologists in Early Hearing
Detection and Intervention*
Role 1. Identification of children with auditory impairments using at-risk criteria and appropriate audiological screening
techniques.
■■ Attend equipment trainings and provide screening in-services to other personnel involved with the EHDI process.
■■ Assist with state data tracking and management through the screening, referral, and diagnostic process.
■■ Review the screening program outcomes to ensure that the protocol used has met the desired identification targets.
■■ Provide screening rechecks prior to referral for diagnostic evaluation.
Assist with tracking referrals from screening to rescreening to assessment.
Chapter 2
■■
■■ Provide information to families about the screening/rescreening process and necessary follow-up steps for assessment,
where appropriate.
■■ Participate as a resource for the community.
■■ Refer to the Part C point of entry within 2 days of rescreen to initiate the referral process for possible service coordination
and Individual Family Service Plan (IFSP) services. Note: In some communities, this step may not be completed until
a hearing impairment is diagnosed. However, if the family needs support and assistance to obtain a hearing evaluation,
the Part C referral should be initiated.
Role 2. Determination of the range, nature, and degree of hearing loss and communication functions by use of audiological
evaluation procedures.
■■ Assist families with referrals for initial diagnostic evaluation, helping them locate appropriate pediatric audiological
testing facilities.
■■ Refer to confirm diagnosis if necessary.
■■ Assist in the IFSP process with the family and appropriate infant and toddler service provider.
Role 3. Referral for medical and other services necessary for the habilitation or rehabilitation of an infant or toddler with a dis-
ability who has an auditory impairment.
■■ Assist families in understanding diagnostic information (e.g., medical, genetics).
■■ Assist families in identifying appropriate medical and other services that may be needed.
■■ Provide impartial information to families about communication and intervention opportunities and educational services.
■■ Act as a liaison between medical providers, the family, and other IFSP team members.
Role 4. Provision of auditory training, aural rehabilitation, speech reading and listening device orientation and training, and
other services.
■■ Participate as a member of the multidisciplinary IFSP team to plan services.
■■ Assist the IFSP team in developing functional outcomes around the priorities the family has identified.
■■ Provide parents with information about service agency options.
■■ Assist family in transition from Part C to Part B (school) services.
Role 5. Provision of services for prevention of hearing loss.
■■ Provide hearing screening services through local Part C and Part B (Child Find) agencies.
■■ Conduct ongoing surveillance measures to monitor hearing of children “at-risk” for late-onset or progressive hearing
impairment.
■■ Provide information regarding purpose of genetic counseling.
*Roles and responsibilities may be collaborative in nature, depending on availability of pediatric and/or educational audiol-
ogy personnel and services in local communities.
51

52 Chapter 2
Role 6. Determination of the child’s need for individual amplification, including selecting, fitting, and dispensing appropriate
listening and vibrotactile devices and evaluating the effectiveness of those devices.
■■ Refer for personal and assistive hearing instrument selection and fitting.
■■ Assist families in identifying financial resources for amplification devices, when needed
■■ Provide ongoing monitoring of child’s auditory skills and review of recommendations to ensure technology is appropriate
for the child’s current needs. Recommendations may change depending on a child’s performance and listening demands.
Note. From EAA (2002) and EHDI e-book (2019).

Chapter 2

APPENDIX 2–C
Educational Audiology Scope of Practice
(Approved by the Board of Directors of the Educational Audiology Association August 6, 2019)
Purpose
The purpose of the EAA Scope of Practice statement is to identify and describe areas that are unique to the practice of audiology
in education settings. Accordingly, this statement should inform educational licensure requirements for school-based audiologists,
local school district educational audiology practice (NASDSE, 2018) as well as Au.D. and post-graduate professional development
coursework in educational audiology. This statement expands on the audiology scope of practice statements of the American
Chapter 2
Speech-Language-Hearing Association (ASHA, 2018) and the American Academy of Audiology (AAA, 2004).
Rationale
Educational audiology has continued to evolve from early definitions, providing greater clarity and definition to the scope
of practice for audiologists providing services to students in educational settings. A primary goal is to ensure that all deaf
and hard of hearing students, regardless of eligibility status, have full access to communication, specifically, auditory
information, in their learning environments. To do so requires that children are identified, appropriately assessed, receive
counseling and other support services to address their hearing status and educational needs, provided with appropriate
hearing assistive technology and assistive technology services, and that their personal and assistive hearing technology is
monitored regularly to ensure that it is functioning properly.
Background
The specialized practice of audiology in education settings was first described in the 1965 Joint Committee Report,
“Audiology and Education of the Deaf” (Ventry, 1965). The role of audiologists in educational programs and the qualifications
and competencies needed to provide audiological services to children in educational settings were the two major areas of
discussion of this committee. Key roles of audiologists included:
• Complete audiological evaluation of children related to their admission to the educational program
• Annual assessment of children’s hearing, including an interpretation of the result to the teacher
• Hearing aid selection, orientation, and maintenance
• Application of knowledge about speech perception and speech pathology to the speech problems of deaf children
• Inservice training to help keep teachers abreast of new techniques and new information
• Parent counseling
• Evaluation, application, and selection of the amplifying systems and equipment used in the school
• Liaison between the school and the college or university training program or community speech and hearing center
The recommendations of this report influenced the definition of audiology in the first federal education disability legislation,
the 1975 Education for all Handicapped Children Act, PL 94-142, now known as the Individuals with Disabilities Education
Act (IDEA, 2004).
IDEA 2004 Definition of Audiology (34 CFR 300.34(b))
(i) Identification of children with hearing loss;
(ii) Determination of the range, nature, and degree of hearing loss, including referral for medical or other
professional attention for the habilitation of hearing;
(iii) Provision of habilitation activities, such as language habilitation, auditory training, speechreading (lip-reading),
hearing evaluation, and speech conservation;
(iv) Creation and administration of programs for prevention of hearing loss;
(v) Counseling and guidance of pupils, parents, and teachers regarding hearing loss;
(vi) Determination of the child’s need for group and individual amplification, selecting and fitting an appropriate aid,
and evaluating the effectiveness of amplification.
53

54 Chapter 2
Definition: Educational Audiologist

Educational Audiologists deliver a full spectrum of hearing services to all children, particularly those in educational settings.
Audiologists are trained to diagnose, manage and treat hearing and balance problems. Educational audiologists are
members of the school multidisciplinary team who facilitate listening, learning and communication access via specialized
assessments; monitor personal hearing instruments; recommend, fit and manage hearing assistance technology; provide
and recommend support services and resources; and advocate on behalf of the students. Educational audiologists
provide evidence for needed services and technology, emphasize access skills and supports, counsel children to promote
personal responsibility and self-advocacy, maintain student performance levels, collaborate with private sector audiologists,
help student transitions and team with other school professions to work most effectively to facilitate student learning
(www.edaud.org).
School-Based Educational Audiologists refers to educational audiologists who provide services to students as school
employees or via contracted onsite services.
The Population Served by Educational Audiologists
Students with all levels and types of auditory impairments including auditory neuropathy, unilateral or fluctuating hearing
Chapter 2
levels, or an auditory processing deficit, require the expertise of an educational audiologist. In addition, students with learning
disabilities, reading/literacy difficulties, attention problems, and those struggling with English as a second language may
benefit from the educational audiologist’s knowledge of how listening and learning are impacted by noise and classroom
acoustics. Educational audiologists should support these students whether they receive special education and related
services under IDEA or services through Section 504 of the Rehabilitation Act (1973).
Scope of Practice
The work of school-based educational audiologists may vary from one educational setting to another. However, professional
practices must address the areas identified within IDEA under audiology: screening, assessment, amplification, habilitation,
counseling, and prevention (34CFR300.34(c)(1); assistive technology and assistive technology services (34CFR300.5-.6
& C); and routine checking of amplification devices and external components of surgically implanted medical devices worn
by children in school (34CFR300.113), Based on professional scopes of practice in audiology (AAA, 2004; ASHA, 2018),
speech-language pathology (ASHA, 2007), and deaf education (CEC, 2018), the audiologist is the only professional that is
qualified to fit and verify hearing aids and personal hearing assistance technology.
Through collaborative partnerships, educational and clinical audiologists work together to promote the most appropriate
hearing technology and support services for each child or youth they serve. Providing ongoing consultation to the school
nurse on screening programs, the speech language pathologist for communication strategies, or a classroom teacher
regarding acquisition of the phonemic information critical to literacy -- are all part of the scope of practice of the educational
audiologist.
Specific Roles of the Educational Audiologist include:
Identification
• Coordinating hearing screening programs for preschool and school-aged students ensuring professional standards and
state guidelines are followed and screening personnel are appropriately trained.
• Providing and/or managing hearing screening component of school-based Child Find programs.
• Providing community leadership and collaborating with community agencies to increase awareness of hearing differences
and to assure that all children and youth with reduced hearing loss are promptly identified, evaluated, and provided with
resources and appropriate intervention services.

Assessment
• Performing and interpreting comprehensive educationally relevant evaluations, including functional measures, of peripheral
and central auditory systems.
• Making appropriate medical, educational, and community referrals.
• Assessing students’ functional ability to access auditory information in the classroom to link diagnostic information,
educational accommodations, and program planning.
• Collecting and interpreting learning environment data from classroom observations, classroom acoustics measurements,
and other assessments to determine the impact of auditory deficits on communication access, school performance, and
social relationships.
• Describing the effects of students’ hearing levels and auditory processing deficits on communication, academic performance
and psycho-social development and making recommendations to address these problems to the student, parents, and
school personnel as appropriate.
• Managing the use and calibration of audiometric equipment.
Chapter 2
Amplification
• Evaluating and making recommendations for the use of personal hearing instruments (e.g., hearing aids, cochlear implants,
bone conduction devices).
• Ensuring the proper functioning of all personal hearing instruments.
• Evaluating, fitting, and managing personal and classroom remote microphone and other hearing assistive technologies to
ensure access to auditory information using recommended verification and validation protocols.
• Making recommendations for appropriate use and connectivity of personal and assistive technologies (radio, television,
telephone, messaging, alerting, and convenience) for students.
• Providing training and support regarding hearing assistance technologies to students and school personnel on use, care,
limitations, and specific troubleshooting techniques.
Habilitation
• Facilitating and/or providing intervention to develop and enhance speechreading, auditory and listening, and communication
abilities.
• Facilitating and/or providing support for wellness and-social development including educating students about their hearing
status, associated communication implications and accommodations, understanding current hearing aid and cochlear
implant technology and how they best interface with hearing assistance technologies.
• Providing training about hearing, hearing differences and other auditory disorders for school personnel to facilitate a better
understanding of the impact of auditory impairments on language, learning, literacy and social development.
• Facilitating opportunities for connecting with peers and adults who are deaf or hard of hearing.
• Contributing to program placement decisions and making specific recommendations to address listening and communication
needs.
• Collaborating with school, parents, teachers, support personnel, and relevant community agencies and professionals to
ensure delivery of appropriate services.

56 Chapter 2
Counseling
• Providing training and support to parents/families regarding hearing differences and implications for language development,
communication access, educational achievement, wellness and other areas to facilitate a better understanding of the impact
of auditory impairments on language development, communication access, learning, literacy and social development.
• Providing counseling to students to promote identity, self-determination, personal responsibility, self-advocacy, and social
awareness.
Prevention
• Educating students and school personnel about the prevention of hearing loss.
• Managing school programs for hearing loss prevention education.
Contributions to the Multidisciplinary Team

Chapter 2
As part of the educational team, educational audiologists interact directly with parents, as well as general education teachers,
teachers of the deaf/hard of hearing, nurses, and specialized instructional support personnel (e.g., speech-language
pathologists, LSL specialists, educational interpreters, psychologists, social workers).
The efforts of educational audiologists to improve access to auditory information in learning environments address a
fundamental need for all students to be able to hear, and understand, with or without visual supports, in the classroom.
This expertise is unique from that of other professionals whose focus is from an academic, social-emotional and/or speech
language perspective. Together, the educational audiologist and other professionals comprise a team prepared to effectively
address the needs of students with hearing, listening, and auditory processing difficulties.
References
American Academy of Audiology (2004). Audiology: Scope of Practice. Available from www.audiology.org
American Speech Language Hearing Association (2018). Scope of Practice in Audiology. Available from www.asha.org
American Speech-Language-Hearing Association. (2007). Scope of Practice in Speech-Language Pathology Available from
www.asha.org/policy
Council of Exceptional Children (2018). Specialty Set: Deaf and Hard of Hearing. Entry and advanced level of knowledge and skills
for teachers of students who are deaf or hard of hearing. Revalidated 2018. Available from https://www.cec.sped.org/~/media/
Files/Standards/CEC%20Initial%20and%20Advanced%20Specialty%20Sets/Initial%20Specialty%20Set%20%20DHH%20%20
Revalidated%202018.pdf
Federal Register (2006). Regulations for the Individuals with Disabilities Education Act of 2004.
National Association of State Directors of Special Education (NASDSE), 2018. Optimizing Outcomes for Students who are Deaf or Hard
of Hearing: Educational Service Guidelines, pp 69-71, Alexandria, Virginia: NASDSE.
Rehabilitation Act of 1973, Section 504, 29, U.S.C. 794: US Statutes at Large, 87,335-394 (1973).
Ventry, I. (Ed.). (1965). Audiology and Education of the Deaf. Washington DC: Joint Committee on Audiology and Education of the Deaf.

CHAPTER 3
Partnering With Families
With Janet DesGeorges
CONTENTS
Positive Attitudes
Rapport ■ Respect ■ Trust
Effective Communication
Informational Guidance
Quantity of Information ■ Types of Information ■ Parent-to-Parent Communication
Chapter 3
Parent Involvement
Committee/Task Force Work ■ Classroom Support ■ Parent Activities
“My tooth fairy.”
57

CONTENTS (Continued)
Difficult Situations
Parent/School Disagreement Over Individualized Education Program Services ■ Request for a Specific Brand of
Amplification ■ Influence of Private Provider on School Services ■ Families That Have Difficulty Being Involved
■ Differing Opinions on Communication Modality
Summary
Suggested Readings
Appendices
3–A Resources for Parents of Children Who Are Deaf or Hard of Hearing (Text/Online)
3–B Family Needs Interview for Families of Children Who Are Deaf or Hard of Hearing (Text/Online)
3–C Childhood Hearing Loss Question Prompt List (QPL) for Parents (Text/Online)
KEY TERMS Balancing the desires of parents and the opinions of pro-
Chapter 3
fessionals for shared decision-making can be one of the most

Parent involvement, family, rapport, bias, trust, respect, ef- difficult educational challenges. As parents have acquired
fective communication greater knowledge and involvement in their children’s educa-
tions, they have necessitated change toward better account-
ability and “individualization” to obtain services that address
KEY POINTS the needs of their children. Part C of the Individuals With
Disabilities Education Act (IDEA), along with the early hear-
ing detection and intervention (EHDI) system for families of
■■ Parents are critical partners in the education of deaf and
children who are deaf or hard of hearing, have heightened our
hard of hearing children.
awareness of the needs and roles of families. The shift from
■■ Parents increasingly have become their child’s primary
being the specialist to becoming a multi- and interdisciplinary
advocate in schools.
team member has not always been easy for audiologists or
■■ The concept of partnership should not be viewed as
other professionals. Yet the power and impact of collaboration
an additional burden from the professional viewpoint,
by a team of specialists that includes parents as equal partners
but as a positive and critical component to meeting the
cannot be overestimated. A relationship based on partnership
goals of ensuring student success.
and empowerment where the understanding is “together we
■■ Families encounter all kinds of emotions throughout the
can” can go much farther than a “we-they” arrangement to
different phases and time periods of raising a child who
foster successful outcomes from the educational process.
is deaf or hard of hearing.
This chapter’s discussion is primarily about the educa-
■■ There should not be an assumption that families move
tional audiologist’s role in supporting parents, providing them
through their emotions in a linear manner—that is, grief
with information, and helping them make decisions. Partner-
in the beginning, and then “moving on.”
ing to address these goals can bring a greater level of success.
The education of students who are deaf or hard of hear- Although these activities may be considered part of the
ing is complex. It requires the participation, expertise, and counseling process, we should be careful how counseling
input from the professionals who are serving these students, activities are defined. Providing information and support to
in conjunction with a partnership with families. Research parents as they make decisions about methodology and pro-
conducted over the past 30 years identifies parent involve- grams is more guidance than counseling. Specific counsel-
ment as one of the most important factors in student success in ing services are usually directed toward helping parents work
school (Epstein, 2001; Henderson & Berla, 1994; Luckner & through the grieving process or helping their children with
Muir, 2001). Benefits of engaging families include higher personal concerns or challenges associated with their hear-
reading scores, higher grades on homework, improved ating status (see Chapter 10, Supporting Wellness and Social-
titudes toward school, and improved relationships between Emotional Competence, for more information on counseling
parents and teachers (Donahoo, 2001). students). Whether preventive or prescriptive, professional
58

Partnering With Families 59
counseling should be left to individuals who are appropri- to be relaxed with some families, formal with others, frank
ately trained and who have specific experience working with with some, and gentle with others. Avoid perceptions of in-
individuals who are deaf and hard of hearing. When situations timidation or superiority, as these are counterproductive to
arise that require professional counseling, and they often do, building a healthy relationship.
refer the child and family to the appropriate school counselor One effective approach for developing rapport is called
or psychologist. If an appropriately trained counselor or psy- “joining the family” (Haley, 1976). Haley suggested that inter-
chologist is not available, work with the school to identify and ventionists become part of the family system to achieve more
contract with one. The value of understanding the implica- effective services for young children by being a more integral
tions associated with various hearing levels and deafness and part of the support structure. Although home service is not a
direct communication with the student cannot be minimized. routine activity for many educational audiologists, there are
The following questions emphasize the context crucial several advantages to “house calls.” A visit to the home to
to establishing and maintaining positive and supportive re- meet the family members can not only help to establish a rela-
lationships with parents that are addressed in this chapter: tionship but will also provide the audiologist with valuable in-
sights and information to facilitate the diagnostic, habilitation,
■■ How can positive attitudes be developed and maintained
and educational process. A home visit provides an opportunity
with families?
to observe the family setting and interact on “their turf,” which
■■ How can effective communication be established with
is often more comfortable for caregivers. A visit to the home
families?
can also provide additional insights into the home environ-
■■ How should information be provided to families?
ment and culture, routine communication styles and structure,
■■ What can parents do to become more involved in school
functional use of hearing, discipline, daily routines, extended
activities and to support the specific needs of children
family members, and available toys, books, and other materi-
and youth who are deaf and hard of hearing?
als. If such a visit is not possible, the educational audiologist
Chapter 3
■■ When difficult situations arise, what strategies can be
is encouraged to collaborate closely with any home interven-
used to facilitate positive outcomes?
tionists that have been or are currently involved with families.
Empathy is another important component in building a
relationship. Individuals can be empathetic without having
POSITIVE ATTITUDES had identical personal experiences. The development of re-
flective listening skills, learning what questions to ask, how
Effective relationships with parents begin with healthy atti- and when to ask them, and how to interact in a nondirec-
tudes. The attitudes that people develop are, for the most part, tive and nonjudgmental manner are all critical aspects of
shaped by experience, personality, and self-awareness. Some empathy that are discussed further in this chapter. Genuine
people have more pessimistic viewpoints, tending to expect care and commitment to assisting the family are essential.
the worst from a situation, while others have outlooks that are The ability to put oneself in the family’s situation and to
more hopeful. Educational audiologists work with a variety look outward from their perspective often provides a more
of people from a wide range of backgrounds and cultures. In realistic sensitivity to the family’s concerns and needs and
public education, where there is no option of choosing whether can result in a stronger partnership with the family. Empathy
or not to provide services for children and their families, the can also be built by reading articles from parents about their
attitudes of some parents can be very challenging, while others experiences raising a child who is deaf or hard of hearing.
are rewarding. Establishing effective relationships with parents This background can lead to a broader and more diverse
requires a reciprocal understanding where both parties share understanding of the uniqueness of families. One such re-
respect and trust to sustain their partnership. Rapport, respect, source is the Hands & Voices blog (http://handsandvoices
and trust are considered briefly in the following sections as .org/deafhardofhearingchildren/).
important steps toward building effective relationships with
families. The integration of these skills can have a positive
influence on the attitudes of the individuals involved. Respect
To continue to develop a productive relationship, all parties
should respect one another. Respect does not mean agree-
Rapport ment. Rather, it describes how people are treated and the
Establishing rapport with a family is the first step toward honor they hold for one another’s beliefs. Recognition of the
building a healthy relationship. Increasing our sensitivity to importance of the parents and family in the diagnostic and
how each family functions, their resources and motivations, habilitation phases is essential. Educational audiologists, re-
interaction, and learning styles is helpful. Understanding gardless of their own personal biases or beliefs about what
each family’s dynamics can foster interaction techniques is best for an individual child, must strive to maintain an
that are more likely to be compatible with that family’s style. open attitude and acceptance of the options a family may
While maintaining a professional atmosphere, it is possible choose. Respect for the family’s time, their need and desire

60 Chapter 3
to understand all information clearly, including the educa- environments, other audiologists may have more exper-
tional audiology services and intervention program, and tise in the fitting and programming of implantable hearing
their need to make decisions for their child’s current and technology.
future needs reinforces their role as the primary caregiver Trust in a relationship evolves and, therefore, is
and case manager in the long-term process. Likewise, the strengthened over time as interactions between the parties
parents and family should also be respectful of the audiolo- continue to reinforce the initial foundation on which it was
gist’s time, efforts, and commitment to providing services begun. Patience and sensitivity by all parties of a collabora-
for children and youth. tive relationship result in increased trust over the long term.
Another component of respect is sensitivity to socio- A reflection of trust is the ability for parents and profession-
economic factors, family constellation, and cultural differ- als to be authentic and honest with one another, even when
ences, as well as acceptance of the unique characteristics there is disagreement, knowing that sharing sometimes dif-
that may be associated with a variety of family cultures and ficult conversations will not affect the relationship.
systems. Services need to be responsive to family values and
beliefs. If an educational audiologist feels uncomfortable
with certain cultural issues or environments, relationships
and effective outcomes may be compromised. If such dis- EFFECTIVE COMMUNICATION
comforts exist, it is advisable for educational audiologists to
Parents deserve open, honest communication. This means
acknowledge their feelings and discuss alternative options
that professionals must take time to listen and acknowledge
or modifications for service delivery with their supervisor
what parents say. Furthermore, professionals should set
without compromising their professional ethics. Alterna-
aside their biases to work as a member of a team for the best
tive options should include deliberately seeking further
interests of the child/youth and his or her family. Effective
education, resources, and opportunities to build skills in the
Chapter 3
communication practices, as shown in Table 3–1, are espe-

area(s) of discomfort.
cially pertinent during the multidisciplinary assessment and
Finally, respect requires extra care and attention to con-
collaborative planning processes because of the numbers of
fidentiality. The world of hearing challenges/deafness can
people and services involved (see Chapter 13 regarding ef-
be surprisingly small, and families who are concerned with
fective communication practices with school teams).
guarding their privacy should be supported in their efforts.
Effective communication with families is not always
Families should be made aware that all school employees,
easy. Although some parents seem to have little motivation or
including educational audiologists, must abide by regula-
understanding of the real consequences of reduced hearing,
tions under the Family Educational Rights and Privacy Act
despite our efforts, it can be encouraging to remember that
(FERPA), as well as the Health Insurance Portability and
most families will develop skills over time when given sup-
Accountability Act of 1996 (HIPAA) when applicable, as
port, information, and modeling. Remember that your efforts
these laws prohibit disclosure of personally identifiable
may lead to further success in the future, even if you do not
information for students and their families without family
see results. It is important not to give up. For others, language
knowledge and consent (see Appendix 1-C for more infor-
and cultural barriers distance families from participating in
mation on FERPA and HIPAA).
the school environment. When communicating with families
from diverse cultures, educational audiologists need to be sen-
Trust sitive to the impact of differing communication styles (e.g.,
eye contact, the use of space), the role of gender within vari-
Once rapport and respect have been established, trust
ous cultures, potential differences in value systems, and the
should be inherent. Positive interactions over time continue
use of sign language or foreign language interpreters who can
to strengthen good relationships. Credibility is a critical fea-
also misunderstand and, in turn, miscommunicate unfamiliar
ture of trust. Professional competence must be demonstrated
information (Alberg, 2003). The transition from family-
before trust with the educational audiologist can be estab-
focused early intervention to school-based education can be a
lished. The audiologist’s expertise should be apparent in the
difficult adjustment for parents. In addition to understanding
technical aspects of diagnostics and habilitation, communi-
the family’s perspective, professionals also must check their
cation skills, collaboration with other agencies, and follow-
internal barriers, such as those described in the text box. The
through. Educational audiologists who return calls promptly
extra time and effort invested, however, can result in more
and are careful to only make commitments that they can ful-
productive and stronger partnerships over time. Some strate-
fill will earn trust more quickly from the families they serve.
gies for communicating with families include the following:
Trusted professionals recognize when referrals to other
individuals should be made for services that are either out- ■■ Set aside personal biases and assumptions regarding the
side the purview of educational audiology or beyond the family’s wishes for their child.
audiologist’s expertise. Just as educational audiologists spe- ■■ Listen first and listen with commitment; effective listen-
cialize in assessment and intervention within educational ing requires concentration on what the person is saying

TABLE 3–1 Effective Communication Skills

Committed Listening ■■ Gain clarity about an issue;
■■ Understand the needs, perceptions, and emotions of the speaker;
■■ Gather data for feedback;
■■ Allow the speaker to refine thinking by speaking to an attentive listener;
■■ Seek patterns of behavior; and
■■ Lay a path for building responses and solutions. (p. 3)
Paraphrasing ■■ Fully attend

■■ Listening with the intent to understand
■■ Capture the essence of the message in a paraphrase that is shorter than the original statement
■■ Reflect the essence of voice tone and gestures
■■ Paraphrase before asking a question: Pause, Paraphrase, Probe
Powerful Questions ■■ Reflect active and powerful listening and understanding of each person’s perspective
■■ Presume positive intent
■■ Evoke discovery, insight, commitment, or action on behalf of the person
■■ Challenge current assumptions of the individual
■■ Create greater clarity, possibility, or new learning
■■ Move the individual or team toward what he or she desires
■■ Move the thinking forward to current and future actions and do not focus on having the person justify
Chapter 3
or look backward
Reflective Feedback Reflective feedback clarifies ideas or actions under consideration and offers concerns, values, and
suggestions:
■■ Clarify questions or statements for better understanding
■■ Value statements communicate positive features of actions and move toward preserving and building
upon them
■■ Reflective questions communicate concerns, considerations, or options toward improvement
Statements should:
■■ Consider the content of the message and the potential impact on the relationship;
■■ Say what needs to be said (the content) in a way that supports another’s growth and maintains a
positive relationship.
Note. From Kee, Anderson, Dearing, Harris, & Shuster (2010).
Barriers to Committed Listening

Internal Distractions ■■ Bias around poverty, race, religion, and lifestyle may
■■ Emotions and thoughts that have the potential to interfere with listening fully to a person’s point of
hijack our attention view, especially when we confront our own values
Physical Barriers ■■ Semantic misunderstandings for words that carry
■■ Fatigue, hunger different meanings and may be filtered through

Emotional Reactions our personal experiences, beliefs, education, and
■■ Reactive listening, the speaker uses words that trig- mindset
gers our “hot button” External Distractions
Biases and Judgments ■■ Cell phone rings or vibrates during conversation
■■ Previous experiences with the speaker often influ-
ence our ability to listen with intention

62 Chapter 3
and conveying. It shows the person that you care and for their child and family. The following strategies can help
want to fully understand his or her perspective. Begin audiologists facilitate parent empowerment:
by asking the parents about their concerns and their
■■ foster skills to develop independence and a sense of
observations of their child. Completing a history form
competence and worth in families;
with the parents is a good opportunity to obtain this
■■ move from professionally directed services to family-
information. The Family Needs Interview in Appen
centered/team-directed services;
dix 3–B is another effective tool to open the door to
■■ help families to see themselves as integral to achieving
conversations about sensitive topics.
solutions to problems;
■■ Include parents in the assessment of their child, and
■■ develop a relationship where families perceive audiolo-
describe each step of the evaluation process. Their par-
gists as having helpful knowledge and skills;
ticipation will help them understand the results. Spend
■■ create a problem-solving partnership between you and
extra time and effort to have parents leave with at least
the family;
a basic understanding of the outcome of the evaluation.
■■ understand that families often use both intuition/gut
■■ Acknowledge when information or answers to ques-
feelings and objective data to make decisions and to
tions are not known or when additional information
advocate for their child, and professionals can support
would be helpful. Let parents know when they can ex-
parents by respecting their right to process decision-
pect follow-up on information requested.
making both subjectively and objectively; and
■■ Provide parents with written information to review and
■■ capitalize on trained parents of deaf and hard of hearing
share with other family members, as well as other pro-
organizations to provide information.
fessionals. Provide parents with a report (use accurate
but simple language) that includes a description of the To be effective, information must be presented in a man-
implications of the hearing status and current recom- ner that parents and family members can easily understand
Chapter 3
mendations. Obtain written parent permission to share and that can be individualized for each family, child, and
information and to copy the report to appropriate school, situation. When information is used incorrectly, it can lead
private practice, medical, and other professionals. parents down a path of stress and potential problems. Many
■■ Conduct follow-up phone calls to inquire how the child families and caregivers need multiple opportunities to hear
is doing and to see if the family has additional ques- and discuss information, especially when it addresses a topic
tions. These calls are indicative of the educational audi- that is new for them. Educational audiologists must recog-
ologist’s care and concern; the unsolicited contact goes nize that information might not be processed or retained as
a long way toward building and sustaining an effective it was intended. Phonak organized a group of pediatric au-
relationship. diologists and parent representatives (English et al., 2017) to
■■ Remember to use strategies for developing rapport, re- develop a list of questions for parents to use as prompts with
spect, and trust in all communications. their audiologist or early intervention provider in the areas
of diagnosis, family concerns, management of devices, and
support systems. The Question Prompt List (QPL) is located
INFORMATIONAL GUIDANCE in Appendix 3–C.
Educational audiologists practice in the schools to provide

service to and support for children in their learning environ
ments. With children and youth who are deaf or hard of Approximately half of new information is forgotten
hearing, the educational audiologist’s primary role is to help immediately, and half of unfamiliar information is
identify and advocate for student needs related to listening remembered incorrectly.
and communication access and learning. However, consis-
tent and strong parent support often affects the way a student
performs more than the work of the educational audiologist
and other school team members. Even better results can be
achieved when the parents and the school are working to-
gether for the same outcomes. A major step in developing
effective relationships and shared decision-making is to pro-
vide families with information. Trained parents and active
parent organizations such as Hands and Voices, Inc. (http:// There must be ample, and often repeated, dis-
www.handsandvoices.org) can be a valuable resource for cussion time with the educational audiologist to
parents and caregivers. The power of parent-to-parent com- provide clarification of information, to respond to
munication cannot be overestimated. Information is pow- questions, and to provide objective guidance.
erful; it can enable and empower parents to make choices

Quantity of Information and videos/CDs available for parents, sites for ordering
materials, and information about national resources and
It can be difficult to decide how much information parents
programs. The types of information provided to families
should be provided with and under what time frame. Each
should be reflective of the child’s status—that is, current
parent has a different capacity to absorb various quantities
age, age of identification, type of hearing condition, hear-
of materials. The degree of information necessary is usually
ing level, and whether the family has already been involved
a function of where a family is in the diagnostic or treatment
with an intervention program. Universal newborn screening
phase of intervention. Typically, the parent of a newly diag-
follow-up programs often provide a packet of information
nosed infant or child will require a great deal more general
to parents of infants with newly identified hearing loss. The
information than the family of a child diagnosed 5 years pre-
educational audiologist should check to see if the family
viously, although as the educational situation changes and
still has this information, and, if so, use it as a starting point.
technology options increase, all parents will need updated
In addition, educational audiologists need to be prepared to
information.
counsel parents whose child’s hearing condition was identi-
In the early stages after identification, we believe it is
fied later (i.e., after infancy), those who had a delayed onset,
best to give parents enough information to introduce the
or those whose loss has progressed, and to develop a col-
basic areas they will need to be aware of during their child’s
laborative relationship with families who have been dealing
early development and education. Some professionals may
with intermittent programming while attempting to confirm
feel this amount of information is too much for parents to
a diagnosis and obtain services for their child.
process, but this strategy allows the family to decide how
much they want to read, review, or access on their own time- Information for Families: Phase I—Newly
table. It also gives parents adequate information in the event
Identified or Recently Identified
they move or are not seen again by an audiologist for some
Though the world of deafness can seem intimidating and
Chapter 3
time. Additional information can also be given at each ap-
pointment, if there are sufficient opportunities for discussion difficult to navigate, families often bring strength to the
with the audiologist. situation that forms the first step toward self-confidence and
When providing large packets of information to parents, emotional availability to receive the new information they
always identify the materials that require their immediate re- will need. These components include a mother’s and/or fa-
view. Noting or highlighting the materials that are especially ther’s love, seeing their child’s potential as a person, under-
pertinent to their child’s situation is also helpful. Further standing the family’s priorities and values, and their ultimate
reading can be suggested for follow-up visits. Some parents right and responsibility for their child. Families are more
respond to these “assignments” in a formal way; for others, self-confident when they sense that they have something to
a suggestion to read an article may be more appropriate. contribute. This confidence leads them to the knowledge that
Generally, parents should determine when they are they are the experts of their own child.
ready for more detailed information. Their questions are The most immediate and critical information to be pro-
often indictors of when they are ready for more and the type vided to parents at this stage should target the following areas:
of information they want. A good strategy for determining ■■ understanding the basic parameters of their child’s hear-
how much information a family is wanting is to directly ask ing condition (i.e., level, type, configuration);
them, “Do you want more information?,” “Are you feeling ■■ possible cause(s) of the hearing condition;
overwhelmed?,” “Can I help you with specific resources that ■■ implications of this hearing condition (e.g., audibility,
you have questions about?” When families feel they are in language, communication, development);
a trusting relationship, they are more likely to open up and ■■ connections to intervention programs;
share their concerns and questions. Follow-up appointments ■■ role of audibility and visual access;
are key opportunities for audiologists to support and guide ■■ amplification options;
parents. ■■ language and communication options;
■■ connections to other parents; and
Types of Information ■■ connections to deaf mentors, guides, and/or role models.
There are many types of information and formats that are Whatever time is necessary must be taken to complete
effective with families and caregivers. Historically, infor- this phase of the adjustment process. Depending on the diag-
mation has been provided through print material and face- nostic situation, this responsibility could belong to the edu-
to-face discussion, but as personal computer, phone, and cational audiologist, to the dispensing audiologist, or, even
other technology use has increased, apps, social media, and better, both working together to support the family in home,
web searches provide instant access to all sorts of informa- early childhood, and school environments. We have found this
tion and advice. Additionally, online instruction programs collaboration to benefit all parties because it uses each audi-
provide access to sign language and other educational pro- ologist’s time more efficiently, shares the responsibility, and
grams. Appendix 3–A contains a list of materials, books, demonstrates to parents that the audiologists work together

64 Chapter 3
for their child. As part of the information conveyed, parents financial resources (Supplemental Security Income
need to learn about communication options, learn about the [SSI], Medicaid, state disability services for chil-
importance of audibility and amplification, and gain a real- dren, service organizations, etc.);
istic expectation of what each option might provide. Once hearing and speech services (audiology and hearing
the fitting process begins, a written home usage plan can be aids, hearing therapy, speech therapy, hearing aid
particularly helpful in supporting parents during the adjust- bank and loaner programs, if available, etc.);
ment period. This program should include charts for record- health/medical resources (county health depart
ing wearing time and listening activities to do when the child ment; health and medical clinics that serve children;
is wearing hearing instruments. Early and Periodic Screening, Diagnostic, and Treat-
Information for families of children newly or recently ment [EPSDT] benefit [Medicaid]; Women, Infants,
diagnosed is usually more general but still should provide and Children [WIC]; ear, nose, and throat physi-
the breadth necessary to touch on most of the critical top- cians; etc.);
ics parents immediately face. One of the most helpful activi- public schools: Child Find and specialized programs
ties the audiologist can do is to compile a resource booklet for deaf and hard of hearing children, Head Start, etc.;
for parents. Our experience with this type of information parent/family supports (parent groups and organiza-
has been extremely positive. Audiologists (educational and tions for disabilities and deaf/hard of hearing chil-
private) within a community should meet to devise such a dren and their families, preschool support groups);
booklet and to develop a list of local resources if this is not deaf mentor/deaf and hard of hearing guides and role
already available. As mentioned previously, many state new- models;
born hearing screening programs in conjunction with family- child care and respite services;
based organizations have developed such information book- transportation;
lets or packets as part of their early hearing detection and housing (transition, homeless, abuse protection);
Chapter 3
intervention (EHDI) systems, but community audiologists counseling; and

and service providers should add local information and re- emergency (poison control, suicide hotline, fire-
sources for families. Production and duplication costs can be police-ambulance).
shared between the school district (often production) and the
private providers (duplication of copies for their clients). By In Colorado, a group of professionals (audiologists, deaf
involving all area audiologists, an ownership in the product educators, habilitation specialists, Deaf adults, and State De-
is attained, and audiologists are given the opportunity to im- partment of Health and Education representatives) and par-
prove communication among themselves as they share in the ents began by developing a booklet entitled, RESOURCES
development and compilation of resources and materials. The for Families of Children With Hearing Loss in Colorado.
following topics are suggested for the contents of a booklet: This booklet was funded and disseminated to every audiolo-
gist in the state through the Colorado Department of Educa-
■■ an introductory page: a description of the contents, the tion. Within each community, audiologists were instructed to
purpose, and how to use the manual; develop a list of “local resources” that would be added to the
■■ communication options: a definition and description of main booklet, and then to reproduce and distribute copies for
each communication option in a straightforward, nonbi- each local audiologist for dissemination to parents whenever
ased manner (see Appendix 9–J for an example); hearing loss was diagnosed. This process attempts to ensure
■■ the effects of reduced hearing: a description of the that all parents are provided the same basic information and
implications of the varying levels of hearing, includ- options throughout the state. The Colorado chapter of Hands
ing a picture of an audiogram with common sounds & Voices continues to maintain this resource booklet (http://
and speech banana (see Appendices 5–B and 5–C for www.cde.state.co.us/cdesped/deaf.asp).
examples); Several other states now have their own resource in-
■■ amplification options: a basic description of the various formation compiled in print, on a CD, and/or accessible
personal and hearing assistive technologies; through an online web address. Check with your state’s early
■■ glossary: a listing of terminology and definitions com- intervention (IDEA Part C or EHDI) program for more spe-
mon to audiology and deaf education; cific state information. Parents should have information that
■■ reading and resources list: a compilation of books, addresses the specific type and level of hearing identified
videos/CDs, national organizations and resources, and for their child. The audiologist (or groups of audiologists)
state organizations, resources, and providers; may wish to develop packets of information that focus on
■■ local resources: a listing (with contact information) of common etiologies or diagnoses, such as otitis media, uni-
city, county, and regional resources; these may include lateral hearing loss, progressive and late-onset hearing loss,
general information regarding community services noise-related hearing loss, Usher syndrome, or auditory
for children (IDEA Part C agency should be included neuropathy/dyssynchrony spectrum disorder (ANSD). In-
here); formation specific to genetics and hearing is also important.

The National Institute on Deafness and Other Communica- TABLE 3–2 Factors That Influence Parents’ Adaptation to
tion Disorders (https://www.nidcd.nih.gov) and Boys Town Hearing Loss
National Research Hospital (https://www.boystownhospital ■■ Marital situation
.org) provide useful resources on genetics and etiologies of ■■ Family size
various hearing conditions for parents. Additional resources
■■ Birth order
for these topics can be found in Appendix 3–A, and additional
■■ Temperament match
sites for information can be identified by searching relevant
■■ Financial situation
databases on the Internet. Parents can order materials from
online and print catalogs that include products such as vid- ■■ Flexibility for change
eos/CDs, books for parents on hearing conditions, and inter- ■■ Family acceptance
vention programs and materials (Appendix 3–A). The Fam- ■■ Previous experience with disability/hearing loss
ily Needs Interview mentioned previously (Appendix 3–B)
Note. Adapted from Clark and English (2004).
can also be given to families periodically to determine areas
where the family may desire more information or support.
Parents also need information about their rights and the and state parent organizations. Information about workshops,
Individualized Family Service Plan (IFSP), Individualized parent groups, and sign language classes is important to fami-
Education Program (IEP) process, and Section 504 plan. lies. Resources for additional otology or genetic consultation
This information should be provided in print as well as ex- to evaluate the etiology of the hearing loss should also be pro-
plained. Parents typically are involved with the IFSP process vided for parents who do not have this information. This phase
first since age of identification is generally younger than is also a good time to meet deaf or hard of hearing adults if
3 years. Because there is so much flexibility in how IFSPs this opportunity has not yet been provided. Their insight and
are conducted and written, and because the parent is more experience can be helpful to parents and provide a perspective
Chapter 3
“in charge,” the IFSP can be a much less intimidating situ- that hearing individuals cannot authentically represent. There
ation than the IEP (see Chapter 11, Developing Individual are several books written by parents for parents and by adults
Plans, for more information on development of the IFSP and who are deaf or hard of hearing that are included in Appen
IEP and transition between them). Websites developed by dix 3–A. Often a book or a video can serve as a starting point
parent organizations, such as Hands & Voices (http://www for ongoing discussions to help parents adjust to changing fam-
.handsandvoices.org), provide a wealth of information, writ- ily dynamics that often follow diagnosis of reduced hearing.
ten from a parent perspective. The Hands & Voices Advo- Families encounter all kinds of emotions throughout the
cacy, Support, and Training Program has specific resources different phases and time periods of raising a child who is
for educational advocacy (http://www.handsandvoices.org deaf or hard of hearing. There should not be an assumption
/astra/index.html). that families move through these emotions in a linear man-
ner (i.e., grief in the beginning, and then “moving on” once
the diagnosis has been made and intervention begun). Rather,
Information for Families: Phase II— different feelings can resurface each time certain milestones
Living With the Diagnosis are reached that cause the impact of the hearing loss to be
Once a family has adjusted to the diagnosis of their child’s particularly apparent. The most difficult times are often tran-
hearing condition, they should be ready for more detailed sition periods such as entry into preschool, kindergarten, at
information about communication, programs, and education puberty, at high school graduation, and independent living.
options for their child. The first phase of adjustment is often A heightened sensitivity to these circumstances will help
more internal, that is, understanding and meeting the im- educational audiologists be prepared to offer parents support
mediate needs of the child and family. Factors that influence through counseling, meetings, or communication with other
parents’ timelines for adapting to their child’s diagnosis are parents who have been through these difficult times, and
identified in Table 3–2. parent support groups. The Ida Institute (https://idainstitute
The second part of adjustment includes many external ac- .com) program, Growing Up With Hearing Loss, is a counsel-
tivities, such as meeting with other parents, meeting adults who ing tool that helps parents of young children prepare for these
are deaf or hard of hearing, and attending parent groups, work- important transitions, as well as the children themselves as
shops, or Deaf culture activities. The benefit of early childhood they get older. This program is described in Appendix 10–F.
home intervention programs is that the parent education pro-
cess is ongoing and can proceed at the family’s pace as they are
ready to explore new areas. For preschool and older children in
formal educational settings, services in the home typically are Parent-to-Parent Communication
not available, often because of time and travel limitations for Professionals can increase their effectiveness in providing
public school program staff. As a result, special efforts must information to families by partnering with state and local
be made to keep parents informed as well as connected to local parent organizations. Jackson, Wegner, and Turnbull (2010)

66 Chapter 3
examined family members’ perceptions, preferences, and

satisfaction with family support services. Based on the re-
sults of a questionnaire, it was found that families valued “Successful family involvement is not a sporadic
their discussion with other parents of children who are deaf activity. It is a sustained commitment to instill the
or hard of hearing, identifying them as one of the top sources habits of learning and to set high expectations. It is
of support. making connections to teachers and schools not
Henderson, Johnson, and Moodie (2016) conducted only when trouble arises, but as a part of the ev-
a dual-stage scoping review of the literature that included eryday process of children’s schooling.”
39 peer-reviewed articles on parent-to-parent support. Data
from this literature were identified, extracted, and organized Richard W. Riley, Secretary of Education, 1994
into libraries of thematic and descriptive content. This in-
formation was then used to create an eDelphi study with a
handpicked group of 21 experts in parent-to-parent support
from seven different countries. The findings from this dual- bond and shared experiences of families. Many GBYS pro-
stage scoping review and eDelphi study provide a concep- grams serve families as their children move into the school
tual framework that defines the vital contribution of parents years as well, particularly during periods of transition. Col-
in assisting other parents new to a diagnosis. The framework laboration between professionals and parent leaders from a
design includes 3 constructs (Well-Being, Knowledge, and program such as GBYS can result in a complementary rela-
Empowerment) and 17 components. These constructs and tionship that benefits the families and children being served
components are presented in a closed helix visual design as well as the professionals supporting those families.
with the supporting parent and learning parent on opposite
curves. The helix represents the exchange of information
Chapter 3
between the parents (Figure 3–1). PARENT INVOLVEMENT

The parent-to-parent connection continues to grow as
more state EHDI programs adopt the Guide By Your Side The concept of partnership should not be viewed as an addi-
Program (GBYS) of Hands & Voices. This program con- tional burden from the professional viewpoint, but as a posi-
nects trained parents of deaf and hard of hearing children tive and critical component to meeting the goals of ensuring
with parents and family members of infants and toddlers student success. From the very beginning, families can begin
with newly identified hearing conditions to promote self- to learn the tools that will help them, including the laws,
efficiency and reduce isolation by exploring the common policies, and best practices to become equal partners in their
CONTR
IBU
TIO
N
SELF-DETERMINATION
WELL-BE
CHILD
G
WELL-BEIN
PARTICIPATION, GOALS
PARENT & FAMILY

IN
RELATIONAL, EMOTIONAL
G
SUPPORTING PARENT
LEARNING PARENT
LEGAL RIGHTS, REPRESENTATION,

ADVOCACY FINANCIAL RESOURCES
KNOWLEDGE
KNOWLEDGE
SYSTEM NAVIGATION & TRANSITIONS SPECIALISTS, SERVICES
EDUCATION RESOURCES, INFORMATION, SKILLS

EMPOW
MENT
COMPETENCE ENGAGEMENT, DECISION MAKING,

EMPOWER
PARENTING, ADAPTATION,
ERM
& CONFIDENCE PROBLEM SOLVING

ENT
FIGURE 3–1 Conceptual framework of parent-to-parent support for parents of deaf and hard of hearing children. (From Henderson,
Johnson, & Moody, 2016.)

child’s education. Educational audiologists can support this multiple parents, and make their involvement meaningful
process by standing with parents, helping them develop the so they feel like authentic members of the committee and
skills to be effective participants in their child’s education. process. When this type of parent participation occurs, the
Schools can build the foundation for parent involve- outcomes are stronger and have greater credibility. Further-
ment from the beginning of the student’s school years by more, through this process, parents learn about school issues
clearly communicating a desire for families to be engaged and increase their understanding of the challenges teachers
and valuing their contributions. Families who know they are and staff face. Table 3–3 suggests questions that parents can
critical to the educational life of their children beyond the ask regarding their working relationships with professionals.
IEP meeting see the reward of their efforts in the successful, Some parents participate because they have an agenda
self-advocates their own children can become. As noted in of their own that needs attention. Although they are not nec-
Beyond the IEP (http://www.cohandsandvoices.org/newsite essarily disruptive to the process, their focus is set narrowly
/wp-content/uploads/2015/02/Beyondthe-IEPsept2010.pdf ), on their own issues, rather than on what is best for the group.
remind them of their right and responsibility to have a voice To avoid, or at least minimize, these actions, screening of
in their school and that they are always their child’s best ad- parents who have volunteered or selecting an alternative rep-
vocate. They know about the implications of their children’s resentative may be necessary. In addition, a set of operating
hearing status in a way that educators cannot know. Though rules for the participants of the group is essential. The goal
there should be many people on the student’s team of advo- or purpose of the group needs to be stated clearly, with time-
cates, remind families that they are needed to help connect lines and outcomes identified and agreed on. All members
the dots between education and deafness. Parents generally should be respected for the perspective they bring to the task
want to work with their children’s teachers and other pro- but refocused when they stray too far from the objectives.
fessionals. In some situations, and particularly once their
child enters formal schooling, they may feel they have less
Chapter 3
control and that they are not kept informed or given enough Classroom Support
time to discuss their child’s progress. The parent questions It can be very helpful to involve parents in day-to-day class-
in Table 3–3 may be helpful for parents when trying to de- room activities. Parents are often eager to assist in class proj-
termine what they need and want from their relationships ects, tutoring, or being a classroom helper. While it can be
with professionals. difficult to steer a parent away from working with his or her
own child (and it is usually necessary to do so), the instruc-
tional modeling that occurs by having the parent observe
Committee/Task Force Work how the teacher delivers instruction and then the opportunity
All parents should be welcome participants in school pro- to practice with other children has carryover benefits when
grams. Whether it is in helping to plan workshops, working the parent is with the child outside of school.
with curriculum development, planning and implementing When parents have options regarding classroom place-
parent programs, or considering hiring a new teacher or staff ments, one area in which they may choose to advocate is in
member, parents should be involved in the process. Not only helping to identify the best classroom environment for their
is it often a challenge to include parents, but it can also be child, including teaching style and delivery of appropriate
difficult to find a variety of parents who are willing to give accommodations. The Placement and Readiness Checklists
of their time to participate actively on a committee or task (PARC, Appendix 11–D on the companion website) contain
force. Exercise caution when recruiting only one parent a classroom observation checklist that parents can use when
for an activity; avoid the “token” parent syndrome. Invite considering options for classrooms, teaching styles, and
TABLE 3–3 Parent Checklist of Questions to Ask When Working With Professionals

Do I believe I am an equal partner with professionals and accept my share of the responsibility for solving problems and making plans
on behalf of my child?

Do I clearly express my own needs and the needs of my family to professionals in an assertive manner?

Do I treat each professional as an individual and avoid letting past negative experiences or negative attitudes get in the way of
establishing a good working relationship?

Do I communicate quickly with professionals serving my child when significant changes or notable events occur?

When I make a commitment to a professional for a plan of action, do I follow through and complete that commitment?

Do I maintain realistic expectations of professionals, myself, and my child?
Note. From Focal Point, 2(2), 1988. Research and Training Center, Regional Research Institute for Human Service, Portland State University, Portland, Oregon 97207-0751.

68 Chapter 3
FIGURE 3–2 Parent involvement.
services for their child. When teachers and school building should be paid for by the school as part of accessibility
administrators are feeling the pressure of time and energy requirements under Section 504 of the Rehabilitation
constraints, parent involvement can often be seen as an extra Act of 1973 and the Americans with Disabilities Act
Chapter 3
“add-on.” Creating a powerful parent involvement force in (Appendix 1–A).

a school may take some extra energy in the beginning but ■■ Solicit input from all parents when developing pro-
can ultimately be the very resource to help teachers in their grams, workshops, or events. Try a calling tree or e-mail
day-to-day work (DesGeorges, 2010). lists to keep all parents informed of activities.
■■ Rotate the meeting times and days. Different meeting
times may permit more parent involvement in the long
Parent Activities run, even if their attendance cannot be consistent.
One of our biggest challenges with families is keeping them ■■ Establish a parent welcome group that calls on families
active in parent groups. It often seems that it is the same par- who are new to the school or who have a newly identi-
ents who participate in school-sponsored events, and parents fied child. A parent-to-parent chat can often mean as
of younger children participate more frequently than parents much, or more, to the parent as a professional’s sup-
of older ones. Some strategies to increase parent involve- port. Be cautious that parents who make these visits and
ment include the following: calls are good representatives of the program, having a
■■ Try to have as many parents as possible involved in thorough understanding of the school and services and
the planning of parent activities. The intent should be not imposing their values related to communication mo-
to have the activities developed and run by parents for dalities or instructional programs. They also must have
parents. Keep the role of teachers or staff as support to good communication skills. Avoid using parents who
the activities. Have operating rules for parent planning are dissatisfied with the school’s services or experienc-
meetings as well. Care needs to be practiced so that all ing other significant problems. Parent involvement can
participants are heard and their opinions respected. be summarized, both humorously and seriously, by the
■■ Stay on task at the meeting; parent time is valuable and quote illustrated in Figure 3–2 from the Parent Lead-
they need to feel personal accomplishment to continue ership Associates (now available from https://www
their participation. .wrightslaw.com/info/advo.fruitcake.power.htm).
■■ Offer childcare whenever possible; many parents do not
participate due to the cost of babysitting.
■■ Develop a carpool for parents who do not have DIFFICULT SITUATIONS
transportation.
■■ Provide refreshments when appropriate (not essential); Parent counseling and training as identified in IDEA 20041
if possible, either have a fund to purchase snacks or ask is an important related service that can help parents enhance
participants to rotate bringing them. Some parents may the vital role they play in the lives of their children. Helping
prefer potluck dinners—let them choose.
■■ Provide interpreters for non-English-speaking parents
or for deaf or hard of hearing participants. This expense 1
34 C.F.R.§300.24(b)(7).

parents to acquire the necessary skills that will allow them to

support the implementation of their child’s IEP or IFSP may
Influence of Private Provider
help avoid some of the challenging situations described in on School Services
this section. More specific information on ways that parents Private providers may make recommendations with which
can be involved in their child’s educational program can be the school does not agree. This problem occurs in a vari-
found in Chapter 11, Developing Individual Plans. ety of situations, including specific services and types of
Not all families are easy to work with. Unfortunately, habilitation, the recommendation of specific amplification
we must support difficult families and situations from time devices, and different interpretations of a diagnosis.
to time. There are no specific solutions to these problems, When a private provider recommends a specific type
because each family and the dynamics of each situation are of therapy or intervention (such as listening and spoken
different. Some common challenges are identified and dis- language [LSL] for children with cochlear implants or
cussed later together with suggestions for working through a specific computer program for a student with auditory
them. Disputes should be dealt with carefully, maintaining processing deficits [APDs]), schools and educational staff
sensitivity and respect for all participants involved. Some- should remain open to suggestions as they make every effort
times difficult situations cannot be resolved, and more formal to provide appropriate, individualized services. This effort
dispute resolution, mediation, or due process proceedings might include the implant center providing a therapist with
are necessary and can be used successfully (see Chapter 11 extra training in specialized treatment techniques. It does
for more on this topic). However, even these meetings can not mean, however, that the school is mandated to provide
take many hours, and when the financial impact of the time a certified LSL specialist as the only qualified individual to
of the parties involved is calculated, the cost is still quite conduct the therapies. Services are directed by the IEP that
high. Ultimately, if differences remain unresolved, due pro- must describe the needs of the student, the annual goals, and
cess may be the only alternative. the short-term objectives, including the individual(s) respon-
Chapter 3
sible for providing the services and evaluating progress (see
Chapter 11, Developing Individual Plans, for more on IEPs).
Parent/School Disagreement Over Another area of conflict that can arise between schools
Individualized Education Program Services and private providers relates to the diagnosis of APD and
Challenges can occur when the parents and school staff dis- resulting recommendations for amplification. Most schools
agree on type, amount, or scheduling of services. One sce- conduct assessments in a multidisciplinary manner. Aca-
nario concerns parents who want more speech therapy than demic, health, psychological, and speech-language assess-
the school is able to provide. The issue of the academic rel- ment information reflecting the impact of the APD may be
evance of speech production is a little confusing for all of us, missing when APD is diagnosed by a private provider, as this
particularly because this problem occurs most frequently with practice can result in difficulty ascertaining the educational
students who are deaf or those who have very severe hear- significance of the problem. Many audiologists who conduct
ing losses. The increase in children with cochlear implants APD assessments privately use extensive test batteries that
requiring additional therapy to capitalize on the critical post- may ultimately detect an abnormal finding. However, dif-
implant period is also common. Often these children use sign ficulty on only one subtest of a larger battery may not have
language to supplement speech as their established system of enough significance to warrant special education interven-
communication. Although the desire may be for children to tion or remote microphone hearing assistance technology
have the best speech possible, each of these situations must (RM HAT). Furthermore, the recommendation for a service,
be addressed individually recognizing the importance of input such as the use of RM HAT within the school environment,
from family members as well as from the students themselves. is a team decision determined during the IEP or Section 504
process. Amplification for a student with APD should first
be preceded by a successful trial period to determine the
Request for a Specific Brand actual benefits of the system. (See Chapter 6, Auditory Pro-
of Amplification cessing Deficits, for more on APD.)
As the range and variety of hearing instrument options in- Many of the problems that occur between the private
crease, more choices are available for the type and style of provider, parent, and school system could be remedied if all
hearing assistance technology. Parents occasionally request individuals worked collaboratively during the IEP process
a certain make, model, or style of personal or classroom sys- to identify student needs and resulting service recommen-
tem for their child. Although educational audiologists make dations. As has been emphasized, relationships are much
every effort to accommodate parent requests, the schools more effective when all parties work together and use es-
are under no obligation to provide a specific brand or style, tablished communication practices. It is also critical that
provided that the equipment used by the school performs the educational audiologist or individual coordinating these
the necessary functions and is appropriate for the student’s meetings have accurate information on school legal obliga-
needs as designated in the IEP. tions and current case law. (See Chapter 15, Collaborative

70 Chapter 3
School–Community Partnerships, for more information and self-responsibility on the part of the student. (See Chap
resources on this topic.) ter 10, Supporting Wellness and Social-Emotional Compe-
tence, for more detailed discussions of working with students
on these issues.)
Families That Have Difficulty Being Involved It is important to support families to help them become
Families that have limited capacity to provide support for involved with their children’s education. One of the often-
their children in the home, have difficulty attending IEP overlooked purposes of parent-to-parent connections is the
meetings, or do not follow through on recommendations opportunity for families to see positively modeled behav-
made by the school are challenging for all of us. Whether iors of effective parent involvement and advocacy from
the families are noncompliant, willing but unable, or dys- their peers—other families. Families that are previously un-
functional, their children are often left to the schools for engaged may begin to move forward when they meet other
education and support. Completing audiological assess- parents who are taking responsibility for the education of
ments, obtaining medical treatment, conducting hearing in- their own children.
strument fittings, and completing financial aid applications
are all necessary but difficult steps when families are unable Differing Opinions on
or unmotivated to follow through on needed services. It is
for these children that school professionals must work to- Communication Modality
gether so that they are able to receive the services to which Communication modality and educational methodology
they are entitled. Educational audiologists need to be con- remain topics in deaf education that generate a variety of
nected to their community agency network for assistance in opinions. Although communication modality remains the
arranging transportation to appointments or obtaining home parents’ choice for their child, deaf education programs
continue to reflect preferences for some options over others.
Chapter 3
services to help parents with appointments and the comple-

tion of financial assistance paperwork. Often these are the It is understandably difficult for school districts to provide
children who benefit the most from the school’s ability to the full range of options from spoken language to signed
provide comprehensive audiology support. English to ASL and cued speech, especially when the popu-
An additional concern is poor hearing instrument use lation of students who are deaf or hard of hearing is small.
outside of the school. This problem typically occurs with The special considerations requirements of IDEA2 focus on
children/youth whose families do not see the benefits of the this topic as part of the IEP process. Differences of opin-
hearing instrument for their child, do not encourage hearing ion between school staff and parents should be addressed
instrument use at home, or are afraid that the hearing in- through objective means that assess the effectiveness of the
strument will be broken or lost if used during out-of-school child’s communication in the current modality, alternative
activities. Our efforts to maintain the hearing instruments at modalities and methodologies under consideration, as well
school and to demonstrate the advantage of amplification in as educational performance.
all aspects of the child’s life are important in instilling future The educational audiologist is a critical team member
who can help in the discussion by providing objective func-
tional data on the status and progress of auditory develop-
ment and the need for additional visual input. Additionally,
the necessity of objective evaluation data to monitor com-
The Department of Labor, in an August 8, 2019, munication and other areas of development when guiding
opinion letter (https://www.dol.gov/whd/opinion methodology decisions should be supported. Generally, the
/FMLA/2019/2019_08_08_2A_FMLA.pdf ), stated more delayed the child’s language, the greater the consid-
that the Family and Medical Leave Act (FMLA) pro- eration for providing additional inputs, accommodations, or
vides for families to attend their children’s IEP meet- curricular modifications. Regardless of communication op-
ings “if their presence is significant to their ability tions selected by families, we should continue to emphasize
to provide care for their children.” While FMLA that their children’s successes with the chosen method(s)
is unpaid, it is job-protected and can be intermit- are affected by the fidelity with which the family embraces
tent. FMLA is founded on care for a person (i.e., and integrates the communication system into their every-
child) with “a serious health condition” (i.e., dis- day routines.
ability eligible for special education services). The
care includes attending care coordination meetings
(i.e., IEP meetings) in order to “provide appropriate
physical or psychological care” to the employee’s
children.
2
34 CFR §300.324 (2)(iv).

TABLE 3–4 Eight Essential Characteristics for Individuals Working With Parents of Children With Hearing Differences
1. Possess a basic conviction that, given an appropriate support system, people can grow and change if they so desire.
2. Possess a nonjudgmental attitude regarding cultural and lifestyle differences.
3. Possess an empathetic—not sympathetic—attitude (feel “with” versus feel “for”).
4. Be a perceptive listener regarding nonverbal as well as verbal messages.
5. Possess the basic conviction that parents can and do directly influence the outcomes of intervention; time and effort now will
pay off later.
6. Be able to accept parental expression of a variety of emotions without personalizing and becoming defensive.
7. Be able to develop a warm, caring relationship while retaining a professional role.
8. Respect the privacy of parents.
Note. From “Key considerations in the provision of family centered services” by Noel D. Matkin, 1994. Paper presented at the Colorado State Symposium on Deafness,
Colorado Springs, CO.
SUMMARY Clark, J., & English, K. (2004). Counseling in audiologic prac-
Chapter 3
tices: Helping patients and families adjust to hearing loss. Bos-
This chapter discussed the multiple facets involved when ton, MA: Allyn & Bacon.
building relationships with families. Because each family is DesGeorges, J. (2016). Avoiding assumptions: Communication de-
cisions by hearing parents of deaf children. American Medical
different and each situation unique, educational audiologists
Association Journal of Ethics, 18(4), 124–128.
should rely on their experience and professional judgment DesGeorges, J., Johnson C. D., & Seaver, L. (2013). Educational
along with the input of other members of the professional advocacy for students who are deaf or hard of hearing: The
team to determine the most effective way to work with each Hands & Voices guidebook. Boulder, CO: Hands & Voices
family. More importantly, never underestimate the capability Publications.
of families to discern the needs of their children and what is English, K. (2002). Counseling children with hearing impairment
required to address them. It is the responsibility of all profes- and their families. Boston, MA: Allyn & Bacon.
sionals to help parents gain the tools to be their child’s best ad- Luterman, D. (2008). Counseling persons with communication dis-
vocate and to pass those advocacy skills on to their children. orders and their families (5th ed.). Austin, TX: ProEd.
Suggestions on strategies to facilitate and maintain pro- Marschark, M. (2017). Raising and educating a deaf child (3rd ed.).
ductive partnerships, ways to talk with families, and what to New York, NY: Oxford University Press.
Putz, K., Kennedy, S., Olson, S., & DesGeorges, J. (Eds.). (2017).
talk about with them have been presented. Matkin (1994) sug-
We are Hands & Voices: Stories for families raising children
gested eight essential characteristics that should be practiced who are deaf/hard of hearing. Boulder, CO: Hands & Voices.
when working with families that have children who are deaf Schwartz, S. (Ed.) (2007). Choices in deafness: A parent’s guide
or hard of hearing. These are presented in Table 3–4 and sum- to communication options (3rd ed.). Bethesda, MD: Woodbine
marize the contents of this chapter well. In the end, however, House.
there is one primary rule to remember: treat families as you Seaver, L. (Ed.). (2010). The book of choice: Support for parenting
would want yours to be treated. School programs can initi- a child who is deaf or hard of hearing (4th ed.). Boulder, CO:
ate an effective program where families are meaningfully in- Hands & Voices.
volved, offering their support, and desire to create systemic Waldman, D., & Roush, J. (2010). Your child’s hearing loss: A
educational improvement, so that all children who are deaf guide for parents (2nd ed.). San Diego, CA: Plural Publishing.
and hard of hearing can succeed to their highest potential.
SUGGESTED READINGS
American Speech-Language-Hearing Association. (2008). Guide-
lines for audiologists providing informational and adjustment
counseling to families of infants and young children with hear-
ing loss birth to 5 years of age [Guidelines]. Retrieved from
https://www.asha.org/policy.

APPENDIX 3–A
Resources for Parents of Children Who Are Deaf or Hard of Hearing
Alexander Graham Bell Association for the Deaf and Hard Through advocacy, education, research, and financial aid,
of Hearing (AG Bell) AG Bell helps children and adults who are deaf or hard of
3417 Volta Place NW hearing (D/HH) have the opportunity to listen, talk, and thrive
Washington, DC 20007-2778 in society. AG Bell has chapters in the United States and
(202) 337-5220 international affiliates. Services include special interest for
https://www.agbell.org parents, Volta Voices magazine, academic journal, financial
aid and scholarship awards, and many other programs.
American Association of the DeafBlind AADB is a national consumer organization of, by, and for
248 Rainbow Drive #14864 deaf-blind Americans and their supporters. “Deaf-blind”
Livingston, TX 77399-2048 includes all types and degrees of dual vision and hearing
aadb-info@aadb.org loss. Membership consists of deaf-blind people from diverse
http://www.aadb.org backgrounds, as well as family members, professionals,
interpreters, and other interested supporters.
American Society for Deaf Children Organization that provides information and advocates
Chapter 3
PO Box 23 for use of American Sign Language (ASL). Will provide

Woodbine, MD 21797 referrals to support groups and ASL resources for parents,
(800) 942-2732 including ASL camps and the ASDC national conference.
https://deafchildren.org
Aspen Camp School for the Deaf Summer camp emphasizing self-esteem and independence
PO Box 272 through recreation.
Snowmass, CO 81654
(970) 923-2511
https://www.aspencamp.org/
BEGINNINGS for Parents of Children Who Are Deaf or Parent-driven group that provides emotional support and
Hard of Hearing access to information, serving as an impartial central
156-A Wind Chime Court resource for families with deaf or hard of hearing children
Raleigh, NC 27605 as well as deaf parents with hearing children.
(919) 715-4092
https://ncbegin.org
Better Hearing Institute Organization that provides information and resources on all
P.O. Box 1840 aspects of hearing loss, from medical to hearing instruments
Washington, DC 20013
(703) 642-0580 (V/TDD)
https://www.hearing.org
Boys Town National Research Hospital Maintains research registry for hereditary hearing loss; fact
555 N. 30th Street sheets on genetics and specific syndromes. BabyHearing.
Omaha, NE 58131 org is for parents to gain information on hearing screening,
(402) 498-6511 hearing, communicating, preparing for school, and parenting
https://www.boystownhospital.org children who are D/HH.
https://www.babyhearing.org
Central Institute for the Deaf Private oral residential and day school that publishes assess
825 S. Taylor Avenue ment and classroom materials for professionals in deaf
St. Louis, MO 63110 education.
(877) 444-4574 ext. 135
http://cid.edu
72

CueSign CueSign believes in, supports, and promotes the importance

cuesign.inc@gmail.com of full, visual access to language for deaf and hard of
https://www.cuesign.org/ hearing individuals through both cued languages and signed
languages in all environments.
Educational Audiology Association (EAA) Professional organization that supports and provides infor
700 McKnight Park Drive mation on educational services to students with hearing loss
Suite 708 and related auditory disorders.
Pittsburgh, PA 15237
(800) 460-7322
http://edaud.org
Family Voices A national organization and network of families and friends
P.O. Box 37188 of children and youth with special health care needs and
Albuquerque, NM 87176 disabilities that promotes partnership with families—includ
(888) 835-5669 ing those of cultural, linguistic, and geographic diversity—
http://familyvoices.org/ in order to improve health care services and policies for
children.
Hands & Voices Organization dedicated to providing unbiased information
P.O. Box 3093 and support to families of children who are deaf or hard
Boulder, CO 80307 of hearing, and professionals who serve them. Good online
(303) 492-6283 articles on education and legal rights.
Chapter 3
http://www.handsandvoices.org
http://handsandvoices.org/fl3/index.html
HEAR NOW Starkey Hearing Foundation’s “Hear Now” is an application-
6700 Washington Ave based program that provides hearing help to low-income
South Eden Prairie, MN 55344 Americans. Each person they help is fit with new, top-of-
(800) 328-8602 the-line digital hearing aids customized to their hearing loss.
https://www.starkeyhearingfoundation.org/Hear-Now
Hearing Loss Association of America Organization of individuals with hearing loss dedicated
7910 Woodmont Ave., Suite 1200 to open the world of communication through providing
Bethesda, MD 20814 information, education, support, and advocacy.
(301) 657-2248 (V)
https://www.hearingloss.org
House Ear Institute Resources for information, research, and treatment for those
2100 West Third Street, Suite 111 with early childhood deafness and their families.
Los Angeles, CA 90057
(213) 770-2187
https://hei.org
International Hearing Dog Inc. Nonprofit organization that trains and provides dogs at no
5909 E. 89th Avenue cost to adults over 18 years old who are living alone or with
Henderson, CO 80640 other persons who are D/HH who have at least a 65-decibel
(303) 287-3277 (unaided) hearing loss and are able to care for the dog.
https://www.ihdi.org
John Tracy Clinic Multiple materials in English and Spanish about listening,
806 West Adams Boulevard language, speech, and child development. Families enrolled
Los Angeles, CA 90007 in Worldwide Parent Education program receive personalized
(213) 748-5481 guidance from hearing loss specialists. Live, online video
https://www.jtc.org classes for groups of parents can be arranged on request.

74 Chapter 3
Laurent Clerc National Deaf Education Center/Gallaudet Center provides information on topics including ASL,
University assistive technology, early intervention, educational advocacy
800 Florida Avenue NE (app), hearing aids, cochlear implants, deaf mentors, reading
Washington, DC 20002 to deaf children, research, Odyssey magazine, and more.
(202) 651-5855 (TTY/Voice)
https://www3.gallaudet.edu/clerc-center.html
Miracle-Ear Children’s Foundation Supports underserved Americans with a limited income
150 South Fifth Street and no other resources for hearing aids, such as insurance,
Suite 2300 Medicaid, Veterans Affairs, or other state or federal
Minneapolis, MN 55402 programs.
(800) 241-1372
https://www.miracle-ear.com/foundation
National Association for the Deaf (NAD) Civil rights organization of, by, and for deaf and hard of hearing
8630 Fenton Street, Suite 820 individuals in the United States. The advocacy scope of the
Silver Spring, MD 20910-4500 NAD is early intervention, education, employment, health
Videophone: care, technology, telecommunications, youth leadership, and
■■ (301) 587-1788 (ZVRS) more.
■■ (301) 328-1443 (Sorenson)
■■ (301) 338-6380 (Convo)
■■ (301) 453-2390 (Purple)

https://www.nad.org
Chapter 3
National Cued Speech Association Organization that supports and provides information about
1300 Pennsylvania Ave. NW, Suite 190-713 the use of cued speech. Maintains a list of local instructors.
Washington, DC 20004 Catalog with related materials.
(800) 459-3529
http://www.cuedspeech.org
National Institute on Deafness and Other Communication Federal institute that provides research support and
Disorders resource information on multiple aspects of deafness. Links
National Institutes of Health to genetic information and hereditary hearing loss registry.
31 Center Drive, MSC 2320
Bethesda, MD 20892-2320
https://www.nidcd.nih.gov
Oticon Inc. Manufacturer that provides pediatric hearing aids and
580 Howard Avenue hearing information.
Somerset, NJ 08873
peoplefirst@oticonusa.com
https://www.oticon.com/solutions/for-children/sensei
Signing Exact English (SEE) Center Nonprofit organization that provides information and
10443 Los Alamitos Blvd support for parents and professionals on Signing Exact
Los Alamitos, CA 90720 English communication.
(562) 430-1467
https://seecenter.org

APPENDIX 3–B
Family Needs Interview
for Families of Children Who Are Deaf or Hard of Hearing
DIRECTIONS TO THE FACILITATOR:

Many families of young children who are deaf or hard of hearing need additional information and/or support to enable them
to make the best decisions regarding their child’s early intervention services. Listed below are some of the needs frequently
identified by these families. This interview should be used with the family to identify areas where the early intervention pro-
gram may be able to provide these additional supports. Support may take several different forms including printed materials,
videotapes, web resources, referrals to other agencies, connections to other parents, and discussion. Some questions may be
adequately addressed through information shared during this interview process.
Child’s Name: Date Completed:

Person being interviewed: Relationship to Child:
Interviewer:
Chapter 3
NOT AT DATE/INFORMATION
TOPICS NO YES
THIS TIME PROVIDED
General Information: Would you like information in any of the following areas?
1. General growth and development
2. Playing or talking with my child
3. Teaching my child
4. Handling my child’s behavior
Information about Hearing and Hearing Differences: Would you like information in any of the following areas?
5. Normal hearing and how the ear works
6. Cause of my child’s hearing condition
7. Hearing aids and how they will help my child
8. Cochlear implants and other types of hearing devices
9. Keeping the hearing aid(s) on
Communication: Would you like information in any of the following areas?
10. Teaching my child to listen
11. Hearing differences and the effect on my child’s ability to learn to talk
12. Language development
13. Sign language
14. How my child will communicate
15. How I can communicate with my child
Services and Educational Resources: Would you like information in any of the following areas?
16. Special services available for my child
17. Communication accessible activities and programs in my
community
75

76 Chapter 3
18. Special services available in my local school district

19. Ideas to more effectively communicate with my child’s teacher or
therapist
20. Ideas to manage time regarding my child’s hearing needs and
therapies
21. Other conditions my child may have
Family and Social Support: Would support in any of the following areas assist you in meeting the needs of your
family and child?
22. Talking with someone in my family, or a friend, about my concerns
23. Opportunities to meet with other parents of children who are deaf
or hard of hearing
24. Opportunities to meet deaf and hard of hearing adults
25. Information about parent support groups
26. Help with our family’s, or extended family’s, acceptance and
understanding of the hearing difference
27. Meeting with a counselor who specializes in hearing loss issues
28. Meeting with a counselor regarding family issues
Chapter 3
29. Explaining my child’s hearing difference to others

30. Help with sibling issues
Do you need assistance in any of the following areas? These issues and concerns may need to be referred to the
case manager or other resources in the community.
1. Help locating good babysitters for my child
2. Help locating a day care program for my child
3. Help locating therapists or other specialists
4. Help with transportation
5. Funding for hearing aids
6. Funding for therapy
7. Funding for child care/respite care
8. Funding for other special equipment my child needs
9. Resources for food, housing, medical care, clothing, or
transportation
Please list other topics or information that the family would like to receive or discuss:
Source: Adapted with permission from “The Family Needs Survey” by D. Bailey and R. Simeonsson, 1988.

APPENDIX 3–C
Childhood Hearing Loss Question Prompt List (QPL) for Parents
Many parents have questions or concerns about their child’s hearing loss that they want to discuss with their audiologist. During busy clinic visits,
parents may forget to ask their questions. Parents like you helped create this question sheet to help parents get the information and support they
are looking for. The questions on this list are organized by topic. Some questions may matter more to you than others.
If you find it helpful, you can use this list to help you remember what to ask. Circle the questions you are interested in, or write down your own
questions before your clinic visit. Plan to ask your most important questions first. You can keep using this question list for as long as you like.
I. Our Child’s Diagnosis

1. What kind of hearing loss does my child have?
2. Why does my child react to some sounds?
3. Are there tools to help me and others experience what hearing is like for my child?
4. Will my child’s hearing get better/worse over time?
5. Do hearing aids fix hearing loss in the way glasses fix vision problems?
6. How do you and my family decide what technology, if any, is right for my child?
7. Is it likely that my child’s speech will be affected?
Chapter 3
8. We often feel overwhelmed with the decisions we have to make. Can you help us prioritize these decisions?
9. Are there related medical concerns I should know about?
10. Why is it recommended that we see a geneticist?
11. I’m finding it hard to come to terms with the diagnosis and what it might mean for my child and family. How can I get support?
II. Family Concerns

12. How can I share the importance of hearing devices with family and others?
13. What resources are there to help us pay for our child’s hearing needs?
14. What can we do at home to encourage our child’s communication development?
15. What resources are there to build children’s confidence, resilience, social skills?
16. If we want to learn sign language, how/where do we start?
17. What are some effective ways to get my child’s attention and communicate?
18. What should I be looking for at home to know if my child is making appropriate progress?
III. Management of Devices

19. How much should my child use his/her hearing devices?
20. How do I take care of the hearing devices?
21. What strategies do parents use to keep the devices on a child’s ears?
22. What do we do if the hearing aids stop working?
23. How can I encourage my child to feel confident about using hearing devices?
24. Will it take a while for my child to get used to his/her hearing aids?
25. Should we take the hearing aids off when our child naps, breastfeeds, etc?
26. When the hearing aids are touched, does the feedback noise bother our child?
V1.00/2017-12/2017 © Sonova AG All rights reserved
IV. Support Systems, Now and in the Future

27. I’d like to talk to other people in our situation. How can I meet other parents with children with a hearing loss, and/or adults who
are deaf or hard-of-hearing?
28. What agencies are available to help our family?
29. If I wanted support from a social worker or family counselor, how would I obtain a referral?
30. How can I help our childcare provider support our child’s communication needs?
31. Do children with my child’s level of hearing typically go to their local school?
32. What kind of help will my child need if he/she wants to participate in sports, music, and other activities?
77

CHAPTER 4
Hearing Screening
and Identification
CONTENTS
State Hearing Screening Mandates

Screening Requirements in Private Schools, Charter Schools, and Other Nontraditional Education Settings
Purposes of Hearing Screening and Identification Programs
Professional Guidelines ■ Age Considerations ■ Prevalence Considerations
Resources for Hearing Screening and Identification Programs
Personnel and Time ■ Scheduling Considerations
Screening and Identification Program Considerations
Early Childhood ■ School-Age Children and Youth
Chapter 4
“I hear the beep!”
7979

CONTENTS (Continued))
(Continued
Screening and Identification Procedures

Visual Inspection ■ Auditory Brainstem Response ■ Otoacoustic Emissions ■ Pure-Tone Audiometry
■ Tympanometry ■ Behavioral Observation
Screening and Identification Protocols

Infants and Young Children ■ School-Age Children and Youth
Hearing Screening and Monitoring Children Who Cannot Respond to Traditional Measures
Screening Personnel
Audiologists ■ Speech-Language Pathologists ■ Parent Volunteers, School Nurses, and Paraprofessionals
■ Training of Support Personnel
Screening Equipment and Maintenance

Screening Equipment ■ Equipment Maintenance/Calibration ■ Infection Control
Screening Environment
Location of the Screening Room ■ Noise Levels ■ Other Factors
Organization of Screening and Identification Programs
Scheduling of the Screening ■ Activities Prior to the Screening ■ Activities During the Screening
Follow-Up Procedures
Follow-up Screening for Middle Ear Conditions and Medical Referrals ■ Referrals for Audiological Evaluations
■ Educational Screening
Data Management and Reporting

Determining the Effectiveness of Hearing Screening and Identification Programs
Data From Screening Program ■ Sensitivity and Specificity ■ Cost Effectiveness
Chapter 4
Summary
Appendices
4–A State Hearing Screening Laws for Children in Schools (Text)
4–B HEAR Checklist (Text/Online)
4–C Record of Ear and Hearing Problems (Online)
4–D Basic Hearing Problems Questionnaire for Students With Developmental Delays (Text/Online)
4–E Preparation Checklist for Preschool and School Hearing Screening (Online)
4–F Parent Notification Letter for Hearing Screening (Online)
4–G Class Hearing Screening Results Record Forms (Online)
4–H School Hearing Rescreening/Referral List (Online)
4–I Sample Teacher Notification of Screening Results (Online)
4–J Sample Parent Notification of Screening Results—Pass (Online)
4–K Sample Parent Notification of Screening Results—Recheck (Online)
4–L Sample Parent Letter to Refer Child for Further Audiological Evaluation (Online)
4–M Sample Medical Referral Letter and Return Medical Referral Form (Online)
4–N Sample Medical Referral Form (Physician) (Online)
80

Hearing Screening and Identification 81
KEY TERMS ■■ Questions to be discussed when developing and imple-

menting a hearing screening and identification program
Hearing screening, state screening laws, sensitivity, speci- include the following: What are the existing state and
ficity, incidence, prevalence, pure tone, tympanometry, oto- federal mandates for hearing screening?
acoustic emissions (OAEs), child find, high-risk checklists, ■■ What are the purposes of the hearing screening and
noise-induced hearing loss, otitis media, protocols identification program?
■■ What resources are available to run the program?
■■ What do professional guidelines recommend for screen-
KEY POINTS ing protocols?
■■ What test procedures will be used for screening and for
■■ Variances in state hearing screening mandates empha- identification?
size the importance for educational audiologists to know ■■ What pass/refer criteria will be used?
the laws regarding hearing screening in their states. ■■ What children will be screened?
■■ Hearing screening is the starting point for potential ser- ■■ How will children who cannot respond to traditional
vices for deaf and hard of hearing students. techniques be screened?
■■ The prevalence of reduced hearing increases as chil- ■■ What are the criteria (noise level, visual distractions)
dren age; from about 2 to 3 per 1,000 at birth to 4 to 5 for the screening room?
per 1,000 at school age (National Health and Nutrition ■■ What personnel will be needed for the screening and
Examination Survey [NHANES]) and to 9 to 10 per identification program?
1,000 (White, 2019) in teens including 12% of 12- to ■■ What equipment will be necessary, and how will it be
19-year-olds with documented noise-induced threshold calibrated and maintained?
shifts (NHANES, 2009–2010). ■■ Who will organize the screening and identification
■■ Otoacoustic emissions (OAEs) have increased the ef- program?
fectiveness of screening programs for young children ■■ What follow-up procedures will be used for rescreening
and other children who cannot respond to traditional referrals and absentees?
play conditioning or pure-tone screening methods. ■■ What recordkeeping and reporting are required, and
■■ Advancements in wireless pure-tone screening technol- how will it be accomplished?
Chapter 4
ogy will reduce background noise issues and increase ■■ How will the effectiveness of the screening and identi-
screening efficiency using automated protocols that fication program be evaluated?
provide flexible programming for various populations
Although it may be difficult to provide specific answers
as well as threshold options to 0 dB hearing level (HL).
for all of these questions, this chapter addresses each one
The initial step in a school-based audiology program and provides options that the educational audiologist and
is to ensure there is a method of identifying those children other screening team members can consider when design-
who have reduced hearing or other auditory disorders. This ing and implementing a hearing screening and identification
is typically done, at least in part, through a hearing screening program. Issues related to screening for auditory processing
and identification program. A hearing screening program’s are addressed in Chapter 6, Auditory Processing Deficits.
purpose is to identify those children who might have reduced
hearing, whereas a hearing loss identification program
should identify those who definitely have reduced hearing.
Identification procedures are required by Individuals with STATE HEARING SCREENING
Disabilities Education Act (IDEA) under the definition of MANDATES
audiology.1
A hearing screening program should separate a large State laws that govern hearing screening vary from no re-
population of children into two groups—those who have quirement to comprehensive protocols that require screen-
normal results (pass) and those who have abnormal results ing at multiple grade levels with specific procedures and
who need further testing (refer). Because a hearing loss follow-up. Appendix 4–A contains a summary of state hear-
identification program is designed to determine the pres- ing screening requirements. Statutes contain general provi-
ence or absence of reduced hearing, follow-up procedures sions, while subsequent regulations provide the necessary
beyond hearing screening must be included. This chapter specifications required to implement and carry out the law.
addresses procedures specific to hearing screening and iden- The Centers for Disease Control and Prevention (CDC) col-
tification, and Chapter 5, Assessment, focuses on diagnostic lects and reports data on the Early Hearing Detection and
procedures. Intervention (EHDI) Program, a federally funded initiative
1
34 C.F.R. §300.

82 Chapter 4
that includes screening of infants for hearing loss, audiologi- challenges. Generally, state screening mandates apply to
cal evaluation to confirm hearing status, and referral to early all publicly funded school programs, including alternative
intervention services. The 2016 CDC EHDI Summary (May and charter schools that are part of the local school district.
2018) reported an average of 98% of infants were screened Juvenile detention facilities and other state-operated pro-
according to 56 respondents from 49 states, seven territories, grams that contain youth who are at the grade levels iden-
and the District of Columbia. tified in the state screening regulations also need to be
The EHDI management system works from state-level screened. Private school students should also have the op-
laws and regulations that articulate local policies and pro- portunity to participate in public school screening programs.
cedures. In 2019, 43 states (plus the District of Columbia, Depending on each state’s regulations, public schools may
Guam, and Puerto Rico) had statutes related to newborn provide
hearing screening (http://www.infanthearing.org, retrieved
■■ the services at private schools;
June 30, 2019). According to the InfantHearing.org website
■■ equipment and training for the private schools to con-
(retrieved June 30, 2019), only 28/43 states required screen-
duct their own screening; or
ing of all babies; some states set the compliance standard as
■■ screening to private school students (including those
low as 85%, meaning that so long as 85% of hospitals in the
attending online schools) at a nearby public school or
state conducted newborn hearing screening, the state would
another neutral site.
be considered “in compliance” with the federal mandate.
Other states manage newborn hearing screening programs Currently, Internet-based hearing screening programs
without a state mandate. Systematic early childhood hearing continue to have too many uncontrolled variables to be a
screening after the newborn period until school age does not valid and reliable alternative to traditional live screening.
exist primarily due to the logistical challenge of capturing Students in all of these settings require access to hearing
this age group. In addition to family and pediatric physicians identification as part of the local federally mandated Child
and clinics, entities that provide screening for young chil- Find program for students suspected of having a disability.
dren include public health departments (e.g., Early Periodic
Screening, Diagnostic, and Treatment [EPSDT] services),
federally and/or state-funded preschools (e.g., Head Start),
school district Child Find programs, and some community PURPOSES OF HEARING
Chapter 4
agency or service groups. While professional standards

guide hearing screening in this population, those standards SCREENING AND
may vary among professional groups (e.g., physicians, pub- IDENTIFICATION PROGRAMS
lic health nurses, and audiologists) as well as by state.
Most states require hearing screening for school-age chil- When designing a hearing screening program, the educa-
dren at least at kindergarten entry, but, as with newborn hearing tional audiologist must collaborate with the school nurse
screening legislation, there is significant variability in the speci- and/or other appropriate school staff. Because health screen-
ficity of the laws (NASBE, n.d.). These variances emphasize ings are generally completed with all members of the tar-
the importance of educational audiologists being knowledge- geted student group, they are considered a population-based
able of the mandates regarding hearing screening in their states. procedure rather than a special education requirement based
on individual need. The audiologist’s responsibility is to
help ensure that the screening procedures utilized will result
Screening Requirements in Private in an effective system that distinguishes children who have
Schools, Charter Schools, and Other normal hearing from those who may have reduced hearing
Nontraditional Education Settings and who are in need of follow-up testing to identify whether
Screening students in private schools, charter schools, on- reduced hearing is present. The key professionals involved
line and other nontraditional settings often presents unique should have the specific outcomes of the program clearly
in mind. Table 4–1 describes the steps in the screening and
identification process.
Screening programs must be properly evaluated to
The Centers for Medicare and Medicaid Services demonstrate acceptable performance. Parameters that are
(CMS) recommend that children enrolled in Medicaid commonly used to evaluate the screening and identification
should receive hearing screenings at each well-child program are sensitivity and specificity. A good screening
checkup. The program known as EPSDT provides a program should have a high sensitivity rate so that overall
comprehensive benefit to ensure that children are referral rates are not excessive, balanced with a high degree
identified and treated as early as possible. of specificity so that reduced hearing is not missed. Sensitiv-
ity and specificity, as used to evaluate program effectiveness,
are discussed later in this chapter.

TABLE 4–1 Screening and Identification Process
Step Goal Procedure Outcome

Step 1 SCREENING: Separate individuals Screening protocol based on state or Pass or refer
with normal hearing from those local regulations and guidelines. The
with a possible hearing loss. procedures may include a second
screening using the same procedures or
may add additional procedures such as
threshold screening or immittance.
Step 2 IDENTIFICATION of hearing Identification protocol includes If findings are positive for reduced
loss: Confirm whether reduced procedures that inform follow-up hearing: refer to audiologist for
hearing is present; describe some assessment including threshold audiological assessment, physician
preliminary components of the screening, immittance, and otoacoustic for medical assessment, and/
hearing status. emissions. These procedures should be or refer to special education for
conducted by an audiologist or a trained multidisciplinary evaluation.
audiometric technician and require If findings are negative for reduced
parent permission. They are conducted hearing, student may be flagged for
in the school or other screening setting. periodic screening or cleared from
referral list.
cognitive skills. Most hearing screening programs for this

Definitions age group will have as their goal the detection of potential
hearing differences that may affect the development of these
Sensitivity: the ability of the screening procedure skills. Screening may include procedures to identify otitis
to identify the target population accurately (e.g., hit media due to its prevalence at these younger ages. If hearing
rate or number of individuals who have reduced loss has a later onset (e.g., school-age), or fluctuates due to
hearing). otitis media, the potential to develop, or be at risk for de-
Chapter 4
Specificity: the ability of the procedure to not veloping, language, communication, and listening problems
identify (e.g., to pass) those who truly do not have remains. These delays are often manifested by poor academic
the disorder the screening program is designed to performance, communication challenges, and/or social and
identify. behavior concerns. As a result, some screening programs for
school-age children will have a broader goal of identifying
auditory and listening problems that include auditory pro-
cessing abilities. The increase in recreational noise exposure
Professional Guidelines in teens and the need for hearing loss prevention awareness
and education has generated a greater interest in the identi-
Considerations for the development of hearing and identification of noise-induced hearing loss (NIHL). As a result,
fication programs are detailed in professional guidelines of screening protocols that target the identification of hearing
the American Academy of Audiology (AAA), the American loss in the 3000 to 6000 Hz range are recommended for this
Speech-Language-Hearing Association (ASHA), and the age group (Johnson & Meinke, 2008; Meinke & Dice, 2007).
Educational Audiology Association (EAA). These guide-
lines contain specific referral criteria and other recommen-
dations for each target age group. Audiologists should re-
view the following documents when developing or revising
their protocols: Definitions
■■ Childhood Hearing Screening (AAA, 2011);
■■ Joint Committee on Infant Hearing Position Statement: Prevalence: number of existing cases of a spe-
Principles and Guidelines for Early Hearing Detection cific disease or condition in a given population at
and Intervention Programs (JCIH, 2007, 2019); and a given time.
■■ Hearing Screening Advocacy Statement (EAA, 2009). Incidence: frequency of occurrence, expressed as
the number of new cases of a disease or condition
in a specified population over a specified time pe-
Age Considerations riod (Stach, 2019).
A major concern for infants, toddlers, and preschoolers is
the development of language, communication, speech, and

84 Chapter 4
(NHANES) are excellent resources for educational audiolo-

Prevalence Considerations gists who need data and sociodemographic characteristics
Prevalence data regarding reduced hearing, as identified in among children in the United States. The prevalence data from
Table 4–2, vary significantly due to the definitions and refer- NHANES III study are summarized in Table 4–2. A follow-
ral criteria used. Efficacy data on whether a particular hear- up study (Niskar et al., 2001) analyzed the NHANES III
ing level results in functional communication challenges is data for NIHL, concluding that 12.5% of children 6 to
not well documented in the literature. While the functional 19 years old had NIHL in one or both ears. Males had a
ability of an individual with reduced hearing is specific to greater prevalence than females and older students more
the unique contributing characteristics of that person, there than younger ones. Screening at 6000 Hz was recommended
is evidence that any level of reduced hearing can result in to identify NIHL.
hearing, listening, behavior, and communication problems Su and Chan (2017) conducted an analysis of NHANES
(le Clercq et al., 2019). In addition to state guidelines, the demographic and audiometric data from NHANES III to
philosophy of the school district and of the audiologist will NHANES 2009 to 2010. Table 4–3 summarizes the hearing
play an important role in determining the components in- loss prevalence data for four categories: pure-tone average
cluded in the screening and identification program, the (.5, 1 and 2 kHz) thresholds greater than or equal to 20 dB
specific criteria for referral, and the protocol for follow-up. HL and 15 dB HL in one or both ears, high-frequency
For example, the audiologist’s belief about the educational pure-tone average (HFHL) (3, 4, 6, and 8 kHz or 3, 4, and
impact of minimal and fluctuating conductive hearing losses 6 kHz) greater than or equal to 15 dB HL, and evidence of
may affect the screening level used for pure-tone screening a noise-induced threshold shift (NITS). These findings il-
and the inclusion of immittance screening in the program, or lustrate the significant difference in prevalence between the
interest in NIHL may affect the frequencies used for screen- 20 dB and 15 dB HL criteria as well as the relatively stable
ing. Likewise, the belief about the efficacy of the evaluation prevalence over time at 20 dB HL versus varying prevalence
and treatment of auditory processing disorders will dictate at 15 dB HL and 15 dB HFHL, a potential factor when de-
what attempts will be made to identify these disorders. termining screening levels. The data also show a decrease
The reports on prevalence of reduced hearing from the in prevalence of NITS in the 2009 to 2010 findings. The
CDC’s National Health and Nutrition Examination Surveys study findings reported that nonwhite race/ethnicity and low
Chapter 4
TABLE 4–2 Summary of Reported Hearing Loss Prevalence Data in School-Age Children
Prevalence Definition Source

3% Bilateral hearing loss of 16 dB HL or greater (better ear average), Ross, Brackett, & Maxon, 1991
unilateral, or high-frequency hearing loss
5.9% (second grade) Hearing thresholds above 25 dB HL on at least one of six frequencies Montgomery & Fujikawa, 1992
11.3% (eighth grade) (2000, 4000, and 8000 Hz, combined ears)
12% (twelfth grade)
14.9% ≥16 dB HL low- or high-frequency average loss Niskar, Keiszak, Holmes, Esteban,
Low frequency: 7.1% (5.6% unilateral, 1.5% bilateral) Rubin, & Brody, 1998 (NHANES III)
High frequency:12.7% (9.6% unilateral, 3.1% bilateral)
4.9% ≥16 dB HL low- and high-frequency average loss
11.3% Bilateral SNHL (20–40 dB HL) 1% Bess, Dodd-Murphy, & Parker, 1998
Unilateral SNHL (≥20 dB HL) 3%
HF SNHL (>25 dB HL at two or more frequencies
above 2K, one or both ears 1.4%
TOTAL MINIMAL HL 5.4%
Conductive HL 3.4%
all other degrees of HL 2.5%
TOTAL HL 11.3%
2.1% All hearing loss based on categories below: Johnson for Colorado
Bilateral SNHL (≥20 dB HL PTA) .33% Department of Education, 2005
Unilateral SNHL (≥35 dB HL PTA) .15%
High frequency SNHL (PTA ≥35 dB HL) .05%
Chronic conductive (bilateral or unilateral) .09%
All other HL (minimal HL requiring monitoring not included
in previous categories) 1.4%

TABLE 4–3 National Health and Nutrition Examination Surveys (NHANES) Summary of Hearing Loss
Prevalence in 12- to 19-year-olds, 1988 to 2010 (Su & Chan, 2017)
PTA ≥20 dB HL ≥15 dB HFHL ≥15 dB NITS

NHANES III (1988–1994) 4% 17% 15.5% 15.8%
NHANES (2005–2006) 5% 20% 18% 16%
NHANES (2007–2008) 5% 22.5% 20% 17.5%
NHANES (2009–2010) 4.5% 15.2% 12% 12.8%
Note. HFHL, high-frequency hearing loss; HL, hearing level; NITS, noise-induced threshold shift; PTA, pure-tone average.
socioeconomic status were risk factors for reduced hearing. ing problems will be identified. It is, therefore, critical that the
See Chapter 12 for more information about NIHL. audiologist maintain contact with teachers, school nurses, and
parents to encourage questions about the listening behaviors
of specific children and referrals for additional testing.
RESOURCES FOR HEARING
SCREENING AND
IDENTIFICATION PROGRAMS SCREENING AND IDENTIFICATION
Personnel and Time PROGRAM CONSIDERATIONS
Resources available for screening and follow-up will impact Early Childhood
the development and implementation of a hearing screening
Screening programs to detect reduced hearing among
program. Personnel and time are critical factors to be consid-
school-age children have existed in most school systems in
ered in determining the scope and protocol of the program.
Chapter 4
the United States for many years. As discussed previously,
Regardless of the desire of an audiologist to identify all lev-
it is also important for educational audiologists to be in-
els of reduced hearing and particularly those that are educa-
volved in the periodic early childhood screening of infants
tionally significant, it can be frustrating to screen for these
and toddlers to facilitate early identification and intervention
problems when resources for follow-up are not available. In
for children with reduced hearing. Regardless of the state
fact, screening without adequate follow-up can potentially
agency responsible for identification and services to infants
cause more harm than if the screening was not done. If
and toddlers under Part C of IDEA, educational audiologists
follow-up testing is significantly delayed or is not done at all,
should serve as consultants and provide resources for the
teachers and parents may believe that a child who actually
program. However, when the education agency is respon-
has a hearing problem has normal hearing ability. Likewise,
sible for these services, it is imperative that educational au-
if teachers and parents are aware that a child has referred
diologists be directly involved in developing, implementing,
from a hearing screening procedure, they may blame hearing
and monitoring the hearing screening program for infants
loss for all difficulties the child is having when, in fact, other
and toddlers. Regardless of the role played by educational
reasons for the academic problems may exist.
audiologists in such programs, they should be aware of the
screening protocols appropriate for infants and toddlers. The
Scheduling Considerations Joint Committee on Infant Hearing (JCIH) 2007 Position
Statement (JCIH, 2007) outlined guidelines for EHDI pro-
The educational audiologist must work closely with the
grams that include procedures for hearing screening, confir-
schools, staff, and others involved in the screening program
mation of hearing loss, and continued surveillance of infants
and be sensitive to their needs. Even the best hearing screen-
and toddlers who are at risk for hearing loss. Currently, hear-
ing and identification program will experience failure if the
ing screening for infants, toddlers, and preschoolers may be
screening or follow-up is scheduled on the same day as an
promoted by a variety of options, including
assembly or other school activity. Teachers who do not under-
stand the importance of the hearing screening program or the ■■ high-risk checklists;
protocol that will be used may object to having their classes ■■ periodic early childhood hearing screening;
participate in the screening. Also, because of the fluctuating ■■ Child Find (discussed under School-Age Children and
nature of some hearing conditions, the training and experience Youth);
of the screeners, and the environments in which screening is ■■ auditory developmental checklists; and
conducted, it is unlikely that all of the children who have hear- ■■ education of parents, physicians, and other professionals.

86 Chapter 4
High-Risk Checklists Periodic Early Childhood Hearing Screening

With the widespread implementation of universal newborn Universal newborn hearing screening has greatly enhanced
hearing screening, high-risk checklists now play a primary the early identification of various hearing disorders. However,
role in identifying those infants who may pass newborn late-onset and progressive hearing losses are not identified at
screening but need ongoing audiological monitoring to birth, and conductive hearing losses fluctuate. In addition,
identify late-onset, progressive, or fluctuating hearing loss there are children lost to follow-up with unknown hearing
associated with certain conditions. Risk indicators that need status. Ideally all children, birth through age 7 years, should
to be monitored are identified in Table 4–4. receive periodic, ideally annual, hearing screenings to identify
these potential conditions. Ensuring these annual screenings in
Otitis Media the early childhood years is difficult because the primary estab-
Otitis media remains one of the most common childhood lished screening programs are generally limited to Early Head
health conditions for which screening of infants and tod- Start, Head Start, and Parents as Teachers (PAT). Children seen
dlers for associated hearing loss should be a priority. Data through Child Find programs receive hearing screenings, but
have shown that about 90% of all children will have otitis it is a referral program rather than population-based screening.
media with effusion (OME) in the early childhood years Although educational audiologists may not have a direct
(Tos, 1984), with 50% having OME during their first year role in EHDI programs, they are an essential component to
of life and more than 60% by 2 years of age (AAP, 2004). supporting follow-up, including hearing screening through
As part of their research on language development and aca- Child Find programs, assessment, and intervention. Edu-
demic achievement in children with OME, Roberts, Burchi- cational audiologists should educate physicians, health de-
nal, and Zeisel (2002) conducted a comprehensive literature partments, and early childhood care agencies regarding the
review categorizing studies by the areas of language, speech, importance and necessity of annual screenings in order to
auditory processing, and learning implications, with a gen- increase community, statewide, and national support for this
eral conclusion of the research findings (Table 4–5). The standard of care. This education will have the added advan-
summary is a good reminder of the research parameters and tage of encouraging hearing screenings during routine, well-
variability of performance in children, especially those who baby checks. The EAA has recommended specific roles for
do not have reduced hearing associated with OME. Educa- educational audiologists in the document, “Early Detection &
tional audiologists should refer to the American Academy Intervention of Hearing Loss: Roles and Responsibilities for
Chapter 4
of Pediatrics’ revised Clinical Practice Guideline, The Di- the Educational Audiologist” (http://edaud.org).
agnosis and Management of Acute Otitis Media (2013), and
the American Academy of Otolaryngology-Head and Neck Auditory Developmental Checklists
Surgery Foundation (February 1, 2016) for specific follow- It is important for educational audiologists to continue to be
up and treatment recommendations for acute otitis media. alert to the concerns that parents and other caregivers have
TABLE 4–4 Risk Indicators Associated With Permanent Congenital, Delayed-Onset, or Progressive Hearing Loss in Childhood
( JCIH, 2007)
1. Caregiver concern regarding hearing, speech, language, or developmental delay
2. Family history of permanent childhood hearing loss
3. Neonatal intensive care unit stay of greater than 5 days or any of the following regardless of length of stay: extracorporeal
membrane oxygenation (ECMO), assisted ventilation, exposure to ototoxic medications (gentamicin and tobramycin) or loop
diuretics (furosemide or Lasix), and hyperbilirubinemia requiring exchange transfusion
4. In utero infection, such as cytomegalovirus, herpes, rubella, syphilis, or toxoplasmosis
5. Craniofacial anomalies, including those involving the pinna, ear canal, ear tags, ear pits, and temporal bone anomalies
6. Physical findings, such as white forelock, associated with a syndrome known to include a sensorineural or permanent conductive
hearing loss
7. Syndromes associated with hearing loss or progressive or late-onset hearing loss, such as neurofibromatosis, osteopetrosis, and
Usher syndrome; other frequently identified syndromes include Waardenburg, Alport, Pendred, and Jervell and Lange-Neilson
syndromes
8. Neurodegenerative disorders, such as Hunter syndrome, or sensory motor neuropathies, such as Friedreich ataxia and Charcot-
Marie-Tooth syndrome
9. Culture-positive postnatal infections associated with sensorineural hearing loss, including confirmed bacterial and viral (especially
herpes viruses and varicella) meningitis
10. Head trauma, especially basal skull or temporal bone fracture requiring hospitalization
11. Chemotherapy

TABLE 4–5 Summary of Research Pertaining to Language, Speech, Auditory Processing, and Learning Implications of Otitis Media
With Effusion (OME)
Area Findings References

OME and Auditory “Difficult to conclude or refute Folsom, Weber, & Thompson, (1983); Anteby, Hafner, Pratt, & Uri
Processing a link between OME and (1986); Gunnarson & Finitzo (1991); Moore, Hutchings, & Meyer
central auditory processing” (1991); Pillsbury, Grose, & Hall (1991); Hall & Grose (1993); Hall &
(p. 113) Grose (1994); Hall, Grose, & Pillsbury (1995); Hogan, Meyer, & Moore
(1996); Hall, Grose, Dev, & Ghiassi (1998); Hall, Grose, Dev, et al.
(1998); Moore, Hine, Jiang, et al. (1999); King, Parsons, & Moore (2000);
Hogan & Moore (2003); Knudsen (2002)
OME and Speech “Not an indication that OME Shriberg, & Smith (1983); Eimas & Clarkson (1986); Roberts, Burchinal,
represents a significant risk to Koch, et al. (1988); Paden, Matthies, & Novak (1989); Nittrouer
speech production in otherwise (1996); Mody, Schwartz, Gravel, & Ruben (1999); Paradise, Dollaghan,
healthy children” (p. 114) Campbell, et al. (2000); Shriberg, Friel-Patti, Flipsen, & Brown (2000);
Shriberg, Flipsen, Thielke, et al. (2000); Paradise, Feldman, Campbell,
et al. (2001); Campbell, Dollagahan, Rockette, et al. (2003); Paradise,
Dollaghan, Campbell, et al. (2003)
OME and Language “OME-language linkage Vernon-Feagans, Manlove, & Volling (1996); Vernon-Feagans, Emanuel, &
continues to be open to some Flood (1997); Feldman, Dollaghan, Campbell, et al. (1999); Maw, Wilks,
debate” (p. 115) Haarvey, et al. (1999); Rovers, Straaatman, Ingels, et al. (2000); Paradise,
Dollaghan, Campbell, et al. (2000); Paradise, Feldman, Campbell, et al.
(2001); Casby (2001); AHRQ (2002); Roberts, Burchinal, & Zeisel
(2002); Vernon-Feagans, Hurley, & Yont (2002); Feldman, Dollaghan,
Campbell, et al. (2003); Paradise, Feldman, Campbell, et al. (2003);
Paradise, Dollaghan, Campbell, et al. (2003)
OME and Academics, “Data linking a history of Roberts, Sanyal, Burchinal, et al. (1986); Feagans, Sanyal, Henderson,
Chapter 4
Attention, and OME to later academic et al. (1987); Roberts, Burchinal, Collier, et al. (1989); Teele, Klein, Chase,
Behavior skills, attention and behavior et al. (1990); Arcia & Roberts (1993); Lous (1993); Feagans, Kipp, &
continue to be mixed” (p. 116) Blood (1994); Gravel & Wallace (1995); Paradise, Feldman, Colborn,
et al. (1999); Roberts, Burchinal, Jackson, et al. (2000); Minter, Roberts,
Hooper, et al. (2001); Roberts, Burchinal, & Zeisel (2002)
Note. From Roberts et al. (2002).
about the status of a child’s hearing. While questionnaires as School-Wide Hearing Screening
an independent screening tool have been found to be unreli- The concept of school-wide hearing screening for school-
able (Munoz, Caballero, & White, 2014), they can be useful age children is universal, but the specific grades screened
in educating parents and caregivers about the expected audi- vary from state to state, and often from program to program.
tory and communication behaviors of their young children The National Association of State Boards of Education re-
at specific ages as well as in identifying potential delays. ports (NASBE, n.d.) 34 states including the District of Co-
Chapter 9 contains various auditory development checklist lumbia have state school-age screening mandates (see Ap-
tools. These checklists should not be used to screen hear- pendix 4–A for listing of state requirements). Most of the
ing, though problems noted on a checklist could indicate the states recommend screening in the elementary grades with
need to screen or rescreen hearing. kindergarten and first grade being the most frequent grades
screened. Beyond the first grade, school-wide screening
tends to occur every other year, with fewer students being
School-Age Children and Youth screened at the secondary level.
Preschool and school-age children will typically be re-
ferred for hearing screening through one of the following
processes: “Child Find” and Special Education Hearing Screening
■■ school-wide hearing screening; “Child Find” screening and identification refers to free,
■■ “Child Find” and special education hearing screening; or community-based health and developmental screenings for
■■ teacher, parent, or physician referrals. children, birth to age 21 years. Schools are responsible for

88 Chapter 4
Child Find
(a) General. (1) The State must have in effect policies STATE, and children with disabilities attending private
and procedures to ensure that-(i) All children with dis- schools, regardless of the severity of their disability, and
abilities residing in the State, including children with dis- who are in need of special education and related ser-
abilities who are homeless children or are wards of the vices, are identified, located, and evaluated.
providing this program under Part B (3-21) of IDEA,2 while dents who are absent when the screening occurs, those not in
screening for a child from birth to age 3 years depends on the grades routinely screened, or students who move into the
the state lead agency for Part C and how the programs are school mid-year. Also missed will be students who have fluc-
set up. Child Find screenings are usually focused on infants, tuating hearing levels but who had normal hearing during the
toddlers, and preschool-age children because there are no mass screening and those with auditory processing disorders.
universal programs that lead to identification of disabilities Mass screening programs may also mistakenly pass some
for this age group. However, students in out-of-school place- children who have reduced hearing (false-negative responses).
ments up to age 22 years (or whatever age the state estab- It is important to encourage referrals from teachers, par-
lishes for students to exit out of special education) also have ents, and physicians, and it is helpful to have information
access to the Child Find process. about behaviors that may indicate that a child has a hear-
Child Find screenings include developmental (speech- ing problem to facilitate the referral process. To supplement
language, cognitive, motor, social) as well as health (general referrals for hearing screenings, some school districts may
health, vision, hearing) components and, as such, are usually use hearing behavior checklists to encourage referrals from
conducted by a team of professionals who have expertise in parents, teachers, or other school personnel. (See Appen
these early childhood development and health areas. Audiolo- dix 4–B for the HEAR checklist of these behaviors, also use-
gists, school nurses, or trained paraprofessionals may con- ful for inservice training.) To identify children with chronic
duct the hearing screening component. However, since the middle ear problems or known sensorineural hearing losses,
Chapter 4
screening often includes a full range of procedures designed it is often helpful to ask parents to complete a hearing his-
to “identify” auditory problems that may be impacting the tory form (Appendix 4–C) when they enroll their child in
child’s development, audiologists may choose to work these school. Although designed to screen children for central au-
screenings. These children also often require more diagnostic ditory processing problems, the Fisher’s Auditory Problems
skill due to their age and other developmental factors. Refer- Checklist (Fisher, 1985) could also be adapted to obtain re-
rals may be generated by parents, physicians, childcare pro- ferrals from teachers for children suspected of having hear-
viders, public agencies, or others who identify the concern. ing or listening problems (available from http://edaud.org).
Children identified with disabilities through the Child
Find process are generally referred to special education for
eligibility determination. In many states, all students referred
for special education are required to have a vision and hear-
SCREENING AND IDENTIFICATION
ing screening prior to their psychoeducational evaluation. PROCEDURES
This practice is useful because the screenings can facilitate
Procedures used in hearing screening and identification pro-
detection of sensory deficits that might interfere with as-
grams vary depending on the age and development of the
sessment and/or relate to the child’s performance, ultimately
child or youth, the goals of the program, and the resources
affecting educational eligibility, services, and placement.
available to the program. Prieve, Schooling, Venediktov, and
It is also advantageous to screen the hearing of all spe-
Franceschini (2015) completed an evidence-based system-
cial education students annually to prevent an unidentified
atic review on the accuracy of pure-tone and otoacoustic
hearing from potentially interfering with their educational
emission (OAE) screening for identifying hearing loss in
progress.
preschool and school-age children. While they found that
both procedures identified reduced hearing, studies that
Teacher, Parent, or Physicians Referrals compared both procedures in the same population found
Referrals from teachers, parents, or physicians are critical in that the pure-tone screening had a higher sensitivity than
helping to identify children with auditory disorders. Tradi- OAE screening and was therefore considered the preferred
tional school-wide hearing screening programs may miss stu- procedure. The most common procedures that are included
2
34 CFR §300.111.

in screening protocols are summarized in Table 4–6. They response to sound. Soft clicks are presented to the ear via
include the following: earphones or a probe, while electrodes, strategically placed
on the head, record the brain’s response to sound. Because
■■ Supplementary Procedures (High-risk factors and his-
of the technique required in administration and interpretation
tory generally are in the student’s health record; risk
of this procedure, it is not practical as a screening procedure.
factors may be noted at screening for school-age popu-
However, AABR, which is fully automated and norm refer-
lations. Auditory development checklists are typically
enced for newborn screening, permits a variety of personnel
part of the assessment for the special education referral.)
to perform the procedure with a high degree of accuracy and
High-Risk Indicator Checklist
reliability. When used as a screening procedure, AABR pri-
Auditory Developmental Checklist
marily detects hearing losses that are greater than 30 dB in the
History
frequency region above 1000 Hz. The ABR is also sensitive
■■ Direct Procedures
to the stimulus intensity so that degree of hearing loss can be
Auditory Brainstem Response
estimated. ABR may also be used as a screening measure in
Otoacoustic Emissions
older children but often requires sedation if the child is unable
Pure-Tone Audiometry
to be still for a prolonged period of time. Ambient noise, mus-
Tympanometry
cle artifact, and other neurologic involvement can interfere
Supplementary screening procedures are meant to pro- with the accuracy of ABR measurements. Conductive hearing
vide additional information to the results obtained from the loss results in present but delayed waveform responses.
direct methods and should never be used in isolation as a
screening method. For infants and children unable to con-
sistently respond to behavioral procedures, physiological Otoacoustic Emissions
screening tests are the preferred method of screening. For all The development of OAEs represents one of the most signif-
age groups, present OAEs can rule out hearing levels greater icant technological advancements affecting hearing screen-
than 30 to 40 dB HL and abnormal middle ear function, and ing technology. OAEs are not a test of hearing directly but
acoustic immittance is invaluable in further determining the rather a measure of the integrity of the outer hair cells of the
status of the middle ear system. Referral criteria for the vari- cochlea. An auditory stimulus is presented to the external ear
ous screening procedures should be based on professional via a probe inserted into the ear canal. A microphone in the
Chapter 4
guidelines, the goals of the screening program, and any state probe measures the “echo” that is produced from the ear in
laws that must be followed. For example, if a school district response to the sound.
has as its goal the identification of every hearing loss that There are two ways of eliciting OAE responses, tran-
might be educationally significant, including minimal hearing sient evoked (TEOAE) and distortion product (DPOAE). A
losses, a screening level of 15 dB HL may be selected by the TEOAE utilizes a brief pulse of sound, such as a broadband
district. But if the district wants to identify only those losses click or tone burst and measures the resulting response during
that have a high likelihood of being educationally significant, the quiet period between each presentation. With DPOAE,
a higher screening level, such as 20 dB HL, may be chosen. two continuous tones of different frequencies are presented
simultaneously, which result in an emission that is a distorted
copy and, hence, new frequency of the sounds presented.
Visual Inspection Through signal analysis, the distortion product is analyzed.
Visual inspection can be as simple as looking at the ear to The responses for both TEOAEs and DPOAEs are rela-
identify external structural abnormalities or ear canal drain- tive to the noise floor so that excessive background noise,
age. Any abnormalities should be noted on screening forms so heavy breathing, or other internally produced noises can
that the information can be reviewed by appropriate personnel make detection of some responses difficult. Both types of
and subsequent decisions regarding follow-up made. A more measurements are frequency specific: TEOAEs in the fre-
sophisticated visual inspection involves use of otoscopy, a pro- quency range of 500 to 5000 Hz and DPOAEs in the 1000
cedure requiring specific training as well as an otoscope. When to 8000 Hz range (Gorga et al., 1993; Probst, Lounsbury-
otoscopy is performed, further information about ear canal Martin, Martin, & Coats, 1987). While OAEs cannot be
abnormalities, possible foreign objects, and the condition of used to predict hearing thresholds, TEOAEs generally de-
the tympanic membrane can be obtained. Otoscopy may be tect hearing loss at levels of 30 dB HL or greater, while
employed when nurses or audiologists are involved in more DPOAEs are reported to detect hearing loss of 40 dB HL or
targeted screening programs such as Child Find screening. greater (Gorga et al., 1993; Probst et al., 1987). Abnormal
middle ear conditions usually result in absent OAEs. Care-
ful interpretation of OAE results is necessary so as not to
Auditory Brainstem Response mislead parents that hearing is entirely normal when passing
Auditory brainstem response (ABR) and automated audi- responses are obtained; for example, OAEs are generally
tory brainstem response (AABR) are physiological proce- present with auditory neuropathy/dyssynchrony spectrum
dures utilized for hearing screening based on the brainstem’s disorder (ANSD), although they may disappear over time.

90 Chapter 4
Generally, OAEs are quick, simple to conduct, and do

not require a sound booth. Although cost may be a detrac-
tor for some, the utility of this procedure easily justifies the
expenditure when pure-tone screening is not a viable option.
The automated versions of each technology indicate whether
the OAE response reached the pass criterion.
Automated OAEs are frequently used for newborn
screening because of the reduced disposable cost when elimi-
nating the AABR electrodes and ear cuffs. There has also
been an increase in the use of OAEs in early childhood and
school screenings. As a procedure, OAEs have increased the
effectiveness of screening programs for young children and
other children who cannot respond to traditional play condi-
tioning or pure-tone screening methods. With this technol-
ogy, every child can be screened unless there are mitigating
circumstances present. According to Hoffman, Shisler, and
Eiserman (2011), a successful OAE screening program for
young children involves well-designed equipment, dispos-
able foam probe tips, and an easy to understand display for
screening results. OAE screening is particularly useful in pe-
diatric and school screening programs because it can screen
both middle ear and inner ear function as a single proce-
dure (though a refer then requires tympanometry to identify
middle ear etiology). The Early Childhood Hearing Outreach
(ECHO) initiative provides a guidebook for OAE screening, FIGURE 4–1 Creare’s newly developed wireless automated hear-
ing test system provides ambient noise attenuation sufficient for
Early Childhood Hearing Screening & Follow-Up, Imple-
threshold testing outside the sound booth. (Photo courtesy of
menting a Successful Otoacoustic Emissions (OAE) Hearing
Chapter 4
Creare, LLC.)
Screening Program, An Audiologist’s & Facilitator’s Train-
ing and Technical Assistance Guide (https://www.infanthear
ing.org/earlychildhood/docs/Audiologists-Guide.pdf). than would be ideal for the identification of mild hearing
losses. Advancements in wireless pure-tone screening tech-
nology, such as Creare’s automated hearing test system
Pure-Tone Audiometry (Figure 4–1), will reduce background noise issues and in-
Pure-tone screening is a quick procedure; the screening can crease screening efficiency using automated protocols that
be easily done by a trained volunteer or paraprofessional, provide flexible programming for various populations as
and the test can be completed by most children with relative well as thresholds options to 0 dB HL. Although Internet-
ease. Assuming that the number of frequencies screened, based hearing screening programs are evolving, there are
typically four, is sufficient, pure-tone screening is effective management issues that must be addressed to have an effec-
in identifying students who might have a peripheral hearing tive and reliable program.
loss in one or both ears. It is not, however, possible to iden- Conditioned play audiometry (CPA) is a very effective
tify hearing losses that are milder than the screening level pure-tone technique with children between about 2/2.5 and
used. Because of the limitations imposed by noise levels in 4 years of age or other children with developmental disabili-
the environment in which screenings often occur, pure-tone ties. The procedure requires no specialized equipment and
screenings frequently use screening levels that are higher because of the variety of play tasks that can be used children
rarely habituate to the task. Training, to condition the child
for the task, can be accomplished by using the earphone as
a speaker and presenting the signal at a loudness level that
is easily heard. For children who object to wearing standard
Nuggets from the Field or insert earphones, the earphones may need to be handheld.
In this case, the modification needs to be noted because re-
When conducting OAE screening with young sults may not represent true hearing sensitivity due to the al-
children, play video cartoons without sound on tered calibration effect. When this situation occurs, the CPA
an iPad or video monitor to focus their attention must be supplemented with a physiological procedure such
away from the procedure. as OAEs. Table 4–6 summarizes the AAA (2011) recom-
mended procedures and referral criteria screening.

TABLE 4–6 Summary of Pediatric Hearing Screening Procedures
Procedure Target Population Advantages Limitations

High Risk Indicator Birth to 2 years ■■ Quick and easy to administer ■■ Requires audiological screening to
Checklist ■■ Identifies infants who require identify hearing loss
monitoring of hearing sensitivity due ■■ Cannot be used as a singular
to presence of risk factors screening tool; 50% of cases of
hearing loss may be missed
■■ Tracking may be difficult to assure
that follow-up screening occurs
Auditory Birth to 3 years; other ■■ Quick and easy to administer ■■ Cannot be used as a singular
Developmental difficult to assess ■■ Provides functional data about child’s screening tool; does not correlate
Checklist populations use of hearing and listening skills with actual hearing sensitivity
History All ages ■■ Identifies medical, familial, and other ■■ Cannot be used as a singular
developmental information that may screening tool; does not determine
impact hearing ability hearing sensitivity
Visual Inspection of All ages ■■ Identifies visible structural ■■ Cannot be used to determine
the Ear/Otoscopy abnormalities, ear canal drainage hearing sensitivity
■■ Requires minimal training ■■ Otoscopy requires additional
■■ Otoscopy additionally identifies training and an otoscope usually
conditions present in the ear canal limited to nurses and audiologists
and eardrum
Auditory Brainstem Newborns, infants, ■■ Identifies hearing losses greater than ■■ Requires quiet or sleeping infant
Response (ABR) and toddlers, difficult 30 dB HL primarily above 1000 Hz or child; sedation often necessary
■■ Click ABR to assess populations ■■ Predicts hearing thresholds for children who cannot sit still for
long periods of time
Chapter 4
■■ Tone Burst ABR ■■ Ear specific
■■ Bone Conduction ■■ No behavioral response required ■■ May miss mild and low-frequency
ABR hearing losses
■■ Automated units require minimal
training to use ■■ Equipment is expensive
■■ Interpretation complex
■■ Not frequency specific
■■ Difficult to interpret if central
nervous system pathology present
■■ Measures only to brainstem
Otoacoustic Emissions Newborns, infants, ■■ Identifies losses greater than 30 dB ■■ Valid screening difficult prior to
(OAEs) and toddlers, difficult HL (TEOAE) or 40 dB HL (DPOAE) 24 hours of age
to assess populations ■■ Noninvasive, simple procedure ■■ Measures only to cochlea
■■ Does not require a very quiet ■■ Compromised by middle ear or
environment outer ear involvement
■■ Quick and easy to administer with ■■ Cannot predict hearing thresholds
most children
■■ Minimal cooperation required—does
not require sedation
■■ Frequency specific
■■ Ear specific
■■ Useful with neurologically
compromised
■■ Automated units require minimal
training to use
(Continues)

92 Chapter 4
Procedure Target Population Advantages Limitations

Pure-Tone Audiometry 2.5 years to adult ■■ Identifies children who require further ■■ May not be valid with children who
assessment have developmental problems
■■ Quick and easy to administer with ■■ Requires some training to conduct
developmentally appropriate ages procedure
■■ Inexpensive ■■ Requires very quiet environment
■■ Results are generally reliable
Tympanometry 6 months or older ■■ Valid indicator of middle ear function ■■ Does not assess hearing sensitivity
■■ Automated units are quick and easy ■■ Follow-up protocols are variable
to administer with most children
■■ Minimal cooperation required
■■ Equipment is relatively inexpensive
Behavioral 3 months to 2 years; ■■ Provides functional data about child’s ■■ Requires a defined protocol
Observation special populations use of hearing ■■ Requires some degree of child’s
(Note: this procedure ■■ May provide ear-specific information cooperation
should no longer ■■ May provide frequency-specific ■■ Requires experienced audiologist
be considered a information depending on stimulus to administer
screening method used ■■ Generally requires a sound booth
except in very unique
or specially designed equipment
circumstances)
■■ Needs confirmation from another
test procedure to corroborate
pass/refer status
Chapter 4
Tympanometry in time. It may be necessary to use repeated screenings to

Most audiologists recognize the importance of utilizing identify all children with chronic middle ear disorders. It
tympanometry with young children and at-risk populations. is difficult to determine the most effective screening proto-
However, despite accurate and reliable equipment, a con- col, but the potential harmful effects of chronic middle ear
tinued high incidence of middle ear disease, and continued disease on learning make it critical that tympanometry be
recognition of the negative effects on learning that can occur routinely provided for infants, toddlers, and preschoolers,
from long-standing otitis media, tympanometry screening either to accompany pure-tone screening or as a second-tier
remains controversial. Many factors may have contributed to screening with OAEs. Pass and refer criteria must be estab
this problem, including a procedure that was more sensitive lished with consideration of the age and risk factors of the
to tympanic membrane abnormalities than many physicians target population and with consideration of national and lo
were able to diagnosis, referral criteria that were not well de- cal medical treatment recommendations and philosophies.
veloped or validated, controversy among physicians regard- Professional guidelines should be consulted when develop-
ing treatment, and lack of consistent follow-up guidelines. ing these procedures.
Further questions existed as to the purpose of tympano Recommendations for screening for abnormal middle
metry among school populations relative to identifying chil- ear status are included in the AAA Clinical Practice Guide-
dren who may have a medical condition requiring medical lines: Childhood Hearing Screening (2011) and are included
treatment versus an educational condition interfering with in Table 4–7.
learning. Acoustic immittance measurements have historically
The scheduling and follow-up protocols for tympano consisted of three procedures: tympanometric peak pressure,
metry can also be challenging. It is difficult to know when static admittance, and the acoustic reflex. Current screening
and how often to perform tympanometry. If the screening for middle ear disorders consists primarily of tympanomet-
is scheduled during the winter months when the incidence ric width measured in decaPascals at half of the height of the
of middle ear problems is greatest, the refer rate will be tympanogram (peak to the tail), and static admittance or size
higher than if the screening is done at another time of the of the peak of the tympanogram. Consideration should also
year. Likewise, because middle ear problems are transitory be given to canal volume in the interpretation (e.g., when
in nature, the fact that children pass a screening does not pressure-equalizing tubes are present). Acoustic reflex mea-
mean they are clear of middle ear diseases at another point sures are not used in screening procedures.

TABLE 4–7 Summary of American Academy of Audiology Screening Procedures and Referral Criteria
Age/Group Screening Procedures Referral Criteria

Preschool and school-age children (preschool, ■■ 20 dB at 1K, 2K, 4K Lack of response at any one frequency
kindergarten, grades 1, 3, 5, 7, or 9) ■■ Screen for high-frequency hearing in either ear; rescreen immediately
loss when combined with hearing loss
prevention education
Preschool, kindergarten, grade 1 ■■ Add tympanometry >250 daPa tympanometric width;

■■ Tympanometry should be a second- rescreen within 8 to 10 weeks if passed
stage screening following failure of pure tones
pure-tone or otoacoustics emissions
(OAE) screening
Preschool and school-age children for whom ■■ OAEs (primary DPAOE levels at Referral based on automated OAE’s
pure-tone screening is not developmentally 65/55 dB SPL) preset cut-off values; rescreen with
appropriate (ability levels <3 years) tympanometry
Note. AAA Clinical Practice Guidelines: Childhood Hearing Screening (2011).
Behavioral Observation school-age children, and children with developmental dis-

abilities. Newborn protocols are not specifically addressed
Behavioral observation is not recommended as a screening
here. Personnel, screening environment, and other organiza-
technique except in unique circumstances where there are no
tional and management considerations are discussed sepa-
other screening options. The conditions (equipment, envi-
rately from the protocols.
ronment, tester qualifications) under which these procedures
need to be conducted render them inappropriate as screening
measures. Conditioned play audiometry (CPA) and visual re Infants and Young Children
Chapter 4
inforcement audiometry (VRA) are procedures most often
Though most infants born in the United States now have ac-
used with children and do, however, remain components of
cess to hearing screening as a newborn, there must continue
the audiological assessment battery. As such, they are dis-
to be screening programs for infants and toddlers to monitor
cussed in Chapter 5, Assessment.
those with identified risk conditions, those who may not have
received follow-up assessment, and those who may not have
been screened at birth. Since population-based screenings
SCREENING AND do not exist for most infants and young children following
IDENTIFICATION PROTOCOLS the newborn period, physician’s offices, health departments
(EPSDT), Early Head Start, Head Start, community-based
The purpose of a protocol is to utilize a set of procedures programs such as ECHO and PAT mentioned previously, and
that will ensure the intended outcome. Protocols, therefore, local Child Find screenings, and public-school preschool
must be designed specifically for each of the populations for programs provide the most common options for screening.
whom they are intended so that sensitivity and specificity Table 4–8 summarizes the four components of a hearing
considerations are maximized. To ensure the integrity of the screening protocol for infants and young children through
screening and identification program, it is critical that audi- age 4 years. Infants and young children at risk for hearing
ologists are involved in their development and management. loss due to factors associated with the birth, genetic history,
Screening and identification protocol development must ad- or other conditions should also be monitored through this
dress the following: process.
■■ age or developmental considerations that affect the abil-
ity to participate in specific procedures; School-Age Children and Youth
■■ hearing conditions that are age specific;
Most public school programs have traditionally provided
■■ referral criteria;
some level of vision and hearing screening for its students
■■ follow-up components to assure those referred receive
(see list of state statutes in Appendix 4–A). Because public
the intended care; and
education remains the first opportunity to have access to a
■■ parent notification and/or permission.
large population of children, school entry at kindergarten
The following discussion will present screening issues or first grade has been the most common time to conduct
and suggested protocols for infants and young children, population-based screenings after the newborn period.

94 Chapter 4
TABLE 4–8 Suggested Hearing Screening Protocol: Infants and Young Children 6 Months Through 4 Years
Screening Components Procedural Recommendations Referral Criteria Considerations1

History Ask for information regarding the following: ■■ Use information to inform screening and follow-
■■ Family history of hearing loss up process; if family history of hearing loss,
■■ Problems during pregnancy or delivery
monitor twice/year until school age
■■ Number of episodes of ear infections, tubes, or
other ear surgeries
■■ Parental concerns
■■ Speech/language development
■■ Other developmental concerns
■■ Previous hearing tests, including newborn

screening
Visual Inspection Look for: ■■ Refer for medical attention if ear drainage is
■■ Structural defects observed; any other concerns should be noted
■■ Drainage from the ear canal
but not used to refer for medical attention and/
or audiological attention if otoacoustic emissions
■■ If using otoscopy, look for ear canal and
(OAEs) or pure tones and tympanometry
tympanic membrane abnormalities
screenings are passed
Hearing Sensitivity ■■ Automated OAE or if child can reliably perform ■■ OAE: if OAE screening is not passed follow with
play audiometry tympanometry
■■ Conduct pure-tone audiometric screen at ■■ Play audiometry: refer if any signal presentations
20 dB HL at 1000, 2000, and 4000 Hz are not passed at frequency and decibel levels
indicated and tympanometry is normal
Tympanometry Conduct when: ■■ Rescreen in 6 to 8 weeks if TW >250 daPa; if

■■ Automated OAE procedure is abnormal (e.g., child has tympanostomy tubes, refer if equivalent
Chapter 4
“refer”) ear canal volume <1 cm

■■ Audiometry is performed ■■ If flat tympanogram with ear canal volume <0.4 cm3
occlusion of ear canal may be indicated (e.g., wax)
1
Note.
■ Do not screen children with known reduced hearing levels, hearing aids, cochlear implants, or other personal hearing instruments; do note that they are seen
routinely by an audiologist.
■ Do not screen children with outer ear physical abnormalities such as an absence of an ear canal, or malformed ear. Refer to an audiologist unless records indicate
the diagnosis and follow-up treatment recommendations.
■ Refer all children who are unable to participate in the hearing screening to an audiologist.
■ Concerns noted through history and/or visual inspection should increase the importance of obtaining audiometry and acoustic immittance screening.
■ Children attending public school at-risk preschool programs should be screened annually.
■ Refer to audiologist when middle ear condition is normal (OAE or pure-tone screening is abnormal and acoustic immittance is normal).
■ Always rescreen following medical treatment by physician.
However, as the prevalence data illustrate, even with the Because of the potential for NIHL among teenagers,
benefit of newborn screening, audiologists continue to iden- as confirmed by the NHANES studies, it is important for
tify children with reduced hearing at school entry. programs to screen youth as well. Screening protocols for
Middle ear disorders are common in young school-age teens should specifically target the identification of NIHL.
children, and tympanometry screening has been shown to be School-age screening programs should include opportuni-
an effective way to detect these problems. It should be em- ties for education related to hearing loss prevention, espe-
phasized that immittance testing is not effective in determin- cially at the middle and high school levels. Pamphlets home
ing a child’s hearing sensitivity. Pure-tone, OAEs, or other to parents, class discussion, and programs such as Danger-
screening tests are necessary to determine if hearing loss ous Decibels™ are effective methods to increase awareness
might be present. When tympanometry is included as part of of the hazards of noise and techniques for hearing loss pre-
a school-wide screening program, it is typically used in lower vention and are especially relevant when coordinated with
elementary grades (kindergarten, first grade) due to the higher the annual hearing screening program. Another practice is
incidence of middle ear problems in younger children. to screen students for recreational and other noise expo-

Protocol to Identify Noise-Induced Hearing Loss

Recent reports (Hendershot, Pakulski, Dowling, & Price, sure, followed by hearing screening for those who re-
2011; Sekhar et al., 2011) suggest that the most effective port noise exposure that includes pure-tone threshold
method for identifying teens with NIHL is a combination measurements at 1 to 8 kHz.
of a high-risk screening questionnaire for noise expo-
TABLE 4–9 Suggested Hearing Screening Protocol: School-Age Children and Youth
Screening Components Procedural Recommendations Referral Criteria Considerations1

Visual Inspection Look for: Refer for medical attention if ear drainage is
■■ Structural defects observed; any other concerns should be noted
■■ Drainage from the ear canal
but not used to refer for medical attention and/
or audiological attention if audiometry and acoustic
immittance screenings are passed
Audiometry ■■ Grades K, 1, 3, 5: administer pure-tone Rescreen if any signal presentations are not passed
audiometric screen at 25 dB HL at 500 Hz (not at frequency and decibel levels indicated; refer if
necessary if including tympanometry), 20 dB HL condition is present at rescreen
at 1000, 2000, and 4000 Hz
■■ Grades 6 to 12: administer pure-tone
audiometric screen one time in middle school
(grades 6 to 8) and twice in high school
(grades 9 to 12) at 20 dB HL at 1000, 2000,
and 4000 Hz; 20 dB HL at 6000 Hz
Chapter 4
Otoacoustic Emissions Special populations: conduct otoacoustic emission ■■ OAE refer/tympanometry pass = refer to
(OAE) screening for children who are unable to audiologist
perform audiometry, follow with tympanometry if ■■ OAE refer/tympanometry refer = rescreen 6 to
OAE is not passed 8 weeks
Tympanometry ■■ Grades K and 1: Administer in conjunction with ■■ If child has tympanostomy tubes, refer if
pure-tone screening. equivalent ear canal volume <1 cm3
■■ Grades 3 or higher: administer in conjunction ■■ Rescreen asymptomatic abnormal middle ear
with pure-tone screening to children with function within 4 to 6 weeks; refer at rescreen if
history of otitis media and other at-risk groups condition persists (TW >250 daPa)
■■ Special populations: tympanometry not
necessary if OAE screening is passed
1
Note.
■ Do not screen children with known reduced hearing levels, hearing aids, cochlear implants, or other personal hearing instruments; do note that they are seen
routinely by an audiologist.
■ Do not screen children with outer ear physical abnormalities such as an absence of an ear canal or malformed ear. Refer to an audiologist unless records indicate
the diagnosis and follow-up treatment recommendations.
■ Refer all children who are unable to participate in the hearing screening to an audiologist.
■ Concerns noted through history and/or visual inspection should increase the importance of obtaining audiometry and acoustic immittance screening.
■ Always rescreen following medical treatment by physician.
sure followed by a specific hearing screening protocol for states and schools. Therefore, professional guidelines are
those students who report exposure. Chapter 12, Prevention important as support in developing individual school screen-
of Noise-Induced Hearing Loss and Tinnitus in Youth, ad- ing protocols. To be most effective, the protocol must be
dresses this topic in more detail. designed to target the hearing concerns associated with each
In the absence of state or federal standards, procedures, age group being screened. Table 4–9 summarizes a sug-
referral criteria, and follow-up vary significantly among gested screening protocol for school-age children and youth.

96 Chapter 4
tional diagnostic equipment and expertise available through

HEARING SCREENING AND a children’s hospital or other pediatric audiology center.
When sedation is necessary, the information gained from an
MONITORING CHILDREN assessment must be weighed against potential health risks.
WHO CANNOT RESPOND TO See Evaluation of Hearing in Children with Special Needs in
TRADITIONAL MEASURES Pediatric Audiology, third edition (2019) for specific guid-
ance with this population of students.
Although pure-tone and tympanometry screening will be ap-
propriate for most school-age children, some children have
mental, physical, or behavioral problems that interfere with
performing traditional screening procedures or obtaining re-
SCREENING PERSONNEL
liable results. Screening procedures appropriate for younger Numerous persons, including audiologists, speech-language
children, including both behavioral and physiological tech- pathologists (SLPs), school nurses, paraprofessionals, au-
niques, may be effective with these children and youth. diometric technicians, and parent volunteers, have been
OAEs are currently the most common procedure used. It involved in hearing screening and identification programs
should be emphasized that the hearing status of every child in the schools. In determining the personnel for a specific
must be determined as part of initial placement in special program, it is important to look at the cost-effectiveness of
education, either through screening or further evaluation. using various personnel, while ensuring there is adequate
With the technology and resources currently available, “did expertise and supervision for the program.
not test” or “cannot test” should never be accepted as the
final result for any child.
It may be necessary for some children to be tested by a Audiologists
pediatric audiologist apart from the school system. Although Audiologists play a key role in developing and managing
this may be relatively expensive, all children, regardless of hearing screening programs. However, it is generally not
functioning level, should have their hearing screened or cost effective for the audiologist to be involved in the actual
evaluated to identify potential hearing loss. While newborn administration of the screening procedures. Technicians,
hearing screening results may be available, additional au- paid or volunteer, can be adequately trained to perform
Chapter 4
diological assessment should occur at entry to preschool routine screenings, thus saving the district the higher salary
and again at entry to kindergarten, because progressive of the audiologist for this task. The exception may be the
and late-onset hearing loss is most likely during these early screening of those children and youth who cannot respond
childhood years. Schools may use special education funds to standard techniques, including pure tones, tympanometry,
to help pay for these evaluations, utilize the child’s public or otoacoustic emissions. The complexity of screening these
or private insurance (with parent permission), or access the children requires that the audiologist be actively involved in
state’s Medicaid program if the child is eligible. Once it has the administration and interpretation of the tests.
been determined that a child has normal hearing sensitivity, Activities related to hearing screening typically per-
hearing for most children and youth with severe disabilities formed by the audiologist include the following:
can be monitored on an annual basis with OAEs. In addi-
■■ planning and administering the hearing screening and
tion, it is often helpful to supplement the screening infor-
identification program;
mation with an analysis of functional hearing to determine
■■ coordinating with community agencies to assure appro-
if developmental listening problems are present that need
priate EHDI services are available;
to be addressed. A list of common functional communica-
■■ training and supervising screening personnel; and
tion assessments that might be considered are summarized
■■ performing follow-up services, including rescreening, di
in Appendix 5–G.
agnostic evaluation, referral to other agencies, and educa
For those children and youth whose disabilities prevent
tional management.
obtaining reliable OAE screening results, a basic set of ques-
tions may be asked each year of the teachers and parents
to identify potential hearing concerns that might trigger a
need for audiological assessment. This procedure may also Speech-Language Pathologists
be used to monitor changes in auditory behavior for children Quite often, SLPs perform pure-tone hearing screenings in
with identified hearing loss. While we recognize that ques- the schools. They are often given this task because they are
tionnaires are not valid as an independent screening tool, we in many schools on a regular basis and because they have
do find them helpful for this population. The Basic Hearing received some training to conduct hearing screening. As
Problems Questionnaire located in Appendix 4–D is an ex- with audiologists, it is not, however, cost effective to have
ample of a tool for this purpose. Audiological assessment SLPs perform the initial screenings. Individuals with less
for students with severe disabilities often requires the addi- training can adequately conduct the screenings at a lower

cost, without interfering with the regular workload of the ■■ operational and procedural aspects of the screening pro-
SLP. Therefore, SLPs may assist with conducting follow-up gram, including how the results of the program will be
screening, screening young children who require the use of reported to parents and teachers; and
more advanced screening procedures, as well as educating ■■ the screeners’ role in the screening program, including
students about risk factors associated with NIHL and pre- an understanding that they cannot diagnose hearing loss
ventive measures that may help to decrease the risk. or report results independently.
Training sessions for routine visual inspection and
Parent Volunteers, School Nurses, pure-tone screening can usually be accomplished in a half-
and Paraprofessionals day. School districts or agencies should also consider formal
certification programs, such as occupational hearing conser-
As stated previously, it is more cost effective to have some-
vation training certifiable by the Council for Accreditation
one other than audiologists or SLPs administer the screening
in Occupational Hearing Conservation. Additional training
tests. The same situation applies to school nurses. When ad-
time may be needed depending on the background knowl-
equately trained and provided with ongoing supervised prac-
edge of the screeners, the population being screened, and the
tice, parent volunteers and paraprofessionals can perform
procedures used such as play audiometry, acoustic immit-
routine screening quite effectively. The use of volunteers in
tance, and automated OAE. Training must include practice,
a screening program is attractive, because there is no cost to
under the direction of an audiologist, including screening of
the school district or agency. However, because they are not
peers and of children who are the same ages as those who
paid, they may not always show up at the scheduled time,
will be screened. Review sessions should be provided each
and their abilities and motivation can vary widely. Procedural
year for those who have satisfactorily completed the initial
consistency may also cause problems when the volunteers
training session.
change frequently. For these reasons, the use of paraprofes-
sionals, particularly health aides, may be more effective.
Alternatively, many schools employ technicians whose pri-
mary responsibility is screening hearing. It is not uncommon SCREENING EQUIPMENT
for them to also perform vision screening. It is also likely
that health aids and audiometric technicians remain with the
AND MAINTENANCE
Chapter 4
screening program over a period of several years, resulting Screening Equipment
in procedural consistency, better screening skills, and ulti-
mately, a more valid and reliable screening program. Pure-Tone Audiometers
Screening audiometers with limited frequencies and in-
tensity levels are available; however, it may be more cost
Training of Support Personnel
effective to use a single-channel portable audiometer with
Some states have licensure laws that regulate the training two earphones and the ability to produce at least octave fre-
and use of technicians who perform hearing screening. It quencies between 250 and 8000 Hz at levels ranging from
is critical that educational audiologists are aware of such 0 to at least 90 dB HL. The money saved when purchasing
regulations in their states and follow them as a minimum a screening audiometer may not be worth the flexibility that
standard for working with technicians. Both AAA (2010) is lost with its limitations. With a standard pure-tone audi-
and ASHA (2010) have guidelines regarding the use of audiometer, the audiologist can determine the screening level
ology support personnel. These guidelines address qualifica- and the frequencies to be screened, rather than using the
tions, training, role, and supervision for support personnel predetermined levels and frequencies set by a screening au-
and can be downloaded from the respective organization diometer. Additionally, the standard pure-tone audiometer
websites. can be used for both screening and threshold procedures,
To be adequately trained to conduct hearing screening, whereas the screening audiometer can be used only for
the individuals performing the screening need to learn more screening. Audiometers should be calibrated to ANSI S3.6-
than how to perform the actual screening test. Some topics 2010 specifications.
that should be presented to potential screeners include
■■ the purpose of hearing screening; Automated Otoacoustic Emissions
■■ the screening equipment, including how to set it up, The type of OAEs selected, distortion product (DPOAE) or
how to check its functioning, how to identify possible transient evoked (TEOAE), are often based on the prefer-
malfunctions in the equipment, and how to do basic ence and experience of the educational audiologist. When
troubleshooting if a problem occurs; choosing OAE equipment, considerations include software
■■ normal childhood development and typical behaviors protocol and programing options (stimulus parameters and
of children during screenings and ways to handle these pass/fail criteria), refer rates, and ease of use. Refer rates are
behaviors; reduced by using a multistep screening process to identify

98 Chapter 4
middle ear status. However, these students must be re- Equipment Maintenance/Calibration
screened later to ensure the middle ear status clears. In ad-
Regardless of the type of equipment used in a screening pro-
dition to the actual equipment used, disposable probe covers
gram, it is critical that it be working properly on the day of
must also be purchased. Primary considerations for select-
the screening. Unless the equipment is performing as it is
ing OAE equipment have been recommended by the Early
supposed to be, the screening will not be accurate, resulting
Childhood Hearing Outreach (ECHO) initiative, listed in
either in passing some children who have a hearing problem
Table 4–10; additional information can be found at their
or in excessive failures. A backup plan with loaner equip-
website (http://www.kidshearing.org).
ment should be developed for emergencies. All equipment
should be calibrated at least annually (ANSI S3.6-2010),
Tympanometry and screeners should be trained to perform a daily calibra-
There are several automated tympanometers used for screen- tion check prior to the use of the equipment. Additionally,
ing. The audiologist should be certain that the equipment can screeners should be alert to excessive referrals during the
quickly and easily provide measurements of the components screening, and they should check the equipment any time it
that will be considered in the screening (e.g., gradient, ear seems to be functioning improperly.
canal volume, and peak pressure) and that it meets the ANSI
S3.39-1987 standards for instruments to measure acoustic
immittance. Although some instruments are capable of
multifrequency measures, a 226 Hz probe tone is recom- Infection Control
mended for screening. As with the pure-tone audiometers, Infection control is particularly important in screening pro-
a tympanometry screener that is lightweight and durable is grams. The screeners see many different children in one
advantageous. Some instruments contain both a pure-tone day, thus increasing the chance of getting an infection from
audiometer and acoustic immittance, which reduces the a child or passing an infection from one child to another.
amount of equipment that must be transported and set up, Everything that is touched from the child to the screening
resulting in a more efficient test setup, especially when con- equipment, toys used, and so on, are potential sources of mi-
ducting following screening. The disadvantage is that when croorganisms and contaminants. The best way for screeners
one component malfunctions, both are out of commission to avoid the spread of disease is to wash their hands thor-
while repairs occur. oughly with antibacterial hand sanitizing gel before screen-
Chapter 4
If tympanometry is done, it is helpful to use an otoscope ing each child. Headphones should be disinfected with a
for a visual inspection of the ear canal and tympanic mem- wipe before each use or disposable covers used. Addition-
brane prior to inserting the probe tip. Disposable or sanitized ally, screeners should periodically wipe table surfaces, toys,
probe tips and otoscope specula are required for each child. and equipment with a disinfectant throughout the day.
TABLE 4–10 Primary Criteria for Selecting Otoacoustic Emission (OAE) Equipment for Screening Children 0 to 5 Years of Age
(revised July 13, 2015) http://www.infanthearing.org/earlychildhood/docs/OAE%20EquipmentEvaluationChecklistforGuide.pdf
Buy only a basic unit Only consider the basic OAE screening models. As a lay screener, you do not need a model intended for
audiologists to use for diagnostic purposes. These cost more, have features you do not need, and can be
more complicated to operate.
Get a DPOAE screening Get a distortion product (DP) OAE screener rather than a transient evoked (TE) OAE screener. You do
unit not need to understand the difference. DPOAE units have been demonstrated to be easier to use with
young children in natural settings.
Look for a probe that stays Notice how well the probe stays seated in the ear canal. After you insert the probe and let go, it should
firmly in the ear not wobble or fall out easily even when the child moves a little.
Strongly weigh the All OAE equipment requires disposable probe covers for securing the probe in the child’s ear during
advantages of compressible the screening. Some models have compressible foam probe covers. These tend to be easy for screeners
foam probe covers to use because they expand to create a secure fit in ear canals of different sizes, they keep the probe in
place if the child moves a bit, and they allow the equipment to run in moderately noisy environments.
Select equipment that Some OAE models work better than others when screening in settings where noise is present. Most
allows you to screen in young children will remain cooperative for only a short period of time. If the equipment runs only when
moderately noisy it is very quiet or requires too much time to complete a screening if any noise is present, it will be
environments impractical and frustrating for lay screeners to operate. Be sure the equipment you select has been tested
in the settings/conditions under which you intend to screen. Comparing the performance of multiple
models, under similar conditions, will allow you to make the most informed choice.

SCREENING ENVIRONMENT If forced to screen in an environment that is too noisy,

there will be an excessive number of referrals on the screen-
An appropriate screening environment should be quiet and ing test, and the actual screening will take longer than when
free from visual distractions. OAEs and tympanometry are done in a quite environment. This means there are longer in-
less vulnerable to noise than pure-tone screening, but exces- terruptions in the school’s schedule on the day of the screen-
sive noise during OAEs could increase the duration of the ing and also during follow-up screening. Typical screening
test due to the computer-averaging technique that will not data, including the number of children screened per hour
measure a response if the ambient noise level is too high, and the number of referrals, can be compared to similar data
including the child’s breathing if loud. obtained when screening in a poor acoustic environment to
When selecting the location for pure-tone screening, the educate administrators as to the importance and cost effec-
following variables must be considered: tiveness of a good environment for the screening.
It is never acceptable to raise the intensity of the signal
■■ location of the screening room,
to compensate for a noisy environment. If the noise prob-
■■ noise levels both in the room and from outside the room,
lems in the test room cannot be resolved, it may be neces-
■■ location of electrical outlets, and
sary to terminate the screening. Audiologists and screening
■■ size of the screening room and potential visual distractions.
personnel are often too accommodating to school adminis-
trators, and, in the process, lead them to believe that these
Location of the Screening Room poor environments are acceptable.
Typically, the location for screening should be as quiet as
possible and away from the main traffic flow of the building. Other Factors
In the absence of a sound-treated room or a mobile screen-
Although noise is the primary environmental concern for
ing vehicle that can be brought to the school, possible loca-
pure-tone screening, there are some other factors that must
tions for hearing screening include vacant classrooms, the
be considered. A sufficient number of electrical outlets
health clinic, the media center, or small conference rooms.
should be available. It is possible to run extension cords to
Even though storage closets are considered a bad joke, they
outlets in another location, but this may create a safety haz-
often provide suitable acoustics for screenings. At times, ad-
ard if the cords are not taped securely to the floor and fire
ministrators may suggest screening in the children’s class-
Chapter 4
codes considered. The room must also be large enough to
room, but this is usually not an efficient location, because
accommodate the screeners and the children comfortably.
it necessitates moving the equipment from one classroom
Depending on the organization used during the screening,
to the next.
the room may need to be only large enough to hold two
people, or it may need to accommodate an entire classroom
Noise Levels of children and several screening stations. This latter de-
The place in which hearing screening occurs is a critical sign is less desirable due to added noise created by so many
concern because it is difficult to find an ideal environment people in the same room.
for pure-tone screening. The maximum allowable ambient
noise levels for octave bands, when screening at a 20 dB
level, are provided in Table 4–11. It is obvious that the fre- ORGANIZATION OF SCREENING
quency that will be the most difficult to screen in a less-than-
ideal environment is 500 Hz. AND IDENTIFICATION PROGRAMS
When developing the screening and identification program,
TABLE 4–11 Approximate Allowable Ambient Noise Levels it is important to consider how it will be organized. A well-
for Octave Bands for Screening at 20 db HL organized program will run more efficiently, and those in-
volved in the program will be more aware of what to expect.
Center Frequency
A checklist for preschool and school screening preparation
for Octave Band Maximum Allowable Level
is presented in Appendix 4–E. Important items to consider
500 Hz 39.5 dB SPL include the following:
1000 Hz 46.5 dB SPL ■■ Scheduling the screening
2000 Hz 48 dB SPL Consulting the principal or school nurse to deter-
mine dates
4000 Hz 54.5 dB SPL ■■ Activities prior to the screening
6000 Hz
Notifying parents
Educating teachers and administrators regarding
Note. From Acoustical Society of America, ANSI S3.1-1999/2008. purpose and procedures

100 Chapter 4
Completing necessary forms this information can be included with the parental notifica-
Determining the school’s daily schedule tion (Appendix 4–F).
Training technicians/volunteers/assistants
Preparing educational materials for students and Education of School Personnel
parents Teachers and administrators need to be aware of the pur-
■■ Activities during the screening pose of the hearing screening program and how the program
Providing advance notification to classes will be implemented in the school. This information may be
Getting classes to the screening location provided in written form, but it is usually more effective to
Completing necessary forms and paperwork have a brief inservice to let the school staff know about the
program. It may be most efficient to provide this information
to teachers with other general health services information.
Scheduling of the Screening
Information that should be provided includes
When setting up a mass screening program, it is critical to
consider when the screenings will occur. In school systems, ■■ the purpose and importance of the hearing screening
screenings of new students, special education students, and program;
other referrals will also occur throughout the year, but the ■■ how teachers can report hearing concerns about a spe-
school-wide hearing screening will likely occur only once cific student(s);
during the school year. Screening in the fall is advantageous ■■ where and when the screening will take place,
because there is maximum time for follow-up during the ■■ how classes will be notified when it is time for them to
remainder of the school year. In addition, the refer rate will be screened;
typically be lower in the fall than in the winter months when ■■ how the school will be notified of the screening results,
children are more prone to having upper respiratory infec- ■■ how follow-up will occur; and
tions. However, when scheduling school-wide screenings, ■■ how staff can have their hearing screened.
the resources of the program must be considered. If person- If teachers are aware of the procedure, they can answer
nel and time are not available to rescreen the students who their students’ questions about the screening and help them
refer shortly after the initial screening, it may be better to know what to do. Likewise, school nurses and administra-
postpone or stagger the initial screening of some schools or tors who understand the screening program can help facili-
Chapter 4
grades until later in the school year. tate the process. Finally, when feasible, it is beneficial to
It is also necessary to determine if the school-wide hear- offer screening to school staff while the program is at their
ing screening for each school will be completed in one day or school. When involving staff, they will usually gain a better
over a period of several days. It is usually easier to limit the understanding of the importance of hearing for learning and,
initial screening to one day if volunteers are used. If there is subsequently, an appreciation of the program that they can
only one screener, such as an audiometric technician, in the pass this onto their students and be more amenable to the
school district, it may take several days to screen all children potential disruption of their class period.
in each school. Typically, this does not present a problem in
elementary schools because each class is interrupted only Other Considerations
once during the initial screening. There may, however, be a
The process for recording screening results whether class
problem at the secondary level because screening over sev-
lists, individual screening forms, or computer data entry
eral days could be very disruptive to the school’s schedule.
should be prepared in advance and ready for use on the day of
The principal, school nurse, or other school representative
the screening. Notes to be sent to the students’ parents to no-
must be contacted to determine the actual screening dates to
tify them of the screening results should also be ready if they
avoid conflicts with other school activities.
will be used. It is helpful to know the school’s schedule for
lunch, recess, and special classes and activities prior to the
Activities Prior to the Screening day of screening so that classes can be screened at convenient
times. It is usually best to screen younger students earlier in
Parent Notification
the day when they are more alert, but the arrangement of the
Although parent permission is not required for school-wide school’s schedule may dictate that a different order be used
hearing screenings in most schools because the screening is for screening. A final consideration prior to screening is to
a routine part of the district’s program, some parents may provide local physicians and pediatricians with information
prefer that their child not participate. It is, therefore, wise concerning the hearing screening and follow-up procedures.
to let parents know through a note, a newsletter, or a web-
site posting that the screening will occur and that they will
be notified if their child has a possible problem. It is also Activities During the Screening
helpful to ask parents about any hearing loss or middle ear For a school-wide hearing screening program in a school sys-
problems their child has experienced. If history of recent ear tem to be efficient, it is important that the organization on the
problems is part of the screening protocol, a form to obtain day or days of the screening be carefully planned. Depending

on the number of screeners and location of the screening, it on students who referred from pure-tone or OAE screening
typically works best to bring a small group or an entire class only, the school nurse, health aide, or audiometric technician
to the screening location at one time. Because some children may be able to conduct the middle ear condition follow-up
may be out of the classroom for special education classes or screening. Alternatively, the audiologist could schedule the
other activities, the teacher should be notified approximately rescreening for both groups at the same time, perhaps 3 to
10 minutes prior to the screening so that the children can all be 4 weeks after the initial screening.
in a single location prior to their screening time. Instructions If a student does not pass the rescreening, it is very
for the screening can be given to the children as a group, or helpful to establish pure-tone threshold estimates. Thresh-
they can be given to each child individually. Younger children old information helps prioritize students for audiological
may benefit from both. Once children have been screened, it assessment referrals, as well as provides physicians valu-
is advantageous to send them back to the classroom imme- able information on the hearing implications of middle ear
diately in order to reduce the noise from children who have problems. If hearing is normal but middle ear function re-
completed the screening and to reduce missed class time. mains abnormal, the audiologist will need to decide whether
For the screening to run efficiently, it is helpful to have further monitoring is warranted prior to making a physician
the assistance of one or two paraprofessionals or parent vol- referral. Cumulative testing data are helpful to physicians
unteers who are familiar with the school. These assistants for their treatment and management decisions.
can alert classes approximately 10 minutes before they will Physician referrals may be made by the audiologist or
be screened, bring classes to the screening location, help the school nurse for students who need a medical evaluation.
in recording screening results, handle necessary screening Often the school nurse has a closer relationship with parents
forms, and keep quiet and order in the screening room. increasing the likelihood of follow-through. Nurses may
even call parents to discuss the referral. Because many re-
ferrals are not acted on, the student’s hearing and middle ear
FOLLOW-UP PROCEDURES status should continue to be monitored at periodic intervals
with subsequent notice sent to the parents. When students
The most critical part of a hearing screening program is the are seen and/or treated by the physician, follow-up testing is
follow-up. Without appropriate follow-up, all of the effort in- also necessary to ensure the conditions have been resolved.
vested in the screenings will be in vain. More importantly, the For some students with chronic ear conditions, this monitor-
Chapter 4
presence of a screening program without appropriate following is an ongoing process that can continue for several years.
up may be misleading and even harmful to the children. Par-
ents or teachers may know that the screening was done and
may assume that a child’s hearing is normal when, in fact, Referrals for Audiological Evaluations
there is a potential hearing loss present. The parents or teach- Students who refer from the screening, who did not exhibit
ers will therefore not attend to the auditory needs of the child a potential middle ear condition, should be seen for a more
and will look for other reasons to explain the difficulties the thorough evaluation. Typically, referrals are made to the edu-
child is having. The opposite can also occur. Children who cational audiologist who may conduct a threshold screening
have normal hearing, but fail a screening, may have academic or, if appropriate equipment is available, a basic audiological
problems incorrectly attributed to reduced hearing. Follow- assessment at the student’s school. Alternatively, if the audi-
up for screening programs should always include ologist has a sound booth, the student can be referred for the
audiological assessment at that location. As with other facets
■■ rescreening of those who did not pass due to potential
of the screening program, the resources of the program may
middle ear conditions and absentees from the initial
dictate to whom the referrals are initially made. Ideally all
screening;
referrals should be made to the educational audiologist who
■■ referral for medical follow-up;
can determine the nature and degree of the hearing condi-
■■ referral for audiological follow-up; and
tion, the listening, language, and learning implications, and
■■ educational screenings/evaluations.
then refer the student to a physician and/or clinical audi-
ologist as the situation dictates. However, when schools do
not employ an educational audiologist, arrangements for
Follow-Up Screening for Middle Ear follow-up evaluations through a local audiologist or other
Conditions and Medical Referrals center should be prearranged as part of the schools’ hearing
A third stage of the screening program is follow-up screen- services program in order to expedite the follow-up process.
ing of all children who referred due to middle ear condi-
tions or who were absent for the initial screening. These
screenings should be scheduled at the student’s school 8 to Educational Screening
10 weeks later to allow adequate time for the condition to Whether monitoring a student’s middle ear status or making
resolve (AAA, 2011). Since this time interval may be lon- a new diagnosis of reduced hearing, the audiologist must
ger than the audiologist wants to wait to conduct follow-up consider the need to refer to the school’s multidisciplinary

102 Chapter 4
team. Educational audiologists may be able to identify the screening protocol to make it more effective. Second, in-
need for further evaluation by discussing a child’s educa- formation about the effectiveness of the hearing screening
tional status with his or her parents or teachers. The Screen- program is useful in convincing administrators, teachers,
ing Instrument for Targeting Educational Risk (S.I.F.T.E.R.) and parents of the importance of the program. As people see
(Anderson, 1989), or the Preschool S.I.F.T.E.R. (Anderson & the number of children screened, identified, and treated as
Matkin, 1996), is a common tool completed by the child’s a result of the hearing screening program, support for the
teacher that offers information about the student’s classroom program will increase. The data have become particularly
performance and potential educational implications related important as screening programs have come under greater
to the child’s hearing condition. The audiologist should scrutiny due to their potential disruption of instructional time.
communicate directly with the school after evaluating any
student who does not pass the follow-up screenings to en-
sure that all the child’s needs, not just the medical or audio- Data from Screening Program
logical ones, are addressed. Types of information that will help determine the program’s
effectiveness are
■■ total number of children screened;
DATA MANAGEMENT ■■ number and percentage of children who did not pass the
initial screening;
AND REPORTING ■■ number and percentage who did not pass the follow-up
The screening program needs to keep accurate records of the rescreening;
students who are screened and the screening results. Most ■■ number and/or percentage of children who missed the
schools use electronic databases that include health records initial screening and/or rescreening;
and even audiological data and reports. Whether using au- ■■ number and percentage who were referred for follow-
tomated or paper documentation, it is important to know up (audiological, medical, and/or educational);
how and what information is to be reported to the school ■■ number and percentage who had diagnosed hearing
and the parents. problems or disorders on final evaluation and the type
Most schools have secure databases that parents log of problem or disorder found (degree: bilateral, unilat-
Chapter 4
onto to view their child’s academic and health records. Re- eral; high frequency; type: sensorineural, conductive,
gardless of if and how parents are notified of the hearing mixed, auditory processing deficit);
screening and follow-up results, it is critical that they re- ■■ actual numbers and percentage who passed the hear-
ceive timely notification if their child needs to be referred ing screening but were later found to have a hearing
for follow-up. Notices used for medical referrals or other loss; and
nonschool services need to be worded cautiously so that the ■■ data validating appropriate equipment calibration and
school is not obligated to pay for the evaluation. Any ser- performance.
vices that a school requests for a child to receive a free and The audiologist can use these data to monitor the ef-
appropriate public education (FAPE) generally must be paid ficiency and success of the program. For example, if the
for by the school. Wording that “recommends” a referral number not passing the initial screening seems too high, the
rather than directly refers a child is best. Sample record- initial screening procedure can be examined to determine if
ing, notification, and referral forms are in Appendices 4–F the screeners were not testing properly, if the noise level in
through 4–N (see list at beginning of chapter, these Appen- the environment was too high, or if the equipment was not
dices are online only). When this information is maintained functioning properly. Based on this information, steps can
electronically, the data fields are examples that can be incor- be taken to alleviate problems identified. Likewise, the num-
porated within the database. ber of students actually seen for follow-up and the results of
the follow-up evaluation are critical. If most of the children
are not seen for follow-up, the efforts of the screening pro-
gram are wasted. Additionally, if many of the students seen
DETERMINING THE EFFECTIVENESS for follow-up evaluation are found to have normal hearing,
OF HEARING SCREENING AND additional contact may be necessary to clarify the findings,
IDENTIFICATION PROGRAMS or it may be necessary to modify the screening protocol to
provide more efficient referrals.
The final aspect of a good hearing screening program is an
evaluation to determine its effectiveness. These data are im-
portant for at least two reasons. First, it is critical to monitor Sensitivity and Specificity
the program to ensure that it is running efficiently. A review Although the screening tests used by most educational au-
of data from the program may reveal a need to modify the diologists have been shown to be effective, it may be useful

ing test determines those people who do not have a hearing

loss. Sensitivity can be thought of as the true positive rate,
and specificity is the true negative rate. A chart showing how
to determine sensitivity and specificity for a specific test is
provided in Figure 4–2.
Cost Effectiveness
Another factor that should be considered in the evaluation
of a screening program is the cost effectiveness of the pro-
gram. The total cost of personnel, equipment, equipment
maintenance, and recordkeeping for each year can be com-
pared to the number of students screened to determine the
cost of screening each student. Additionally, the number of
FIGURE 4–2 Determining sensitivity and specificity of screening
students identified as having reduced hearing can be com-
tests.
pared to the total cost of the program to determine the cost
of identifying each student with a hearing loss. The benefits
for educational audiologists to determine the sensitivity and of the screening program, including the number of students
specificity of the screening tests for the specific population seen for medical treatment, the number using hearing aids or
they are testing. Sensitivity is a measure of how well the assistive technology, and the number provided educational
screening test detects those people who actually have a hear- consultation and assistance, can also be considered in terms
ing loss, whereas specificity measures how well the screen- of the total cost of the program.
SUMMARY American Academy of Otolaryngology-Head and Neck Surgery
Chapter 4
Foundation. (February 1, 2016). Retrieved from http://www
The hearing screening program is the basis for most of the .entnet.org/sites/default/files/feb2016omeguidelinefactsheet.pdf
other services that we provide as educational audiologists. Colorado Department of Education. (2017). Guidelines for Child-
hood and Youth Hearing Screening Programs. Retrieved from
It is critical that it be effective and well supported. It is,
https://www.cde.state.co.us/cdesped/guidelines_childhood
therefore, important to plan and administer the program ef- youth_hearingscreening_2017
fectively, and to share data and information from the pro- Lieberthal, A., Carroll, A., Chonmaitree, T, Ganiats, T., Hoberman, A,
gram with administrators, teachers, parents, and the public. Jackson, M.A., . . . Tunkel, D. E. (2013). The diagnosis and
As others see the effectiveness of the program, particularly management of acute otitis media. Revised clinical practice
the benefits to the students who are identified with reduced guideline. Pediatrics, 131(3), e964–e999.
hearing, the program will gain the support necessary for its Madell, J., Flexer, C., Wolfe, J., & Schafer, E. (2019). Pediatric
continuation and growth. audiology diagnosis, technology, and management (3rd ed.).
New York, NY: Thieme Medical Publishers.
SUGGESTED READINGS
AND RESOURCES
American Academy of Audiology. (2011). Clinical practice guide-
lines: Childhood hearing screening. Retrieved from https://
www.audiology.org

APPENDIX 4–A
State Hearing Screening Laws for Children in Schools
Alabama No state statute

Alaska AS 14.30.127
(a) A vision and hearing screening examination shall be given to each child attending school in the state. The
examination shall be made when the child enters school or as soon thereafter as is practicable, and at regular
intervals specified by regulation by the governing body of the district.
Arizona Arizona Administrative Code R9-13-102

A school administrator shall ensure that the following students have a hearing screening each school year:
1. A student enrolled in preschool, kindergarten, or grade 1, 2, 6, or 9;
2. A student enrolled in grade 3, 4, or 5, unless there is written documentation that the student had a hearing
screening in or after grade 2;
3. A student enrolled in grade 7 or 8, unless there is written documentation that the student had a hearing
4. A student enrolled in grade 10, 11, or 12 unless there is written documentation that the student had a hearing
5. A student receiving special education; and
6. A student who failed a second hearing screening in the prior school year.
Arkansas No state statute

Chapter 4
California 17 CA ADC § 2951

(1) Each pupil shall be given a hearing screening test in kindergarten or first grade and in second, fifth, eighth, tenth
or eleventh grade and first entry into the California public school system.
View testing and referral standards at https://govt.westlaw.com/calregs/Document/IEC7BF220D60511DE88AEDD
E29ED1DC0A?viewType=FullText&originationContext=documenttoc&transitionType=CategoryPageItem&context
Data=%28sc.Default%29
Colorado C.R.S. 22-1-116

The sight and hearing of all children in the kindergarten, first, second, third, fifth, seventh, and ninth grades, or
children in comparable age groups referred for testing, shall be tested during the school year by the teacher,
principal, or other qualified person authorized by the school district.
Connecticut General Statues of Connecticut Sec. 10-214. Vision, audiometric and postural screenings: When
required; notification of parents re defects; record of results.
b) Each local or regional board of education shall provide annually audiometric screening for hearing to each
pupil in kindergarten and grades one and three to five, inclusive. The superintendent of schools shall give written
notice to the parent or guardian of each pupil (1) found to have any impairment or defect of hearing, with a brief
statement describing such impairment or defect, and (2) who did not receive an audiometric screening for hearing,
with a brief statement explaining why such pupil did not receive an audiometric screening for hearing.
Delaware Delaware Administrative Code 14-800-815 Health Examinations and Screening

3.1 Vision and Hearing Screening
3.1.1 Each public school student in kindergarten and in grades 2, 4, 7 and grades 9 or 10 shall receive a vision and
a hearing screening by January 15th of each school year.
DC No state statute
Florida 64F-6.003 Screening.

(2) Hearing screening shall be provided, at a minimum, to students in grades kindergarten, 1 and 6; to students
entering Florida schools for the first time in grades kindergarten through 5; and optionally to students in grade 3.
104

Georgia State of Georgia Rule 511-5-6-.02.

1) The parent or guardian of a child being admitted for the first time to a public school shall furnish to the school
authorities a properly executed Department of Public Health Form 3300: Certificate of Vision, Hearing, Dental and
Nutrition Screening. The Certificate shall be subject to audit by the Department and by the local Health Department.
(2) The vision, hearing, dental, and nutrition screenings reported on the Certificate must have been conducted
within one year prior to the time that the child is admitted for the first time to a public school.
Hawaii No state statute
Idaho No state statute
Illinois Illinois Administrative Code Title 77 Section 675.110 Frequency of Screening

b) Hearing screening services shall be provided annually for all school age children who are in grades K
(kindergarten), 1, 2, and 3; are in any special education class; have been referred by a teacher; or are transfer
students. These screening services shall be provided in all public, private, and parochial schools. Hearing screening is
recommended in grades 4, 6, 8, 10, and 12.
Indiana Indiana Code 20-34-3-14 Hearing tests

Sec. 14. (a) The governing body of each school corporation shall annually conduct an audiometer test or a similar
test to determine the hearing efficiency of the following students:
(1) Students in grade 1, grade 4, grade 7, and grade 10.
(2) A student who has transferred into the school corporation.
(3) A student who is suspected of having hearing defects.
Iowa No state statute
Kansas K.S.A. 72-6229. Free tests required; when and by whom tests performed; reports to parents.
(a) Every pupil enrolled in a school district or an accredited nonpublic school shall be provided basic hearing
screening without charge during the first year of admission and not less than once every three years thereafter.
Kentucky Kentucky Administrative Regulations 702 KAR 1:160. School health services
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(5) A preventive student health care examination shall be reported on the Preventive Student Health Care
Examination Form, KDESHS002, or an electronic medical record that includes all of the data equivalent to that on
the Preventive Student Health Care Examination Form, and shall include:
(a) A medical history;
(b) An assessment of growth and development and general appearance;
(c) A physical assessment including hearing and vision screening
Louisiana Louisiana Administrative Code Title 28 Part CLVII §301. Health Screening
Every LEA, during the first semester of the school year or within 30 days after the admission of any students
entering the school late in the session, shall test the sight, including color screening, for all first-grade students,
and hearing of each and all students under their charge, except those students whose parent or tutor objects to
such examination. Such testing shall be conducted by appropriately trained personnel and shall be completed in
accordance with the schedule established by the American Academy of Pediatrics.
Maine Code of Maine Rules 05-071-045 Rule for Vision and Hearing Screening in Maine Public Schools
A. Hearing screening will be conducted in preschool, kindergarten and grades 1, 3, and 5.
B. A pure tone audiometer will be used to screen hearing.
Maryland Code of Maryland Regulations 13A.05.05.07 School Health Services Standards– For All Students
C. Health Appraisal.
(3) Screening of students shall be carried out according to mandated or recommended screening programs
established by the Department of Education and the Maryland Department of Health. These shall include:
(a) Hearing and Vision Screening Tests. The local board of education or local health department shall provide
and fund hearing and vision screenings for all students in the public schools. The local health department
shall provide and fund hearing and vision screenings for all students in any private school that has received
a certificate of approval under Education Article, § 2-206, Annotated Code of Maryland, and students in any
nonpublic educational facility in this State approved as a special education facility by the Department.
(Continues )

106 Chapter 4
(b) Unless evidence is presented that a student has been tested within the past year, these hearing and vision
screenings shall be given in the years that a student enters a school system, enters the first grade, and enters
the eighth, or ninth grade. Additional screenings may be required under the policies adopted by the local
board of education or local health department.
(c) The results of the hearing and vision screenings shall be made a part of the permanent record file of each
student and given to the parents of any student who fails the screenings and reported to the local board of
education or the local health department. If a student fails the screenings, the parent/guardian shall report on
the recommended services received by the student to the local board of education or local health department
on an approved form.
Massachusetts Code of Massachusetts Regulations 105 CMR 200.400: Vision and Hearing Screenings
(C) The school committee or board of health shall cause the hearing of each student in the public schools to
be screened in the year of school entry and annually through grade 3 (or by age nine in the case of ungraded
classrooms), once in grades 6 through 8 (ages 12 through 14 in the case of ungraded classrooms), and once in
grades 9 through 12 (ages 15 through 18 in the case of ungraded classrooms). The hearing of each student shall
be tested by means-of some form of discrete frequency hearing test such as the Massachusetts Hearing Test or
comparable method approved by the Department of Public Health.
General Laws of Massachusetts Chapter 111. Section 67G: Audiometric testing of children; costs
Every person in control of a child who has reached age four shall cause such child to be given a complete pure
tone test using conventional audiometric tests at such public schools and by such pediatric audiologists or school
testers as are approved and designated by the commissioner. The costs for such examinations shall be borne by
the commonwealth.
Michigan Michigan Administrative Code R 325.3274 Frequency of screening

(2) Hearing screening of school-age children shall be done at least in grades K, 2, and 4, or screening shall be done
at least biennially starting at age 5 and continuing at least to age 10 years.
Minnesota 2018 Minnesota Statutes. 121A.17 School Board Responsibilities.

Subdivision 2. Screening required before kindergarten enrollment. A child must not be enrolled in kindergarten
in a public school unless the parent or guardian of the child submits to the school principal or other person
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having general control and supervision of the school a record indicating the months and year the child received
developmental screening and the results of the screening not later than 30 days after the first day of attendance. If
a child is transferred from one kindergarten to another, the parent or guardian of the child must be allowed 30 days
to submit the child’s record, during which time the child may attend school. Subdivision. 3. Screening program. (a) A
screening program must include at least the following components: developmental assessments, hearing and vision
screening or referral, immunization review and referral, the child’s height and weight, the date of the child’s most
recent comprehensive vision examination, if any, identification of risk factors that may influence learning, an interview
with the parent about the child, and referral for assessment, diagnosis, and treatment when potential needs are
identified.
Mississippi 2.4 Conducting Hearing & Vision Screening

A public agency may conduct hearing and vision screening without obtaining written parental permission if there
is an agency policy stating that any student who has not been successful in the regular education program may be
screened for vision and hearing as a means of determining whether hearing and/or vision problems are the cause
of the child’s lack of success in the regular program. All hearing and vision screening must be conducted according
to guidelines set forth by the Mississippi Department of Education.
Missouri No state statute
Montana A.R.M. 37.111.825 Health Supervision and Maintenance

(7) Pursuant to the advisory authority of 50-1-202 (11) and (12), MCA, the department recommends that
students be evaluated by registered professional nurses or other appropriately qualified health professionals on
a periodic basis in order to identify those health problems which have the potential for interfering with learning,
including:
(c) hearing screening
Nebraska 173 NAC 7 Attachment 1

Required annual school health screenings by Grade or Age Level; For procedural guidelines and competencies for
each screening, see DHHS School Health Guidelines for Nebraska Schools.
HEARING: pure tone audiometry annually ages 3-5, K,1,2,3,4,7,10

Nevada Nevada Revised Statutes 392.420 Physical examinations of pupils

In each school at which a school nurse is responsible for providing nursing services, the school nurse shall plan for and carry
out, or supervise qualified health personnel in carrying out, a separate and careful observation and examination of every
child who is regularly enrolled in a grade specified by the board of trustees or superintendent of schools of the school
district in accordance with this subsection to determine whether the child has scoliosis, any visual or auditory problem, or
any gross physical defect. The grades in which the observations and examinations must be carried out are as follows:
(a) For visual and auditory problems:
(1) Before the completion of the first year of initial enrollment in elementary school;
(2) In at least one additional grade of the elementary schools; and
(3) In one grade of the middle or junior high schools and one grade of the high schools;
New Hampshire No state statute
New Jersey N.J.A.C. 6A:16-2.2 Required health services

(l) Each district board of education shall ensure that students receive health screenings.
3. Screening for auditory acuity shall be conducted annually for students in kindergarten through grade three and
in grades seven and 11 pursuant to N.J.S.A. 18A:40-4.
New Mexico No state statute
New York 8 CRR-NY 136.3

(1) It shall be the duty of trustees and boards of education to provide:
(ii) hearing screening, if not documented on the health certificate to all students within six months of admission
to the school and in grades pre-kindergarten or kindergarten, 1, 3, 5, 7, and 11, and at any other time deemed
necessary; such screening shall include, but not be limited to, pure tone screening; the results of any such hearing
tests requiring a follow up examination shall be in writing and shall be provided to the pupil’s parent or person in
parental relation and to any teacher of the pupil within the school while the pupil is enrolled in the school.
North Carolina North Carolina General Statutes 130A-440 (Applicable to children enrolling in the public schools for the
first time before the 2016-2017 school year) Health assessment required.
(b) A health assessment shall include a medical history and physical examination with screening for vision and
Chapter 4
hearing and, if appropriate, testing for anemia and tuberculosis. Vision screening shall be conducted in accordance
with G.S. 130A-440.1. The health assessment may also include dental screening and developmental screening for
cognition, language, and motor function. The developmental screening of cognition and language abilities may be
conducted in accordance with G.S. 115C-83.5(a).
North Dakota No state statute
Ohio Ohio Revised Code 3313.673 Screening of beginning pupils for special learning needs.
(A)Except as provided in division (B) of this section, prior to the first day of November of the school year in which
a pupil is enrolled for the first time in either kindergarten or first grade, the pupil shall be screened for hearing,
vision, speech and communications, and health or medical problems and for any developmental disorders.
Oklahoma No state statute
Oregon No state statute
Pennsylvania The Pennsylvania Code § 23.5. Hearing screening tests.

(d) Pupils to be tested. Each year, pupils in kindergarten, special ungraded classes and grades one, two, three, seven
and 11 shall be given a hearing screening test.
Rhode Island State of Rhode Island General Laws § 16-21-14. Hearing, speech, and vision screenings – Records –
Statewide hearing screening program.
(b) Upon initial entry, all school children shall be given a hearing screening test by a properly trained professional
employed by the department of elementary and secondary education, at intervals consistent with regulations
promulgated by the director of health and the commissioner of elementary and secondary education.
Section 11.0 Hearing Screening
11.1 School children in pre-kindergarten programs operated by public school districts, as well as all school children in
kindergarten, first, second, and third grades and any student(s) new to a school without a prior record of a hearing
screening shall be given a hearing screening test by a properly trained and qualified person in the manner and at
such intervals as comports with current guidelines of the American Speech-Language-Hearing Association (ASHA).
(Continues)

108 Chapter 4
South Carolina No state statute
South Dakota No state statute
Tennessee No state statute
Texas Texas Administrative Code Title 25 RULE §37.24 Hearing Screening

(a) Screening is required, for individuals who attend a facility, to detect hearing disorders. Hearing screening under
this subchapter must be conducted using screening methods and referral criteria, and in compliance with other
requirements, as follows . . . See Texas Administrative Code for details https://texreg.sos.state.tx.us/public/readtac$ext
.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=25&pt=1&ch=37&rl=24
Utah No state statute
Vermont The Vermont Statutes 16-031-002-1422 Periodic hearing and vision screening; guidelines
School districts and primary care providers shall conduct periodic hearing and vision screening of school-aged
children pursuant to research-based guidelines developed by the Commissioner of Health in consultation with the
Secretary of Education.
Virginia Virginia Administrative Code 8 VAC 20-250-10. Testing of Sight and Hearing; Monitoring.
That sight and hearing of pupils in grades K, 3, 7, and 10 be screened within 60 administrative working days of the
opening of school. Whenever a pupil is found to have any defect of vision or hearing or a disease of the eyes or
ears, the principal shall notify the parent or guardian in writing, of such defect or disease. This screening of pupils
will be monitored through the administrative review process.
Washington WAC 246-760-020

(1) A school shall conduct auditory and distance vision and near vision acuity screening of children:
(a) In kindergarten and grades one, two, three, five, and seven; and
(b) S howing symptoms of possible loss in auditory or visual acuity and who are referred to the district by
parents, guardians, school staff, or student self-report.
West Virginia West Virginia Code 18-5-17. Compulsory pre-enrollment hearing, vision and speech and
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language testing; developmental screening for children under compulsory school age.
(a) All children entering public school for the first time in this state shall be given prior to their enrollments
screening tests to determine if they might have vision or hearing impairments or speech and language disabilities.
County boards of education may provide, upon request, such screening tests to all children entering nonpublic
school. County boards of education shall conduct these screening tests for all children through the use of trained
personnel. Parents or guardians of children who are found to have vision or hearing impairments or speech and
language disabilities shall be notified of the results of these tests and advised that further diagnosis and treatment
of the impairments or disabilities by qualified professional personnel is recommended.
Wisconsin No state statute
Wyoming Wyoming Administrative Rules 206.0002.6 Accreditation

(a) Health/Safety Services. The district shall ensure that students are educated in a safe environment that meets
all applicable building, health, safety and environmental codes and standards required by law for all public buildings.
(W.S. 21-15-115(a)(i)).
(i) The district shall provide an organized program provided by qualified personnel to:
(A) Identify potential and existing health problems through routine health screening including: Hearing screening
for acuity and otological problems
Note. National Association of State Boards of Education, State Policy Database. Retreived from http://statepolicies.nasbe.org/health. For state newborn hearing
screening statutes see http://www.infanthearing.org/legislative/provisions/requires.html.

APPENDIX 4–B
HEAR Checklist
INDICATORS ASSOCIATED WITH HEARING LOSS

Children and youth who have any of the following history are of greater concern for potential hearing loss. Bolded items
are of greatest concern for potential permanent hearing loss.
H: Health
❒ Large number of episodes of ear infections, PE tubes, or ear surgeries
❒ Problems during pregnancy or delivery
❒ Neonatal Intensive Care Unit (NICU) stay of 5 or more days
❒ Prolonged mechanical ventilation (5 days or longer)
❒ Hyperbilirubinemia requiring exchange transfusion
Congenital infections known or suspected to be associated with hearing loss (i.e., toxoplasmosis, syphilis, rubella,
❒
cytomegalovirus [CMV], and herpes)
❒ Bacterial meningitis
❒ Head trauma, especially basal skull/temporal bone fractures
Diagnosed or suspected neurodegenerative disorders such as Hunter syndrome, Friedreich ataxia, and
❒
Charcot-Marie-Tooth syndrome
Exposure to ototoxic medications (gentamicin, tobramycin, chemotherapy) or loop diuretics (Furosemide/
❒
Lasix)
Family history of permanent childhood or early onset hearing loss
❒
Chapter 4
E: Education
❒ Delayed in speech, language, or phonics development
❒ Difficulty following directions (watches others for cues; relies on vision heavily)
❒ Failing grades or retention
A: Appearance
❒ Outer ear abnormalities such as those that involve the pinna, ear canal, ear tags, ear pits, and temporal bone anomalies
❒ Craniofacial anomalies, including cleft lip and cleft palate
Syndromes associated with hearing loss or progressive or late-onset hearing loss, such as of Usher, Waarden-
❒
burg, Alport, Pendred, and Jervell and Lange-Nielson
R: Report
❒ Teacher or caregiver reports concerns regarding hearing
❒ Teacher or caregiver reports concerns regarding behavior or attention
❒ Caregiver or student reports regular engagement in noise-hazardous activities
❒ Student reports tinnitus or ringing in the ears
HEAR Checklist Additional Comments:

Note. From Colorado Department of Education (2017), Guidelines for Childhood & Youth Hearing Screening Programs, reprinted with permission.
109

Appendix 4–C
Insert School Name Here
Date:
Request for Information
RECORD OF EAR AND HEARING PROBLEMS
Children who have had repeated ear infections and intermittent hearing loss are more likely to have
speech, language, and listening difficulties when they start school. We would like to identify these
children so that we can be alert for present or developing hearing problems that may affect learning.
When completing this form, please consider all ear-related issues including hearing loss, ear infections,
ear aches, draining ears, medicine taken for ears, doctor noticed fluid behind eardrum, hole in eardrum
and surgeries. If you have questions, please contact:
Parent or caregiver: Please help by answering the following questions.
Child's Name: Birthdate:
1. Was your child’s hearing screened at the hospital at birth?
q YES, results were normal
q YES, a referral was made for follow-up screening, results were normal
q YES, a referral was made for follow-up screening, results were not normal. Please explain the
diagnosis:________________________________________________________________
q NO
q I don’t know
2. Did your child have any ear infections or other ear problems before the age of 1? q YES q NO
3. Has there ever been a discharge or drainage from your child’s ears? q YES q NO
4. About how many ear infections or other ear problems has your child had since birth?
q 0-2 q 3-5 q 6-10 q 10 or more
5. Does your child tend to have 4 or more ear infections or ear problems each year? q YES q NO
Copyright © 2021 Plural Publishing, Inc. All rights reserved. Permission to print for clinical use is granted. The files
are NOT allowed to be hosted electronically without written permission of the publisher.
6. Has your child had an ear infection or other ear problem in the last 6 months? q YES q NO
7. Did your child ever have an ear infection or other ear problem that lasted 3 months or more?
q YES q NO
8. Was your child on medication during these ear problem episodes? q YES q NO
9. Has your child ever been seen by an Ear Doctor (Otologist or ENT)? q YES q NO
If yes, please indicate doctor
Month/Year of last visit
10. Has your child ever had tubes placed in his/her eardrums? q YES q NO
If yes, how many times? At what age(s)?
11. Has anyone related to your child had ear infections or other ear problems (parents, brothers or
sisters, cousins)? q YES q NO
12. Does your child have any permanent ear problem or hearing loss that you know about?q YESq NO
Please describe (For example: can’t hear in one ear, difficulty hearing high-pitched sounds):
13. Has your child been very sick or in the hospital since he/she was born? q YES q NO
If yes, what was the problem or diagnosis?
14. If you have any other concerns about your child’s development, please describe here.
Please return this completed form to:
APPENDIX 4–D
Insert School District, Agency, or Program Name Here
BASIC HEARING PROBLEMS QUESTIONNAIRE FOR STUDENTS

WITH DEVELOPMENTAL DELAYS
Name: Dob:
School: Grade:
Form completed by: Date completed:
1. Does this student have an identified hearing loss? ❑ YES ❑ NO
If yes, has this student’s hearing/listening behavior changed in the past year? ❑ YES ❑ NO
2. If no, do you feel this student might have a hearing problem? ❑ YES ❑ NO
If yes, has this student’s hearing/listening behavior changed in the past year? ❑ YES ❑ NO
3. Does this student startle to loud sound? ❑ YES ❑ NO

Chapter 4
4. Does this student turn to sound? ❑ YES ❑ NO
If not, is it due to a motor problem? ❑ YES ❑ NO
5. Does this student respond to/acknowledge his/her name? ❑ YES ❑ NO
6. Please give an example of how this student responds to sound in

his/her typical environment:
7. Has this student had recent ear or upper respiratory infections? ❑ YES ❑ NO
8. What is this child’s estimated developmental age?
9. Does this child’s motor development interfere with his/her ability to respond
to sound? ❑ YES ❑ NO
Please add any other comments about this student’s hearing/listening behavior.
Return this form to your educational audiologist:
110

Appendix 4–E
PREPARATION CHECKLIST FOR PRESCHOOL AND SCHOOL HEARING SCREENING
Scheduling: __Consult the principal, program director, or school nurse to establish the
best dates to conduct the screening.
__Discuss use of noise related hearing loss/hearing loss prevention
information and activity with appropriate school personnel (school nurse,
health education teacher, administrator).
__Determine the schedule day(s) selected.
__Identify area where screening will be conducted and electrical needs.
Notifications: __Notify parents, teachers and administrators of screening date(s). Be sure
to provide teachers adequate notice to adjust their teaching activities
while students will be out of class, to allow for input of observational or
historical data regarding a child's hearing status, and to prepare the
students. Some schools or programs want to notify parents of the
screening.
Forms and __Prepare form or database to record screening results.
Paperwork: __Prepare parent notification letter of screening, screening dates, and how
they will be notified of results.
__Determine summary form for school to report students and their
screening results that will require follow-up (e.g., rescreening,
audiological evaluation, medical referral).
__Prepare letter notifying parents of screening results for those students
requiring follow-up.
Training: __Schedule training session with volunteers or aides who assist with the
screening, including sanitation and infection control procedures. This may
be conducted on the day of screening prior to beginning the screening.
__Provide pre-training for preschool, kindergarten, and difficult to test
children. Information and directions can be given to teachers or the nurse
to conduct the pre-training.
Equipment: __Determine needed equipment: number of audiometers, OAE screeners, if
used, and tympanometers, if used, and secure them for the screening.
__Obtain disposable probe tips and ear phone cuffs if used.
__Check for calibration records on equipment utilized.
Screening Day: __Set up the screening site.
__Provide antibacterial wipes and gel to clean hands and all equipment.
__Review plan for getting students to the screening site.
__Perform equipment/calibration check.
__Conduct volunteer training of procedures.
__Have refreshments available for volunteers and staff.
Appendix 4–F
PARENT NOTIFICATION LETTER FOR HEARING SCREENING

Dear Parent or Caregiver,
Hearing is important to your child's ability to learn and progress satisfactorily at school. For this
reason, your school will be screening your child's hearing on (DATE) as part of our school-wide
screening program. This hearing screening is a very simple procedure and will take only a few minutes.
If you do not want your child to participate in the screening, please let your child's teacher know prior
to the screening date.
If your child is absent or has difficulty with the hearing screening procedure, we will recheck
him/her 3-4 weeks following the screening and notify you if there is a continued concern. If you have
any questions about the hearing screening or wish to talk with someone, please contact:
Name:_____________________________________________________
Phone number: email:___________________
Appendix 4–G
CLASS HEARING SCREENING RESULTS

School: Date:
Teacher: Grade:
Screening Date:_______ Screening Date:_______

NAME Disposition
Pure Tone Tymp Pure Tone Tymp
R___ L___ R___L___ R___ L___ R___L___ _Nrml _Ref _Rck
KEY: + = Pass; R = Refer
Appendix 4–H
HEARING RESCREENING RECORD FORM
SCHOOL HEARING RESCREENING/REFERRAL LIST

School: Date:
Screening Rescreening
Tchr/
Pure Tone/
Pure Tone/
Vis Insp
Vsl Insp
Name Grade Follow-Up
Tymp
Tymp
OAE
OAE
Screening Codes A = Absent N = Normal R = Rescreen AR = Audiological Referral MR = Medical Referral

Follow-Up Codes SN = Sensorineural COND = Conductive MXD = Mixed NL = Normal on later tests
MI = Mild MOD = Moderate SEV = Severe PROF = Profound HF = High Frequency
NR = No response UNI = Unilateral RT = Right LF = Left DR = Under doctor's care HA =
Hearing Aid WD = Withdrew from school
Appendix 4–I
SAMPLE TEACHER NOTIFICATION OF SCREENING RESULTS
Date: School:
To: (Insert Teachers’ Name)
From: (Insert Audiologist’s Name)
Based on screening today, the student(s) listed below is experiencing reduced hearing for which
s/he is under care of, or has been referred to, a physician for treatment or has been referred to
me for additional audiological assessment. Until this condition is resolved, or further
information is available about the student’s hearing status, the student(s) will benefit from:
1. Being seated close to you or person responsible for instruction.
2. Getting his/her attention prior to giving instruction.
3. Checking to be sure s/he has understood directions, classroom discussion, etc.
4. Speaking while facing the students to watch your lips.
5. Repeating important information that classmates say.
Please call me if you feel further intervention is needed or if you have any questions. I can be
reached at (insert phone number/email address). Thank you for your help with this student(s).
Student(s):
Appendix 4–J
SAMPLE PARENT NOTIFICATION OF SCREENING RESULTS - PASS
Student: Date:
Dear Parent/Caregiver,
Hearing is important to your child's ability to learn and to progress satisfactorily at
school. For this reason, your child's school recently screened your child’s hearing as part of our
school-wide screening program. We are pleased to inform you that your child PASSED all
aspects of the screening on the date noted above.
Please be aware that hearing may change at any time. If you become concerned about
your child's hearing in the future, please contact his/her school to request another hearing
screening. If you have any questions about the results or about the hearing screening program
at your child's school, please contact me at (insert phone number/email).
Sincerely,
Name:_____________________________________
Title:______________________________________
Appendix 4–K
SAMPLE PARENT NOTIFICATION OF SCREENING RESULTS - RECHECK
Student: Date:
school. For this reason, your child's school recently screened your child’s hearing as part of our
school-wide screening program. The hearing screening included pure-tone (to measure hearing)
and tympanometry (to measure middle-ear function) procedures. Your child had difficulty with
one or both parts of the screening. This result does NOT necessarily mean that your child has a
hearing problem. Your child’s hearing will be rescreened at school in (insert time) weeks. You
will be notified of the results of the rescreening at that time and any additional follow-up that
may be needed. If you have any questions about the results or about the hearing screening
program at your child's school, please contact me at (insert phone number/email address).
Sincerely,
Name:______________________________
Title:_______________________________
Appendix 4–L
SAMPLE PARENT LETTER TO REFER CHILD

FOR FURTHER AUDIOLOGICAL EVALUATION
Student: Date:
Hearing is important to your child's ability to learn and to progress satisfactorily at school.
Because your child's initial hearing screening at school indicated a concern, he/she was recently
rescreened. Your child continued to have difficulty with one or both parts of the hearing screening. This
screening test is NOT conclusive, but it is recommended that your child have a more detailed
audiological (hearing) evaluation, so we can learn more about his/her hearing status.
Many hearing problems in children are not severe and may not be permanent. It is, however,
important that even mild hearing loss levels be identified so that recommendations can be made to
minimize its effects on communication and learning. A comprehensive hearing test will help us
determine if your child has a hearing problem and, if so, the type and level of the problem.
Please call (insert phone number) my office to schedule an appointment for an audiological
evaluation as soon as possible. This evaluation is provided for students by the school district at no cost.
If you decide to take your child to a private audiologist for the evaluation, you may call the same
number to obtain the results of the screening to share with the audiologist. In this case we also ask that
you send a report of the results from that audiologist back to me so that we can maintain our records
and provide any necessary follow-up support. If you have any questions, please contact me.
Sincerely,
Name:_____________________________________Phone:______________________________
Title: Email:
Appendix 4–M
SAMPLE MEDICAL REFERRAL LETTER AND RETURN MEDICAL REFERRAL FORM
Student: Date:
school. Because the initial hearing screening indicated a concern, your child was recently
rescreened. Your child continued to have difficulty with one or both parts of the hearing
screening. This screening test is NOT conclusive, but it is recommended that:
§ Your child be seen by a physician (pediatrician, family physician, or otolaryngologist) to
determine if there is a medical problem that is affecting your child's ability to hear. The
results of the screening are provided below so you can share them with your physician.
A form for your physician to complete and return to school regarding the findings of the
examination is attached.
§ Your child will be rescreened after he/she has seen your physician. This hearing
rescreening can usually be conducted at your child’s school.
Many hearing problems in children can be helped with medical attention. It is

recommended that you schedule an appointment for your child as soon as possible. If you have
any questions about the screening results or about the hearing screening program at your
child's school, please contact me at (insert phone number/email address). Also, please call to
let us know when your physician has cleared your child for the rescreening.
Sincerely,
Name:__________________________________
Title:___________________________________
*****************************************************************
SCREENING RESULTS
Student: Date:
Hearing Middle Ear

(screened at 20dBHL) (complete results or attach print-
out)
tympano-
500 Hz 1000Hz 2000Hz 4000Hz static canal metric
compliance volume width
RIGHT
LEFT
Impressions:
Appendix 4–N
SAMPLE MEDICAL REFERRAL FORM
Student: Date:
School:
Dear Physician,
This student recently participated in the school hearing screening program. The results of the
screening and the rescreening indicated that he/she may have a hearing problem that would benefit
from medical attention. It is therefore recommended that that the student be seen by you for further
evaluation. Your cooperation in completing the information below will help us make appropriate
modifications for the student at school. If you have any questions about the hearing screening results,
please contact me at (insert phone number/email address).
*****************************************************
PLEASE COMPLETE AND RETURN TO:
Insert name of school nurse or educational audiologist
School District
Street Address
City, State Zip Code
Student: School
Person Completing Evaluation:
Address:
Phone/Email:
Results of Evaluation:
Recommendations:
Will the student be returning to you for further care? q YES q NO
SIGNATURE: DATE:
CHAPTER 5
Assessment
CONTENTS
The Cross-Check Principle in Educational Audiology

Basic Assessment of Hearing
Case History ■ Otoscopy and Visual Inspection ■ Behavioral Assessment ■ Physiological Assessment
Modifications for Special Populations
Pure-Tone Modifications ■ Speech Modifications
Monitoring Hearing Sensitivity
Types of Monitoring ■ Schedules for Monitoring
Additional Audiometric Information and Functional Hearing Assessment
Speech Recognition for Sentences and Phrases ■ Speech Perception in Noise Testing ■ Listening in
Noise ■ Speech Recognition With Visual Support ■ The Functional Listening Evaluation ■ Auditory
and Listening Development Skills ■ Audiometric Assessment Considerations Without a Sound Booth
■ Cultural Considerations
Assessment of the Educational Effects of Hearing Status

The Classroom Listening Assessment ■ Use of Teacher Checklists ■ Interpretation of Audiological
Information ■ Need for Comprehensive Evaluation
Chapter 5
“I just made my ear with play-doh!”
111

Communication of Assessment Results

Audiograms ■ Written Reports ■ Teacher Letters ■ Letters to Physicians or Other Professionals ■ Telephone or
Personal Conferences ■ E-mail, Texting, and Web-Based Communication ■ Documentation ■ Privacy Issues
Personal Vulnerability and Safety
Summary
Appendices
5–A Audiology Case History (Text/Online)
5–B Familiar Sounds Audiogram (Text/Online)
5–C Sample Audiogram (Text/Online)
5–D Word Recognition in Quiet and Noise for Normally Developing Children (Text)
5–E Speech Audibility Audiogram for Classroom Listening (Text/Online)
5–F Adaptations for Assessing Children/Youth Who Are Blind/Visually Impaired (Text/Online)
5–G Common Functional Outcome Measures for Listening Performance (Text)
5–H The Functional Listening Evaluation (Text/Online)
5–I Classroom Participation Questionnaire—Revised (Text/Online)
5–J Auditory Problems Self-Checklist (Text/Online)
5–K Relationship of Hearing Loss to Listening and Learning Needs (Text/Online)
5–L Michigan Department of Education—Low Incidence Outreach Educational Impact Matrix for Students
Who Are Deaf or Hard of Hearing (Text/Online)
5–M General Teacher Letter (Text/Online)
5–N Ordering Information for Selected Assessment Products (Text)
Chapter 5
KEY TERMS One of the major activities of educational audiologists is

assessment of auditory function. Although the administra-
Assessment protocol, audibility, test protocol, functional tion of tests to determine the nature and status of hearing
listening, cross-check principle, basic hearing assessment, is of primary importance, the area of educationally related
comprehensive hearing evaluation, remote microphone hear auditory assessment includes much more. As educational
ing assistance technology (RM HAT) audiologists, our focus is on the educational implications
of reduced hearing and listening and the benefits that can be
received from personal hearing instruments and RM HAT.
KEY POINTS For educational audiologists, the purposes of assessment in-
clude the following:
■■ Single test results should always be confirmed by one
■■ determining the status of hearing or auditory processing;
or more independent test measures.
■■ monitoring changes in hearing sensitivity;
■■ Comprehensive evaluations of hearing status and audi-
■■ determining the communication, learning, and other
tory function include both formal and informal assess-
educational effects of reduced hearing or auditory
ment measures.
processing;
■■ Functional assessment is required by the Individuals
■■ determining the need for personal hearing instruments
with Disabilities Education Act (IDEA).
and RM HAT; and
■■ Audiology assessment extends beyond the sound booth
■■ monitoring the use and benefit from personal hearing
to the environments in which students are educated.
instruments and RM HAT.
■■ The distinction between audibility and speech intelli-
gibility is important for parents and teachers to under- Educational audiologists are responsible for seeing that
stand relative to audiogram interpretation. all aspects of a comprehensive assessment are provided for
112

Assessment 113
children and youth in their target student population. When to be in conflict with prior assessment results, additional
educational audiologists are unable to perform one or more assessment may be required. As technology has evolved,
of these assessment activities, they should collaborate with more children are receiving a diagnosis of deaf or hard of
other audiologists or members of the multidisciplinary team hearing without the behavioral or functional component, and
to complete the assessment. It is beyond the scope of this when this is the case, the educational audiologist should be
publication to describe all assessment instruments, technolo- responsible for facilitating a more comprehensive profile
gies, and protocols in detail, and readers are referred to the of the child’s or youth’s hearing and listening abilities.
professional practice guidelines and publications included
in the Suggested Readings and Resources at the end of this
chapter for additional information. The brief overviews and
summaries included here may be useful to educational au- BASIC ASSESSMENT OF HEARING
diologists when explaining portions of a child’s assessment
to parents, caregivers, or school staff unfamiliar with audiol- The basic pediatric audiology assessment is required to
ogy assessment terminology. identify the presence of typical or atypical hearing and
This chapter discusses purposes of comprehensive hear- to determine the nature and degree of the hearing condi-
ing and listening assessment in the schools. Specific issues tion. Additionally, the protocol provides information about
related to auditory processing are addressed in Chapter 6, the child’s performance in understanding speech stimuli.
Auditory Processing Deficits, and amplification issues are Basic assessment for children or youth should include the
covered in detail in Chapter 8, Hearing Instruments and Re- following:
mote Microphone Technology. Specifically, this chapter ad- ■■ case history;
dresses the following questions: ■■ otoscopy and visual inspection;
■■ How does the cross-check principle apply in educa- ■■ behavioral assessment; and
tional audiology? ■■ physiological assessment.
■■ What is included in a basic assessment of childhood Before providing a brief review of each of these topics, it
hearing? is important to remember that during all assessment pro-
■■ What modifications in hearing assessment protocols are cedures, audiologists must be aware of the need for infec-
useful with special populations? tion control and must take necessary precautions to protect
■■ What special audiometric tests might be needed for stu- themselves and their students (https://www.asha.org/aud
dents with co-occurring disabilities? /infection-control/). More specific information on infec-
■■ What is involved in monitoring hearing sensitivity? tion control procedures can be found in Chapter 4, Hearing
■■ What additional audiologic information should be Screening and Identification, and for more detailed descrip-
obtained to determine the impact of reduced hearing tions and review of pediatric assessment procedures, see
Chapter 5
levels and potential benefit from accommodations for Recommended Readings and Resources at the end of this
learning? chapter.
■■ How can the educational effects of compromised hear-
ing be assessed?
■■ How should results of assessments be communicated Case History
to parents, teachers, other school personnel, and other
The case history is a critical part of every audiology assess-
professionals?
ment that not only provides information to assist in the di-
agnosis but also can help in determining the effects of the
hearing status and planning for management. Knowledge
THE CROSS-CHECK PRINCIPLE of the occurrence and success or failure of prior medical
IN EDUCATIONAL AUDIOLOGY treatment or educational intervention is often valuable when
planning future management. If a student has received or is
Educational audiologists are seeing an increasing number currently receiving treatment with potentially ototoxic drugs
of children identified with reduced hearing at very young (e.g., cisplatin), this may impact a monitoring schedule and
ages, as well as additional numbers of children and youth have implications for future progression of hearing levels
with multiple learning challenges. Jerger and Hayes (2006) and educational needs, as well as potential benefit from am-
cautioned early on that children should always be diagnosed plification (Hua, Bass, Khan, Kun, & Merchant, 2008). Case
using a test battery; that is, single test results should always history information also can be useful when a family record
be confirmed by an independent test measure. The func- or other etiology for compromised hearing is identified. Sub-
tional listening component of an assessment battery often sequent referral for family genetic evaluation, testing, and
falls under the scope of the educational audiologist, and it is counseling, if not completed previously, has the following
important to remember that when results in this area seem potential benefits: etiology, estimation of recurrence risk,

114 Chapter 5
TABLE 5–1 Information to Be Obtained from the Case History the audiologist to review the information on the form with
Major concern(s) about the child or youth
the parent or teacher in a face-to-face or phone interview
whenever possible. Sometimes the informants may have
Pregnancy and birth information
misunderstood a question on the case history form, or they
Medical history may have provided incomplete information. An interview is
General (including significant illness, surgeries, and also helpful in providing the educational audiologist with a
medications)
sense of how the informant views the child and in establish-
Ear
ing trust between the audiologist and the informant.
Developmental history
Auditory
Visual Otoscopy and Visual Inspection
Speech and language
Motor Otoscopy is an important part of every audiology evalu-
Cognitive ation. The visual examination of the external ear, the ear
Social and emotional canal, and the tympanic membrane provides observations
Family history that often confirm the audiologic findings and that may lead
History of reduced hearing or deafness to a medical referral. It is critical that otoscopy be used to
History of ear disease ensure that the ear canal is clear before beginning any pro-
Educational difficulty cedure that requires insertion of instrumentation into the ear
Speech-language difficulty canal, such as use of insert earphones for pure-tone, speech,
Educational experiences immittance, or otoacoustic emissions testing, and real-ear
Regular education (Section 504 plan?) probe microphone measurements. For immittance testing,
Special education (Individual Family Service Plan additional observations about the presence of ventilation
or Individualized Education Program?) tubes and the intactness of the tympanic membrane are use-
Accommodations or other support services ful when interpreting the test results and making referrals.
Use of technology Video otoscopy is another technique that can be helpful in
Personal hearing instrument(s) educational settings because it provides photographic evi-
Remote microphone hearing assistance technology dence that can accompany a medical referral and is an effec-
Other: tive and interesting educational tool for students.
prognosis for progression of hearing status, and identifica-

Behavioral Assessment
tion of possible syndromes with associated characteristics Behavioral techniques for the assessment of hearing require
some type of overt response from the individual being tested.
Chapter 5
that could have educational impact (Lesperance, 2018). A

list of information typically included in an initial case his- Successful completion of behavioral assessment requires
tory is included in Table 5–1. that the individual be cooperative and able to understand and
One or both parents often are the primary source for perform the response requested or able to be conditioned to
case history information. The case history interview is a respond consistently to the stimuli being used. If these con-
useful mechanism for evaluating the parents’ perception of ditions do not exist, special modifications for test procedures
their child’s current and prior auditory function. However, and protocols are required.
the value of input from teachers and others involved with
students should not be overlooked. It takes additional time Pure-Tone Air and Bone Conduction Thresholds
for the educational audiologist to contact other professionals Pure-tone air conduction thresholds provide a direct indica-
involved in a child’s care, but collaboration can be beneficial tion of the hearing sensitivity at each frequency tested. A
in providing a more complete picture of background and comparison of the air and bone thresholds indicates if the
day-to-day performance. loss is conductive, sensorineural, or mixed, and a compari-
Case history information is obtained through the use of son of ear-specific thresholds identifies a loss in one or both
a form, an interview, or both. A sample comprehensive case ears and the degree of hearing for each ear.
history form is included as Appendix 5–A, and additional By recording the thresholds on audiograms containing
forms targeting screening and auditory processing referrals familiar environmental sounds, speech information, or both,
can be found in Chapters 4 and 6 . The logistics of send- the effects of the child’s hearing status on the perception
ing and obtaining a case history form may be difficult in a of speech can be estimated while visually helping parents
school system. However, when used, it can be completed by and teachers begin to understand the impact of compromised
the parent/caregiver or teacher before the diagnostic evalu- hearing for different sounds. Examples of audiograms that
ation and is especially useful when the parent/caregiver or may be useful include one with the “speech banana” (Wat-
teacher is not present for the assessment. It is helpful for kins, 2004), one with pictures of familiar sounds (North-

Assessment 115
ern & Downs, 2002, included as Appendix 5–B), one with reception threshold and pure-tone average do not agree, the
percentages of normal conversational speech heard at vari- reason for the discrepancy should be identified. Possible
ous levels (Olsen, Hawkins, & Van Tassell, 1987), and the reasons include a lack of understanding of the directions for
Count-the-Dot audiogram (Killion & Mueller, 2010; Muel- either the pure-tone or speech tests, not responding to either
ler & Killion, 1990). For the first three audiograms, the pure tones or speech at threshold levels, an unusual hearing
area greater than the child’s recorded thresholds illustrates configuration, a nonorganic (functional) hearing loss, equip-
the specific sounds the child can hear or the percentage of ment malfunction, or careless testing procedures.
speech that is audible to the child. By counting the number
of dots greater than the child’s thresholds on the Count-the- Word Recognition Ability
Dot audiogram, the audiologist has an estimate of the child’s Tests of word recognition ability (often designated as speech
audibility (the percentage of sounds audible). This practice perception) are designed to determine the percentage of words
is illustrated on the sample audiogram form included in Ap- that can be understood under ideal listening conditions. A list
pendix 5–C. Each of these formats is helpful when inter- of words typically is presented at a level 30 to 40 dB above the
preting the audiogram to parents, teachers, and other school child’s speech reception threshold and should be administered
personnel as long as the audiologist checks to make sure the using recorded stimuli. For younger children, performance
information provided is understood. may be enhanced with a carefully monitored live-voice pre-
Most school-age children are able to perform traditional sentation that allows more flexibility to modify the speed of
pure-tone threshold audiometry reliably. Pure-tone thresh- presentation and the frequency of reinforcement. If live voice
olds for the octave frequencies from 250 through 8000 Hz is used, a note should be included that justifies this modifica-
in each ear should be established. When there is a difference tion. Speech perception should also be assessed in competing
of more than 20 dB HL (hearing level) in adjacent thresh- noise as discussed later in this chapter. Normative data for
olds, it is also advisable to test thresholds at the mid-octave word recognition in quiet and noise in children with typical
frequency. When calculating pure-tone averages, it is help- hearing can be found in Appendix 5–D.
ful to calculate a high-frequency average in addition to the Word recognition scoring most often is accomplished
traditional average of 500, 1000, and 2000 Hz. The high- by determining the percentage of words the student repeats
frequency average of 1000, 2000, and 4000 Hz often pro- or identifies correctly but can also be done phonemically to
vides a more realistic estimate of hearing thresholds in rela- provide more precise information for the educational audiol-
tion to speech perception, especially in noisy situations. ogist and others working with the student. It is important to
remember that a student’s score indicates maximum perfor-
mance under ideal conditions and may not reflect functional
Speech Thresholds word recognition for everyday communication. As with the
Speech thresholds are useful in providing an overall esti- speech reception threshold assessment, it is important to use
Chapter 5
mate of the minimum level of hearing and in providing a word lists that are age and linguistically appropriate for the
cross-check for pure-tone threshold results. When obtaining child. Table 5–2 contains a list of word recognition tests
the speech reception threshold, it is critical to use spondee
words that are familiar, and it may be necessary to use a
modified or reduced set of spondee words for children with
limited vocabulary. Techniques for familiarization, such as TABLE 5–2 Word Recognition/Speech Perception Tests for
Children
word repetition or picture or written word identification,
should be completed before formal speech threshold test- Minimum Vocabulary
ing. Results from recorded presentations are more reliable Test Age (in Years)
than scores from monitored live voice (Roeser & Clark, Northwestern University Children’s 3
2008), and the use of recorded speech materials is strongly Perception of Speech (NU-CHIPS)
recommended as standard practice. However, the flexibility, (Elliot & Katz, 1980)
speed, and ability to maintain rapport with the child afforded
by monitored live-voice testing can be justified when test- Word Intelligibility by Picture 4.5
Identification (WIPI) (Cienkowski,
ing chronologically or developmentally younger children.
Ross, & Lerman, 2009)
To avoid discrepancies in test results, it is important to use
recorded presentations whenever possible and monitor live- PB-Kindergarten Lists (Haskins, 1949) 5
voice presentations carefully when included.
Lexical Neighborhood Test (LNT/ 3–4
The speech reception threshold should agree with the
MLNT) (Kirk, Pisoni, & Osberger, 1995)
child’s three-frequency pure-tone average unless the child
has a precipitous hearing loss. In this case, speech reception CID W-22 Lists (Hirsh et al., 1952) 8
thresholds should approximate the two-frequency pure-tone
NU-6 Lists (Tillman & Carhart, 1966) 12
average or a high-frequency pure-tone average. If the speech

116 Chapter 5
Outer Hair Cell Inner Hair Conductive Hearing

Test Normal Hearing Loss Cell/Nerve Fibers Loss
Hearing Loss
Tympanograms A A A B or C
Acoustic Reflexes 70-90 dB HL 70-90 dB HL for Absent or Elevated Absent or Elevated
hearing losses
<60 dB HL
Emissions Present > 6 dB SN Absent Present > 6 dB SN Absent or obscured
ABR Normal Latencies Normal Latencies Absent or Latencies shifted to
and Latency- for losses up to desynchronized; longer
Intensity Function 60 dB Hl; Latency- cochlear
Intensity Function microphonics
may be steep- present
sloped
FIGURE 5–1 Desk chart for hearing loss triage. (From Berlin, Hood, & Morlet, 2010 [updated 2019].)
standardized for use with children along with the minimum ligibility, which refers to how listeners use the accessible
vocabulary age required for each test. information they have for speech. According to Boothroyd
For a child with a vocabulary age of 3 years or greater, (2019), an SII of 100% requires that the average speech
the Northwestern University Children’s Perception of Speech level at each frequency be at least 15 dB above the listener’s
(NU-CHIPS) (Elliot & Katz, 1980) is appropriate. The Word threshold and/or background noise. The impact of differing
Intelligibility by Picture Identification (WIPI) test (Ross & loudness levels is illustrated on the Speech Audibility Au-
Lerman, 1970) is useful for children whose vocabulary is diogram for Classroom Listening (Appendix 5–E).
at a 4.5-year-old level. Both tests use a picture-pointing re-
sponse in a closed-set format. The advantage of “guessing” on
closed-set tests may tend to overestimate the child’s functional Physiological Assessment
word recognition ability. Open-set lists requiring word repeti- Physiological assessment techniques include measurements
tion by the child include the Lexical Neighborhood Test and
Chapter 5
of immittance, otoacoustic emissions (OAEs), and evoked

Multi-syllabic Neighborhood Test (Kirk, Pisoni, & Osberger, potentials (auditory brainstem response [ABR] and auto-
1995) for ages 3 to 4 years and older, the PB-Kindergarten mated auditory brainstem response [AABR]). Immittance
lists (Haskins, 1949) for ages 5 years and older, the CID W-22 measures and OAEs are often found in educational audiol-
lists (Hirsh et al., 1952) for ages 8 years and older, and the ogy programs; evoked potentials are less common although
NU-6 lists (Tillman & Carhart, 1966) for ages 12 years and portable ABR screening units are becoming increasingly in-
older. A challenge may occur when attempting to interpret corporated in newborn screening follow-up programs. The
word repetition responses for children or youth who have sig- advantages and limitations of these tests as they are used in
nificant articulation errors. However, it can be very useful to screening programs are discussed in more detail in Chap
record individual errors and identify perception error patterns ter 4, Hearing Screening and Identification. Because these
to use this information when adjusting technology settings, procedures require specialized equipment that may not be
as well as for collaboration with others (e.g., speech-language available in educational settings, students are often referred
pathologists, teachers of the deaf and hard of hearing) who to audiology clinics for this testing. Any time a school
are providing services for the child. Ordering information makes a referral to an outside entity to determine the child’s
for the NU-CHIPS, WIPI, and Lexical Neighborhood tests hearing status, the school has the responsibility to pay for
can be found at the end of this chapter (Appendix 5–N). the assessment or cover the out-of-pocket premium or co-
pay if the parents give permission to use the child’s public
Speech Audibility Versus Speech Intelligibility (e.g., Medicaid) or private insurance. It is important that ed-
Speech audibility is the amount of useful acoustic informa- ucational audiologists understand the procedures that were
tion that is accessible to the student. One audiometric mea- done when an outside referral was made so they can assist
sure of audibility is the Speech Intelligibility Index (SII) in interpreting the results to school personnel and parents or
using the Count-the-Dot method (Killion & Mueller, 2010). caregivers. Figure 5–1 can be helpful as a quick reference
The SII measure of audibility differs from speech intel- when reviewing reports with physiological test results.

Assessment 117
Auditory tests to help determine neuro-otologic condi- rate videos to distract younger children during immittance
tion may include ABR, OAE, vestibular assessment, tinnitus assessment because the only requirement is that they remain
evaluation, or special behavioral audiometric tests. Tests that quiet for a few seconds for each portion of the testing. Auto-
are primarily used for medical diagnoses (e.g., sedated ABR, mated immittance equipment that is designed for screening
videonystagmography, calorics) typically are not included provides less comprehensive information but may be used
within the role of the educational audiologist. Despite this, when quick pass/fail information for middle ear functioning
we must recognize that there are students within the schools is desired. See Chapter 4, Hearing Screening and Identifica-
who have neural hearing conditions that may be progressive tion, for more information on immittance testing.
and potentially life-altering and have an impact on both the
student and the family. When it is suspected that a child has Otoacoustic Emissions Testing
a neural hearing issue, the educational audiologist must ei- The addition of OAEs to a physiological test battery is help-
ther perform the special audiometric tests or refer the child ful in determining cochlear function. A probe containing a
to an appropriate audiology clinic for further assessment. microphone is placed in the ear canal to provide the stimulus
Doettl and McCaslin (2017) reported that 5% to 8% of and record the cochlear emission as a response. OAEs may
children in general experience vertigo or dizziness, but that be elicited after either a click or transient stimulus (transient
70% to 85% of children with reduced hearing demonstrate evoked OAEs [TEOAEs]) or elicited after stimulation with
vestibular abnormalities. Although educational audiologists two tones (distortion product OAEs [DPOAEs]). Although
typically will not provide comprehensive vestibular testing, there have been some attempts to correlate response levels
we can be a significant collaborator in the screening and with acoustic thresholds, it is important to remember that
referral process for deaf or hard of hearing children. Janky, OAEs are not direct indicators of hearing sensitivity.
Thomas, High, Schmid, and Ogun (2018) recommended As OAE equipment has become more portable and au-
using simple screening questions for children whose hearing tomated, it is frequently used in newborn hearing screening
thresholds are greater than 66 dB HL for potential compre- programs. For educational and pediatric audiologists, it is
hensive vestibular testing. Pediatric audiologists from Cin- helpful in identifying cochlear responses when screening
cinnati Children’s Hospital recently reported a case study children and youth who have significant developmental and
to illustrate how educational audiologists can be involved learning challenges (see Chapter 4, Hearing Screening and
in collaborative screening, referral, and vestibular rehabili- Identification). In addition, OAEs are included in protocols
tation with a physical therapist (Castiglione & Lavender, to help identify children and youth with auditory neuropa-
2019). Finally, guidelines for medical referral of children or thy/dyssynchrony (AN/AD) (also referred to as auditory
adults for a variety of hearing-related conditions are sum- neuropathy spectrum disorder (ANSD), and as part of the
marized in an article by Steiger, Miller, and Saccone (2018). audiology tests administered before an assessment for audi-
tory processing deficits.
Chapter 5
Acoustic Immittance Testing
Evoked Potential Measurement
With the high incidence of middle ear problems in young
Although equipment for evoked potential assessment typi-
children, immittance testing becomes a particularly impor-
cally is not available in educational settings, it is important
tant component of every child’s audiology evaluation. The
for educational audiologists to have a working knowledge of
immittance measurements are objective, require no volun-
ABR and auditory steady-state response (ASSR) measure-
tary response, and are the most sensitive audiologic proce-
ment to facilitate referrals when appropriate. In addition, ed-
dures for determining the status of the middle ear system.
ucational audiologists should be knowledgeable enough to
Complete immittance testing includes tympanometry and
collaborate effectively with centers providing this service to
the measurement of static acoustic immittance, physical vol-
children and youth and to help interpret results and reports
ume, and acoustic reflex thresholds. Although some young
from assessments completed elsewhere to parents and school
children, especially those who have had ear infections, may
personnel. Readers are referred to the Suggested Readings at
object to placing a probe in the ear, every effort should be
the end of this chapter for more detailed information on the
made to attempt these measurements. This is especially true
use of evoked potentials in auditory assessment.
for young children and those with additional learning chal-
lenges who have reduced hearing and for whom it may be ■■ Auditory Brainstem Response Measurement: ABR
difficult to obtain pure-tone bone conduction results. On oc- testing plays an important role in both identification and
casion, an extremely frightened or screaming child may re- assessment, especially with young children and those
member the experience negatively, jeopardizing subsequent with significant learning challenges who are not able
test sessions. However, children are often positively rein- to be reliably assessed using conditioned behavioral
forced by watching a kid-friendly video (without sound), techniques. The combination of both air and bone con-
the computer screen, or by receiving a computer print-out duction ABR measurements can provide useful infor
“drawn by their ears.” Many pediatric audiologists incorpo- mation for children and youth who have inconsistent or

118 Chapter 5
inconclusive results from behavioral testing and for dix 5–F contains specific adaptations for assessing children
those suspected of having auditory neuropathy spec- who are blind or visually impaired. See Suggested Readings
trum disorder (ANSD or AN/AD [Guidelines Develop- and Resources at the end of this chapter for links to guide-
ment Conference on ANSD, 2008]). Although ABR is lines and techniques for use with young children from the
not a direct measurement of hearing, threshold mea- American Academy of Audiology (AAA, 2012) and the Amer
surements using tone-burst stimuli have been shown to ican Speech-Language-Hearing Association (ASHA, 2004).
correlate with pure-tone thresholds (Stapells, 2000). Children for whom reliable or complete results cannot
■■ Auditory Steady-State Response Measurement: The be obtained behaviorally should have OAEs or other physi-
ASSR is an auditory evoked potential test with emerg- ological tests performed, either by the educational audiolo-
ing clinical applications. It holds promise as a method gist or in collaboration with an outside audiology clinic. It
of estimating frequency-specific hearing sensitivity in is important that every child suspected of being deaf or hard
patients who cannot or will not provide reliable or valid of hearing have an audiology evaluation to determine the
behavioral thresholds (Cone-Wesson, Dowell, Tomlin, nature and level of hearing. The use of CNT (could not test)
Rance, & Ming, 2002; Johnson & Brown, 2005; Kor- or DNT (did not test) without additional information and
czak, Smart, Delgado, Strobel, & Bradford, 2012), but referral should be avoided by all educational audiologists.
the ability of ASSR to clearly distinguish mild hearing
thresholds from normal hearing levels has been ques-
tioned (Sousa, Didone & Sleifer 2016). Pure-Tone Modifications
Behavioral observation audiometry (BOA) may be used for
infants younger than approximately 6 months of age, for
MODIFICATIONS FOR children whose developmental age is younger than 6 months,
and for those who have motoric involvement that pre
SPECIAL POPULATIONS cludes independent head control. Personal observations are
considered highly subjective and should only be attempted
In an educational environment, there will be many stu-
by experienced pediatric audiologists who use a stan
dents who will not be able to respond to standard pediat-
dard protocol. With the alternate assessment technology
ric techniques. Included in this group are infants, toddlers,
available today, use of behavioral observation audiometry
preschoolers, and other children who are difficult to test
alone for definitive diagnosis of hearing status is considered
because of physical, mental, or emotional challenges. But
inappropriate.
most of these children can be successfully tested behavior-
For children whose developmental age is between
ally by an educational audiologist if modified techniques
6 months and 2 years, visual reinforcement audiometry
are used. For young children or those with complex needs,
(VRA) should be attempted, and children with good head
preparation for the testing environment, equipment, and pro-
Chapter 5
control can often participate successfully in VRA at slightly

cedures can be helpful. In addition to practice with wearing
younger ages. This can be a highly useful technique for
earphones or a headband, ask parents to read a social story
children younger than 3 years of age, although some chil-
as many times as possible that explains what is going to hap-
dren may habituate to the reinforcement before a complete
pen during the appointment.
audiogram is obtained. Educational audiologists who use
Children who are developmentally delayed should be
VRA should familiarize themselves with research concern-
tested using techniques appropriate for children at their de-
ing the reinforcement parameters of an appropriate assess-
velopmental age rather than their chronological age. Appen
ment protocol. The design and placement of reinforcers, as
well as stimulus and reinforcement schedules, significantly
affect success with VRA (Diefendorf, 1988; Moore, Wilson, &
Thompson, 1977; Thompson & Folsom, 1984). Use of sa-
lient stimuli can also be a helpful modification when testing
Nuggets from the Field young children (e.g., use of a bandpass-filtered signal from
the child’s favorite songs). Conditioned play audiometry is
“. . . we tend to have low expectations for non- useful for children whose developmental ages are between
routine children, using the argument that children 2 and 5 years of age (Norrix, 2015). By varying the play
with autism or complex needs are difficult to activity, a child’s interest typically can be maintained long
test . . . it is we who need to work harder to reach enough to establish complete thresholds. Both VRA and
these children, making time to learn about their conditioned play audiometry (CPA) are described in detail
individual expectations.” in the AAA Guidelines (2012).
Because the attention spans of young and developmen-
Carroll, B. (2019) tally delayed children are often limited, the educational
audiologist should vary the order of the frequencies tested

Assessment 119
When standard instructions do not work, try this . . .

■■ Bright-colored soft toys, bubbles, or stickers on your ■■ If the activity is too interesting to maintain attention
nose, ears, or eyeglasses can help ease anxiety. on the task, simplify it.
■■ Prepare the environment; have toys and equipment ■■ Objects dropped or put into a container may need
easy to reach but out of sight. to be out of sight after the child’s response; contain-
■■ Reinstruct, but remember not to ask child to listen ers should have lids.
(especially for a toddler who may be inclined to ■■ Ask the child to count beeps instead of raising his
say, “No!”). or her hand.
■■ Have “now” and “next” prompt cards to ease transi- ■■ Turn over picture or playing cards for each beep.
tion to different stimuli or tests. ■■ Have the child activate sound, light, or 3- to 5-second
■■ Change response activity often; typically, initial activi- video on an iPad by pressing a button (carefully
ties can be reintroduced after using two or three control for false-positive responses when using this
others. Suggested activities include: technique).
using a homemade container with a face and open ■■ Decorate your test booth to be “kid-friendly” (with
mouth for an object (e.g., small block) on the lid; pictures, bright colors, and so on) and have lots of
parking cars in a garage; toys that can be used for play audiometry in reach
placing simple puzzle pieces or pegs in holes; but out of sight. If items or pictures are distracting,
assembling Mr. Potato Head; be prepared to cover them.
placing blocks on shapes on a board or checkers ■■ Use a Huggie headband for bone-conduction
on a checkerboard; testing.
putting coins in a bank; ■■ Parents in the testing room may be helpful if the
placing objects on matching pictures; child is young or insecure, and this can facilitate par-
tossing bean bag or small, light balls (e.g., Wiffle ent counseling after the test session.
balls) into a box or basket; and
putting pop-beads together.
Chapter 5
to obtain maximal information from the child. If only two child should return for additional testing on a periodic basis
thresholds can be obtained, thresholds for a low-frequency until complete information is obtained. Testing during sub-
sound (e.g., 500 Hz) and for a high-frequency sound (e.g., sequent sessions should focus on measuring thresholds that
4000 Hz) will provide more information about the child’s have not been previously obtained.
hearing for speech than if only thresholds for two midfre- Many young or developmentally delayed children do
quency sounds (e.g., 1000 and 2000 Hz) are obtained. It not easily tolerate the use of insert or conventional ear-
is also important to note every response made by young phones for audiometric testing. Initially, sound-field testing
children because they may not continue to respond unless can be used to determine the hearing sensitivity of the bet-
the stimulus is changed. Without a system for tallying re- ter ear so intervention can begin. However, efforts to obtain
sponses, it can be easy to overlook some responses, and ear-specific thresholds should be continued. When insert or
valuable information may be lost. Another technique for conventional earphones are not tolerated, lending parents an
maximizing information obtained from young children is to old set of earphones to use at home with the child may help
measure thresholds in sound field to determine the hearing some children overcome their fear of wearing earphones.
in the better ear before attempting to measure thresholds for Another technique that may be useful is to hold an earphone
each ear individually. that has been detached from the headband near the ear to
Although the information obtained from a child during be tested. It must be recognized that valid thresholds can-
one test session may be limited, if audiologists select this not be measured if the earphone is not properly placed over
information wisely, they can learn enough about the audi- the child’s ear, but the information obtained can suggest the
tory status of the child to begin making recommendations presence of significant differences in the sensitivity of the
to the parents and school personnel, especially when these child’s two ears, and the child may be less fearful of ear-
results are used to complement objective findings from im- phone placement during the next session.
mittance and OAE testing. When complete thresholds can- Assessing responses to signals from a bone-conduction
not be measured on a child during one testing session, the (BC) vibrator can also present challenges for smaller children

120 Chapter 5
and those with craniofacial anomalies. Padding the head- ceptively better than predicted from the pure-tone average
band with foam or brightly colored material or use of a soft if the child has hearing thresholds with a sloping or uneven
BC headband (e.g., Huggie, Baha softband) can be helpful configuration.
in these situations. If the child continues to be cooperative, If a child cannot repeat words intelligibly so that a
assessment of BC responses immediately after pure-tone speech perception score can be calculated, the point-to-
testing in a sound field may help clarify the presence or the-picture tests discussed previously may be appropri-
absence of a conductive component for an identified hear ate. Another more informal way to obtain some idea of a
ing loss. child’s ability to recognize words is to have the child point
to common objects or to body parts. Some young children
will wave to “bye-bye,” point to “Mama,” or repeat their
own name. Additionally, the educational audiologist can use
Speech Modifications several tests of auditory perception, depending on the child’s
When a child cannot repeat spondee words to obtain a speech age and developmental status. Selected tests are described
recognition threshold, a task involving pointing to pictures in Table 5–3.
or objects representing spondee words should be attempted. All of these tests, except the Sound Effects Recogni-
Speech pattern perception tasks (Erber & Alencewicz, 1976; tion Task (SERT), use a limited set of words or sounds to
Moog and Geers, 1990) can also be used as a modification assess the child’s ability to perceive speech and its acoustic
of standard speech threshold tasks with younger and/or more components. The SERT uses environmental sounds to as-
involved children. When this is not successful or possible, sess the child’s ability to discriminate among non-speech
a speech awareness or detection threshold can be obtained stimuli. Most of these tests were developed for use with
with either VRA or CPA. Because the child does not have children with hearing deficiencies, but they can also be used
to recognize the speech for either of these techniques, the with young or low-functioning children with normal hearing
speech threshold typically will be approximately 10 dB bet- sensitivity. Ordering information for those that are commer-
ter than the speech recognition threshold. It can also be de- cially available can be found in Appendix 5–N.
TABLE 5–3 Description of Selected Tests of Auditory Perception
Test Description
Auditory Numbers Test (ANT) (Erber, 1980) Test of ability to discriminate the numbers 1 through 5 and to identify
temporal patterns for series of numbers; designed for children with
hearing impairments
Chapter 5
Auditory Perception of Alphabet Letters (APAL) Recorded test of ability to perceive the letters of the alphabet; closed-
(Ross & Randolph, 1988) set response with 26 alternatives; score is weighted according to how
acoustically close the response is to the target sound; appropriate for
children with hearing impairments
Children’s Auditory Test (CAT) (Erber & Alencewicz, Point-to-the picture test designed for students with severe or profound
1976) hearing losses; assesses ability to both identify appropriate stress patterns
and recognize monosyllabic, trochaic, or spondaic words
Early Speech Perception Test (ESP) Recorded test battery for young children with profound hearing losses
(Moog & Geers, 1990) and limited vocabulary and language skills; tests both pattern perception
and simple word identification; pictures or toys are used for response;
standard and low-verbal versions are available; appropriate for children
3 years of age and older
Ling Six-Sound Test (Ling & Ling, 1978) Test of ability to detect or recognize six specific speech sounds (m, oo,
ee, ah, sh, s), within low-, mid-, and high-frequency ranges
Minimal Auditory Capabilities Battery Recorded test battery with 13 subtests; two additional subtests
(MAC Battery) (Owens et al., 1985) determine benefit from visual enhancement; appropriate for students
with profound, postlingual hearing impairment
Sound Effects Recognition Task (SERT) Recorded test of ability to discriminate gross environmental sounds;
(Finitzo-Hieber et al., 1977) pictured, closed-set response with four alternatives; appropriate for
children between 3 and 6.5 years of age

Assessment 121
MONITORING HEARING well as function and use of amplification, but it may be use-
ful for some students to have more frequent evaluations.
SENSITIVITY Children and youth with altered sensorineural hearing con-
ditions identified within the past 2 years should have their
After reduced hearing has been documented, it is necessary
hearing sensitivity monitored every 4 to 6 months until the
to continue to monitor the child’s or youth’s hearing sensi-
stability of their hearing thresholds is documented. Like-
tivity. The hearing of children with chronic conductive hear-
wise, preschool children should be evaluated every 3 to
ing problems may fluctuate frequently, and some children
6 months to ascertain that an accurate audiogram has been
with sensorineural hearing issues may have a progressive or
obtained and to document stability. In addition to monitoring
fluctuating hearing status. Although we should be cautious
hearing sensitivity, these evaluations are useful in monitor-
to avoid unnecessary overamplification, additional hearing
ing the progress of auditory skills and providing information
decreases may sometimes occur, making it wise to periodi-
for updating Section 504 plans, Individual Family Service
cally monitor not only the child’s hearing sensitivity but also
Plans (IFSPs), and IEPs.
the hearing instrument settings. (See Chapter 8 for more in-
Children with chronic conductive hearing issues should
formation on personal amplification.)
be monitored regularly because of the potential fluctuating
nature of these conditions. Typically, these children should
Types of Monitoring have a hearing evaluation every 3 to 4 months with monthly
The monitoring of children’s hearing is most often accom- monitoring at a minimum using tympanometry and, if avail-
plished by repeating the pure-tone air conduction thresholds able, OAEs to determine changes in the ear’s status. Because
at regular intervals. It is helpful to record the thresholds on of the transitory nature of conductive hearing status, it may
a cumulative chart so that any changes in hearing sensitivity be necessary to monitor hearing more frequently at certain
can be quickly noted. When a significant change occurs, the times of the year (e.g., during cold and allergy seasons).
educational audiologist should collaborate with the child’s Regardless of the schedule for monitoring that is used,
clinical audiologist and physician to determine if the change teachers and parents should be encouraged to stay alert for
is the result of middle ear involvement, a progressive hear- changes in the student’s performance or behavior. Any time
ing decrease, or the possibility of overamplification. Ad- a change is noticed, the child’s hearing should be checked
ditionally, the educational audiologist should collaborate immediately to determine if the change is related to a fluc-
with educational team members to increase awareness of, tuation in hearing sensitivity. The educational audiologist
and provide relevant accommodations for, a change in the needs to be sure to include the recommended audiology as-
child’s hearing. sessment schedule in the IEP, IFSP, or Section 504 plan.
Immittance and OAE testing are also useful in moni-
toring children’s auditory function, particularly for those
ADDITIONAL AUDIOMETRIC
Chapter 5
having chronic middle ear problems and/or those using am-
plification. Results from these procedures can be obtained
more quickly than pure-tone thresholds and are more sensi-
INFORMATION AND FUNCTIONAL
tive to changes in the peripheral auditory system that may HEARING ASSESSMENT
affect hearing sensitivity. When atypical immittance or OAE
results are found, pure-tone thresholds should be obtained to Although the basic audiology evaluation can provide edu-
document any fluctuations in hearing, and the child should cational audiologists with information about the nature and
be referred to a physician for medical follow-up, if indi- degree of hearing conditions, additional testing is necessary
cated. As stated earlier, teachers and parents should also be to determine the potential educational effects for each deaf
notified of changes in the child’s hearing status so that nec- or hard of hearing student. Furthermore, IDEA requires
essary educational accommodations can be made until the that each student be evaluated in all areas related to the sus-
problem (e.g., middle ear infection) is resolved. pected disability—that is, “a variety of assessment tools and
strategies to gather relevant functional, developmental, and
academic information about the child, including information
Schedules for Monitoring provided by the parent . . . .”2 Therefore, the educational
The Individuals with Disabilities Education Act (IDEA, audiologist must go beyond the audiogram to perform ad-
2004) requires that all students with Individualized Educa- ditional tests to capture hearing and listening performance
tion Programs (IEPs) have reevaluations at least every 3 years in the various learning environments of the student. A sum-
unless more frequent evaluations are specified in the stu- mary of functional measures for listening and communica-
dent’s IEP.1 Audiology evaluations generally are conducted tion can be found in Appendix 5–G. Information that can be
annually to monitor hearing and listening performance, as
1 2
34 CFR §300.303(b)(2). 34 C.F.R. §300.304(a)(1).

122 Chapter 5
children. Although this test is typically used for determining

the presence of central auditory processing problems, it can be
Assistive technology service means any service used for other purposes. The test contains lists of 10 sentences
that directly assists a child with a disability in the se that are pictured so the child can point to the appropriate pic-
lection, acquisition, or use of an assistive technol ture. The limited vocabulary and number of sentences make the
ogy device . . . includes (a) The evaluation of the PSI appropriate for children 3 years of age and older.
needs of a child with a disability, including a func-
tional evaluation of the child in the child’s custom- Blair Sentences
ary environment.
Six lists of sentences appropriate for children in the second
grade and above were developed by Blair (1976). Each list
IDEA 2004 [34CFR300.6(a)]
includes 25 sentences with two key words identified in each
sentence. The child is required to repeat the entire sentence,
and the score is based on the percentage of key words re-
peated correctly.
obtained by educational audiologists includes performance
in the following areas: Common Children’s Phrases and Nonsense Phrases
■■ speech recognition for sentences and phrases; To overcome the difficulty young children may have remem
■■ listening in noise; bering entire sentences, the authors of the Functional Lis-
■■ speech recognition with visual supports; and tening Evaluation (FLE) developed the Common Children’s
■■ auditory and listening development skills. Phrases and Nonsense Phrases for use with the FLE (John
son & Owens, 1996) These phrases are three to five sylla
bles in length and are grouped into eight lists of 20 phrases
Speech Recognition for each calibrated to a third-grade vocabulary level. The test is
Sentences and Phrases scored based on the percentage of phrases the child repeats
The basic audiology evaluation includes measurement of stu- correctly. The phrases were obtained from frequently spo-
dents’ abilities to discriminate or recognize single words in ken phrases used in elementary school classrooms and are
a sound-treated environment. Although this provides useful appropriate for children from 4 years of age and up. The
information, it does not represent real-world communication Nonsense Phrases were created from the common phrases
situations. Children rarely listen to words in isolation; words by rearranging the word order. These phrases are more chal-
are most often provided within the context of a phrase or sen- lenging because of the absence of grammatical predictability
tence. Conversational speech also contains a range of loud- and context, therefore requiring more effort to attend, listen,
ness levels from soft speech to very loud speech and often and comprehend. The nonsense phrases are useful for test-
Chapter 5
occurs in varying levels of competing noise. Some sentence ing children and youth with greater auditory access (e.g.,
and phrase materials have been developed for children, and, unilateral, minimal, or mild hearing levels).
as with word recognition tests, it is important to use materials
that are appropriate for each child’s language abilities. Most Bamford-Kowal-Bench Sentences
of the sentence and phrase lists that have been developed for The Standard American English version of the Bamford-
use with children do not have normative data, but they can still Kowal-Bench Sentences (BKB/SAE) includes lists of syn
provide us with information about children’s use of context.
Ordering information for commercially available print and
recorded speech tests can be found in Appendix 5–N.
Word Intelligibility by Picture Identification Sentences Nuggets from the Field

Sentences have been written for the WIPI test (WIPI Sen-
tences) for testing young children (Weber & Reddell, 1976). “I will also use the nonsense phrases to make an ar-
There are four lists of sentences, each containing 25 sen- gument for pre-teaching. I present some (more dif-
tences with a key word in each sentence. These materials are ficult) nonsense phrases to teachers, in noise from
useful with children 4.5 years of age and older who can re- a distance, without the pre-teaching of phrases and
spond either by pointing to the appropriate picture or by re- then again, after they have been exposed to the
peating the entire sentence, whichever is easier for the child. phrases. It really demonstrates the significant posi-
tive impact of pre-teaching on auditory cognitive
Pediatric Speech Intelligibility Test closure! I also do this with a CI simulation—they
The Pediatric Speech Intelligibility (PSI) test (Jerger & Jerger, always think that I am playing a different clip!”
1984) is another sentence test that can be used with very young

Assessment 123
tactically and semantically equivalent sentences (Bench & appropriate for children 5 years of age and older. The test
Bamford, 1979; Bench, Kowal, & Bamford, 1979; Kenworthy, is presented in the sound field at an approximate conversa-
Klee, & Tharpe, 1990). Each list contains 16 sentences that tional level of 70 dB SPL. Performance is scored by percent-
were developed from language samples taken from deaf and age of words (N = varies per list) and sentences (N = 20)
hard of hearing children who were between 8 and 15 years correctly repeated.
of age. They have been found to be appropriate for use with
children with typical hearing as young as 5 years of age. The
sentences are scored based on the percentage of the 50 key Listening in Noise
words that are repeated correctly by the child. As evidenced by the speech recognition measures just de-
scribed, the measurement of a student’s ability to listen in
noise is a critical part of the audiology assessment. Class-
Speech Perception in Noise Testing rooms are noisy places, and the typical word recognition
scores obtained in quiet are not reflective of children’s abili-
Bamford-Kowal-Bench Speech in Noise Test
ties to understand speech in the classroom. Again, this in-
The BKB sentences have now been recorded with compet- formation is useful in alerting and demonstrating to teachers
ing noise (four-talker babble) as a speech-in-noise test (Ety- and other team members the difficulties a child may experi-
motic Research, 2005). The BKB-SIN is used to estimate ence in the classroom, and it can also provide justification
the signal-to-noise ratio (SNR) needs of children to under- for the use of a RM HAT or classroom audio distribution
stand speech in the presence of noise. Knowing a child’s systems for children with auditory problems. (See Chap-
SNR loss is critical to the determination of accommodations ter 8, Hearing Instruments and Remote Microphone Tech-
and RM HAT recommendations. A normal SNR loss of 0 dB nology, for additional information).
might be a contraindication for RM HAT, but a SNR loss of Speech recognition testing in noise can be accom-
15 might indicate the need for a personal DM/FM system plished with either words or sentences. Although the stimuli
over a classroom audio distribution system. The BKB-SIN can be presented through insert or conventional earphones,
is also used as a validation tool by comparing performance scores obtained in this manner may not be reflective of a
with and without RM HAT. This assessment should be a rou- child’s ability to listen in a classroom because the binau-
tine component of audiological assessment for every deaf ral advantage (listening to signal and noise through both
or hard of hearing child. Norms are available for children in ears simultaneously) is not available. For this reason, we
three age groups—5 to 6, 7 to 10, and 11 to 14 years—and recommend testing a child’s ability to listen to speech in
are available together with the recordings. competing noise without earphones. The angle of presenta-
tion for the speech and noise will most likely depend on
Speech Intelligibility in Noise Test the placement of the speakers in the sound booth, but it is
Kalikow, Stevens, and Elliott (1977) developed lists of sen-
Chapter 5
generally better to use separate speakers for the speech and
tences for the Speech Intelligibility in Noise (SPIN) test. noise signals with the speech presented at 0 degrees azimuth
Although this test was designed for administration in noise, (AAA, 2008a). Rarely do the speech and competing noise
the sentences can be administered in quiet conditions as come from the same source in the classroom, so separate
well. The final word in each of the 50 sentences in each list speakers are more reflective of actual classroom listening.
is used to determine the child’s score. This test is appropri- Additionally, the binaural advantage will not be reflected in
ate for children approximately 10 years or older and can be the score unless the speech and noise come from separate
administered by having the child repeat the entire sentence speakers (Etymotic Research, 2005; Mueller & Sweetow,
or only the final word. An interesting feature of this test is 1978). More information on speaker placement for hear-
that the key words in 25 of the sentences in each list are ing aid and DM/FM testing is provided in AAA Clinical
highly predictable from the context of the sentence, but the Practice Guidelines: Remote Microphone Hearing As-
key words in the other 25 sentences have low predictability. sistance Technologies for Children and Youth from Birth
Scoring of the high-predictability sentences compared with to 21 Years (2008) (https://www.audiology.org). (See also
the scoring of the low-predictability sentences can give in- Chapter 8, Hearing Instruments and Remote Microphone
formation about how children are able to use the context of Technology.)
the sentence to determine the key word. Various types of competing stimuli can be used for test-
ing speech recognition in noise, but the ones most commonly
Hearing in Noise Test for Children used are the speech noise generated by the audiometer or
The Hearing in Noise Test (HINT) developed for adults at a multitalker babble typically used with recorded testing.
the House Ear Institute has been adapted for use with chil- Multitalker noise is also available on .wav recordings that
dren to measure word and sentence recognition in compet- can be generated from a personal computer for field-testing
ing noise (Schafer, 2010). The HINT-C consists of 13 lists use. Whereas speech noise would predict performance when
of 10 phonetically balanced sentences that have been found there is a continuous competing noise in the classroom

124 Chapter 5
(e.g., an air conditioner), multitalker babble is more repre- Almen (1993), using a paradigm suggested by Ying (1990)
sentative of difficulties encountered when classmates and and Ross, Brackett, and Maxon (1991), developed the FLE
teachers talk simultaneously. The level of presentation for to provide a systematic method to evaluate listening in the
the speech signal typically is that of normal conversational student’s classroom to meet the IDEA functional evaluation
speech, between 45 and 55 dB HL, but the level of the noise requirements. The FLE has been used by educational audi-
may vary depending on the audiologist’s choice. SNRs rang- ologists to assess the effects of noise, distance, and visual
ing from +10 to –10 are often used, with different levels access on a students’ listening abilities. Procedures for this
simulating listening in a quiet or a noisy classroom. If time evaluation are described in the protocol in Appendix 5–H.
permits, it is helpful to obtain information from more than The FLE paradigm is designed to evaluate students in their
one level for comparison and interpretation. Because there classrooms, or in rooms that are similar to their classrooms,
are no normative data for sound-field listening in noise, it to take into account room acoustics and other individual
is important for educational audiologists to use a consistent classroom characteristics. Eight lists of words, phrases, or
arrangement so they will know the amount of decrease in the sentences are presented via monitored live voice in the eight
speech recognition score that typically is associated with the conditions: four in quiet with close and distance proximities,
procedure they are using. Furthermore, using the student as and auditory only and auditory and visual access and the
his or her own control by comparing speech recognition per- same four conditions repeated with background noise pres-
formance in quiet versus competing noise conditions yields ent. The Common Children’s Phrases and Nonsense Phrases
valuable information about the impact of noise. described previously are recommended because they pro-
vide long enough speech stimuli to reflect the effects of the
reverberation characteristics of the classroom but are not so
Speech Recognition With Visual Support long as to be affected by auditory memory.
Most audiometric speech tests are administered using audi- Each student’s performance is compared across the
tory input alone, but it can be helpful to determine a child’s eight conditions to highlight the listening implications of
or youth’s ability to understand speech using combined au- each condition. The best condition score (generally quiet/
ditory and visual information. This information can provide close/with visual cues) can be used as the target when the
the educational audiologist with an idea of the child’s benefit benefit of hearing assistive technology is demonstrated. The
from use of visual speech cues and the importance of ac- Interpretation Matrix averages the scores to see the overall
cess to speechreading in the classroom. A comparison of impact of noise, distance, and visual input. The test protocol
the score a student receives using auditory-only information takes approximately 30 minutes to administer if phrases are
with performance using both auditory and visual informa- used as the speech material, longer if some of the conditions
tion is often very helpful in coaching the teacher concerning are repeated with RM HAT. A comparison of performances
the student’s consistent need for access to speechreading and using Common Versus Nonsense Phrases also adds insight
Chapter 5
other visual cues for communication in the classroom.

Any of the tests commonly used for speech recognition
testing, including both words and sentences, can be pre-
sented with visual support. Obviously, the presenter’s face
FLE: SAMPLE RESULTS
needs to be seen clearly by the child when stimuli are admin- FOR STUDENT WITH
istered via the auditory-visual mode. If there are shadows in SINGLE-SIDED DEAFNESS
the test booth that obscure the educational audiologist’s face,
the test score will not accurately reflect the child’s ability to Averaged Results: Common Children’s Phrases
make use of additional visual cues. If scores from either au- Versus Nonsense Phrases
ditory or visual alone are to be compared with the combined Common Phrases (able to use linguistic knowledge
auditory-visual score, then the auditory-visual mode should to fill in blanks)
be presented last. This presentation order will avoid inflated ■■ Effect of Noise: quiet 99%, noise 96%
scores for either auditory or visual modes caused by learning ■■ Effect of Distance: close 99%, distant 96%
effects that could be provided if the easier (more accessible) ■■ Effect of Visual Input: auditory + visual 98%,
auditory-visual mode was presented first. auditory only 98%
Nonsense Phrases (ability to understand words
without topic knowledge)
The Functional Listening Evaluation ■■ Effect of Noise: quiet 74%, noise 51%
The need to document a student’s ability to hear and un- ■■ Effect of Distance: close 66%, distant 59%
derstand in environments other than a test booth is evident. ■■ Effect of Visual Input: auditory + visual 66%,
Sound booth conditions are very controlled and represent an auditory only 59%
artificial listening situation that may not adequately reflect
a student’s ability to listen in the classroom. Johnson and Von

Assessment 125
regarding how children use language to fill in missing in- opment scales that are commercially available is provided
formation (see example in text box). The results provide in Appendix 5–N.
significant information about how various factors affect a
child’s performance in the classroom. A sample FLE score
form is illustrated in Figure 5–2. The FLE (2013 version) Audiometric Assessment Considerations
may be downloaded from the author’s website, https://adevan Without a Sound Booth
tage.com, or a refillable self-calculating form is available at A number of educational audiologists and educational au-
https://www.phonakpro.com/content/dam/phonakpro/gc_hq diology programs do not have an audiometric sound-treated
/en/resources/counseling_tools/documents/child_hearing booth for testing. When a booth is not available for use, al-
_assessment_functional_listening_evaluation_fle_2017.pdf ternative ways to meet the permissible ambient noise level
The Recorded FLE is available from https://success standards for audiometric test rooms (American National
forkidswithhearingloss.com. The recorded version uses Standards Institute [ANSI], 1999) are on the horizon. A
HINT sentences in noise presented at +5 dB SNR. To evalu- recent study by Clark, Brady, Snyder, Earl, and Scheifele
ate in the auditory+visual conditions, the test administrator (2018) described a procedure for use of noise-canceling
must mouth the words simultaneously to the auditory pre- earphones with college students. Their results supported
sentation of each of the sentences. the conclusion that use of noise-canceling earphones is a
Modifications can be made for younger children by feasible alternate testing arrangement when sound-treated
using a picture-pointing task such as the WIPI or NU- enclosures are not available. Creare has also developed
CHIPS picture cards and reducing the number of presenta- headphones that permit testing to 0 dB (see Chapter 4, Fig-
tions. Modifications must be noted when presentations are ure 4–1). Two caveats pertinent to educational audiologists
reduced, or other significant modifications are made; the include (a) if testing thresholds below 20 dB HL are not re-
test results should be qualified as formal observation or in- quired, then 20 dB can be added to the ANSI maximum per-
formal assessment since the reliability declines with fewer missible ambient noise when testing (Margolis & Madsen,
presentations. 2015) and (b) not all noise-canceling earphones have the
same attenuation properties, so audiologists must be familiar
with the properties of the noise-canceling device being used
Auditory and Listening Development Skills (Clark et al., 2018). One other innovative alternative that
is being developed for out-of-booth audiometric testing is
Several comprehensive tests of auditory skills may prove a web portal iPad-based audiometer (Lefrancois, 2018). To
useful to educational audiologists. These include obtain current information on this option, see https://www
■■ Glendonald Auditory Screening Test (Erber, 1982); .shoebox.md.
■■ Computer Assisted Speech Perception Testing and Train
Chapter 5
ing Program (CASPER) (Boothroyd, 1987);
■■ Placement Test of Developmental Approach to Success- Cultural Considerations
ful Listening II (Stout & Winkle, 1992); We know from personal experience and a multitude of de-
■■ Functional Auditory Performance Inventory (FAPI) mographic reports that the linguistic diversity of our stu-
(Stredler-Brown & Johnson, 2008); dents is increasing. Data from the Longitudinal Outcomes
■■ Auditory Perception Test for the Hearing Impaired of Children with Hearing Impairment (LOCHI) reported
(APT)—Revised (Allen, 2007); and that 28 languages other than English (LOTE) were used in
■■ Cottage Acquisition Scales for Listening, Language, the homes of 406 children, although the majority of these
and Speech (CASLLS) (Wilkes, 1999). children were reported to use spoken English in their homes
(Crowe, McLeod, & Ching, 2012). Cultural perceptions and
Although these tests assess performance of children and
expectations may influence how the report of assessment
youth on a variety of auditory tasks that differ slightly from
results is received. Although it may not be feasible for every
test to test, all measures attempt to determine the level at
school district to have multilingual staff and resources for
which speech can be perceived through audition (i.e., de-
every family, the following ideas are recommended when
tection, discrimination, identification, recognition, or com-
testing students and communicating with families of deaf
prehension) and the linguistic level children can compre-
and hard of hearing students who use languages other than
hend (i.e., isolated sounds, syllables, words, sentences, or
English, including sign languages:
conversation). These tests are useful in planning auditory
habilitation programs for deaf or hard of hearing children ■■ increased sensitivity to cultural diversity in dress (e.g.,
and youth and in monitoring progress as skills are acquired. earphone placement when student is wearing a burka,
They can also be used to help teachers and parents recognize hijab, or other head covering);
and understand the progression of children’s auditory skills. ■■ provision of information brochures and packets in dif-
Ordering information for selected tests and auditory devel- ferent languages;

Chapter 5
126
THE FUNCTIONAL LISTENING EVALUATION
Plural_Johnson_Ch05.indd 126
Name: Rory Date: _______________ Examiner: __________________________________ Age/DOB: 14
AUDIOMETRIC RESULTS INTERPRETATION MATRIX
Hearing Sensitivity: Pure Tone Ave: Right Ear 1101 dB Left Ear 48 dB
Noise Distance Visual
Word Recognition: Right Ear CNT Left Ear 88% @ 75 dBHL Input
Sound Field: Aided X Unaided h quiet noise close distant aud-vis aud
Quiet 88% @ 55 dBHL 85 65 85 65 85 85
close- 2 4 quiet- 2 7 close- 1 2
Noise 72% @ 55dBHL @ 15 S/N aud aud quiet
85 75 85 80 75 65
close- 1 3 quiet- 1 8 close- 3 4
FUNCTIONAL LISTENING EVALUATION CONDITIONS aud/vis aud-vis noise
65 25 65 25 25 25
distant- 7 6 noise- 4 6 distant- 5 6
Amplification: None h Hearing Aids X FM h Cochlear Implant h aud aud noise
Sound Field h Other__________________ 80 25 75 25 80 65
distant- 8 5 noise- 3 5 distant- 8 7
Classroom Ambient Noise Level (unoccupied): 42 dBA aud/vis aud/vis quiet
Assessment Material: Children’s Nonsense Phrases
Distance (distant condition): 15 ft Noise Stimulus: Multitalker Average of
Speech level @ listener’s ear: 65 dBA above scores: 79% 48% 78% 49% 66% 60%
Noise level @ student’s ear: 60 dBA quiet noise close distant aud/vis aud
Approximate speech to noise levels: close 15 dB distant 25 dB
INTERPRETATION AND RECOMMENDATIONS

FUNCTIONAL LISTENING SCOREBOX Rory demonstrated some behaviors that might be expected from a
14-year-old male. He quickly became bored reducing his attention to
close/quiet close/noise distant/quiet distant/noise the task. He needed persistent prompting to stay on task.
1 85% 3
75%% 8 80% 5
25% His teacher was present for the administration and was surprised by
auditory-
visual the degradation in performance with the increase in distance.The
demonstration of the combined negative effects of distance and noise
2 85% 4
65% 7
65% 6
25% was helpful to her understanding of the need for an FM system in school
auditory and the need to control other environments when an FM system cannot
be used.
FIGURE 5–2 Sample FLE scoring form.
2/25/2020 4:18:52 AM
Assessment 127
■■ identification of priority cultures and languages used in fies each student’s individual listening requirements and
your local area; how well the classroom environment is equipped to sup-
■■ requests for cultural and linguistic staff development port those needs. Evidence for accommodations (e.g., RM
for team members; HAT) that are needed to provide full access to communica-
■■ requests for sign language or foreign language inter- tion and instruction is an integral part of the assessment.
preters for use during assessments and follow-up family Further support for the CLA comes from the requirement
conferences as mandated by IDEA3; and for a functional evaluation in the child’s customary environ-
■■ reschedule appointment times to explain results to fami- ment to be completed as part of assistive technology services
lies when interpreters can be present. under IDEA.4 Minimally, there are four components that
provide the framework for the CLA—observation, behav-
The Clerc Center at Gallaudet University has compiled a list
ioral assessment, self-assessment, and classroom acoustics
of resources on their Info to Go page that is organized into
measurements. Within this framework, multiple methods are
five categories: multicultural, African American, Hispanic,
used to obtain subjective and objective data that are col-
Native American, and Asian and Pacific Islander (https://
lected from various procedures and observers including the
www3.gallaudet.edu/clerc-center/info-to-go/multicultural
student. Together this information is analyzed to corroborate
-considerations.html). The EAA listserv is also a great re-
patterns of performance that can then be prioritized to lead
source for questions concerning assessment materials for
to accommodations and related support services. The four
students and their caregivers who use LOTE.
components are described in the following sections, and Ap-
pendix 5–G contains information on functional assessments
that can be used by teachers and families when complet-
ASSESSMENT OF THE ing the CLA. The educational audiologist should discuss
EDUCATIONAL EFFECTS with relevant team members (i.e., teacher of the deaf/hard
of hearing, speech-language pathologist, classroom teacher)
OF HEARING STATUS who is best suited for conducting the various components
Perhaps one of the most distinguishing differences between of the CLA.
clinical and educational audiologists is the educational audi-
ologist’s focus on determining the impact of reduced hearing
Observation
for students within their learning environments. To be ef-
fective in the schools, we must know the potential ramifica- Observation in the classroom provides the educational au-
tions of compromised hearing to help parents and teachers diologist an opportunity to analyze the classroom arrange-
know how to support students to achieve positive outcomes. ment, communication within the classroom, instructional
Additionally, educational audiologists must be aware of the strategies and classroom management techniques used by
Chapter 5
impact of hearing status to facilitate collaborative discus- the teacher, and classroom acoustics. In addition to observ-
sion of co-occurring conditions that may interact with hearing these components, the observation lends authenticity to
ing status and affect a student’s academic progress. It is not the recommendations that are made as a result of the CLA.
unusual for parents, educational team members, and other Observation tools that can be used to obtain this information
school personnel who are generally unaware of the effects are suggested in Table 5–4. Some tools may be completed
of reduced hearing to assume that all deficits are related to by the audiologist, such as the Placement Checklist from
a student’s hearing, when, in fact, there may be other condi- the Placement and Readiness Checklists (PARC) (Appen
tions that need to be identified and addressed. The following dix 11–D), and others may be completed by the teacher.
sections discuss strategies that can be used by educational
audiologists when assessing the impact of reduced hearing
in the classroom. Behavioral Assessment
Behavioral assessment of classroom listening requires ac-
tual evaluation with the students in their classrooms or cus-
The Classroom Listening Assessment tomary environments. The goal is to identify the effects on
The Classroom Listening Assessment (CLA) incorporates listening for various classroom conditions encountered by
many of the components of the audiology assessment that the students. The Functional Listening Evaluation (Appen-
have been discussed. The purpose of the CLA is to evaluate dix 5–H) and the Ling Six-Sound Check (Appendix 8–I)
how deaf and hard of hearing students or those who have are methods to assess a student’s classroom listening. If the
special listening needs are functioning in their classrooms student uses personal hearing instruments or RM HAT, per-
and other learning environments. The assessment identi- formance with these instruments should also be assessed.
3 4
CFR§300.322(e). 34 CFR 300.6[a].

128 Chapter 5
TABLE 5–4 Suggested Classroom Listening Assessment Protocols
Type Tool Author

Observation Placement Checklist from Placement and Readiness Checklists (PARC) Johnson, 2011b
for Children Who Are Deaf or Hard of Hearing
Listening Inventory for Education—Revised (LIFE-R) Anderson, Smaldino, & Spangler, 2011
Screening Instrument for Targeting Educational Risk (SIFTER): Elementary Anderson, 1989, Anderson & Matkin
(1989), Preschool (1996), Secondary (2004) 1996, Anderson 2004
Children’s Auditory Processing Scale (CHAPS) Smoski, Brunt, & Tannahill, 1998
Classroom Classroom Acoustics Appraisal, Clinical Practice Guidelines: Remote AAA, 2011
acoustics Microphone Hearing Assistance Technologies for Children and Youth
from Birth to 21 Years. Supplement B: Classroom Audio Distribution
Systems—Selection and Verification
Functional Functional Listening Evaluation (FLE) Johnson, 2011a

assessment Ling Six-Sound Test Ling, 1976
Self-assessment Listening Inventory for Education—Revised (LIFE-R) Anderson, Smaldino, & Spangler, 2011
Classroom Participation Questionnaire (CPQ) Antia, Sabers, & Stinson, 2007
Self-Assessment of Communication–Adolescent (SAC-A); Significant Elkayam & English, 2003
Other Assessment of Communication–Adolescent (SOAC-A)
Self-Assessment wall, ceiling, and floor surfaces. Any indication of a poten-

A component that is often left out is how the student views tial noise or reverberation problem should be referred to the
his or her own listening and communication function. The school district facilities management for further assessment
student’s perception of his performance may differ from by an acoustical engineer. A classroom acoustics screening
that of peers, school personnel, and others, depending on survey worksheet is located in Appendix 7–A.
the situation. The self-assessment gives the student a stake in Tools should be chosen that best reflect the child’s devel-
the assessment process and may also open the door to coun- opmental abilities as well as the purpose of the assessment
seling and self-advocacy opportunities. The LIFE (http:// (e.g., general listening ability versus RM HAT efficacy). For
successforkidswithhearingloss.com) and the Classroom students who use RM HAT devices, the assessment should
Participation Questionnaire (CPQ) (Appendix 5–I) are ef- include documentation of the benefit provided by the tech-
Chapter 5
fective tools for this purpose. The CPQ identifies how nology. Procedures for measuring classroom acoustics are
well a student understands his or her teachers and peers as discussed in more detail in Chapter 7, Classroom Acoustics
well as positive and negative feelings that may be associ- and Other Learning Environment Considerations.
ated with classroom participation. The Self-Assessment Data obtained from the CLA should be discussed with
of Communication-Adolescent (SAC-A) and companion the student’s educational team and included in an audiology
tool, the Significant Other Assessment of Communication- report that includes classroom performance implications as
Adolescent (SOC-A), are additional protocols that identify they relate to the student being assessed. Recommendations
communication issues that can be addressed through coun- should be included to address classroom listening and com-
seling. See Chapter 10, Supporting Wellness and Social- munication performance needs.
Emotional Competence, for additional information on stu-
dent self-assessment.
Use of Teacher Checklists
Classroom Acoustics Measurements Another useful way to determine the educational effects of
students’ hearing status is to use teacher checklists, a com-
Classroom acoustics measurements include noise and re-
ponent that was also discussed previously regarding the
verberation measurements and identification of critical
CLA. Although educational audiologists may want to de-
distance. The purpose is to determine whether classrooms
velop their own checklists, there are three that are frequently
meet the American National Standards Institute/Acoustical
used in the schools:
Society of America (ANSI/ASA) S12.60-2010 classroom
acoustic standard of 35 dbA and 0.6 seconds reverbera- ■■ Screening Instrument for Targeting Educational Risk
tion time for permanent and relocatable classrooms. Actual (SIFTER) (Anderson, 1989), Preschool SIFTER (An-
noise measurements must be taken, and reverberation data derson & Matkin, 1996), and Secondary SIFTER (An-
can be calculated from tables using formulas based on the derson, 2004);

Assessment 129
■■ Children’s Auditory Performance Scale (CHAPS) the self-checklist, but the information obtained can be helpful
(Smoski, Brunt, & Tannahill, 1998); and when counseling students and teachers about the perceptions
■■ Fisher’s Auditory Problems Checklist (Fisher, 1985). of individual deaf or hard or hearing students.
All of these checklists are brief and can be completed
by the student’s teacher in a relatively short period of time.
They are useful when the child is first identified with re- Interpretation of Audiologic Information
duced hearing, as well as a tool to monitor the student’s When interpreting a student’s audiology information, it is
performance from year to year. Ordering information for important to include hearing status data, classroom listen-
the SIFTER., CHAPS, and Fisher’s Checklist is included in ing performance, as well as other issues that might impact
Appendix 5–N. learning. These areas are described in the following sections.
Screening Instrument for Targeting Educational Risk Hearing Status

The SIFTER asks the child’s teacher to rate the child com- The first step in determining the educational effects of re-
pared with the other children in the classroom on 15 items. duced hearing is to analyze all components of the hearing
It is scored by taking the teacher’s ratings and plotting them condition including the type of hearing disorder (conductive,
on a chart that indicates pass, marginal, or fail for each sensory, neural), the etiology of the hearing condition (if
of the five areas of academics, attention, communication, known), the level of the child’s hearing, whether both or one
classroom participation, and school behavior. If children fail ear is involved, and the student’s speech perception abili-
a specific area, they should be referred for further evalu- ties. Students with fluctuating conductive hearing issues,
ation in that area. Children who are in the marginal cate- those with mild/minimal sensorineural hearing conditions,
gory should be monitored for future difficulties. There are and those with reduced unilateral hearing (UHL) and single-
three versions of the SIFTER developed for differing age sided deafness (SSD) have been shown to be at risk for lan-
groups—preschool, elementary, and secondary. guage and academic delays (Bess, Dodd-Murphy, & Parker,
1998; le Clercq et al., 2019; Kiese-Himmel, 2002; Lieu,
Children’s Auditory Performance Scale 2004; Oyler & McKay, 2008; Fitzpatrick, Whittingham, &
Originally a tool for considering behaviors associated with Durieux-Smith, 2014). Although these delays may be re-
central auditory processing problems, the Children’s Audi- ported as minimal, proper management is necessary for these
tory Performance Scale (CHAPS) was re-released in 1998 children to maintain their developmental milestones and to
for use in identifying listening problems whether peripheral achieve their potential in the classroom. As a general rule of
or central. The 36-item rating scale assesses five behaviors thumb, without intervention, students with reduced bilateral
rated in comparison to peers in the classroom: listening in sensorineural hearing levels of approximately 30 dB have
the conditions of noise, quiet, ideal, and with multiple in- been shown to have a 1-year academic delay. Students with a
Chapter 5
puts, and auditory memory sequencing and auditory atten- hearing decrease of 40 dB have been shown to have on aver-
tion span. A valuable use of this tool is sorting out listening age a 2-year academic delay, and those with a 50-dB hear-
problems from potential learning disabilities. Listening in ing level may be as much as 3 years delayed (Blair, 1986).
noise problems are identified through the various listening As would be expected, the primary deficit areas for children
conditions. Evidence of possible learning disabilities results with reduced hearing are in those subjects that are language
from poor ratings in the areas of auditory memory or audi- based. Anderson and Matkin (Anderson, 1991, 2007) created
tory attention span. a chart that details the potential academic, speech-language,
and psychosocial characteristics of students with various
Fisher’s Auditory Problems Checklist degrees of hearing. The revised chart is included in Appen
The Fisher’s Auditory Problems Checklist (Fisher, 1985) was dix 5–K and can be quite useful for educational audiologists
also initially developed to screen children for central audi- to share with parents, teachers, and other professionals.
tory processing disorders, but it, too, has been used to assess
listening abilities. It requires the teacher to identify areas of Other Factors
concern from a list of 25 items and is scored by determining Although the degree of hearing levels will give a general
the percentage of items not checked. Student’s scores can then idea of a student’s anticipated performance, we must con-
be compared with the mean grade level scores to determine sider additional information to determine how each child or
if further testing should be recommended. Students scoring youth may function in the classroom. The age of onset, eti-
below 72% should be referred for further evaluation. Ap- ology, age of amplification, prior management of the hear-
pendix 5–J contains an adapted version of Fisher’s Auditory ing issues, parental support, and the child’s intelligence and
Problems Checklist to be used as a self-checklist with older personality are some of the factors that can affect the child’s
students. It is important to note that the norms for the original academic performance. Neurologic functions, such as atten-
Fisher’s Checklist cannot be used for scoring and interpreting tion, fatigue, processing, memory and sensory integration

130 Chapter 5
skills, are also important to consider. Additionally, the in- ■■ functional “listening” skills,
formation obtained about the child’s auditory and visual ■■ use of amplification,
skills from any testing that was done must be included when ■■ academic/vocational performance,
predicting how a specific child’s hearing status will impact ■■ personal adjustment and transitions, and
educational progress and student outcomes. ■■ optional contributing factors.
After a profile of the student’s current functioning has been
developed, the ratings can be used to assist in the identifica-
Need for Comprehensive Evaluation tion of the appropriate intensity of services in minutes per
It is important for educational audiologists to be aware of the week and presented for guidance to the IEP team and subse-
whole child, not just the child’s auditory skills. Frequently, quent placement for the student to receive those services. The
deaf and hard of hearing students have other conditions that form summarizing this matrix is included in Appendix 5–L,
may affect their academic performance. If educational au- and the background and instructions can be downloaded free
diologists, who are most aware of the effects that can be with the form from the Michigan Department of Education
expected from compromised hearing, are alert to these con- (https://mdelio.org/sites/default/files/documents/DHH/Ser
ditions, they will be identified earlier, and appropriate, indi- viceDeliveryTools/ImpactMatrix/Impact_Matrix_For_Stu
vidualized intervention can begin. dents_who_are_Deaf_or_Hard_of_hearing_V2.7.2.pdf).
National Association of State Directors of Special

Education, Inc. (NASDSE)
The third edition of the NASDSE Educational Service Guide- COMMUNICATION OF
lines (2018), Optimizing Outcomes for Students who are ASSESSMENT RESULTS
Deaf or Hard of Hearing, identifies eight areas that should
be considered when evaluating deaf and hard of hearing For the assessments completed by educational audiologists
students in order to get a complete profile of the student’s to be useful, the results must be communicated in a mean-
abilities: ingful way to parents, teachers, and other professionals.
These include
■■ auditory status and auditory function;
■■ vision (acuity and functional vision); ■■ audiograms;
■■ spoken language (comprehension and production); ■■ written reports;
■■ American Sign Language or other sign system (if used); ■■ teacher letters;
■■ speech; ■■ letters to physicians or other professionals;
■■ cognitive and academic performance; ■■ telephone or personal conferences; and
Chapter 5
■■ social, emotional, and behavioral; and ■■ e-mail, texting, and Web-based communication systems.
■■ self-determination and self-advocacy.
These forms of communication do not stand alone. In
In addition, the guidelines recommend use of a variety of fact, examining test results and recommendations more than
assessments, use of a variety of professional expertise, use once and in more than one way is often necessary to help
of valid and reliable measures, and assurance of access when parents and teachers fully understand the student’s hearing
including the student. For more detail and assessment re- status and its implications at home and school.
sources from NASDSE, see Optimizing Outcomes for Stu- It is important for educational audiologists to ensure
dents Who Are Deaf or Hard of Hearing (3rd ed., Chapter 4, that those receiving information understand the results and
Evaluation and Eligibility, pp. 23–28l). can implement the recommendations appropriately. In an
earlier survey of teachers who had all received both a writ-
ten report and a form letter concerning a deaf or hard of
Michigan Educational Services Matrix
hearing student in their classrooms, it was found that only
Another protocol for providing comprehensive evaluations 74% of teachers were even aware of their students’ hearing
for students with reduced hearing is the Michigan Educa- status (Blair, EuDaly, & Von Almen, 1993). Additionally,
tional Impact for Students Who Are Deaf or Hard of Hearing fewer than half of the teachers believed that they understood
(2018). This matrix was designed for use with school-age the information contained in the report or the form letter.
deaf or hard of hearing students to summarize assessment Although this survey was completed a number of years ago,
results completed with students in a profile format. Based on it reminds us that ensuring that teachers and others working
the results of formal and informal assessments, the student with the child receive and understand the results of assess-
is rated for each of the following areas: ments can be a challenge for educational audiologists. With-
■■ audiological factors, out clear and appropriate communication, the child may not
■■ language and vocabulary, be served optimally.

Assessment 131
Audiograms Reports sent to parents and teachers should also be free

from professional jargon. Traditional terms describing the
Educational and clinical audiologists record the results of
hearing level, such as “moderate hearing loss,” are mislead-
their basic audiometric assessment on an audiogram that
ing and should not be used. A recent comment from a parent
typically is sent to parents, teachers, physicians, and other
dramatically illustrates this point, “A moderate hearing loss
professionals. Some professionals are familiar with the au-
didn’t seem like a big deal to me. I compared it to moderate
diogram format and can use the information it provides, but
exercise.” Rather, it is important to discuss the audiology test
audiograms do not communicate useful information to most
results using the concepts of audibility (the amount of useful
readers. To overcome this limitation, some audiologists use
acoustic information that is accessible to the student in typi-
conventional audiograms modified to provide space for a
cal conversation, i.e., Speech Intelligibility Index or SII) and
brief interpretation of the test results and brief recommen-
speech intelligibility (how well a listener uses the accessible
dations (see Appendix 5–C). Some of the audiograms de-
information). Audibility and speech intelligibility are two
scribed earlier in this chapter may be more “teacher/parent
important concepts that parents and teachers need to under-
friendly” by including the “speech banana” (Watkins, 2004),
stand. When using terms like “conductive hearing loss” or
pictures of familiar sounds (Appendix 5–B, Northern &
“unilateral hearing loss,” include descriptions of what the
Downs, 2002), the “speech string bean” (Madell, 2016),
terms mean. If it is necessary to send information to physi-
percentages of normal conversational speech heard (Appen
cians or other professionals using more technical language,
dix 5–E, Anderson & Arnoldi, 2011), and Count-the-Dots
it may be appropriate to write a second or revised report for
(Appendix 5–C, Keen, 2014; Killion & Mueller, 2010). Re-
those persons. However, these individuals may also benefit
gardless of the audiogram used, we should be sure that those
from interpretations and recommendations stated in less tech
who receive copies understand the information included, as
nical terms.
well as what should be done to support the child.
Teacher Letters
Written Reports
Form letters sent to teachers are another common way edu-
Written reports are one of the most common methods we cational audiologists may communicate with team mem-
use to communicate the results of our assessments. These re- bers and school personnel (Appendix 5–M). Form letters
ports are effective only if they are understood by the person are individualized by highlighting recommendations that are
who receives the report and only if the person can remember particularly important for each student or by leaving blank
the recommendations that were made for the student. Stach spaces to add handwritten notes about the student who has
(2008) identified four underlying strategies that should been evaluated. Another idea that can be helpful to teach-
guide our reporting: (a) separating documentation from re- ers is to provide “Helpful Hearing Hints” for the student
Chapter 5
porting, (b) simplifying and standardizing the language used on a brightly colored 5 × 8 card. These hints should be lim-
for effective communication, (c) getting the order right, and ited to only three or four items that are most important for
(d) emphasizing important outcomes and recommendations the student involved. Teachers can keep the cards on their
while remaining silent on those that are not. Blair (2002) re- desks where they are a daily reminder of strategies that can
ported that classroom teachers who were surveyed stressed be implemented to help students with reduced hearing in a
that reports should use lay terms rather than technical jar- classroom setting. A sample card is illustrated in Figure 5–3
gon, be short and concise, and provide practical suggestions and Appendix 13–C.
that are personalized to the student. A letter from the student written directly to his or her
Reports to parents and teachers typically include a short teacher is an extremely powerful tool for conveying the ac-
paragraph describing pertinent background information and commodations needed (see Appendix 10–C for an example).
the reason for referral, a brief description of the tests com- This method of communication with the teacher not only dem
pleted and the results, a summary of the implications of the onstrates that students are responsible for identifying and ad-
results for communication and learning, and recommenda- vocating for their own accommodations but also establishes
tions for any necessary referrals as well as management of direct communication between the students and the teachers.
the student and his or her hearing status. Recommendations
should be specific and should be limited to no more than three
or four items. Because it is often difficult to prioritize and
limit the recommendations, it may be helpful to subdivide
Letters to Physicians or
them to focus teachers, parents, educational team members, Other Professionals
and other professionals on the one(s) they should consider Educational audiologists may also need to communicate the
first. For example, the recommendations could include the results of the evaluation to the student’s physicians or other
subheadings of “Audiologic Recommendations,” “Medical professionals. Although the audiogram and evaluation report
Recommendations,” and “Educational Recommendations.” may be appropriate for these professionals, writing, faxing, or

132 Chapter 5
HELPFUL HEARING HINTS
For______________________
• needs to be seated near the front of the classroom and away from noise
sources, such as heating and air conditioning units, hallway doors and noisy students. A seat
at one side of the classroom may be helpful for ease of following classroom discussions.
• Check for understanding by asking specific questions about the material (e.g., "What did
I say?" or "What page will you start on?") rather than asking if heard you.
________________may not always recognize if he has heard and understood correctly.
• The following additional suggestions will be helpful:
—Wait until your class is quiet before speaking.
—Maintain visual attention when speaking.
—Write important information on the smartboard so _______ can see it.
FIGURE 5–3 Helpful hearing hints.

Chapter 5
emailing a separate letter to address specific concerns and to and parents often benefit from having information related
collaborate on strategies to address the educational needs of to their child’s hearing repeated. Conferences are time con-
the student are also helpful. These letters are often short and suming and sometimes difficult to arrange, but they are im-
provide only the specific information needed by the profes- portant. They allow the educational audiologist to review
sional involved (see Appendix 9–A, for example). Attempting information directly with those involved with the student
to view our communication from the perspective of the reader so questions can be answered and recommendations can
can lead to altering the amount and sequence of information be adapted to the student’s specific environment and needs.
provided, but the key remains to use consistent terminology, Face-to-face conferences also have the advantage of provid-
keep written letters and reports clear and concise, and keep ing the educational audiologist with additional information
compliant with parental permission and confidentiality reg- to facilitate management of the student as well as providing
ulations. See Chapter 15 for additional information concern- opportunities for developing positive collaborative relation-
ing collaboration with community professionals. ships that ultimately benefit the student.
When providing information to parents, teachers, and
other team members, we should take the time to ensure that
Telephone or Personal Conferences information presented is understood. Techniques to enhance
Another way to provide information to those involved with understanding include the following:
the student is through either a telephone call or personal
contact. When parents are present for the student’s evalua- ■ Asking parents and teachers about how they perceive
tion, the educational audiologist explains the results to them, the child’s hearing before explaining the test results.
but conferences with teachers may occur less frequently, This allows the educational audiologist to use the par-

Assessment 133
ents’ and teachers’ terminology and to focus on their legal requirements. It is wise to remember that electronic
perceptions when explaining the audiometric results. communication is easily retrieved, and procedures must be
■■ Writing out the recommendations in simple language in place to preserve student and family privacy (see section
after the oral explanation. Parents and teachers can that follows).
read over the recommendations to be sure they under-
stand them and then sign them. Give each participant a
copy and maintain a copy in the student’s file to serve Documentation
as documentation (see following section) as well as a Clear and accurate documentation is a fundamental neces-
future reminder of recommendations made for specific sity in educational audiology programs. Documentation
concerns. serves as the record of assessment procedures, results,
■■ Asking the parent or teacher to tell the audiologist what recommendations, and follow-up activities, and it must be
he or she plans to tell another person (e.g., spouse, maintained in the student’s file (electronic or paper) after
school staff ) about the audiometric results and recom- contacts with children or youth and their caregivers. Notes
mendations. Allowing them to retell the information should be legible, dated, and signed, and copies of all writ-
reinforces it for them and ensures that they have under- ten reports, phone calls, and correspondence should be in-
stood the key points. cluded for each student assessed. If a school or educational
agency is billing third parties for assessments, there may be
Although it is important that parents and teachers understand
additional requirements for specific types of documents. In
the student’s hearing, it is also important to focus on the
every case, documentation is crucial for efficient follow-up
questions and concerns they have about the student. Provid-
care as well as for legal reasons.
ing information that is immediately useful to the parents and
teachers will help them be more open to other suggestions.
It is also helpful for the educational audiologist to meet
with parents and teachers at times that are convenient for
Privacy Issues
them. Although this may be difficult for the educational au- School systems, including educational audiologists who are
diologist, parents and teachers generally are grateful for this educational system or agency employees, are covered under
consideration, and they are likely to be more open to infor- the Family Educational Rights and Privacy Act (FERPA; see
mation and suggestions offered during the meeting. Appendix 1–C), and we have always assumed that patient
Conferences with parents and teachers should be col- privacy is paramount to ethical practice. Congress enacted
laborative whenever possible. To facilitate this process, all the Health Insurance Portability and Accountability Act
team members and the parents should be treated as equal (HIPAA) of 1996 to, among other things, improve the ef-
members of the student’s educational team. If the educa- ficiency and effectiveness of the health care system through
tional audiologist is perceived as the outside “hearing ex- the establishment of national standards and requirements
Chapter 5
pert,” he or she may need to work on the team relationship. for electronic health care transactions and to protect the
The educational audiologist should be open to suggestions privacy and security of individually identifiable health in-
from others and willing to share in the decision-making formation. New questions and concerns have been raised
process. When interactions are collaborative, parents and about the application of HIPAA to electronic transmission
teachers feel they are an integral part of the student’s total of health records within school districts, and educational au-
program and will be more supportive of suggestions to en- diologists who participate in telepractice also may be sub-
hance recommended accommodations and support services. ject to additional requirements for privacy protection under
See Chapter 13, Supporting the Educational Team, for more HIPAA. These issues are continuing to be discussed, and
suggestions on collaboration with school personnel. readers are referred to the document Joint Guidance on the
Application of the Family Educational Rights and Privacy
Act (FERPA) and the Health Insurance Portability and Ac-
E-mail, Texting, and Web-Based countability Act of 1996 (HIPAA) To Student Health Records
(https://www2.ed.gov/policy/gen/guid/fpco/doc/ferpa-hipaa
Communication -guidance.pdf) for current information on the status of these
Electronic report forms and Web-based communication sys- regulations.
tems are increasingly used within educational and medical
systems. Whenever this is the case, educational audiologists
must be aware of the privacy regulations and procedures
required within the school district(s) served. It is strongly PERSONAL VULNERABILITY
recommended that when electronic communication is being AND SAFETY
considered for transmission of student assessment informa-
tion, the educational audiologist should consult with the dis- As audiologists, by virtue of our solitary work in a sound-
trict’s legal counsel to ensure that procedures meet current proof room, we are at risk for potential abuse allegations as

134 Chapter 5
well as potential recipients of sexual assault. In addition, health and safety is sometimes not a choice, but still
we touch children through our work with their ears in ways needs to be allowed by your parents or other adults
that are acceptable for us as professionals but may not be in charge and should never have to be a secret from
perceived as appropriate when used by others. To avoid any anyone.
type of potential problems, Kidpower Teenpower Fullpower 2. Tell parents what you will need to do with their chil-
International5 offers a set of tips adapted from The Kidpower dren and encourage them to talk about this with them,
Book for Caring Adults and Kidpower Comprehensive Pro- so that it is clear to their children that what you are
gram Training Manual by van der Zande (2010). Kidpow- doing has been approved by their parents and is not a
er’s tips for personal safety for audiologists and other adults secret so everyone can know about it. Encourage par-
who are in isolated situations with individuals who might ents to acknowledge any complaints without getting
pose a risk to them are identified in the box that follows. upset. For example, parents can say, “I’m sorry you
Additional Kidpower tips are for audiologists and other don’t like this and I’m glad you are telling me. I wish
health care professionals for teaching children about safety we didn’t have to do these tests, but touch for health is
with touch even though they need to touch them in intrusive not a choice.”
ways. Even when children are nonverbal, communicating 3. Tell each child directly, “The reason it is okay for me to
these messages will show in your attitude. Tips include the touch you this way is because I need to for your health
following: and safety. You can tell everyone about what we are
doing here.” If a child objects, use this as a teaching
1. You can use the touching you need to do with children moment. For example, you could explain, “Thank you
as an opportunity to educate them and their parents for telling me you don’t like this. It’s important to speak
about safety with touch. The Kidpower safety rules up when anything makes you uncomfortable. But this
about touch are that touch and games for play or affec- test is for your health and it is not a choice. You can
tion should be the choice of each person, safe, allowed tell everyone that we had to do this, even though you
by the adult in charge, and never a secret. Touch for didn’t like it!”
1. Make a safety plan with your colleagues so that you have agitated or is behaving in a way that makes you uncom-
a way to get help if you need it. This might be a code fortable, act on your feelings instead of trying to talk
word that you say into an intercom, or a panic button. yourself out of having them. Ask for a co-worker to check
Chapter 5
Remember a shout for help may not be heard through in on you after a few minutes or to join you.
the soundproof walls. Have everyone agree on how safety 4. Mentally prepare yourself to take action when some-
problems will be handled. For example, have one person one starts to act in a way that might become dan-
come into the room with you to distract the person and gerous. You might just leave. For example, you can
another call 9-1-1 if the situation has become dangerous. make an excuse for leaving abruptly, such as, “I’ll be
Rehearse how you will work together as a team to man- right back! I just want to get something for you.” Or,
age different safety problems. “I’ll be happy to help you as soon as you sit down!” Or,
2. Arrange the room so you can easily leave if you need to. “You are right! I’m so sorry!” Or, “STOP! We all want to
Put your chair next to the door, so that the child/youth or BE SAFE!”
other person is not in between you and the door. 5. Remember to put safety first.Your safety is more impor-
3. When you are with someone, use your awareness and tant than ANYONE’s embarrassment, inconvenience, or
pay attention to your intuition. If the child/youth seems offense.
5
Kidpower Teenpower Fullpower International is a nonprofit organization dedicated to helping people of all ages and abilities learn how to protect their
emotional and physical safety and how to build their confidence. The website https://www.kidpower.org offers extensive resources about how to prevent
most child abuse, bullying, and other personal safety problems.

Assessment 135
SUMMARY Johnson, T., & Brown, C. (2005). Threshold prediction using the
auditory steady-state response and the tone burst auditory brain
Assessment is a critical part of the educational audiologist’s stem response: A within-subject comparison. Ear and Hearing,
role. It is important not only for documenting and monitor- 26(6), 559–576.
Laurent Clerc National Deaf Education Center. (2015). Info to Go,
ing hearing levels and performance but also for determining
Multicultural Considerations. Retrieved from https://www3
the implications of reduced hearing and the effects of various .gallaudet.edu/clerc-center/info-to-go/multicultural-consider
management strategies within the educational environment. ations.html
Our assessments must never rely on electrophysiological Madell, J. (2016). The speech string bean. Volta Voices, 23(1),
measures to the exclusion of behavioral testing. We must 29–31.
go beyond traditional audiological evaluations and seek to Madell, J., & Flexer, C. (2018). Maximize children’s school out-
integrate functional listening performance with the results comes: The audiologist’s responsibility. Audiology Today,
of other professionals to provide information that will be 30(1), 18–26.
applicable and beneficial in the classroom. Finally, for the Madell, J., & Flexer, C. (2008). Pediatric audiology: Diagnosis,
results of the assessment to be useful, we must be able to technology and management. New York, NY: Thieme.
communicate effectively with parents, teachers, educational Michigan Department of Education, Low Incidence Outreach.
(2018). Educational Impact Matrix for Students who are Deaf
team members, and other professionals.
or Hard of Hearing. Retrieved from https://mdelio.org/sites/de
fault/files/documents/DHH/ServiceDeliveryTools/ImpactMa
trix/Impact_Matrix_For_Students_who_are_Deaf_or_Hard
SUGGESTED READINGS _of_hearing_V2.7.2.pdf
National Association of State Directors of Special Education, Inc.
AND RESOURCES (NASDSE). (2018). Optimizing outcomes for students who are
American Academy of Audiology. (August 2012, revised October deaf of hard of hearing: Educational service guidelines (3rd ed.).
2019, under review). AAA practice guidelines: Assessment of Alexandria, VA: Author.
hearing in infants and young children. Retrieved from https:// Northern, J., & Downs, M. (2014). Behavioral hearing testing.
www.audiology.org Hearing in children, 6th ed. San Diego, CA: Plural Publishing.
Bess, F., & Gravel, J. (2006). Foundations of pediatric audiology. Schafer, E. (2010). Speech perception in noise measures for chil-
San Diego, CA: Plural Publishing. dren: A critical review and case studies. Journal of Educational
Carroll, B. (2019). Autism spectrum disorder and hearing loss: A Audiology, 16, 37–48.
new frontier of clinical care. Audiology Today, 31(1), 23–29. Simmons, J., & McCreery, R. (2007). Auditory neuropathy/dys-
Dhar, S., & Hall, James W., III. (2018). Otoacoustic emissions: synchrony: Trends in assessment and treatment. The ASHA
Principles, procedures, and protocols (2nd ed.). San Diego, Leader, June 19.
CA: Plural Publishing. Stapells, C. (2000). Threshold estimation by the tone-evoked ABR:
Fitzpatrick, E., Whittingham, J., & Durieux-Smith, A. (2014). A literature meta-analysis. Journal of Speech-Language Pathol-
Chapter 5
Mild bilateral and unilateral hearing loss in childhood: A ogy and Audiology, 24, 74–83.
20-year view of hearing characteristics, and audiologic prac- Steuve, M., & O’Rourke, C. (2003). Estimation of hearing loss in
tices before and after newborn hearing screening. Ear and children: Comparison of auditory-steady-state response, audi-
Hearing, 35(1), 10-8. tory brainstem response, and behavioral test methods. American
Guidelines Development Conference. (2008). Guidelines for iden- Journal of Audiology, 12, 125–136.
tification and management of infants and young children with Tharpe, A. M. (2004). Who has time for functional auditory assess-
auditory neuropathy spectrum disorder (ANSD). Colorado ments? We all do! Volta Voices, 11(7), 10–12.
Children’s Hospital. Retreived from http://www.coloradochil Tharpe, A., & Seewald, R. (2017). Comprehensive handbook of pe-
drens.org diatric audiology (2nd ed.). San Diego, CA: Plural Publishing.

APPENDIX 5–A
Audiology Case History
Date: ______________________
General History
Student’s Name: Date of Birth: Age:
Person completing form: Relationship to student:
Mother’s Name: Father’s Name:
Home Address: Phone:
City: State: Zip code: E-mail:
Educational Information
Grade: School: Teacher or school contact:
Classroom type: traditional portable open pod
School performance: Above average Average Below average
Repeated a grade?  Yes  No If so, which grade(s)? Frequent school absences?  Yes  No
Please list specific areas of academic difficulty if any:
Please list any other learning concerns?

Chapter 5
Does your son/daughter receive any special education services? If yes, what services?

Does your son/daughter have any speech-language problems? _____ If yes, please explain:
Developmental/Medical/Family History
Please indicate if your son/daughter has experienced any of the following:
____ Premature birth ____ Currently takes medication

____ Problems before, during, or after birth ____ Known hearing problems
____ Hyperbilirubinemia/jaundice ____ Speech-language difficulties
____ Bacterial meningitis ____ Sensory integration issues
____ Congenital or perinatal infections ____ Autism spectrum disorder
____ Asphyxia/lack of oxygen at birth ____ Attention deficit hyperactivity disorder
____ Mechanical ventilation ____ Syndromal abnormality
____ Head or neck abnormalities ____ Serious illness or accidents
136

Assessment 137
____ Fetal alcohol syndrome ____ Ear problems (including: infections, eardrum
____ Delays in development perforations, wax, drainage, ear pain)
____ Fever over 104 degrees ____ Ear surgeries (i.e., tubes, etc.)
If your child has experienced any of the above, please explain (include specific treatment and medications):

If anyone in your family has trouble hearing, please list their relationship to your child:
________________________________________________________________
Behaviors and Characteristics

Please indicate if your son/daughter exhibits any of the following:
____ Sensitive to loud sounds ____ Disruptive or rowdy
____ Appears to be confused in noisy places ____ Temper tantrums
____ Easily upset by new situations ____ Shy
____ Difficulty following directions ____ Anxious
____ Restless/problems sitting still ____ Lacks self confidence
____ Short attention span ____ Lacks motivation
____ Impulsive ____ Uncooperative
____ Easily distracted ____ Disobedient
____ Daydreams ____ Inappropriate social behavior
____ Forgetful ____ Easily frustrated
Chapter 5
____ Asks for repetition ____ Tires easily
____ Reverses words, numbers, or letters ____ Difficulty understanding the meaning of words
____ Prefers to play alone ____ Difficulty learning new concepts
____ Seeks attention ____ Difficulty with reading
____ Difficulty expressing idea
Is there any additional information that is important for the audiologist to know?

APPENDIX 5–B
Familiar Sounds Audiogram
PITCH (CYCLES PER SECOND)

125 250 500 1000 2000 4000 8000
10
f s th
20
z v p
j mdb h
30 g k
n
ng
HEARING LOSS (DECIBELS)
ch
40 e l i sh
u o a
r
50
60
70
80
90
100
Chapter 5
110
120
Figure 5B–1 From Hearing in Children, Sixth Edition (p. 13) by Jerry L. Northern, PhD. Copyright © 2014 Plural Publishing, Inc. All rights
reserved.
138

APPENDIX 5–C
Sample Audiogram
School District/Co-op/Agency Name Insert your

EDUCATIONAL AUDIOLOGY SERVICES• logo here
Address
Phone/FAX/web/email
AUDIOLOGIC ASSESSMENT
(Page 1)
NAME:__________________________________ SCHOOL:______________________________ DATE:_____________
DATE OF BIRTH:_____________ GRADE:_____ ID#:_________ SEX: M / F AUDIOLOGIST: __________________
Right
Left
KEY
HISTORY
Air X
Reason for referral_________________________________________________________________________
Air Masked n h
❑ No significant health history reported ❑ Birth history ❑ Newborn hearing screening: Pass__ Refer __ Bone < >
❑ Family history of hearing loss ❑ Ear infections ❑ Speech/language concerns ❑ Noise exposure Bone Masked [ ]
❑ Previous testing _______________________ ❑ Other________________________________________ No Response
Unaided
S(F)
Sound Field
RIGHT EAR LEFT EAR FM System FM
Low Pitch FREQUENCY IN HERTZ High Pitch Low Pitch FREQUENCY IN HERTZ High Pitch Narrow Band N(B)
250 500 1000 2000 4000 8000 250 500 1000 2000 4000 8000 Warble Tone W
Soft Did Not Test DNT
0 0 Within Normal
WNL
Limits
10 10
Speech Reception
Normal SRT
20 20 Threshold
Speech Awareness
SAT
Hearing Level in dB HL
30 30
Threshold
(re: ANSI 2004)
40 40 Pure Tone Average PTA

High Frequency
Chapter 5
50 50 HF-PTA
Average (2,4,6K)
60 60 Test Technique:
❑ COR (Conditioned Response)
70 70 ❑ CPA (Play Audiometry)
❑ Traditional
80 80
❑ Sound Field
90 90 ❑ Headphones
❑ Insert Earphones
100 100 Test Reliability:
Very
❑ Good ❑ Average ❑ Poor
120 Loud 120
Audible Dots:______% Audible Dots:______% Audiometer:
[Killion & Mueller (2010). SII Count-the-Dots audiogram for estimating the articulation index. HJ 63(1)] ________________________
IMMITTANCE Right Left (dBHL) SRT SAT PTA HF-PTA WORD RECOGNITION [Live Voice/Recorded]
Tympanogram Type Right Ear % dBHL LV Rec
Ear Canal Volume (cm3) Left Ear % dBHL LV Rec
Compliance (cm3) Sound Field % dBHL LV Rec
Pressure (daPa) Aided SF % dBHL LV Rec
OTOACOUSTIC HEARING INSTRUMENTS SPEECH PERCEPTION [Live Voice/Recorded]

EMISSIONS (OAEs): Real Ear Simulated Real Ear Listening Check 2cc Ear/Condition Score List
Type:______________ Ear(s) Aided: Right Left % dBHL LV Rec
Hearing Aid(s): % dBHL LV Rec
Not Tested
Serial Number(s): % dBHL LV Rec
Present R / L FM System: % dBHL LV Rec
Absent R / L Comments: % dBHL LV Rec
Comments: _________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________
IMPORTANT: Please see attached Audiologic Assessment Page 2 for interpretation and recommendations.
139

140 Chapter 5
Assessment
School District/Co-op/Agency Name Insert your

EDUCATIONAL AUDIOLOGY logo here
Phone/FAX/web/email
AUDIOLOGIC ASSESSMENT
(Page 2)
NAME:_________________________________SCHOOL:_________________________DATE OF ASSESSMENT:_____________
ASSESSMENT RESULTS (non-amplified) IMMITTANCE RESULTS SPEECH PERCEPTION

Right Left SF* Degree of Hearing Loss Right Left
Comments:
❑ ❑ ❑ Normal ❑ ❑ Essentially normal middle
❑ ❑ ❑ Borderline ear function. _____________________________
❑ ❑ ❑ Mild ❑ ❑ Possible middle ear problem. _____________________________
❑ ❑ ❑ Moderate h Type B tympanogram(s) consistent
_____________________________
❑ ❑ ❑ Severe with non-mobile eardrums(flat)
_____________________________
❑ ❑ ❑ Profound HEARING INSTRUMENTS
Right Left Type of Hearing Loss Right Left _____________________________
❑ ❑ Conductive ❑ ❑ Hearing aid(s) is functioning
_____________________________
appropriately and providing
❑ ❑ Sensorineural
benefit to meet amplification _____________________________
❑ ❑ Mixed goals.
❑ ❑ Auditory Neuropathy/Dys-synchrony ❑ ❑ Hearing aid is not functioning
_____________________________
* Sound Field: a difference between ears cannot be ruled out. appropriately and / or not _____________________________
Hearing Loss is: providing adequate benefit.
Hearing Assistance Technology (HAT):
_____________________________
❑ Unilateral (one ear) __Right __Left
Functioning as intended and meeting goals _____________________________
❑ Bilateral (both ears)
for HAT? Yes ❑ No ❑ Comments:_____
❑ High Frequency _______________________________
_____________________________
EDUCATIONAL IMPLICATIONS
❑ Hearing is adequate for educational purposes (e.g., communication and learning) at this time; no accommodations needed.
❑ Hearing loss may impact communication skills as well as access and participation in daily life functions; some accommodations may be
needed (see recommendations).
Chapter 5
❑ Hearing loss is educationally significant and impacts communication and learning; accommodations needed (see recs below).
❑ Fluctuating hearing loss from recurrent middle ear problems may impact listening and learning; accommodations may be needed.
❑ Hearing ability has not significantly changed since previous testing dated_____________________________.
RECOMMENDATIONS (Please refer to marked items only)

❑ There are no further recommendations at this time. ❑ This student will benefit from special, flexible seating in all academic
❑ Today’s test results suggest that the parent/guardian should arrange settings.
an appointment with physician / ear specialist / private audiologist. ❑ This student’s educational programming (IEP) should reflect
Comment:________________________________________ appropriate accommodations and modifications for his/her hearing
_________________________________________________ loss, and should be based on the student’s identified communication
❑ A follow-up audiologic assessment should take place following and other needs as determined by the IEP team. This student may
medical evaluation and treatment. Please call ______________to require support services and/or assistive technologies to enhance
schedule this appointment. access to auditory information in the classroom.
❑ An annual audiologic assessment needs to be administered by the ❑ This student will benefit from continued use of personal hearing
Educational Audiologist in order to monitor this student’s hearing. instruments provided by the parent/guardian.
❑ Due to this educationally significant hearing loss, it is recommended ❑ This student will benefit from continued use of hearing assistance
that an Auditory Skills Assessment and/or additional follow-up at technology provided by the school district to improve access to
this student’s school be completed by the Educational Audiologist, auditory information in the educational setting.
with further recommendations to follow. ❑ Test results today suggest that this student should avoid exposure
❑ To maximize benefit for this student, it is recommended that to high noise levels (i.e. loud music, machinery) or wear ear
communication between home, school, medical and private service protection to protect ears from further hearing loss.
providers be maintained. ❑ Other recommendation(s):________________________________
❑ Please see attached handout(s) for further accommodations and ___________________________________________________________
modifications which may be of benefit for this student based on ___________________________________________________________
today’s test results. ___________________________________________________________
If there are questions regarding this report, or if I can be of further service on behalf of this student, please do not hesitate to contact me.
__________________________________
Educational Audiologist
Source: Adapted from Audiology Assessment, Educational Audiology Services, Denver Public Schools

Assessment 141
The New Count-the-Dot Audiogram1

by Killion & Mueller: the Hearing Journal January 2010 vol 63 No 1 page 10.
Name Date of birth
School Grade
Completed By AI of ____ dots = ____%
Sound Frequencies in Hz
125Hz 250Hz 500Hz 1kHz 2kHz 4kHz 8kHz
-10
10
20
30
40
Hearing Level in dBHL
50
60
70
80
This is the Speech Intelligibility Index (SII) based method of calculating the Articulation Index (AI). There are 100
dots indicating the importance of different frequencies and intensities for the perception of speech. Instead of
Chapter 5
the technically correct ‘audible speech cues weighted by the importance function at each frequency’, the
authors recommend calling them ‘audible dots’. This supersedes the first black and white (and grey) count-the-
dot PTA from 1990 and has more dots above 4kHz now, acknowledging findings of more recent research. There
is no copyright on this format (by original authors or Peter Keen) so that people can use it!
How to use it: Put the thresholds for both ears onto the Audiogram as normal. Count the dots below the
(straight) lines joining the O and X symbols (use the better ear for each frequency). For Aided thresholds, add
these to the audiogram using the A symbol, then count the audible dots. All thresholds must be in dBHL, so
Aided results using a sound level meter must be converted – see chart below. The total ‘audible dots’ represent
the percentage Articulation Index, so 65 audible dots = an AI of 65%. For children who are still developing their
phonology and acquiring speech and language, Peter Keen recommends:
Good: AI of 90% to 100%
Satisfactory: AI of 70% to 89%
Concern: AI of 69% or less
Conversion chart: dBA (Sound Field, sound level meter reading) to dBHL. System developed by Dr Mike Nolan
Frequency 250Hz 500Hz 1kHz 2kHz 3kHz 4kHz 6kHz 8kHz
-17 -8 -10 -10 -11 -10 -15 -12
e.g. at 500Hz: 55dBA - 8dB converts to 47dBHL
1Form devised (Jun 2014) by Peter Keen, Consultant Educational Audiologist, Keenhearing:
peter.keenhearing@btinternce.com. Adapted with author permission.

APPENDIX 5–D
Word Recognition in Quiet and Noise for
Normally Developing Children
BODKIN, K., MADELL, J., & ROSENFELD, R.

AMERICAN ACADEMY OF AUDIOLOGY CONVENTION,
1999, MIAMI, FLORIDA—POSTER SESSION
Summary:
■■ Subjects: 126 “normal” children (i.e., hearing, ME function, development), ages 3 to 17 years
■■ Purpose: to obtain age-appropriate normative data in a variety of listening situations and to evaluate a practical means
of speech-in-noise (SIN) testing suitable for routine clinical evaluations, not just research studies
■■ Method: testing conducted at normal and soft conversational levels in quiet and at two competing noise levels using
age-appropriate word recognition tests; competing signal was four-talker speech babble
■■ Stimuli:
CA 3–4: NU-CHIPS (open set)
CA 5–6: PBKs
CA 7+: W-22s
■■ Findings: word recognition scores did not decrease significantly as the listening task became more difficult, regardless
of age
■■ Benefit: procedure may be a useful diagnostic tool to differentiate between children with normal and abnormal auditory
function
Chapter 5
Note. CI, confidence interval; SD, standard deviation. From Bodkin, K., Madell, J., & Rosenfeld, R. (1999). Reprinted with permission.
142

APPENDIX 5–E
SPEECH AUDIBILITY AUDIOGRAM
FOR CLASSROOM LISTENING
Permission is granted to individuals who have purchased this form to reproduce or electronically share it only to serve their specific students. Sharing this content in any manner not related to a specific student’ s education is prohibited.
Student Grade School Date

Loudness 250 500 1000 2000 4000 8000 Hz
in dB HL
Soft speech Teacher voice
(35 dB HL) (50 dB HL)
Typical hearing children: 93-98% word Typical hearing children: 92-100% word
recognition in quiet 86-94% at 35 dB HL in recognition at 50 dB HL in quiet, 90-97% in
0 0 S/N noise.1 +5 S/N, and 89-96% in 0 S/N noise.1
95% audibility of speech energy perceived with 0-20 dB HL should perceive 98% of speech sounds
hearing levels between 0 – 10 dB HL at a comfortable level in a quiet classroom and
10 64% at +10 S/N, 34% at 0 S/N2 acceptable reverberation levels (35 dBA or less
background noise in an unoccupied classroom &
75% audibility of speech energy perceived with reverberation no greater than 0.9 sec3)
hearing levels between 10 – 15 dB HL
15 84% at +10 S/N, 48% at 0 S/N
44% at +10 S/N, 24% at 0 S/N
60% audibility of speech energy perceived with
hearing levels between 15 – 20 dB HL
20
29% at +10 S/N, 9% at 0 S/N
40% audibility of speech energy perceived with 95% audibility of speech energy perceived with
hearing levels between 20 – 25 dB HL hearing levels between 20 – 25 dB HL
25
9% at +10 S/N, 0% at 0 S/N 81% at +10 S/N, 55% at 0 S/N
hearing levels between 25 – 30 dB HL hearing levels between 25-30 dB HL
30
0% in any setting that is not quiet 67% at +10 S/N, 41% at 0 S/N
hearing levels between 30 – 35 dB HL hearing levels between 30-35 dB HL
35
hearing levels between 35 – 40 dB HL hearing levels between 35 – 40 dB HL
40
Chapter 5
30% audibility of speech energy perceived with
Hearing with amplification
45 hearing levels between 40 - 45dB HL
Hearing without amplification
16% at +10 S/N, 0% at 0 S/N
S/N means the loudness of the speaker’s voice (i.e. teacher) over the background noise. 0 S/N = noise and voice are
the same loudness. FM negates the affects of background noise and distance and provides optimal access to verbal
instruction in large and small groups.
Loudness: dB
Results of Functional Listening Evaluation4: Type of speech materials used: Close = Feet
SPEECH PERCEPTION Close / Quiet Close / Noise Distant/Quiet Distant/Noise Distant = Feet
Auditory + Visual Quiet = S/N*
Noise = S/N*
Auditory Only *at child’s ear level
Audibility represents the listening challenge, or fragmented speech perception, experienced by listeners with hearing loss.
Audibility should not be interpreted as speech perception.
Recommended Hearing Technology/
AUDIBILITY Quiet +10 dB S/N 0 dB S/N Accommodations:
No noise Good classroom Very noisy
listening condition classroom listening
condition
Estimated Audibility
Soft Speech
Estimated Audibility
Teacher’s Speech
1. Bodkin, K, Madell, J., & Rosenfeld, R. (1999). Word recognition in quiet and noise for normally developing children, AAA Convention, Miami, Poster Session.
2. Nelson, P. Anderson, E., Nie, Y., Katare, B. (2010). Effect of reduced audibility on masking release for normal- and hard-of-hearing listeners, JASA 127, 1903
3. Yang, W., & Bradley, J. S. (2009). Effects of room acoustics on the intelligibility of speech in classrooms for young children. J. Acous. Soc. Am., 125(2), 922-933.
4. Revised 2004 by Johnson. Based on Functional Listening Evaluation by C.D. Johnson & P. Von Almen, 1993.
Karen L. Anderson, PhD, 2011 www.kandersonaudconsulting.com
© 2011 Karen Anderson and Kathy Arnoldi From Building Skills for Success in the Fast-Paced Classroom, page 132, Butte Publications.
Note. From Karen Anderson and Kathy Arnoldi. (2011). Building Skills for Success in the Fast-Paced Classroom. Retrieved from http://success
forkidswithhearingloss.com Reprinted with permission.
143

APPENDIX 5–F
Adaptations for Assessing Children/Youth Who
Are Blind/Visually Impaired
General Considerations Prior to Test Procedures

Testing ■■ Observe localization abilities for speech as well as
■■ Consider relationship of vision impairment to Usher warble tones; responses may be subtle such as eye-
syndrome as a possible etiology widening, quiets, ear pointing, or head tilt
■■ Review functional vision assessment (completed by a ■■ Pure-tone threshold audiometry
certified teacher of the visually impaired) Use tactile cues during training of conditioned play
■■ Review visual assessment for information about dis- response (e.g., pair the auditory stimulus with a tac-
tance and visual field abilities tile stimulus by having the child hold the bone con-
■■ If child has additional disabilities, check for specific duction oscillator [condition using a low frequency
likes/dislikes, reinforcers, and behavioral characteris- stimulus as it is easier to feel])
tics with the special education teacher When necessary, shape the child’s response through
physical guidance as part of the instructional process
(e.g., physically guide child’s hand to achieve the
desired response)
Test Preparation Use a tin bucket with objects that are easy to grasp
■■ Remove physical obstacles in test area and release (e.g., blocks, ping pong balls) to create a
■■ Determine appropriate adaptations based upon child’s noise when responding to sound
visual field, distance vision, color, and light abilities If the TROCA (tangible reinforcement operant con-
■■ If child is not familiar with your voice, introduce your- ditioning audiometry) method is necessary, orient
self by name the child to the reinforcers prior to testing
■■ Allow extra testing time to accommodate modifications Instruct child to point to his/her ear when the “birdie
that may have to be made in assessment procedures sound” is heard
If partially sighted: Demonstrate speech understanding through one of the
Chapter 5
■■ ■■
Obtain large clear pictures (nonglare and without following methods based on the child’s language and
visual clutter) cognitive ability:
Regulate the lighting (indirect light from the child’s Point to/touch body parts
back is best) Repeat spondee words (bisyllabic words with equal
Adjust VRA equipment according to the child’s light stress); when using spondees, think about words that
sensitivity and perception by darkening the sound are easily distinguishable for the child who is blind/
booth (inside and out) and pairing the auditory stim- visually impaired (e.g., pinwheel, popcorn, cupcake,
ulus with a bright red light (for some children bright hot dog, jump rope)
white light may be aversive) that is turned on from Repeat familiar words
outside the booth; condition the child to turn to the If pictures can be used for closed-set test mea-
light every time he or she hears the sound sures obtain ones that are high contrast, clear, and
Eliminate glare of tester window; if necessary, posi- noncluttered
tion child with back to the window using a mirror Play “find the toy”—put familiar objects in a basket
to track the child’s expressions and be cognizant of that the child can pick out when named; make sure
their visual field they have different textures and shapes and that the
■■ Provide the child detailed descriptions of the environ- child is familiar with them first
ment and what is happening at all times ■■ When conducting speech-in-noise testing, orient the
■■ Incorporate more tactile contact and reinforcements child to the task by explaining and describing back-
(rubbing back, patting arm, etc.) ground noise and the primary voice the child should
■■ Alert child verbally prior to touching or providing tac- listen to; acclimate the child by introducing the back-
tile orientation ground noise gradually as children who are blind/
144

Assessment 145
visually impaired may be hypersensitive to noise in ■■ Use electrophysiological tests (auditory brainstem re-
addition to being unfamiliar with the setting; sponse [ABR], otoacoustics emissions [OAEs]) to sup-
Use linguistically appropriate material at various in- plement behavioral measures
tensity levels (+30 dB SL to obtain maximum perfor-
mance; +10 dB SL for understanding quiet speech,
65 dB SPL for typical conversation level, and at a Follow-Up and Accommodations
speech-to-noise ratio of zero for adverse listening
■■ Refer to state deaf blind project if combined vision and
condition)
hearing loss are present
Output determination for speech and noise testing is
■■ Refer for medical care when necessary (e.g., frequent
based on the sound booth speaker arrangement: with
otitis media)
a two-speaker setup, speech and noise should be pre-
■■ Monitor hearing status with routine hearing screening
sented from the same speaker and located in front
■■ Emphasize the need for an acoustically appropriate
of the listener (0 azimuth); with multiple speakers,
learning environment and provide accommodations
speech should be presented from the front speaker
when necessary
(0 azimuth) and noise from speakers at the right and
■■ Consider hearing assistance technology on an individ-
left of the listener
ual basis depending on the functional abilities of the
■■ If the child’s behaviors to sound are difficult to inter-
child, the child’s learning environment, and the child’s
pret, include the teacher of the visually impaired in the
communication needs
test session to help with determination of responses;
parent may also be able to assist
■■ Conduct a functional auditory assessment to identify
how the child is using his/her hearing ability (required
for federal reporting of children who are deaf blind)
Chapter 5

APPENDIX 5–G
Common Functional Outcome Measures
for Listening Performance
Target
Instrument Population Description Goal/Purpose
Auditory Behavior in Ages 4–14 Parent/caregiver questionnaire consisting of 24 To assess parental perceptions of their
Everyday Life (ABEL), auditory behaviors that are organized into three children’s auditory behaviors.
Purdy et al. (2002) categories: aural-oral, auditory awareness, and
social/conversational skills.
Children’s Home Ages 3–12 Parents/caregivers judge 15 situational listening To assess perceptions of listening
Inventory for Listening behaviors using an 8-point scale on the behavior and subsequent
Difficulties (CHILD), “Understand-O-Meter.” An average score can communication needs; may be used
Anderson & Smaldino be computed to compare ratings of different to determine current ability, monitor
(2000) individuals, listening skill improvement over time, progress over time, or evaluate the
or amplification benefit. Children who are 7 to benefits of amplification devices or
8 years can be administered the inventory either other accommodations.
through interview or by reading the questions
themselves.
Children’s Auditory School age Respondents judge the amount of listening Initially designed as a screening tool
Performance Scale difficulty experienced by a child on 36 items to identify children who should be
(CHAPS), Smoski, organized in six conditions and skills (noise, quiet, referred for a (central) auditory
Brunt, & Tannahill ideal, with multiple inputs, auditory memory processing evaluation; also used to
(1998) sequencing, and auditory attention span) by assess perceptions of situational
comparison to other children in the same listening behavior; may be used to
situation and of similar age and background. determine current ability, compare
Average scores for each of the conditions as perceptions of various respondents
Chapter 5
well as a total score place the child in “normal” (parents, teachers), or determine the
or “at-risk” categories. Rating comparisons benefits of amplification devices or
from difference sources (e.g., parent, classroom other accommodations.
teacher, special education specialist) offer insight
into difficulties that may be environmental or
situational.
Classroom Participation School age A self-assessment of communication and To assess classroom communication
Questionnaire (CPQ), classroom participation skills using a 4-point access and participation abilities; useful
Antia, Sabers, & Stinson rating scale on a 28-item (long) or 16-item as a counseling tool to discuss solutions
(2007) (short) form. Items are asked randomly and to communication problems and to
then the interpretation is organized under four validate the effectiveness of various
headings: Understanding teacher, Understanding amplification and assistive technology
students, Positive Affect, and Negative Affect. options.
The self-assessment can be completed by most
students age 7 years or older and may be read
to nonreaders. The self-assessment serves as
a counseling tool to assist students in solving
classroom communication and participation
issues including use of amplification and hearing
assistive technology.
Children’s Outcome Ages 4–12 Checklist for child, parent, and teacher to identify To document change in hearing
Worksheets (COW), and rate pre- and postfitting performance performance with hearing instruments.
Williams (2004) observed in 16 everyday situations.
146

Assessment 147
Target
Developmental Index Infant A functional auditory milestones checklist To determine the child’s current
of Audition and through consisting of 14 skills arranged in a hierarchy level of function and to assist in the
Listening (DIAL), Palmer & age 22 according to the age group in which it is expected development of goals for future
Mormer (1999) to emerge (from infant to age 22 years). milestones; may also be useful to
guiding parental and child expectations.
Early Listening Function Infant to Parents/caregivers observe their child during To identify if a child is able to detect
(ELF), Anderson (2002) young child quiet, typical, and loud listening activities at various certain sounds from various distances
distances from 6 inches to 15+ feet/next room. in both quiet and noise; to increase
Child’s response is judged as yes, maybe, or no. parent involvement in analyzing
The audiologist or early interventionist scores their child’s listening behaviors, to
the results using a weighted formula comparing estimate amplification benefit; to
responses at less than or greater than 6 feet. track improvements in auditory
development over time.
Student/Pediatric Infant A brief validation tool for RM HAT use that To validate benefit of RM HAT use;
Amplification Listening through compares performance in five areas (responds may also be used to compare various
Evaluation, Johnson school age to name, attending to person speaking, types of RM HAT.
(in Gabbard, 2004) distinguishes between words that sound alike,
responds appropriately to spoken directions, and
comprehends oral instruction and concepts)
with and without RM HAT. Behavior is rated on
a 5-point scale. Each of the five areas includes
analysis in quiet, noise, distance, and auditory only
situations. Additional questions address ease of use
issues. There are two forms: one for infants and
young children and one for school-age children.
Functional Auditory Infant Auditory skills are assessed in seven areas To assess and monitor progress of
Performance Indicators through (awareness and meaning of sounds, auditory developing auditory skills within
(FAPI), Stredler-Brown & school age feedback and integration, localizing sound source, a comprehensive framework
Johnson (2004) auditory discrimination, auditory comprehension, incorporating basic to higher-level
short-term auditory memory, linguistic auditory linguistic skills; to identify goals for
Chapter 5
processing) in a variety of conditions (visual/ therapy and/or classroom instruction;
auditory versus auditory only, close versus the benefits of amplification may also
distance, quiet versus noise, prompted versus be validated based on several of the
spontaneous). Thirty-three skill areas are conditional responses.
assessed through direct observation and/or
parent report and judged by the respondent as
“not present,” “emerging,” or “acquired.” Using
weighted scoring, a profile of the child’s functional
auditory skills is generated. Though hierarchical in
structure, it is expected that children are working
on multiple skills from different categories in an
integrated intervention program.
Functional Listening Preschool Listening performance is assessed and compared To provide evidence of listening
Evaluation (FLE), through in eight conditions (close-quiet, close-noise, abilities under the typical conditions
Johnson (2009) school age close-auditory/visual, close-auditory only, encountered in a student’s customary
distance-quiet, distance-noise, distance-auditory- learning environment; to validate
visual, distance-auditory only) using word, phrase, the benefits of hearing assistance
or sentence material. The assessment occurs technology as directed by the
in the child’s classroom in order to reflect the functional evaluation requirements for
acoustical parameters of the child’s typical assistive technology under IDEA.
listening and learning environment. Conditions
may be repeated to compare or validate the
benefits of various amplification devices and
arrangements. Scoring is based on percentage
of correct responses or other analysis used
depending on the stimulus material employed.
(Continues)

148 Chapter 5
Target
Ling Six-Sound Test, Young A simple, quick test to assess reception of six To assess a person’s ability to detect,
Ling (1976) children to speech sounds that cover the frequency range identify, or discriminate six speech
adult of basic speech production: ah, oo, ee, sh, s, m. sounds that cover the speech
Basic detection (is the sound present or absent), frequency spectrum; used to verify
identification (repeat the sound heard), and/or basic hearing aid, cochlear implant,
discrimination skills (are two sounds presented and FM function.
the same or different) can be assessed based
on the auditory skill level of the child and the
subsequent response requirements.
Listening Inventory School age A set of three questionnaires that assesses To provide evidence of benefit
for Education (L.I.F.E., efficacy of amplification use. The Student of amplification by students (self-
Revised), Anderson, Appraisal of Listening Difficulty contains 15 report) and teachers (observation);
Smaldino, & Spangler common classroom listening situations (five are also beneficial as a training tool for
(2011) optional) that the student rates on a 5-point implementing appropriate strategies
scale to compare pre- and postamplification and accommodations to enhance
use. For nonreaders, photos that describe the listening and communication in the
situations may be used to assess the situations. classroom.
The accompanying Teacher Appraisal of Listening
Difficulty contains 16 questions that assess
change in behavior or performance based on
the use of amplification. A total appraisal score
suggests the level of support for amplification
use. The Teacher Opinion and Observation List
contains four areas that allow teacher comments
on the effects of amplification intervention in the
classroom. Suggestions for improving classroom
listening are included that are helpful counseling
tools for both students and teachers.
LittlEARS Auditory 0–24 months Parent/caregiver questionnaire of 35 simple To provide information regarding
Questionnaire, Kuehn- “yes” or “no” questions regarding basic auditory hearing aid benefit, cochlear implant
Inacker, Weichboldt, behaviors. Examples are provided for each item. candidacy, and postimplant evaluation
Chapter 5
Tsiakpini, Coninx, & of auditory skill development.

D’Haese (2003)
Meaningful Auditory Preschool A parent report scale about how often a child To determine the status of basic
Integration Scale and school demonstrates various auditory and speech skills developing auditory skills in young
(MAIS), Robbins, age that is administered in a structured interview children who are profoundly deaf in
Renshaw, & Berry format. The10 skills are grouped into three everyday situations before and after
(1991) categories: vocalization, spontaneous alerting being fitted with hearing aids and/or
Infant Meaningful Infant– to sound, and deriving meaning from sound. A receiving a cochlear implant.
Auditory Integration Toddler scale of 0 to 4 rates the frequency of the target
Scale (IT-MAIS), behavior and is compared to an average.
Zimmerman-Phillips,
Robbins, & Osberger
(2000)
(Continues)

Assessment 149
Target
Parent’s Evaluation Parent/caregiver and teacher questionnaires To assess the effectiveness of

of Auditory/Oral for assessing the effectiveness of amplification. amplification for children based on
Performance of PEACH and TEACH utilize a structured a systematic use of parents’ and
Children (PEACH)- interview technique to avoid biased responses teachers’ observations, respectively.
Teacher’s Evaluation and strict criteria for scoring to increase reliability.
of Auditory/Oral Each questionnaire lists a number of probe areas,
Performance of then gives the specific question(s) that are to be
Children (TEACH), asked by the interviewer. For each probe area,
Ching & Hill (2007) additional questions that might be applicable
to behavior of young children are also given.
The interviewer records the parents’ answer in
its entirety and is instructed to ask for specific
examples of when and where the parents or
teacher has observed the behaviors and record
all examples. Scoring is based on the proportion
of time a child demonstrates a certain behavior,
or the number of examples that parents or
teachers provide regarding a child’s performance
in different situations.
Preschool Screening Preschool Teacher questionnaire rating 15 skills that are A screening tool to identify
Instrument for Targeting organized under the categories of Pre-academics, preschool-age children at risk for
Educational Risk Attention, Communication, Class Participation, developmental or educational
(PRE-school SIFTER), and Social Behavior. Ratings are determined in problems due to hearing loss who
Anderson & Matkin comparison to classroom peers. Using a 5-point need further investigation and
(1996) rating scale, the sum of scores for each category possibly referral to special education.
places the child in ranges of “pass” and “at-risk.”
Screening Instrument School age Teacher questionnaire rating 15 skills that are A screening tool to identify children
for Targeting organized under the categories of Academics, at risk for developmental or
Educational Risk Attention, Communication, Class Participation, educational problems due to hearing
(SIFTER), Anderson and Social Behavior. Ratings are determined in loss who need further investigation
(1989) comparison to classroom peers. Using a 5-point and possibly referral to special
Chapter 5
rating scale, the sum of scores for each category education.
places the child in ranges of “pass” and “marginal”
or “fail.”
Note. Adapted from L. Klop (2005) by Cheryl DeConde Johnson.

APPENDIX 5–H
The Functional Listening Evaluation
Purpose of the Functional Listening the size, ambient noise level, and floor and wall surfaces
of the student’s classroom. While performance during ac-
Evaluation (FLE)
tual class sessions would seem ideal, the test process itself
The purpose of the FLE is to determine how listening abili- may be disruptive to instruction for the rest of the class and
ties are affected by noise, distance, and visual access in a therefore may not reflect the true listening conditions en-
student’s everyday listening environment. The FLE can also countered by the student throughout the day.
be used as a validation tool to demonstrate the benefits of
hearing assistance technology. It is designed to simulate lis-
tening ability in situations that are representative of typical
classrooms and other settings that cannot readily be repli-
cated in sound booth assessment. Through observation of Physical Set-Up of Test Environment
the administration of the evaluation, the student’s teachers, Due to room size and instructional style variations, the occu-
parents, and others may gain appreciation of the effects of pied classroom should be observed to determine maximum
adverse listening conditions encountered by the student. listening distances. Record this as the “far” distance on the
When comparing performance without and with the addi- Summary and Interpretation Form. When setting up for the
tion of hearing assistance technology such as an FM sys- close conditions, measure the 3 foot distance from the stu-
tem, the evaluation results provide evidence of the benefits dent’s ear to the examiner’s mouth.
of the device in enhancing access to the desired input. The
format of the FLE may also be useful in justifying other ac- Close: Noise and examiner are 3 feet in front of the
commodations, such as sign language or oral interpreting, student (see Diagram A).
note-taking, captioning, special seating, and room acoustic Far: Noise remains 3 feet in front of the student; the
modifications. This protocol is based on a listening para- examiner moves back to the pre-determined
digm suggested by Ying (1990), and by Ross, Bracken, and distance (12 to 15 feet in this example) from
Maxon (1992). the student (see Diagram B).
Chapter 5
Materials Needed
■■ CD player, iPad, iPod, or laptop computer to play
noise source
■■ Sound Level Meter or SLM App - use A weighted
scale
■■ Classroom noise source (.wav sound file or CD;
classroom noise or multitalker is recommended)
Word/Phrase/Sentence Lists for test stimuli FIGURE 5H–1A Diagram A. Close.
■■ Tape measure
■■ Acoustic Hoop
Environment for Testing

The student’s classroom should be utilized during a time
when students are not present. If the student has multiple
classrooms choose the one where most speaking and listen-
ing instruction occurs or where there is concern regarding
communication access. If one of the student’s classrooms is
not available, choose a room that most closely approximates FIGURE 5H–1B Diagram B. Far.
150

Assessment 151
Types of Evaluation Materials Children) sentences that were based on the original Bamford-
Kowal-Bench (BKB) sentences (1979). Half of the sen-
In order to simulate classroom listening ability, the speech
tences are recorded in quiet and the other half with a +5 SNR
evaluation material utilized should be developmentally ap-
(signal-to-noise ratio) and follow the condition presentation
propriate and approximate material that is encountered by
order of the FLE. This version simplifies presentation of the
the student in the classroom. Additionally the stimuli should
FLE by eliminating the need for a noise file and adjusting
have sufficient length to reflect reverberation characteris-
noise and speech sound levels; however the SNR cannot be
tics of the room. Consideration should also be given to both
altered. Additional instructions are provided with the CD.
familiar and new material that a student may encounter. In-
dividuals will usually perform better with familiar material
than with stimuli containing unfamiliar vocabulary. Students
with unilateral and mild hearing losses tend to perform well Presentation Levels
under all conditions due to the audibility and inherent re- The conditions of close/far and auditory/auditory-visual are
dundancy in phrase and sentence material utilizing familiar presented in quiet (4 presentations) and then in noise (4 pre-
vocabulary. Nonsense phrases have been constructed to in- sentations) to achieve the eight conditions. Speech-to-noise
crease listening difficulty. ratio levels (SNR) should be based upon the auditory envi-
ronments encountered by the students in their classrooms.
Age, language competency, and memory abilities of the in- Sound level measurements of classroom discourse and ac-
dividual should also be considered when determining the tivity may be necessary to determine these levels. For this
test stimuli. In selecting word, phrase or sentence materials, example, the levels will achieve values resulting in a +5 dB
consider whether the vocabulary and syntax are appropri- speech advantage in the close conditions and a –5 dB speech-
ate for the student’s language level. For students with poor to-noise ratio in the far conditions (12 to 15ft). Levels will
speech intelligibility, as well as young children, it may be vary slightly depending upon the acoustics of the room and
necessary to use materials that incorporate picture-pointing consistency of the examiner’s voicing of the stimuli. Mea-
responses. If closed-set materials are utilized, performance sure and record the classroom ambient noise level (unoccu-
can be expected to be better than with open-set materials. pied), approximate teacher or talker levels, and noise levels
Once the type of stimuli is determined, it must remain con- as directed on the scoring form.
stant throughout the assessment so that the variables manip-
ulated are noise, distance, and visual input. Report the mate- Speech: Calibrate the examiner’s voice at a distance of
rial used on the Summary and Interpretation Form. Common 3 feet from the listener (close condition). Ask
materials include are listed below. In many of these materi- the student to hold the SLM to their ear and
als there will not be sufficient lists for the entire protocol the examiner to talk measuring the examiner’s
(8 lists are needed). If it is necessary to use a list twice, se- voice with the sound level meter so that speech
Chapter 5
lect the lists that were more difficult for the student in order averages 65dBA SPL at the listener’s ear.
to reduce familiarity with the material. The Common Chil- Once that level is measured, check the SPL
dren’s Phrases and the Children’s Nonsense Phrases each level when the sound level meter is held one
contain eight lists of twenty phrases and provide the option foot from the examiner’s mouth (being care-
of phrase or word scoring. ful to keep the voice level the same) so that
The Recorded Functional Listening Evaluation Using the examiner can hold the sound level meter
Sentences (Johnson & Anderson, 2013) is now available on to monitor his/her voice for all conditions to
CD from https://successforkidswithhearingloss.com. This verify that the proper speech level is main-
version utilizes 5-word HINT-C (Hearing in Noise Test for tained. The level at 1 foot from the examiner
Sentence Materials: BLAIR Sentences WIPI Sentences

SPIN Sentences (older students) BKB Sentences
PSI Sentences HINT-C Sentences
Phrase Materials: Common Children’s Phrases Children’s Nonsense Phrases
Word Lists: PB-K NU-6
Picture – Closed Set: WIPI NU-CHIPS
Note: The Common Children’s Phrases and Nonsense Phrases are available in the Educational Audiology Handbook (2nd ed.)
(Johnson & Seaton, 2012) as well as the author’s website: http://www.ADEvantage.com; word and sentence lists should be
available from most pediatric and educational audiologists.

152 Chapter 5 Assessment
will be approximately 3 dBA SPL greater that Scoring

at the listener’s ear for close conditions).
Scoring should be completed using the established proce-
Noise: Locate the noise source 3 feet from the stu-
dures for the selected test material. Scoring may be made
dent and adjust the volume of the noise source
on total phrase/sentence correct or by number of words cor-
(classroom/multitalker noise) using a sound
rect. In some situations it is useful to have another person
level meter, so that the noise averages 60 dBA
(such as the classroom teacher) score the speech test materi-
SPL at the student’s ear. This yields a +5 dB
als. All scores should be reported in percent correct in the
speech-to-noise ratio level.
Scorebox on the Summary and Interpretation Form. Hearing
assistance technology scores should be entered in the boxes
labeled 9–12 for the far conditions repeated. A calculable
Presentation Protocol PDF FLE form is available that populates the interpretation
The FLE should be conducted in the student’s typical hear- matrix from the Scorebox at http://www.ADEvantage.com.
ing mode. If hearing aids or cochlear implants are usually
worn at school, they should also be worn during the evalu-
ation. When this evaluation is used as a validation tool to
demonstrate improvement in listening ability with FM or
other remote microphone hearing assistance technology, the
Variations in Protocol
examiner should repeat the far conditions to demonstrate the This protocol is based on the listening situation of a typical
benefits of the technology. classroom. For an individual student, it may be useful to
modify this protocol to account for variations in the level
Eight phrase, sentence or word lists should be presented in and source of noise, classroom size, teacher’s voice, typical
the order indicated by the numbers on the scoring matrix. listening distances for the student, or other factors. In order
This order balances for difficulty across conditions so that to accommodate these variations, placement of the noise
the final task is the easiest of the far conditions. source, level of noise, distance from the student in the far
condition, and order of presentation may be adjusted. Be
The examiner may choose to alter the order for other reasons sure to note these modifications on the test form.
however.
1. Auditory-Visual: Close Quiet Interpretation Matrix

2. Auditory: Close Quiet The Interpretation Matrix analyzes the effects of noise, dis-
Chapter 5
3. Auditory-Visual: Close Noise tance, and visual input. It is completed by transferring the
percentage correct scores from the Scorebox to the same
4. Auditory: Close Noise numbered box in the interpretation matrix. Individual scores
5. Auditory-Visual: Far Noise are summed and averaged to determine the overall effect of
each condition. Although scores may be affected by differ-
6. Auditory: Far Noise ent speakers, rate of speaking, attention of the listener, or
7. Auditory: Far Quiet status of amplification, comparisons are valid as long as
these variables are kept constant throughout the evaluation.
8. Auditory-Visual: Far Quiet
When validating hearing assistance technology, the target
for desired performance is the score from box 1 (for audi-
When presenting the FLE via live voice, the examiner tory visual) or box 2 (auditory only) of the Scorebox. In
should present the speech materials at a normal speaking other words, the effects of noise and distance can be con-
rate. Instruct the student to repeat the speech stimuli or sidered eliminated when the performance with the technol-
point to the appropriate picture, as indicated by the mate- ogy matches the individual’s best performance in quiet,
rial used. Repeat far conditions (9–12) to validate benefit or at least reduced, if the performance is improved. This
of hearing assistance technology. Test administration takes information can be used as evidence to justify technology
approximately 30 minutes, including set up. For the audi- and other accommodations that may be beneficial for the
tory conditions it is recommended that the examiner use an student. The findings should be discussed with the student,
acoustically transparent hoop over his/her face or instruct his/her parents, and teachers to help them understand the
the student to look down during these conditions as placing student’s listening abilities and communication access op-
a hand or paper in front of the talker’s mouth will change the tions. A summary of the Interpretation Matrix and appropri-
acoustic characteristics of the speech sounds. ate recommendations should be written on the scoring form.

Assessment 153
References Johnson, Benson, & Seaton (1997). San Diego: Singular Pub-
lishing Group, Inc.
Johnson, C.D. (2012). Common Children’s Phrases, Children’s Non-
Ross, M., Brackett, D. & Maxon, A. (1991). Communication As-
sense Phrases, In Educational Audiology Handbook (2nd Ed.)
sessment. In Assessment and management of mainstreamed
(150–153). Clifton Park, NY: Delmar Cengage Learning.
hearing-impaired children (113–127). Austin, Tx: Pro-Ed.
Johnson, C.D. (2013). Functional Listening Evaluation. Available
Ying, E. (1990). Speech and Language Assessment: Communica-
from http://www.ADEvantage.com
tion Evaluation. In M. Ross (Ed.), Hearing-impaired children in
Johnson, C.D. & VonAlmen, P. (1993). The Functional Listening
the mainstream (45–60). Parkton, MD: York Press.
Evaluation. In Educational audiology handbook, (336–339).
Chapter 5

Chapter 5
THE FUNCTIONAL LISTENING EVALUATION
154
Name: Date: _______________ Examiner: __________________________________ Age/DOB:
AUDIOMETRIC RESULTS INTERPRETATION MATRIX
Hearing Sensitivity: Pure Tone Ave: Right Ear ___dB Left Ear ___dB
Noise Distance Visual Input
PTA used: h 500, 1K, 2K h 1K, 2K, 4K
Word Recognition: Right Ear ___% @ ___dBHL Left Ear___% @ ___dBHL quiet noise close distant aud-vis aud
2 4 2 7 1 2
Sound Field: Aided h Unaided h close- quiet- close-
aud aud quiet
Quiet ___% @ ___dBHL
Noise ___% @ ___dBHL @ ___S/N 1 3 1 8 3 4
close- quiet- close-
aud/vis aud-vis noise
7 6 4 6 5 6
FUNCTIONAL LISTENING EVALUATION CONDITIONS distant- noise- distant-
aud aud noise
Amplification: h None h Hearing Aids h Cochlear Implant h Baha 8 5 3 5 8 7

distant- noise- distant-
Hearing Assistance Technology: h FM
h Classroom Other__________ aud/vis aud/vis quiet
Classroom Noise Level: Unoccupied ______dBA SPL; Occupied ______dBA SPL
Assessment Material: ________________________________________________ Average of
above scores: ______% ______% ______% ______% ______% ______%
Distance (distant condition): ___ft quiet noise close distant aud/vis aud
Noise Stimulus: h Multitalker h Classroom h Other_________
Speech level @ listener’s ear: ____dBA SPL ; @ 1 ft from examiner: ____dBA SPL With Hearing Assistance Technology:
Average of
Noise level @ listener’s ear: ____dBA SPL above scores: ______% ______% ______% ______% ______% ______%
Approximate speech to noise levels: close +____dB distant -____dB quiet noise close distant aud/vis aud
Modifications in protocol:
INTERPRETATION AND RECOMMENDATIONS
FUNCTIONAL LISTENING SCOREBOX
close/quiet close/noise distant/quiet distant/noise

1 3 8 5
auditory-
visual
auditory 2 4 7 6
Source: © C.D. Johnson, Updated 2013. Based on Functional Listening Evaluation by C.D. Johnson & P. Von Almen, 1993. Available from www.ADEvantage.com, pdf
fillable form from https://www.phonakpro.com/content/dam/phonakpro/gc_hq/en/resources/counseling_tools/documents/child_hearing_assessment_functional_listen
ing_evaluation_fle_2017.pdf
2/25/2020 4:19:01 AM
APPENDIX 5–I
Classroom Participation Questionnaire-Revised
Deaf/ Hard- of-Hearing Students
Student’s Name_____________________________________ Date Completed________________

School_____________________________________________ Grade _______________________
Teacher Administering Scale ___________________________ District_______________________
ELEMENTARY STUDENTS 3rd GRADE AND ABOVE complete this form for the regular education classroom.
MIDDLE and HIGH SCHOOL STUDENTS complete this form for your Language Arts/English class. If you are not in the
regular classroom for Language Arts/English, then complete the form for your Social Studies or Science class –
whichever of these two classes has the most frequent discussions.
Form completed for: ___ Language Arts/English ___Social Studies ___Science ___ Other (Please specify)
AT HOME
1. How often does your family use sign language? Never Sometimes Often All the time
2. a. Are there any other family members who have a hearing loss? No Yes
b. IF YES, circle who: Father Mother Brother Sister Other_____________________
IN SCHOOL- Please circle one answer for each question. If there are no other deaf/hard-of-hearing
students in your class(es), ignore questions 7 and 8.
Interpreter Sign Speech Speech Writing
& Sign Notes
3. How do you like best to communicate with 1 2 3 4 5
hearing students?
4. How do you like best for hearing students 1 2 3 4 5
Chapter 5
to communicate with you?

teachers?
6. How do you like best for teachers to communicate 1 2 3 4 5

with you?

other deaf/ hard-of-hearing students?
8. How do you like best for other deaf/ 1 2 3 4 5

hard-of-hearing students to communicate with you?
9. Do you typically use an interpreter in class? No Yes
10. How many other deaf/hard-of-hearing students 0 1-2 3-4 5 or more

are in your class(es)?
© Stinson, M., Long, G., Reed, S., Kreimeyer, K., Sabers, D. & Antia, S.D. (2006). Used with Permission.
155

156 Chapter 5
Chapter 5

Assessment 157
Chapter 5

158 Chapter 5
Chapter 5

Assessment 159
Chapter 5

APPENDIX 5–J
Auditory Problems Self-Checklist
Self-perceptions of listening problems are valuable to consider when identifying specific auditory problems experienced by
students. This self-checklist should be used in combination with the Fisher’s Auditory Problems Checklist in order to com-
pare specific self-perceptions of listening problems with observations obtained by a professional. The normative data on the
Fisher’s Checklist was obtained by adult professionals and was not based on students’ own impressions. Scoring on Fisher’s
Auditory Problems Checklist cannot reliably be applied to this protocol but is useful in comparing students’ own perceptions
versus impressions of a professional.
Student Name Date Completed
School Grade
The questions on this checklist will help your teachers understand your listening and comprehension skills. Please answer
each question by CIRCLING “Yes” or “No.”
YES NO 1. Do you think you have a hearing problem?

YES NO 2. Do you have a history of hearing loss or ear infections?
YES NO 3. Do you have difficulty paying attention to your teacher?
YES NO 4. Do you often need directions repeated?
YES NO 5. Do you say “huh” or “what” five or more times per day?
YES NO 6. Do you have difficulty keeping your attention on what you are listening to?
YES NO 7. Do you have difficulty paying attention to your teacher? If yes, indicate about how long you can pay
attention to your teacher? __0–2 min __2–5 min __5–15 min __15–20 min
YES NO 8. Do you find yourself daydreaming in class?
YES NO 9. Are you easily distracted by sounds or noises around you?
Chapter 5
YES NO 10. Do you have difficulty with phonics (sounding out words)?
YES NO 11. Is it hard for you to hear differences between sounds in words (for example, mouth versus
mouse, ran versus rain)?
YES NO 12. Do you forget what is said a short time later?
YES NO 13. Is it hard for you to remember simple routine things from day to day?
YES NO 14. Do you have trouble remembering what you heard last week, last month, or last year?
YES NO 15. Do you have trouble remembering a sequence of information that you have heard?
YES NO 16. Do you experience difficulty following spoken directions?
YES NO 17. Do you frequently misunderstand what is said?
YES NO 18. Do you have difficulty understanding words or ideas that are told to you?
YES NO 19. Is it hard for you to learn when the information is only spoken?
YES NO 20. When you speak, do you have a hard time choosing the words you want to say or
putting words together correctly?
YES NO 21. Is your speech hard for others to understand?
YES NO 22. Does what you see relate to what you hear?
YES NO 23. Do you want to learn?
YES NO 24. Do you need extra time to think about directions you are given?
YES NO 25. Are you having difficulty in any of your classes? If so, which ones? _________________________
_________________________________________________________________________________
What are your best classes?___________________________________________________________
Note. Modified by Cheryl DeConde Johnson from Fisher’s Auditory Problems Checklist.
160

APPENDIX 5–K



         

  
 
     
  
  
  
 
 

  
  
 
 


  


  

 


  
  
 
 


  
   
  
 
 
   
 
 

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Chapter 5
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
  
  
  
 


                     
                


Source: ©1991 Relationship of Degree of Long-term Hearing Loss to Psychosocial Impact and Educational Needs, Karen
Anderson & Noel Matkin, revised 2007 thanks to input from the Educational Audiology Association. Reprinted with
permission. https://successforkidswithhearingloss.com
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162 Chapter 5
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         

  
 
     

  
  

   

 


 
 
  


  
  
 
 

 


  
  
 
 

 


 
  


 
  
  
 
  

Chapter 5


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
  
  
  
 


                     
                



Assessment 163



         

  
 

     
  
 
 
 


 
  

 


 
  

 

    
  
  

   

 

 
  
 
 

 
   
 
 

  
   
 
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
Chapter 5
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
  
  
  
 


                     
                



164 Chapter 5
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         

  
 
     
  
  
   
   
  
  
    
   
  
   
  
   
  
    
   
  
  
   
  
  
  
  
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Chapter 5
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
  
  
  
 


                     
                



Assessment 165



  
  

     
  
   
  
  
  
  
  
  
    
   
   
   
   
  
  
   
   
  
  
  
   
    
  
  
   
  
     
  
Chapter 5
  
  
   
  
    
  
  
 
  
  

  
  
  
 


                     
                



166 Chapter 5




  
 

     
  
  
   
   
   
  
   
    
  
  
    
  
   
    
   
  
  
  


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Chapter 5
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
  
  
  
 


                     
                



Assessment 167


         



  
 
     
  
 
 

  

 

 
 
   

 


  

 


 
 
  

 

 


  

 
   

   
   

 
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
Chapter 5
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
  
  
  
 


                     
                



168 Chapter 5
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         

  
 
     

  

   

 
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 
  
 
 


 
  

 

 
   
 
 

  
  
 

  

 


  
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 
  
 

 
  
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 
 
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Chapter 5
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
  
  
  
 


                     
                



Assessment 169



         

  
 

     
  
  
 
 

  

 
  
 

  

 
  
 
 

 

 


  
  
 
 
  
 
 


  

 
  
 
 


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Chapter 5

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
  
  
  
 


                     
                



Chapter 5
03
170
Student Profile
A. Factors for Consideration Student Name:
Points
APPENDIX
(Matrix)
Birth Date: Age: Hearing Age:
I. Audiological Factors
Grade: Date: Eligibility:

II. Language/Vocabulary
School:
III. Functional Listening Skills
5–L
District:
IV. Use of Amplification Devices
V. Academic/Vocational Performance
Teacher Consultant/Itinerant Teacher:
VI. Personal Adjustment and Transition Notes:
Total Points A
B. Contributing Factors +/- .5

(Optional) Points
Student Cooperation
Additional Supports
Change in Program
Impact Score Guideline for Considering Range of Service

Attendance/Challenging Condition Total
Ratings (in minutes/week)
Others
0-8 0-14 minutes/week
Total Points B
9-16 9-20 minutes/week
Educational Impact Score Total 17-24 21-37 minutes/week
Total A +/- Total B (Optional) = 25-32 35-50 minutes/week
When calculating the total Educational Impact Score, round up to This is NOT to suggest that all students must be seen weekly. This is only a guideline for the individualized
the next integer. education program (IEP) team to consider.
Impact Matrix for Students Who Are Deaf or Hard of Hearing (DHH)
Note. Used with permission. Complete Matrix with instructions for use is available at https://mdelio.org/sites/default/files/documents/DHH/ServiceDeliveryTools
Michigan Department of Education—Low Incidence Outreach Educational
/ImpactMatrix/Impact_Matrix_For_Students_who_are_Deaf_or_Hard_of_hearing_V2.7.2.pdf
2/25/2020 4:19:11 AM
04
Educational Impact Matrix for Students who are Deaf or Hard of Hearing (DHH)
I. Audiological Factors
Audiological factors (medical) include the student’s type and level of hearing as well as listening discrimination scores, as reported by an audiologist
and/or an otolaryngologist/otologist.
Points
0 Points 2 Points 3 Points 4 Points
(0-4)
Bilateral slight to mild hearing Bilateral moderate hearing loss: Bilateral moderately severe Bilateral severe to profound
loss: 16-40 dB PTA 41-55 dB PTA hearing loss: 56-70 dB PTA hearing loss: above 70 dB PTA
Unilateral hearing loss Occasional middle ear problems Fluctuating hearing loss History of progressive hearing
loss
Speech discrimination of 85% or Aided speech discrimination 85% Aided speech discrimination 70- Aided speech discrimination less
above without amplification or above 84% than 70%
Frequent, manageable middle Chronic middle ear problems;

ear problems difficult to manage
Auditory neuropathy
II. Language/Vocabulary
Language/vocabulary includes the level of language and vocabulary skills acquired as measured by standardized assessments and/or English Language
Arts Core Standards. It also includes student’s use of language for interaction with teachers and peers.
Points
(0-8)
At or above age/grade level on One year/grade level below on Two years/grade levels below on Three years/grade levels below
standardized assessment standardized assessments standardized assessments on standardized assessments
English Language Arts (ELA) English Language Arts (ELA) English Language Arts (ELA) English Language Arts (ELA)
core standards for Reading, core standards for Reading, core standards for Reading, core standards for Reading,
Writing, Listening, Speaking, and Writing, Listening, Speaking, Writing, Listening, Speaking, Writing, Listening, Speaking, and
Language scores more than or and Language scores 70-79% and Language scores 60-69% Language scores less than or
equal to 80% on age/grade level on age/grade level through 5th on age/grade level through 5th equal to 59% on age/grade level
through 5th grade conventions grade conventions grade conventions through 5th grade conventions.
Participates, initiates, and Intermittently participates in Participates in classroom and/or Rarely participates in classroom
sustains classroom and social classroom and social interactions social interactions with prompts and/or social interactions, with or
interactions without prompts without prompts
171
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Chapter 5
Chapter 5
172
05
III. Functional Listening Skills
Functional listening skills includes the student’s ability to use listening skills in a variety of settings.
Points
(0-8)
Understands connected speech Obtains class content given cues Responds appropriately to Develops auditory skills within
about topic familiar words and phrases closed sets
Understands concepts and Understands classroom Responds appropriately to Understands single words and
vocabulary vocabulary with support familiar routines short familiar phrases supported
with speech reading
Gains information Understands class content in Understands part of class content Recognizes environmental
small groups with minimal in small groups and a quiet sounds
background noise setting
Follows conversational topics
easily
IV. Use of Amplification Devices

Amplification devices may include hearing aids, cochlear implants, personal FM, classroom system, or other hearing assistive technology (HAT).
Points
(0-4)
Amplification devices not Limited knowledge of Declines use of amplification Does not benefit from
prescribed amplification devices devices amplification devices
Identified/amplified more than Identified and amplified in last Identified and amplified within Identified and amplified within
one year ago 6-12 months last 6 months last 3 months
Independent use and care Needs occasional assistance with Needs regular assistance with Needs daily assistance with
use and care use and care amplification
Reports functioning status of Reports functioning status of Reports functioning status of Reports functioning status of
personal amplification devices personal amplification devices personal amplification devices personal amplification devices
and/or hearing assistive and/or HAT with at least 75% and/or HAT with at least 50% and/or HAT with at least 20%
technology (HAT) with 90% accuracy accuracy accuracy
accuracy
Uses amplification at home and Uses amplification at school but Uses amplification inconsistently Uses amplification at school less
school not at home at home and/or school than 50% of day
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06
V. Academic/Vocational Performance
Academic/vocational performance includes the level of academic progress and/or career-related learning as well as the student’s need for
accommodations or modifications.
Points
(0-4)
Advanced/Proficient on state Partially Proficient on state Partially Proficient/Not Proficient Not Proficient on state
assessment for ELA/writing assessment for ELA/writing on state assessment for ELA/ assessment for ELA/writing or on
writing Alternate State Assessment
State or district testing indicates State or district testing indicates State or district testing indicates State or district testing indicates
no interference with educational minimal impact on educational moderate impact on educational significant impact on educational
and/or vocational performance and or vocational performance and/or vocational performance and/or vocational performance
General education teacher General education teacher General education teacher General education teacher
reports development of skills reports development of skills reports development of skills reports development of skills
necessary to meet 80% of core necessary to meet 70% of core necessary to meet 60% of core necessary to meet 50% of core
standards. standards standards standards
Has no IEP or 504 Has IEP or 504 accommodations Has content modifications and Has significant content
accommodations supporting listening, hearing, accommodations modifications and numerous
and access to instruction accommodations
VI. Personal Adjustment and Transition

Personal adjustment and transition includes the level of self advocacy for technology and/or accommodations as well as skills necessary for
transitions including graduation and/or change of levels.
Points
(0-4)
Advocates for technology and Advocates for technology and Advocates for technology or Does not advocate for self with
accommodations independently accommodations with minimal accommodations 1-2 times per or without prompts
support week with prompts
Knows and uses resources for Knows and uses resources for Uses few resources for access Needs information and training
access in familiar and novel access in familiar settings in current setting and needs for access in new setting
settings support to adjust to new setting
173
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Chapter 5
APPENDIX 5–M
General Teacher Letter
[NAME OF PROGRAM]
Dear (Insert teacher’s name),
A student in your classroom, , has a hearing loss. You can

help your student by:
■■ Facilitating acceptance of the student.

■■ Being sure hearing aids and/or other hearing technologies are used as recommended.
■■ Providing preferential or flexible seating.
■■ Increasing use of visual information.
■■ Minimizing classroom noise.
■■ Using clear speech and encouraging others to do so.
■■ Modifying teaching techniques.
■■ Having realistic expectations.
■■ Asking ______________ for input on his/her needs in your classroom.
Specific suggestions to help you accomplish these things are listed in the following material. These guidelines are gen-
eral and should be adapted as necessary. The items marked with an asterisk (*) are especially important for your student. If
Chapter 5
you have any questions, please contact me for assistance.
Sincerely,
(insert name and contact information)
174

Assessment 175
FACILITATE ACCEPTANCE OF YOUR STUDENT: Your student will benefit from a classroom where he/she feels ac-
cepted and where modifications are made without undue attention.
■■ Welcome the student to your class. Your positive attitude will help other students accept him/her.
■■ Discuss your student’s hearing loss with him/her; let him/her know you are willing to help.
■■ As appropriate, have your student, the audiologist, or another person explain the student’s hearing loss to your entire class.
■■ Make modifications seem as natural as possible so the student is not singled out.
■■ Accept your student as an individual; be aware of his/her assets as well as his/her limitations.
■■ Encourage your student’s special abilities or interests.
BE SURE HEARING AIDS AND OTHER HEARING TECHNOLOGIES ARE USED AS RECOMMENDED: This
will enable your student to access sound and speech in the classroom.
■■ Realize that hearing aids make sounds louder, but not necessarily clearer. Hearing aids don’t make hearing normal.
■■ Be sure your student’s hearing aids or other devices are checked daily to see that they are working properly.
■■ Encourage the student to care for his/her hearing aid(s) by putting it on, telling you when it is not functioning properly, etc.
■■ Be sure your student always has a spare battery at school.
■■ Know who to contact if your student’s device is not working properly.
PROVIDE PREFERENTIAL SEATING: Appropriate seating will enhance your student’s ability to hear and understand
what is said in the classroom.
■■ Seat near where you typically teach. It will be helpful if your student is at one side of the classroom so that he/she can
easily turn and follow classroom dialogue.
■■ Seat where your student can easily watch your face without straining to look straight up. Typically the second or third
row is best.
■■ Seat away from noise sources, including hallways, HVAC systems, pencil sharpeners, etc.
■■ Seat where light is on your face and not in your student’s eyes.
■■ If there is a better ear, place it toward the classroom.
■■ Allow your student to move to other seats when necessary for demonstrations, classroom discussions, or other activities.
INCREASE VISUAL INFORMATION: Your student will use lipreading and other visual information to supplement what
he/she hears.
Chapter 5
■■ Remember your student needs to see your face in order to lipread!
Try to stay in one place while talking to the class so your student does not have to lipread a “moving target.”
Avoid talking while writing on the chalkboard.
Avoid putting your hands, papers, or books in front of your face when talking.
Avoid talking with your face turned downward while reading.
Keep the light on your face, not at your back. Avoid standing in front of windows where the glare will make it dif-
ficult for your student to see your face.
■■ Use visual aids, such as pictures and diagrams, when possible.
■■ Demonstrate what you want the student to understand when possible. Use natural gestures, such as pointing to objects
being discussed, to help clarify what you say.
■■ Use the chalkboard--write assignments, new vocabulary words, key words, etc. on it.
MINIMIZE CLASSROOM NOISE: Even a small amount of noise will make it very difficult for your student to hear and
understand what is said.
■■ Seat your student away from noisy parts of your classroom.
■■ Wait until your class is quiet before talking to them.
USE CLEAR SPEECH AND ENCOURAGE OTHERS TO DO SO ALSO: Clear speech will help your student under-
stand you and others better.
■■ Speak naturally in a good, clear voice. It is not necessary to shout or exaggerate lip movement.
■■ Use a moderate rate of speech.
■■ Pause briefly between phrases to allow time for auditory processing.

176 Chapter 5
MODIFY TEACHING PROCEDURES: Modifications will allow your student to benefit from your instruction and will
decrease the need for repetition.
■■ Be sure your student is watching and listening when you are talking to him/her.
■■ Be sure your student understands what is said by having him/her repeat information or answer questions.
■■ Rephrase, rather than repeat, questions and instructions if your student has not understood them.
■■ Write key words, new words, new topics, etc. on the whiteboard.
■■ Repeat or rephrase things said by other students during classroom discussions.
■■ Introduce new vocabulary to the student in advance. The speech-language pathologist or parents may be able to help
with this.
■■ Use a “buddy” to alert your student to listen and to be sure your student has understood all information correctly.
HAVE REALISTIC EXPECTATIONS: This will help your student succeed in your classroom.
■■ Remember that your student cannot understand everything all of the time, no matter how hard he/she tries. Encourage
him/her to ask for repetition.
■■ Be patient when student asks for repetition.
■■ Give breaks from listening when necessary. Your student may fatigue easily because he/she is straining to listen and
understand.
■■ Expect student to follow classroom routine. Do not spoil or pamper your student.
■■ Expected your student to accept the same responsibilities for considerate behavior, homework, and dependability as you
require of other students in your classroom.
■■ Ask the student to repeat if you can’t understand him/her. Your student’s speech may be distorted because he/she does
not hear sounds clearly. Work with the speech-language pathologist to help your student improve his/her speech as much
as possible.
■■ Be alert for fluctuations of hearing due to middle ear problems.
■■ Request support from the audiologist, the speech-language pathologist, or others when you feel uncertain about your
student and what is best for him/her.
Chapter 5

APPENDIX 5–N
Ordering Information for Selected
Assessment Products
Auditory Perception Test for the Hearing Impaired (APT) Plural Publishing, Inc.
5521 Ruffin Road
San Diego CA 92123
(866) 758-7251
FAX: (888) 758-7255
https://www.pluralpublishing.com
Bamford-Kowal-Bench Speech-In-Noise Test (BKB-SIN) Etymotic Research

https://www.etymotic.com
Children’s Auditory Performance Scale (CHAPS) Educational Audiology Association

3030 W. 81st Street
Westminster CO 80031-4111
(800) 460-7322
http://edaud.org
Children’s Home Inventory for Listening Karen Anderson Audiology Consulting

Difficulties (CHILD) https://successforkidswithhearingloss.com
Children’s Outcome Worksheets (COW) Oticon Corporation

http://www.oticonus.com/ProfessionalSection
/EducationalForms
Classroom Participation Questionnaire (CPQ) ADVantage Consulting
Chapter 5
https://www.advantage.com
Cottage Acquisition Scales for Listening, Sunshine Cottage School for Deaf Children
Language and Speech (CASLLS) 103 Tuleta Dr.
San Antonio, TX 78212
(210) 824-0579
https://www.sunshinecottage.org
Developmental Index of Audition and Listening Educational Audiology Assoc. (see above)
(DIAL)
Early Speech Perception Test (ESP) Central Institute for the Deaf
825 South Taylor Avenue
St. Louis, MO 63110
(877) 444-4574; (314) 977-0132
FAX: 314-977-0023; TTY: 314-977-0037
https://cid.edu
Early Listening Function (ELF) Educational Audiology Assoc. (see above)
Fisher’s Auditory Problems Checklist Educational Audiology Assoc. (see above)
177

178 Chapter 5
Functional Auditory Performance Indicators (FAPI) https://www.arlenestredlerbrown.com

Karen Anderson Audiology Consulting (see above)
Functional Listening Evaluation (FLE) ADVantage Consulting

(see above)
Lexical Neighborhood Test (LNT) and Auditec of St. Louis

Multi-syllabic Neighborhood Test (MLNT) https://auditec.com
Listening Inventory for Education (LIFE) Karen Anderson Audiology Consulting

(see above)
LittlEARS Auditory Questionnaire MedELCorporation

https://www.medel.com
Meaningful Auditory Integration Scale (MAIS) Advanced Bionics Corporation

Mann Biomedical Park
25129 Rye Canyon Loop
Valencia, CA 91355
(800) 678-2575
https://www.bionicear.com
Minimal Auditory Capabilities Battery Auditec of St. Louis (see above)

(MAC Battery)
Northwestern University Children’s Auditec of St. Louis (see above)

Perception of Speech (NU-CHIPS)
Pediatric Speech Intelligibility Auditec of St. Louis (see above)

(PSI)
Screening Instrument for Targeting Educational Karen Anderson Audiology Consulting

Chapter 5
Risk (SIFTER) (Original, Preschool, Secondary) (see above)

Sound Effects Recognition Task Auditec of St. Louis (see above)
(SERT)
Word Intelligibility by Picture Identification Auditec of St. Louis (see above)

(WIPI), 2nd edition

CHAPTER 6
Auditory Processing Deficits
With Lisa R. Cannon
CONTENTS
Auditory Processing Deficit Basics

Terminology and Definitions of Auditory Processing and Auditory Processing Deficits and Disorders
■ Criteria for Determination of an Auditory Processing Disorder ■ Practice Guidelines: The Role of the
Audiologist and Other Professionals ■ APD and Other Disorders

An Educational Model of Auditory Processing
APD and Multitiered Systems of Support
Implementing a School-Based APD Program
Step 1. Developing the APD Team and Philosophy ■ Step 2. Referral and Screening ■ Step 3. Assessment for
APD ■ Step 4. Eligibility for Services ■ Step 5. Intervention
Chapter 6
“It’s so much harder for me to understand in my noisy classroom and the lunchroom than listening in my
quiet home.”
179

Summary
Appendices
6–A Auditory Processing Deficit Screening Questionnaires (Text/Online)
6–B Referral for Auditory Processing Assessment (Text/Online)
6–C Auditory Processing Case History (Text/Online)
6–D Auditory Processing Assessment Resources (Text)
6–E Supplemental and Multidisciplinary Tests of Auditory Processing (Text)
6–F Auditory Processing Assessment Profile (Text/Online)
6–G Accommodations and Modifications Checklist for Auditory Processing Deficits (Text/Online)
6–H Computer-Based Auditory Training Programs (Text)
6–I Instructional Interventions for Students With Auditory Processing Deficits (Text/Online)
6–J A Multitiered Model of Auditory Processing Deficit Interventions (Text)
KEY TERMS abilities rather than specific disorders, such as auditory

processing “disorder.”
APD, CAPD, RtI, MTSS, remote microphone hearing as- ■■ A meaningful audiological auditory processing deficit
sistance technology (RM HAT), processing, CANS, ADHD, (APD) assessment should minimize the confounding
SLI, SLD, comorbidity, executive functioning, multidisci- factors of other disorders and be inclusive of additional
plinary, dichotic listening, temporal processing, neuromatu- assessments that examine the entire continuum of lis-
ration, neuroplasticity, top-down, bottom-up, computer- tening including linguistic and cognitive components.
based auditory training, deficit-specific intervention, com- ■■ Despite the controversies that exist in the field, one
pensatory strategies, metacognitive point of agreement in all APD guidance documents and
literature is the importance of a team approach to APD.
■■ By considering the individual listener, the message, and
the environment, an intervention plan can offer a holis-
KEY POINTS tic approach to managing APD in the school setting.
■■ The growing availability of laptops and tablets in the
■■ School professionals, including educational audiolo- classroom as well as the use of skill-building computer
gists, are tasked with identification of educational dis- programs in general should increase the likelihood that
Chapter 6
The Challenge Is Real

An informal 2018 survey of 38 educational audiologists most (75%) estimate only 1 to 20 referrals per school
practicing in different school systems in Colorado provides year, which makes it difficult to stay current with the re-
valuable insight into the controversies and challenges sur- search and adds challenges to feeling comfortable in as-
rounding assessment and management of APDs in the sessment and interpretation practices. Referrals are not
school setting. Twenty percent of the respondents re- going away, however, as 61% of respondents indicated
ported they do not offer APD testing at all. Of those, that they think referrals are on the rise. About half of
about a half cite time constraints, and a quarter report referrals reportedly come from a speech-language pa-
that they do not feel like there are adequate guidelines thologist (SLP), but about 20% are initiated by parents.
for testing, including a lack of sensitive screening tools, ef- APD assessment is a continuing demand, and educational
ficient test battery, and proven interventions. Add that to audiologists in particular find themselves with plenty of
the fact that of those who do provide APD assessments, questions and remain in need of ongoing guidance.
180

Auditory Processing Deficits 181
schools can offer some of these specific listening processing.” These processes or mechanisms, which occur in
grams for students identified with APDs. the CANS, underlie the following skills:
■■ A common problem encountered by children with
■■ binaural processing (spatial processing, localization,
APD is difficulty understanding in noisy environments;
lateralization, dichotic listening, binaural interaction);
therefore, technology that improves the signal-to-noise
■■ temporal processing (pattern recognition, ordering, reso
ratio has the possibility of benefiting the student.
lution); and
One of the most challenging areas for educational audiolo- ■■ speech processing (identification of and discrimination
gists is the identification and intervention of auditory proof degraded speech or speech-in-noise).
cessing deficits (APDs). Those who have worked with stu-
An APD refers to difficulty in one or more of these skills,
dents are well aware of auditory processing problems and
originating in the CANS, which is not a result of higher-order
their educational impact. As a result of ongoing research and
linguistic or cognitive factors and is specific to the auditory
the growing body of knowledge about APDs, identification
modality. APD, especially in children, can lead to difficulties
and intervention are acquiring a more scientific basis. Grow-
with listening and learning; therefore, it is often complicated
ing public awareness and interest in APDs by both parents
to differentiate APD from other childhood disorders.
and educators has resulted in steady referrals to educational
Differentiating a central auditory processing deficit
audiologists, who must be vital members of the educational
from issues of language, communication, learning, executive
team to help determine whether an APD is causing or con-
functioning, and other processing problems is undoubtedly
tributing to learning difficulties.
the most challenging aspect of APD assessment. Research
has shown that a majority of children identified with learn-
ing and language disorders will also perform poorly on au-
AUDITORY PROCESSING diological tests of auditory processing (Sharma, Purdy, &
Kelly, 2009). In fact, the biggest controversy in the field of
DEFICIT BASICS childhood APD is whether a diagnosis of APD can be valid
An initial step in addressing APDs is understanding what it or considered a unique disorder given the fact that it is nearly
is. Common questions related to understanding APD include impossible to separate the sensory and cognitive components
the following: of listening (Moore, 2018). Educational audiologists find
themselves in somewhat controversial territory while also
■■ What is an auditory processing deficit or disorder? managing the demand for providing APD assessments. A
■■ What behavioral characteristics do children with APD meaningful audiological APD assessment should minimize
have? How are they differentiated from learning dis- the confounding factors of other disorders and be inclusive
abilities, language disorders, and attention deficits? of additional assessments that examine the entire continuum
■■ Are all auditory processing disorders the same, or are of listening including linguistic and cognitive components.
there different types of disorders?
■■ What are the educational implications of APD? Terminology
■■ How are APD services determined?
A clarification of terminology is necessary to communicate
■■ How is APD treated?
effectively about auditory processing and auditory process-
ing deficits.
Chapter 6
Terminology and Definitions of
Auditory Processing and Auditory
Processing Deficits and Disorders
Several agreed upon definitions of APD exist in the audi-
ology literature. The American Speech-Language-Hearing
Association (1996, 2005a) and the American Academy of
Audiology (2010) convened task forces of APD experts to
The term “auditory processing” is used by speech-
develop consensus on the topic and guidance for the profes-
language pathologists (SLPs), psychologists, and
sion. The definitions in these documents provide a founda-
audiologists. To a speech pathologist, the term is
tion on which to build; however, they are complex and not
associated with linguistic processing. To a psycholo-
easily understood by some professionals, much less teachers
gist, it refers to the auditory form of cognitive pro-
and parents. In general, defining APD involves defining both
cessing. To an audiologist, it is a deficit in the pro-
the processes it refers to, as well as the disorder or deficit
cessing of auditory input, specific to the auditory
that results when these processes are deficient.
modality that occurs in the auditory system prior
Our knowledge of the function of the central auditory
to cognitive and linguistic operations.
nervous system (CANS) serves as the basis for what audi-
ologists call “auditory processing” or “central auditory pro-

182 Chapter 6
Deficit Versus Disorder Disorder is a specific term used in ■■ If poor performance is observed on only one test:
the medical community and is relevant for diagnosis, coding, Diagnosis may be withheld unless performance falls
and billing. Auditory processing disorder is often diagnosed at least three standard deviations below the mean or
in the clinical or medical setting in addition to the school set the finding is accompanied by significant functional
ting. The fact that a child may be diagnosed with an AP disor difficulty in auditory behaviors that rely on the pro-
der does not necessarily mean he or she will also be consid cess being assessed.
ered a “child with a disability” at school under the federal The failed test—and other tests that assess the same
and state regulations pertaining to students with disabilities. process—should be readministered to confirm initial
School professionals, including educational audiologists, findings.
are tasked with identification of educational disabilities ■■ Administering and comparing results for several tests
rather than disorders. Educational disabilities occur that measure the same auditory process can be used to
along a continuum of severity, and some require minimal look for patterns in auditory processing abilities and to
accommodations while others require special education support the findings of the evaluation.
supports and services. In the educational setting, use of the ■■ Inconsistencies across tests might signal the presence
term “deficit” rather than “disorder” allows for flexibility of a nonauditory confound, even when CAPD criterion
in addressing students with a range of issues. is met. Likewise, pervasive deficits on all tests may sig-
nal a cognitive deficit or other nonauditory confound.
Auditory Processing Disorder Versus Central Auditory These issues are discussed further under the assessment
Processing Disorder Lack of consensus remains about the section of this chapter.
interchangeable use of APD, CAPD, or (C)APD. Most agree
that the inherent difficulty in isolating “central” from other
higher-order processing skills during behavioral evaluation Practice Guidelines: The Role of the
dictates that we should use the broader term of APD. Every
day processing of speech and functional listening involve Audiologist and Other Professionals
much more than just the auditory modality. However, recent The use of professional practice guidelines is particularly
recommendations from the American Speech-Language- important in situations such as APD, where practices lack
Hearing Association (ASHA) practice portal (2018, www consensus or are not well defined. The ASHA Central Au-
.asha.org/Practice-Portal/Clinical-Topics/Central-Auditory ditory Processing Disorder practice portal (2018), and the
-Processing-Disorder/) have reintroduced the use of CAPD AAA Clinical Practice Guidelines: Diagnosis, Treatment
to attempt to differentiate problems arising with the acoustic and Management of Children and Adults with Central Au-
signal from the more general auditory perceptual, language, ditory Processing Disorder (2010) provide a framework and
and cognitive processing difficulties. Using the term “cen guidance for developing and managing APD assessment
tral” may help to define the relevant assessment, clarify the and intervention services. Several international guidance
multidisciplinary roles, and/or lead to more deficit-specific documents, notably from Britain (2018) and Canada (2012),
interventions. offer perspectives on the need to approach APD holistically,
emphasizing the importance of relating testing to everyday
hearing and listening functions. In addition, white papers
Criteria for Determination of an and conferences on APD give audiologists the opportunity
Chapter 6
Auditory Processing Disorder to remain up to date with current and changing research and
practices.
The diagnosis of an AP disorder may be made only after
Despite the controversies that exist in the field, one
appropriate peripheral and central assessments have been
point of agreement in all APD guidance documents and liter-
completed (see assessment for APD for this discussion).
ature is the importance of a team approach to APD. Schools
While many factors contribute to the presence of APDs,
have an advantage because multidisciplinary assessment and
when test performance can be associated with significant
management of students are typically the norm. The learn-
learning problems and when test interpretation supports a
ing disabilities or special education teacher along with the
diagnosis that can be differentiated from related deficits that
related services professional team, which includes the au-
have overlapping attributes such as ADHD, language defi-
diologist, SLP, school psychologist, social worker, school
cits, cognitive deficits, or learning disabilities, a diagnosis
nurse, and occupational and physical therapists, each pro-
of AP disorder may be made (American Speech-Language-
vide a unique contribution when evaluating the many fac-
Hearing Association, 2005). Currently, the ASHA practice
ets that impact the functioning of the neurological system
portal includes the following criteria for diagnosis of an au-
as it relates to auditory processing. These contributions are
ditory processing disorder:
present from the pre-referral process through intervention
■■ Performance deficits are noted in one or both ears of at planning and benefit the student through a strengthened as-
least two standard deviations below the mean on two or sessment process. However, when the decision regarding
more testes in the battery (Musiek & Chermak, 1997). the identification of an auditory processing disorder is to

be made, it is the audiologist’s responsibility, based on our ■■ Helping to determine the precise nature of the diag-
scope of practice, to do so. The specific roles of the audiolo nosed disorder(s) and the functional implications asso-
gist are defined by the ASHA practice portal as follows: ciated with the disorder(s).
■■ Communicating results and recommendations to the
■■ Remaining informed of research in the area of CAPD
patient/family and other appropriate parties.
as related to the audiologist’s contribution to patient
■■ Developing and implementing culturally and linguisti-
management.
cally appropriate assessment and intervention plans as
■■ Educating other professionals about the needs of indi-
part of an interdisciplinary team.
viduals with CAPD and the role of audiologists in CAPD
■■ Providing education and counsel to the patient and
management.
family.
■■ Participating in interdisciplinary team consultation for
■■ Referring the patient to other professionals, as needed,
the assessment and management of CAPD.
to facilitate access to comprehensive services (e.g., au-
■■ Conducting comprehensive audiologic evaluations.
diology, psychology, and neuropsychology).
■■ Obtaining a CAPD-specific case history.
■■ Selecting an appropriate and individualized CAPD test As indicated in the Code of Ethics (ASHA, 2016a), audiolo-
battery. gists and SLPs who work in this capacity should be specifi-
■■ Administering CAPD-specific assessments and inter- cally educated and appropriately trained to do so.
preting the results.
■■ Diagnosing CAPD. APD and Other Disorders
■■ Communicating results and recommendations to the
The incidence and prevalence of childhood developmental,
patient/family and other appropriate parties.
language, learning and behavior disorders complicates the
■■ Developing and implementing culturally and linguisti-
identification of APD because it necessitates a multidisci-
cally appropriate assessment and intervention plans as
plinary assessment. A full discussion of the comorbidity or
part of an interdisciplinary team.
coexistence between APD and other disorders is covered in
■■ Proceeding with assessment and fitting for hearing as-
detail in multiple chapters of Musiek and Chermak’s Hand
sistive technology systems (HATS), as appropriate.
book of (central) auditory processing disorders (2014) as
■■ Providing education and counsel to the patient and family.
well as in Geffner and Ross-Swain’s Auditory processing
■■ Referring the patient to other professionals, as needed,
disorders: Assessment, management, and treatment (2019).
to facilitate access to comprehensive services (e.g.,
Consider the following U.S. estimates:
speech-language pathology, psychology, neuro-otology,
and neuropsychology). ■■ By age 3 years, 30% of children experience three or
more episodes of otitis media (OM) (NIDCD); early
The ASHA practice portal also lists roles and responsibili- OM has lasting impact on the development of auditory
ties specific to SLPs involved in the assessment and manage- processing abilities (Downs, 2004).
ment of CAPD and language processing disorders. These ■■ One in five children in the United States have learning
are as follows: and attention issues (NCLD, 2017).
■■ Approximately 5% to 6% of public school students have
■■ Remaining informed of research in the area of CAPD as
Individualized Education Programs (IEPs) for specific
related to the SLP’s contribution to patient management.
Chapter 6
learning disabilities (SLDs) (NCLD, 2017).
■■ Educating other professionals about the needs of in-
■■ One-third of those identified with SLD also have at-
dividuals with CAPD and the role of SLPs in CAPD
tention deficit hyperactivity disorder (ADHD) (NCLD,
management.
2017).
■■ Participating in interdisciplinary team consultation for
■■ About 9.4% of children 2 to 17 years of age had ever
the assessment and management of CAPD.
been diagnosed with ADHD (CDC, 2018).
■■ Collecting information about skills related to auditory
■■ Nearly two of three children with current ADHD had at
processing (e.g., auditory working memory, auditory
least one other mental, emotional, or behavioral disor-
comprehension) using a variety of screening and assess
der (CDC, 2018).
ment instruments.
■■ Approximately 2% to 7% of school-age children are
■■ Conducting comprehensive cognitive-communication
estimated to have APDs with a 2:1 ratio of boys to girls
and speech and language assessments.
(Musiek & Chermak, Handbook of (Central) Auditory
■■ Obtaining a CAPD-specific case history.
Processing Disorder, Volume I, 2007).
■■ Identifying the cognitive-communicative and/or speech
and language factors that may be associated with CAPD. The comorbidity issues become readily apparent as
■■ Providing a clinical description of the patient’s speech one considers the neurologic continuum of auditory pro-
perception. cessing described by Richard (2019) that is required. This
■■ Helping to identify or differentiate disorders in phonology continuum begins as an acoustic signal is received in the
or language processing that may be comorbid to CAPD. peripheral auditory system (external, middle, and inner ear),

184 Chapter 6
then transferred and processed auditorily for discrimination

of the acoustic characteristics of the sound (central audi-
tory nervous system and the auditory nerve and brainstem), Being able to provide deficit-specific, targeted, and
then transferred for phonemic processing (Heschl’s gyrus- effective interventions depends on being able to
temporal lobe), then to language processing for discrimi- differentiate problems in the auditory modality
nation of linguistic characteristics of the sound, attaching from other areas, and this is the primary purpose
meaning, and integrating the various components of the sig- of APD assessment in school-age children. A mul-
nal (Wernicke’s area-temporal lobe and angular gyrus), and tidisciplinary team approach is imperative in order
finally executive function resulting in planning and execu- to accomplish this task.
tion of a response (prefrontal/frontal lobe and motor strip).
Assessment needs to consider how all components on this
continuum, as well as other contributing factors including
attention, motivation, language competence and experience, ences over a lifetime. Interactions within and among differ-
and cognitive ability, contribute to performance. ent brain systems shape the efficiency and effectiveness of
listening skills. In their model, assessment and remediation
should include a holistic approach.
AN EDUCATIONAL MODEL OF Educational audiologists are tasked with helping school
AUDITORY PROCESSING teams determine whether an auditory-based deficit is im-
pacting a student’s learning. In order to do this, it is helpful
There are a variety of theoretical frameworks from which to to consider an audiological assessment of APD as only one
view auditory processing. Early researchers developed many aspect of examining auditory processing abilities. A pro-
of the tests still used today to identify specific sites of lesions posed educational model of APD (as shown in Figure 6–1) is
in the CANS to explain auditory deficits. Today, practicing inclusive of the multimodal factors, skills, and professionals
audiologists want to understand more about the function involved in understanding and assessing listening abilities
of the auditory system, especially in children, where there (Colorado Department of Education, 2019). Top-down, cog-
is rarely an etiology available to describe the difficulties. nitive processes including attention, memory, and nonverbal
Kraus and Smith (2019) proposed an auditory-cognitive problem-solving interact with linguistic abilities that inter-
neuroscience framework in which the CANS does not act act with bottom-up auditory and other sensory processes in
alone in processing auditory information and that auditory a dynamic circle that complicates our ability to determine
learning is shaped by cognitive and environmental influ- the “root cause” of a student’s struggles.
APD and Multitiered Systems of Support

Trends in both general and special education have shifted to
include practices that support students with various levels of
interventions. The Individuals with Disabilities Education
Act (IDEA) 2004 introduced Response to Intervention (RtI),
which was intended to ensure that children with learning and
Chapter 6
behavior problems were not referred to special education

because of lack of adequate instruction or support within the
general education classroom. RtI evolved into a more holis-
tic, problem-solving approach know as Multi-Tiered System
of Supports (MTSSs). While each state or education system
may approach RtI/MTSS differently, the general purpose
is the same: to provide a prevention-oriented, systematic
process of delivering interventions based on demonstrated
levels of need. This multitiered approach continues to evolve
within current general education and special education pol-
icy including the Every Student Succeeds Act (ESSA, 2015)
and the developing reauthorization of IDEA. The hallmark
of MTSS is its focus on evidence-based practices that are
FIGURE 6–1 Educational model of APD. (From Colorado monitored for effectiveness and result in high-quality, in-
Department of Education, Exceptional Student Leadership Unit, dividualized instruction at three different levels. A detailed
Guidelines for educational evaluation and intervention of auditory pro- description of the RtI/MTSS model can be found at the RtI
cessing deficits [2019 revision in process]. Used with permission.) Action Network website (http://www.rtinetwork.org).

Students with APD are generally referred for con- Further, sufficient support must be available to the gen-
cerns involving learning, behavior, or speech and language, eral education teacher who is responsible for implementing
which are interfering with academic progress. These stu- the strategies to assure that the fidelity (e.g., quality, of im-
dents would likely proceed through the RtI/MTSS process plementation) is sufficient to conclude that the intervention
in their school before being referred to special education failed rather than how it was implemented.
and, hence, the APD evaluation. Considerations include data
that are already collected through the RtI/MTSS process and
whether the parent has requested an evaluation. If a parent
requests an evaluation, the school needs to either proceed IMPLEMENTING A SCHOOL-BASED
with the evaluation or decline the request by issuing a prior APD PROGRAM
written notice that provides the parents with a response and
a reasonable period of time to address their concern. Gen- Designing and implementing a process for APD assessment
erally, APD assessment would occur as part of the special and intervention requires good planning. A useful strategy
education referral process rather than the RtI/MTSS process. is to design the plan, conduct trial implementation, and then
Because audiologists are not usually routine members of the review the process and make revisions. The following steps
building team, it is helpful for them to provide the team will help to guide you through this process.
information about common symptoms of APD, possible
management strategies that could be implemented under
RtI/MTSS, as well as referral criteria. These areas will be Step 1. Developing the APD
discussed again under designing APD programs. Team and Philosophy
Appendix 6–J contains an MTSS model as it might This is the time to gather your colleagues in speech-language
be adapted for students with APD (Colorado Department pathology, school psychology, and learning disabilities. You
of Education, 2008). Each tier provides successively more might start by discussing professional perspectives to begin
intense interventions. The universal level contains strategies to develop a philosophy that will guide your planning. For
that could be applied to all students with APD concerns; ap- example, examine professional practices within audiology,
proximately 80% to 90% of students respond positively to speech-language pathology, and school psychology. Con-
these strategies and require no additional intervention. The sider your occupational therapist to understand the connec-
targeted level addresses students who are at risk and who tions with sensory processing disorders and your school
are not making expected academic progress. Supports at this nurse for medical and developmental areas. Gain consensus
level may be individual or group based and address 5% to on an educational model of APD that the entire team can get
10% of the student population. The third tier provides the behind. Developing an FAQ (Frequently Asked Questions)
most intensive interventions to the remaining 1% to 5% of about APD serves to document the shared understanding of
students. These interventions are individualized to the needs the team on a variety of issues including what APD is, how
of each student, and the student’s progress is monitored fre- it is assessed, how students are eligible for special educa-
quently so that adjustments can be made or additional as- tion with APD, and what interventions are available to ad-
sessment conducted. Students with IEPs, Section 504 plans, dress APD. Once everyone is comfortable with the topic and
and other learning supports are located throughout the tiers agrees on the need for an APD assessment process, proceed
of this model based on each of their individual needs. The by identifying your purpose and developing a plan com-
Chapter 6
examples of interventions for students with APD at the uni- plete with activities and timelines. The plan should include
versal and targeted levels may or may not be the result of activities to build awareness of APD, identification indica-
an APD assessment. Assessment may only be necessary if tors, screening and assessment procedures, and management
these interventions are not providing sufficient supports for considerations. These activities should minimally encom-
students to be successful in their educational programs. pass audiology, speech-language pathology, and cognitive
Issues with the MTSS model that need to be considered domains. Be sure to identify resources, specifically tests and
include the following: other materials, that are necessary to implement your plan.
The steps described in the following sections will primarily
■■ What kind of information is needed to clarify the stu- pertain to the audiologist’s role in this process.
dent’s problem?
■■ Who should be involved in determining the interven-
tions at the various levels? Step 2. Referral and Screening
■■ How many interventions need to be applied before a Referral and screening may begin with building awareness
student moves to the next level of interventions and ul- regarding typical behaviors associated with APD. Behaviors
timately a referral for special education? common in children with APD are listed in Table 6–1. Chil-
■■ How long should each intervention be applied? dren rarely display all of these behaviors, but it is likely they
■■ How should student progress be monitored? will exhibit several of them.

186 Chapter 6
TABLE 6–1 Characteristics of Children With Auditory Processing Deficits

Reported difficulties:
■■ Following or understanding speech
In noisy situations
In poor acoustical situations (e.g., reverberant)
When the signal is fast or degraded (e.g., phone)
In the absence of multisensory supports
■■ Localizing the source of a signal
■■ Comprehending messages that rely on tone of voice such as sarcasm or humor
■■ Singing or appreciating music (e.g., nursery rhymes)
■■ Learning new or complex languages
Resulting in:
■■ Delayed, inconsistent, or inappropriate responses in oral communication situations
■■ Requests for repetitions (saying “huh” or “what” often)
■■ Trouble following complex auditory directions
■■ Inattention or distractibility in listening situations
■■ Poor performance on auditory-dependent multidisciplinary tests/subtests (e.g., receptive language, phonology)
■■ Associated academic difficulties in reading, spelling, and/or learning
Note. From Colorado Department of Education, Exceptional Student Leadership Unit, Guidelines for Educational Evaluation and Intervention of Auditory Processing
Deficits (2019 revision in process). Used with permission.
Students are often referred by concerned parents or an- includes a list of common questionnaires for APD. Audiolo-
other member of the educational team, most often an SLP. gists often use these questionnaires as an initial part of the
Educational audiologists can use the list of behaviors pro- referral process to begin sorting out auditory-specific behav-
vided in Table 6–1 to educate parents and teachers about au- iors in relation to other areas of functioning. Questions that
ditory processing and APDs and to encourage the referral of should be discussed as a result of this screening information
children with listening difficulties for further consideration. are as follows:
The first step in this process must be a more formal hearing
1. What behaviors does the student exhibit which may be
screening to rule out peripheral hearing loss. Once hearing
indicative of or associated with APD?
loss is ruled out, the use of teacher and parent questionnaires
2. How is the student responding to intervention strategies?
can be used to address the child’s processing concerns. These
3. Is further assessment warranted? Would it change the
questionnaires usually probe auditory behaviors related to
interventions for this student? If so, what domains
academic achievement, listening skills, and communication.
(audiological, speech-language, cognitive, behavioral)
The use of questionnaires should be considered subjective
should be assessed?
with the purpose to gather observational data only. Available
Chapter 6
4. What factors need to be considered for further assess-

behavioral checklists include items that are not restricted to
ment (e.g., age, cognitive status, speech/language com-
APD, and several studies have found no correlation between
petence/English language proficiency, attention)?
parent and teacher report on APD or listening questionnaires
and diagnostic performance on APD tests. Appendix 6–A Referral Considerations
An important part of the APD assessment process is consid-
ering personal factors of the student being referred in order
to determine appropriateness of the referral as well as val
idity of auditory test results. Behavioral assessment of audi-
Nuggets from the Field tory processing requires a basic level of ability to participate
in the assessment including being able to understand the task
When examining behaviors and other reported requirements. Audiologists are cautioned to use professional
concerns, it is helpful to differentiate whether they judgement for the following considerations and to clarify
are primarily seen in the auditory modality com- modifications in test procedures and/or interpretation of re-
pared with other modalities such as visual, tactile, sults in the report.
and so on. ■■ Peripheral hearing: hearing acuity must be normal, or
the child must be cleared by an audiologist prior to con-

sidering testing for auditory processing. Some tests do In addition to these referral considerations, the school
allow for some accommodation for hearing loss; how- team should consider current RtI/MTSS interventions and
ever, in general, loss of audibility in the form of periph- subsequent academic and behavioral performance results
eral hearing loss will confound the already complex task and data obtained by other team members. Based on this
of identification of APD in children and may not result body of evidence, the team may decide to continue with
in added value to an intervention plan. RtI/MTSS interventions and progress monitoring or pro-
■■ Age of the child: screening is generally most appropriate ceed with a referral for assessment. Assessment areas (e.g.,
for children 3 to 6 years of age, assessment beginning at speech-language, psychological, educational, or other)
7 or 8 years; age criteria recommended with each screen- should also be determined at the time the referral is initiated.
ing or assessment instrument should be followed. An A sample referral form for APD assessment is in Appen
age criterion is important as it reflects the developmental dix 6–B. Use of a form such as this ensures that the referral
component of the central auditory pathways and resulting process is well understood by all team members and that
developmental abilities of the child. There is some dis- referral practices are consistent from team to team. It also
agreement among professionals whether children under helps to control the number of referrals by requiring a for-
the age of 7 years should be assessed for APD. While mal referral process.
there are APD assessments available for younger ages,
interpretation of the results using a multidisciplinary ap- Screening
proach may not be readily accessible. Screening instru- Having a plan or process in place at the screening level al-
ments or observation tools may be more appropriate for lows the audiologist and educational team to appropriately
young children with potential auditory processing prob- identify those students who would benefit from further di-
lems and may guide the use of intervention strategies and agnostic testing. Identifying which students are appropri-
future assessment recommendations. ate for screening and assessment should begin with a dis-
■■ Cognitive ability: formal assessments of central audi- cussion of screening tools. Through the RtI/MTSS model,
tory processing are normed on individuals who have these screening tools might be used by any member of the
cognitive ability within a normal range; the assessments school team. In addition to screening, general intervention
impose varying degrees of cognitive load during the suggestions can be made available to teachers for those stu-
testing (e.g., on working memory and attention). Stu- dents who might be suspected of having an APD. Screen-
dents suspected of having certain cognitive deficits may ing tools, as discussed in this chapter, do not require parent
be considered candidates for an auditory processing as- permission because no procedure is being conducted with
sessment after careful consideration by the audiologist. the student. APD screening tests include stand-alone screen-
In order to rule out or to identify scattered weaknesses, ers such as the Differential Screening Test for Processing
a cognitive assessment is highly recommended prior to (DSTP), which can be given by the audiologist, SLP, or
the consideration of an APD referral. another trained professional. Portions of several of the di-
■■ Language competence: language skills can significantly agnostic APD assessments such as the MAPA-2, SCAN-3,
impact performance on auditory processing tasks, par- and Feather Squadron contain screening subtests that can
ticularly those which require higher-level language be used to determine whether additional diagnostic testing
processing. Results must be interpreted carefully, and is warranted. In cases where questions arise from referral
extra caution is recommended with nonnative English- considerations (such as age, attention, etc.), use of a screen-
Chapter 6
speaking students. ing tool is useful in determining next steps. Appendix 6–D
■■ Comorbid conditions: children with auditory process- includes various APD screening tools.
ing deficits share many behavioral characteristics with
other conditions, particularly ADD/ADHD, language
disorders, and learning disabilities. While these condi- Step 3. Assessment for APD
tions may coexist, the auditory processing problem is Setting up the assessment portion of the APD program in-
not the result of these problems (ASHA, 2005). It is cludes several components including the case history, de-
important to try to sort out the behaviors associated with velopment of an assessment protocol, test administration
these conditions so that an accurate diagnosis can be considerations, and test interpretation.
made and to ensure the interventions are targeted to the
problem and analyzed for their impact on the auditory Case History
processing problem. As with the assessment of any hearing condition, the assess-
■■ Speech intelligibility: significant speech intelligibility ment of APD should begin with a complete case history.
problems can affect administration and interpretation The history will help the educational audiologist focus on
of auditory processing test results. If reasonable accom- the immediate concerns of the parents and the teachers, will
modations cannot be implemented, auditory processing provide information that will supplement the more formal
assessment may not be appropriate until a later time. audiometric tests, and will prove invaluable in determining

188 Chapter 6
recommendations concerning the child’s educational manage- cit. In some cases, this referral should precede CAP
ment. Although many of the questions in the history interview testing to ensure accurate interpretation of test results.
will be similar to those discussed in Chapter 5, Assessment, Comorbid diagnoses may preclude CAP testing (e.g.,
the educational audiologist should also obtain information on significant intellectual deficit, severe hearing loss).
the child/youth’s communication, listening and auditory be- ■■ Test findings should be corroborated by relating them to
havior, psychological factors, social background, educational the individual’s primary symptoms or complaints (e.g.,
achievement, and current educational and therapy services. difficulty hearing with the left ear versus the right ear,
Appendix 6–C contains a sample case history form. difficulty understanding rapid speakers, difficulty hear-
ing in the presence of competing noise).
Developing an Audiological APD Assessment Protocol Assessments that test central auditory processing skills
There are many audiological tests that have been designed are either behavioral or electrophysiologic. Behavioral tests
to test auditory processing skills. A test battery approach is are the primary type of tests available in the school setting
necessary to assure that the full range of auditory processes and are the most helpful for assessing functional capabili-
is evaluated across the regions and levels within the CANS ties of the auditory system. Typically, behavioral tests are
so that deficits and patterns of deficits can be identified. The organized by the type of test or method of administration
ASHA practice portal outlines the following principles that (monaural, dichotic, etc.), and best practices suggest using
must be considered when developing an assessment protocol. a variety of tests to assess multiple areas of auditory pro-
cessing. A simplified approach, as pictured in Figure 6–2,
■■ The test battery process should not be test driven; rather,
categorizes APD assessments into three processing or skill
it should be motivated by the referring complaint(s) and
areas: binaural, temporal, and speech (Colorado Department
the relevant information available to the audiologist.
of Education, 2019; Rawool, 2016, 2018).
■■ A central auditory test battery should include measures
that are sensitive to the integrity of the CANS.
■■ Tests should examine different central processes, tasks, Binaural Processing Tests Binaural tests examine and
and the integrity of multiple levels and regions of the compare the interaction between left and right ears. Binaural
CANS. tests may include speech or nonspeech stimuli and assess
■■ Most available behavioral central auditory tests are aspects of spatial hearing such as sound localization and
more appropriate for administration to children 7 years lateralization. The most commonly used binaural tests assess
of age and older due to the challenging nature of the dichotic listening—or listening to different information being
tasks and considerable performance variability. presented to each ear simultaneously. Dichotic listening
■■ Communication checklists, language tests, and cogni- skills are important when listening in noisy environments
tive tests can be used to identify younger children that or when auditory distractions are present. The listener must
may be “at risk” for auditory difficulties (Moore et al., be able to put the stimuli from two ears together (integrate)
2013). A diagnosis should be withheld until formal test- or ignore one ear while listening to the other (separate).
ing can be completed. Dichotic tests assess various levels of the central auditory
■■ Tests should generally include both nonverbal and verbal nervous system (CANS) as well as cortical and corpus cal
stimuli to examine different aspects of auditory process- losum functioning.
ing and different levels of the auditory nervous system.
Chapter 6
■■ Individuals who are medicated successfully for atten-

tion, anxiety, or other disorders that may confound test Temporal Processing Tests Temporal tests use nonspeech
performance should be tested under the influence of stimuli to examine the CANS’ ability to recognize both
their medication.
■■ Neuromaturation, subject state, and cognitive factors
may affect the outcomes of many electrophysiologic pro-
cedures when used with children younger than 10 years
of age. These measures need to be administered and in-
terpreted accordingly.
■■ The duration of the test session should be appropriate to
the individual’s attention, motivation, and energy level.
Organizing and administering tests by process-
As with all behavioral tests, it is important to monitor
ing domain can help to clearly identify specific
the individual’s level of attention and effort and to take
deficit areas, relate them to behavioral indicators,
steps to maintain motivation throughout testing.
and aid in the recommendation of deficit-specific
■■ Referral to the appropriate professional(s) should be
interventions.
made when there is a suspected speech or language im-
pairment or intellectual, psychological, or another defi-

FIGURE 6–2 Auditory processing domains. (Adapted from Rawool, 2018; Colorado Department of Education, Exceptional Student Lead-
ership Unit, Guidelines for educational evaluation and intervention of auditory processing deficits [2019 revision in process]. Used with
permission.)
timing and sequencing of auditory stimuli. Gap detection Table 6–2 provides a summary of common behavioral
tests assess temporal resolution, and patterning tests (pitch assessments used for APD evaluation organized within this
and duration) assess ordering/sequencing of auditory stimuli. processing domain framework. This list is not exhaustive,
Pitch pattern tests also assess frequency discrimination. and audiologists should update such a list as new tests be-
Temporal processing skills underlie almost every aspect of come available. It is not expected that educational audiolo-
listening as analyzing acoustic events happens within a time gists have all assessments listed but rather that there are suf-
window and contributes greatly to perception of rhythm, ficient tests to assess each of the skill areas. Many of the
stress, and intonation, the prosodic (nonverbal) aspects of most widely used APD assessments come within a battery
Chapter 6
speech. of tests such as the SCAN-3 and the MAPA-2. A new APD
assessment, Acoustic Pioneer’s Feather Squadron, is admin-
Speech Processing Tests Speech tests ask the listener to istered via an iPad app that presents assessments through a
perceive words and sentences that are not quite clear. Speech- game format that is quick and motivating for students. Re-
in-noise tests add varying types and levels of background sources for purchasing assessment materials are provided in
noise to the stimulus and may be administered to one (mon Appendix 6–D.
aural) or both ears under headphones or in the sound field. Electrophysiological tests of auditory evoked responses
Many of these tests were not necessarily developed to assess (AERs) from the auditory brainstem response (ABR) are not
the integrity of the CANS; however, they are useful, norm- readily available in educational settings but may be accessed
referenced tools to examine auditory figure-ground skills, through university or hospital audiology clinics and centers
which are important for listening in the classroom. Other when additional information is needed. These assessments
speech tests feature degraded speech, where a portion of the may provide information about the integrity of the central
word has been filtered out or the sentence has been time auditory system through examination of the neuromatura-
compressed, and these assess auditory closure skills. Speech tion and neuroplasticity of the central auditory pathways.
tests are more linguistically “loaded” than the other types of The application of using electrophysiological assessments
auditory tests and are therefore highly dependent on the in APD assessment is an ongoing area of investigation and
listener’s language abilities. not routinely used outside of the research setting.

190 Chapter 6
TABLE 6–2 Summary of Common Behavioral Audiological Tests of Auditory Processing
BINAURAL Processing Tests
Dichotic Sounds Competing Environmental Sounds Test (Precision Acoustics)

Feather Squadron: Dichotic Single and Double Sounds (Acoustic Pioneer)
Dichotic Digits Dichotic Digits (Auditec, MAPA-2)
Feather Squadron: Dichotic Double Words (Digits) Subtest (Acoustic Pioneer)
Dichotic CVs Dichotic Consonant Vowel Test (Auditec)
Dichotic Words Staggered Spondaic Words “SSW” (Precision Acoustics)
SCAN-3: Competing Words Free Recall and Directed Ear Subtests (Pearson, Auditec)
Feather Squadron: Dichotic Words (Colors) Subtest (Acoustic Pioneer)
Dichotic Word Listening Test (Auditec)
Dichotic Sentences Competing Sentences (SCAN-3; Auditec, MAPA-2)
Dichotic Sentence Identification Test (Auditec)
Localization, Lateralization, Listening in Spacialized Noise–Sentences Test “LiSN-S” (Phonak)
and Interaction Feather Squadron: Speech in Noise with Localization Cues Subtest (Acoustic Pioneer)
Feather Squadron: Lateralization Subtest (Acoustic Pioneer)
Masking Level Difference “MLD” (Auditec)
TEMPORAL Processing Tests
Gap Detection Random Gap Detection (Auditec)

Gaps in Noise (Auditec)
SCAN-3: Gap Detection Screening (Pearson, Auditec)
Feather Squadron: Rapid Tones Subtest (Acoustic Pioneer)
Frequency and Duration Patterns Frequency (Pitch) Patterns (Auditec, MAPA-2, Pro-Ed/DSTP)
Feather Squadron: Tonal-Pattern and Rapid Tones Subtests (Auditec)
Duration Patterns (Auditec, MAPA-2)
SPEECH Processing Tests
Speech-in-Noise SCAN 3: Auditory Figure Ground Subtests (0, 8, 12 dB) (Pearson, Auditec)
Feather Squadron: Speech-in-Noise Subtest (Acoustic Pioneer)
Pediatric Speech Intelligibility Test “PSI” (Auditec)
W-22 in Noise (Precision Acoustics)
Words in Noise Test “WIN” (Auditec)
Chapter 6
QUICK and BKB-SIN (Auditec)

Selective Auditory Attention Test “SAAT” (Auditec)
Monaural-Selective Attention Test (MAPA-2)
Speech-in-Noise for Children (MAPA-2)
Auditory Discrimination (Pro-Ed/DSTP)
Filtered Speech NU-6 Low Pass Filtered Speech (Auditec)
SCAN 3: Low Pass Filtered Speech Subtest (Pearson, Auditec)
Time Compressed Speech Feather Squadron: Rapid Speech Subtest (Acoustic Pioneer)
SCAN 3: Time Compressed Sentences Subtest (Pearson, Auditec)
NU-6 Time Compressed (30% and 60%) (Auditec)
NU-6 Time Compressed + Reverberation (Auditec)
Time Compressed Sentence Test (Auditec)
Note. Adapted from Colorado Department of Education, Exceptional Student Leadership Unit, Guidelines for educational evaluation and intervention of auditory process-
ing deficits (2019 revision in process). Used with permission.

Test Administration Considerations to provide management recommendations based on the

Prior to administering APD assessments, an evaluation of behavioral characteristics of the child and to monitor the
peripheral hearing should be performed including pure-tone, child’s behavior frequently in response to them. If concerns
speech, and electroacoustic tests. Ruling out peripheral hear- continue, assessment should be completed when the child
ing problems assures that behavioral complaints are not a reaches age 7 years.
result of undiagnosed hearing loss of some type.
Once the assessments of the APD protocol are estab- Non-English-Speaking Children Several tests have been
lished, the audiologist then selects specific tests within each standardized in other languages. However, there are often
processing area based on the age and presenting concerns significant language differences when those tests are used
of the child/youth being assessed. In addition, the following in the United States. It is therefore best to use tests with
areas should be considered: nonverbal stimuli when assessing the auditory processing
skills of children who have limited proficiency in English. The
■■ Validity and reliability: norms for tests used must be results of these tests may not provide a complete auditory
reviewed and considered. Caution must be used in in- processing assessment, but they may provide information
terpretation since some of the measures have limited useful in documenting and managing the child’s listening
normative data for children and may require that local difficulties.
norms be developed.
■■ Administration issues: ease of administration, adminis- Children With Peripheral Hearing Differences Most of
tration time, availability of needed equipment, and the the auditory processing tests are not normed for administration
acoustic environment may dictate which assessments to children with peripheral hearing losses, making it difficult
are used. to assess the auditory processing skills of these children.
■■ Test interpretation and scoring: test manual proce- In cases of mild, or mild to moderate, reduced hearing levels
dures and interpretation must be adhered to and con- with similar thresholds across frequencies, the educational
sidered along with the results of the multidisciplinary audiologist can administer tests that are not significantly
assessment. affected by peripheral hearing loss. The Dichotic Sentence
■■ Motivation, fatigue, and emotional status: significant Identification (DSI), a modification of the Synthetic Sentence
test variability can occur based on these factors; when Identification (SSI), contains norms for individuals with
either is suspected, repeat assessment may be necessary hearing loss. Dichotic digits and pitch and duration pattern
to determine the reliability of the test responses. tests may also be useful. For unilateral hearing loss, it is
■■ Attention and/or distractibility: in addition to the same possible to administer monaural tests to the normal hearing
considerations for motivation and emotional status, test ear. The experienced clinician may be able to infer information
modifications may be necessary to ensure that the stu- about the student’s processing skills by looking at the results
dent is attending for each test item; any test modifica- of monotic tone tests obtained at frequencies when the
tion should be noted on the protocol and must be taken hearing sensitivity is normal or by looking for asymmetries
into consideration in the test interpretation. in results of the two ears when the peripheral hearing loss
■■ Multidisciplinary assessment: auditory process- is symmetrical. It must be recognized that the assessment
ing assessment should not occur in isolation from provided for students with reduced peripheral hearing will
other speech-language, psychoeducational, or other be incomplete, but the information obtained can assist in doc
Chapter 6
evaluation. umenting auditory problems in addition to the peripheral hear
ing status and can lead to improved management of the child’s
APD Assessment in Atypical Populations auditory problems.
Young Children Some tests for assessing auditory process
ing skills provide normative data for children as young as Supplemental and Multidisciplinary Tests of Auditory
3 years of age. Because of the extreme variability of normal Processing When necessary, the audiologist may incor
auditory development in children below the age of 7 years, porate several additional tests to supplement the APD bat
young children who are suspected of having an APD often tery. The areas of attention and auditory memory are worth
score within the normal range on these tests. As a result, noting because they should be part of the APD protocol.
it may be difficult to diagnose APD adequately in children Typically, attention abilities are examined from a behavioral
younger than 7 years. When asked to determine if a young perspective and most often by the school psychologist
child has an auditory processing problem, the educational using parent and teacher questionnaires. The audiologist,
audiologist can administer one or more of the tests that however, may choose to use the Auditory Continuous Per
have age-appropriate normative data, but the possibility formance Test (ACPT) to examine attention specific to the
of identifying an APD should not be ruled out if the test auditory modality. Likewise, auditory memory is often exam
results are normal. If the parents and/or teacher have strong ined from a cognitive or linguistic perspective by the psy
concerns about the child’s auditory skills, it is advantageous chologist or SLP; however, several subtests of the TAPS-4

192 Chapter 6
■■ listening in noise and distance conditions as well as

without visual access to the speaker (consider a Func-
Nuggets from the Field tional Listening Evaluation “FLE,” see Appendix 5–H);
■■ cooperation and willingness to perform both easy and
difficult tasks;
The purpose of a cognitive evaluation in APD as-
■■ response to frustration;
sessment is generally not to obtain a formal IQ
■■ need for praise and encouragement in order to complete
score. Cognitive evaluations instead offer valuable
a task; and
information into other processing areas such as
■■ acoustic characteristics of the listening and learning
visual, nonverbal, and working memory, which is
environments.
crucial in the interpretation of the audiologist’s
APD assessment.
Test Interpretation
As stated previously, ASHA (2018) recommends that the cri-
teria for an AP disorder be determined based on test perfor-
mance that is at least two standard deviations below the mean
on two or more tests of the battery or that the performance
do the same and may be given by the audiologist instead.
on one test is three standard deviations or more below the
If reading concerns are present, it is imperative to assess
mean when the performance is accompanied by significant
phonemic and phonological skills that can be done with
functional difficulty. In the latter situation, it is also impor-
a variety of tests by a variety of professionals. Regardless
tant to reassess the area in question to rule out attention and
of which professional conducts the assessment, multidis
other confounding variables that might have influenced test
ciplinary tests should be chosen based on the referring
performance. Therefore, assessment results meeting one of
complaints. Appendix 6–E contains a list of common linguistic,
these requirements lead to the identification of an AP disorder.
cognitive, and educational assessments for this purpose.
Consideration of the results of all disciplines involved
in the assessment is also critical to test interpretation and
Observation of the Student A final consideration for test overall functional status of the student. The sample APD
administration is the opportunity for observation of the student profile located in Figure 6–3 provides an illustrative method
in their classroom or customary environment. During formal for quantifying and analyzing test performance across these
assessment, we observe the student’s behaviors. Although this domains (Appendix 6–F contains a blank form). In addi-
observation is done in a very structured situation, it may provide tion to the test results that show the student’s strengths and
clues to why the student is having difficulty in the classroom weak areas, the visual representation helps ensure that all
and may lead to suggestions for classroom management. In areas have been evaluated and that sufficient information
addition, the educational audiologist will find it helpful to is available to respond to eligibility determination. For the
observe the student in the classroom and other settings when student represented in this case, the profile shows significant
this is possible. This observation can be structured with the use AP issues confounded by attention deficits, phonemic delays
of questionnaires such as the Children’s Auditory Performance and mild language delay, average to above average cogni-
Scale (CHAPS) (Smoski, Brunt, & Tannahill, 1998). Behaviors tive ability with significantly higher nonverbal skills, and
the educational audiologist should observe include
Chapter 6
academic deficits in reading and language. No emotional or

■■ attention span for both structured and unstructured social concerns were identified.
tasks; As a result of the assessment, the following questions
■■ comprehension and following directions; should be discussed:
1. Based on the multidisciplinary assessment, what are the
student’s strengths and needs related to listening?
2. Does the severity of the deficits qualify this student for
special education?
3. What are the specific characteristics of the AP deficit?
Nuggets from the Field 4. What are the services and accommodations that might
be needed by this student (for special education eligible
Qualitative information from a classroom obser-
students, determination of services is made by the IEP
vation can be as informative as the test scores
team)?
themselves and may fill in gaps about a student
5. What are the specific interventions recommended for
when test administration is compromised due to
this student (e.g., classroom management, accommoda-
attention, motivation, and other behavioral factors.
tions including hearing assistance technology, instruc-
tional modifications, direct speech-language services)?

Chapter 6
FIGURE 6–3 Sample auditory processing assessment profile.
APD Profiles A popular method of analyzing the AP interpretation is to examine test results within each of the
results is through patterns of deficits. Models have been processing areas and look for patterns of deficits that indi-
developed by Bellis and Ferre (Bellis, 2003), Katz, Smith, cate weaknesses within that area. This type of analysis
and Kurpita (1992), and Medwetsky (2002), among others. will allow for deficit-specific interventions to be imple-
The purpose of these profiles is to aid in the interpretation mented as well as to help parents and other profession-
of auditory processing and related assesments in order to als better understand the complexitites of central auditory
facilitate development of an individualized, comprehensive, processing.
management plan that addresses the student’s functional
deficits. While some student performance profiles will fit
neatly into these models, many will not, making it challeng- Step 4. Eligibility for Services
ing for the audiologist to interpret test results when using Eligibility is a two-part consideration: first, is there evidence
the profiling method. An alternate, simplified approach to of an auditory processing deficit, and second, does it cause

194 Chapter 6
IDEA Eligibility Categories for Students With APD

Specific learning disability [34CFR300.8(10)] ing, or motor disabilities, of mental retardation, of emo-
tional disturbance, or environmental, cultural, or economic
(i) General. The term means a disorder in one or more
disadvantage.
of the basic psychological processes involved in under-
standing or in using language, spoken or written, that Speech or language impairment [34CFR300.8(11)]
may manifest itself in an imperfect ability to listen, think, means a communication disorder, such as stuttering, impaired
speak, read, write, spell, or to do mathematical calcula- articulation, a language impairment, or a voice impairment,
tions, including conditions such as perceptual disabilities, that adversely affects a child’s educational performance.
brain injury, minimal brain dysfunction, dyslexia, and de-
Other health impairment [34 CFR 300.8(c)(9)]
velopmental aphasia.
means a chronic or acute health problem that results in lim-
(ii) Disorders not included. The term does not include learn-
ited alertness with respect to the educational environment
ing problems that are primarily the result of visual, hear-
and that adversely affects a child’s education performance.
an adverse effect on learning sufficient for the student to meet education, the areas where accommodations will be neces-
eligibility requirements for special education and related ser- sary to assist the student, and then a detailed list of the ac-
vices. Since there is not a federal category of disability for commodations and services that will be provided. Appen
auditory processing, part of eligibility also includes identify- dix 6–G contains a checklist of common accommodations
ing the type of disability under which the student qualifies. and modifications for students with APD. This checklist can
In most states, the disability areas are either speech-language be attached to the IEP or the Section 504 plan. Plans should
impairment (SLI) or specific learning disability (SLD). Re- be reviewed periodically, but there are no specific require-
cent court precedent has also indicated that the category of ments specifying review timelines (see Appendix 11–E for
other health impairment (OHI), typically used for attention a sample Section 504 plan).
deficit disorders, can also include auditory processing defi-
cits (McCarty, 2014). Members of the multidisciplinary team
should be familiar with the criteria under each category, as Step 5. Intervention
well as recommended practices within their state, in order to The development of an APD program is not complete with-
make the most appropriate determination. Parents should also out provisions for intervention for the students who are iden-
be aware of these categories so that they understand how AP tified. “The overall goal of intervention is to provide the
applies within them. See the Text Box for these IDEA 2004 individual with the ability to communicate more effectively
federal definitions. Once eligibility is determined, develop- in everyday contexts (e.g. home, classroom) . . . and requires
ment of the IEP is completed by the IEP team for the student. an analysis of functional deficits and specific recommenda-
Chapter 6
Some children with auditory processing disorders or tions for change across settings” (ASHA, 2018). Interven-
deficits may not demonstrate sufficient impact on education covers the broad category of services a student receives
tional performance to meet state eligibility requirements. as part of their IEP or Section 504 plan as a result of an
In such cases, consideration of accommodations under Sec APD or other concurrent disorders affecting learning. Some
tion 504 (Rehabilitation Act of 1974) should be made. Sec of these services might also be provided as part of the RtI/
tion 504 prohibits discrimination against any person with a dis- MTSS series of interventions. Intervention can be provided
ability, including students in public schools, if that program using two basic methods: (a) direct services delivered on an
receives federal funds. The act defines a person with a dis- individual or small group basis to address auditory process-
ability as anyone who: ing deficits from both a bottom-up (auditory skill building)
and top-down (self-management and other compensatory
Has a mental or physical impairment that substantially skills) approach; and (b) indirect interventions designed to
limits one or more major life activities (major life activi enhance the message or mitigate a poor listening environ-
ties include activities such as caring for one’s self, per ment. By considering the individual listener, the message,
forming manual tasks, walking, seeing, hearing, speak and the environment, an intervention plan can offer a holis-
ing, breathing, learning, and working). tic approach to managing APD in the school setting. For a
comprehensive discussion of APD interventions, the reader
Eligibility for Section 504 is established in a meeting is referred to Geffner and Ross-Swain’s Auditory processing
that determines the condition and its impact on the student’s disorders: Assessment, management, and treatment (2019).

Direct Student Services Computer-based auditory training programs are an effec-

Most direct treatment for APD can be classified as one of tive way to meet the rigors necessary to affect change in the
two types: auditory system. These bottom-up auditory training activities
are controlled and adaptive while also being fun for the stu-
■■ skill-building activities (“bottom-up” skills) or dent and easy to administer and track for the professional or
■■ compensatory strategies (“top-down” skills). parent. Students of all ages can work through a series of com-
Direct activities and services should be targeted to those puter games designed to exercise their listening in those areas
areas of deficit identified in the APD and multidisciplinary of auditory need identified in their APD assessment. Most
assessment. A “process-based” remediation plan will match programs are web-based and come with an associated cost.
specific activities such as dichotic listening training or tem- The growing availability of laptops and tablets in the class-
poral processing training to the areas of need identified in the room as well as the use of skill-building computer programs
APD assessment. In addition, if a student has identified weak- in general should increase the likelihood that schools can
nesses in higher-order skills related to accessing auditory in- offer some of these specific listening programs for students
formation, direct services could include training in areas such identified with auditory processing deficits. For a brief descrip-
as problem-solving, active listening, or vocabulary building. tion of current computer-based programs, see Appendix 6–H.
Typically, the SLP and/or special education teacher will
provide most of the direct services identified through the IEP Compensatory Strategies (Top-Down) In order to in
process. Many of the activities may be written as goals and ob- crease the ability to access auditory instruction, students can
jectives on the student’s IEP and thereby be closely monitored benefit from being taught specific compensatory strategies
for progress and effectiveness. Audiologists may or may not to strengthen higher-order central resources (e.g., language,
provide direct services in the school setting, and which profes- memory, and attention). Appropriate compensatory strategies
sional delivers the services will vary from school to school. should be identified for each student with APD, and when
appropriate, the student should be involved in this discussion
Skill Building Activities (Bottom-Up) Skill-building so that the student understands the problem and learns ways
activities seek to improve specific auditory skills by providing to help himself or herself. Training in these aspects can be
intensive repeated practice of the skills. This “auditory considered formal and linked to specific IEP goals or may
training” is based on the premises of brain plasticity and be informally taught such as during a study skills or resource
cortical reorganization. Training activities may be considered class. Either way, students should be provided with structured
informal such as in the case of therapist-directed listening tasks, practice in the understanding and use of which strategies are
or formal such as with the growing selection of computer- most helpful and in which environment.
based programs. Whether informal or formal, Musiek, Chermak, Compensatory strategies identified in the ASHA prac-
and Weihing (2007) identified several important principles of tice portal include metalinguistic and metacognitive strate-
auditory training: gies as well as language and curricular-based interventions.
■■ Materials need to be appropriate for age and language Following are a few examples that are designed as “top-
abilities of the students. down” supports for processing auditory information:
■■ Motivation needs to be developed and maintained ■■ metalinguistic strategies include use of graphic organiz-
throughout the training exercises. ers, phonological awareness, context to build vocabu-
Chapter 6
■■ Tasks need to be varied to increase and broaden perfor- lary and active listening techniques;
mance gains. ■■ metacognitive strategies include organization skills,
■■ Tasks should become increasingly difficult as a func- memory techniques (mnemonics, mind mapping), problem-
tion of the student’s performance; the degree of increase solving, and assertiveness training; and
should be monitored so that the steps are not too large to ■■ language and curricular interventions include language
cause frustration yet large enough to push performance. and vocabulary building specific to academic tasks or
■■ Balance the success-failure rate so that the student con- subjects, use of contextual and visual cues to support
tinues to be motivated in the program. understanding and how to organize incoming spoken
■■ Make sure that there is sufficient time devoted to the and written language to support processing needs.
training program to induce change.
■■ Provide the student with regular feedback regarding Indirect Interventions
their progress.
Indirect interventions in the form of accommodations in-
■■ Monitor the program to ensure that progress is being
crease the accessibility of the message as well as the envi-
made—auditory changes may be measured with psycho
ronment. Indirect interventions may also be both bottom-up
physical, electrophysiologic, and questionnaire methods.
and top-down and generally fall under two categories:
■■ Maintain control of acoustic stimuli used in the train-
ing, and ensure that they are comfortable for the student ■■ instructional strategies (top-down) and
(pp. 81–85). ■■ speech enhancement (bottom-up).

196 Chapter 6
Instructional Strategies (Top-Down) One of the most RM systems including personal and classroom audio distri-
common methods used by educational audiologists to bution systems (CADS) have been used to enhance students’
help accommodate students with APD is providing special abilities to attend in the classroom and are important strate-
strategies to the teacher for delivering instruction. Quite often gies to consider for children who have difficulty listening in
a list of suggested strategies is provided to the teacher as the noise. Any RM system should be provided for an initial trial
only recommendation for a student with APD. Although the period so that the student, teachers, and parents can assess
suggestions on the list are typically beneficial for the student, the benefit in the classroom before permanent use of the
teachers are often overwhelmed by the number of suggestions technology is recommended. Additionally, if a RM system is
and therefore do not consistently follow any of them. Since recommended, the audiologist should use a system that de-
we know that recommendations are only as good as how well livers the teacher’s voice with minimal amplification. Newer
they are implemented, the educational audiologist should RM systems also provide signal enhancement to improve
limit the number of classroom strategies or prioritize them to speech understanding in small and large group listening by
emphasize the most critical considerations. Once the teacher using advanced microphone technologies. Guidelines for
has incorporated these accommodations, others may be candidacy, selection, fitting, and managing HATs are dis-
added if necessary. cussed fully in Chapter 8, including protocols for assess-
The educational audiologist should select the most ben- ing benefit. The AAA Clinical practice guidelines: Remote
eficial accommodations based on the student’s APD testing microphone hearing assistance technologies for children
and functional classroom performance. By giving the teacher and youth from birth to 21 years (American Academy of Au
only three or four suggestions from the list, the educational diology, 2008) is an essential resource for fitting HATs on
audiologist can structure the accommodations to benefit the students with APD.
student. Self-esteem is a critical part of accommodating a As mentioned previously, it is often necessary to ob-
student, especially those with extra learning difficulties. serve in the classroom to determine what should be done
(See Chapter 10, Supporting Wellness and Social-Emotional to improve the student’s classroom environment. If noise
Competence, for more on this topic.) Encourage the teacher levels are a concern, the audiologist may also need to mea-
to be positive and supportive, to praise the student’s effort sure classroom noise levels and the reverberation time and
and successes, and to encourage participation in activities make suggestions for change. (See Chapter 7, Classroom
where the student has strengths and is expected to succeed. Acoustics and Other Learning Environment Considerations,
for more information on this topic.)
With the variety of interventions available for students
Speech Enhancement (Bottom-Up) Two “bottom-up” meth with APD, it is often difficult to know which strategies will
ods to improve accessibility of the auditory signal are the be most successful for which student. Quite often it is a
use of RM (remote microphone) HATs and modifications to combination of strategies that will be most beneficial. Un-
the acoustic environment. fortunately, the management of APD is often trial-and-error
RM HAT often provides significant benefit to students because the effects of specific recommendations are not
with auditory processing deficits in dichotic listening and known until they have been tried. It is therefore necessary
speech-in-noise. Because a common problem encountered for educational audiologists to work closely with teachers,
by children with APD is difficulty understanding in noisy parents, and service providers, as well as the students them-
environments, any technology that improves the signal- selves, to monitor the success of interventions and to alter
Chapter 6
to-noise ratio has the possibility of benefiting the student. or implement other strategies when necessary.
SUMMARY
It is obvious that diagnosis and management of students in emphasizing the most important points for educational
with APD is a perplexing task, but it is of great relevance to audiologists when establishing programs. Further read-
educational audiologists. Providing meaningful evaluation ing, attending workshops, and APD assessment experience
of APD takes time and requires a compilation of interprofes- will take the novice APD audiologist to a point of grow-
sional practices. Figure 6–4 contains a flowchart that suming comfort and satisfaction with the APD program that
marizes the collaboration in an educational APD assessment has been designed. With your team of colleagues, it is im-
and intervention model. portant to constantly review the outcomes of the program
There is a great deal of information in the literature you have established and make the necessary adjustments,
about APDs, often reflecting varying and contradicting view- especially as the body of knowledge of APDs continues to
points. This chapter has just skimmed the surface of APDs increase.

Chapter 6
FIGURE 6–4 Flowchart of educational model for auditory processing deficit assessment. (Colorado Department of Education, Excep-
tional Student Leadership Unit, Guidelines for educational evaluation and intervention of auditory processing deficits [2019 revision in process].
Used with permission.)

198 Chapter 6
SUGGESTED READINGS Canadian Interorganizational Steering Group for Audiology and

Speech-Language Pathology. (2012, December). Canadian guide
AND RESOURCES lines on auditory processing disorder in children and adults:
Assessment and intervention. Retrieved from https://www
American Academy of Audiology. (2010, August). Diagnosis, .sac-oac.ca/sites/default/files/resources/Canadian-Guidelines
treatment and management of children and adults with central -on-Auditory-Processing-Disorder-in-Children-and-Adults
auditory processing disorder [Clinical practice guidelines]. -English-2012.pdf
Retrieved from https://audiology-web.s3.amazonaws.com Chermak, G., & Musiek, F. (2014). handbook of (central) auditory
/migrated/CAPD%20Guidelines%208-2010.pdf_539952af95 processing disorder (Vol. 2). San Diego, CA: Plural Publishing.
6c79.73897613.pdf Colorado Department of Education. (2008). (Central) auditory pro
American Speech-Language-Hearing Association. (n.d.). Cen cessing deficits: A team approach to screening, assessment and
tral auditory processing disorder. (Practice portal). Retrieved intervention practices. Exceptional Student Leadership Unit.
from https://www.asha.org/Practice-Portal/Clinical-Topics Denver, CO: Colorado Department of Education. Retrieved
/Central-Auditory-Processing-Disorder/ from https://www.cde.state.co.us/sites/default/files/documents
Bellis, T. (2003). Assessment and management of centeral auditory /cdesped/download/pdf/apdguidelines.pdf
processing disorders in the educational setting. Clifton Park, Geffner, D., & Ross-Swain, D. (2019). Auditory processing disor
NY: Delmar Learning. ders: Assessment, management, and treatment (3rd ed.). San
British Society of Audiology. (2011). Practice guidance: An over Diego, CA: Plural Publishing.
view of current management of auditory processing disorder Musiek, F., & Chermak, G. (2014). Handbook of (central) auditory
(APD). Seafield, Bathgate, Westlothian, Scotland: Author. processing disorder (Vol. 1). San Diego, CA: Plural Publishing.
Retrieved from http://www.thebsa.org.uk/wp-content/uploads
/2017/04/APD-Position-Statement-Practice-Guidance-APD
-2017.pdf
Chapter 6

APPENDIX 6–A
Auditory Processing Deficit Screening Questionnaires
Screening for auditory processing deficits typically involves sess specific behaviors that can be associated with auditory
systematic observation of auditory behaviors related to aca- processing weaknesses. It is divided into six areas: Linguis-
demic achievement, listening skills, and communication. tic Organization, Decoding/Language Mechanics, Atten-
The following are questionnaires that have been suggested tion/Organization, Sensory/Motor, Social/Behavioral, and
for use in identifying individuals who may be candidates for Auditory Processes. Index scores are used and compared to
auditory processing evaluation. criterion-based cut-off scores.
Children’s Auditory Performance Scale Classroom Performance/Impact

(CHAPS) Questionnaire (Appendix F–3 of
Smoski, W. J., PhD, Brunt, M. A., PhD, & Tanahil, J. C., PhD CDE Guidelines)
(1998). Educational Audiology Association, 700 McKnight Massine, Donna. (2008). Colorado Department of Educa
Park Drive, Suite 708, Pittsburgh, PA 15237 (800-460- tion (Central) Auditory Processing Deficits: A Team Ap
7322). http://edaud.org proach to Screening, Assessment & Intervention Practices.
This checklist is used by educators and parents to as- http://www.cde.state.co.us/cdesped/rs-edaudiology
sess listening difficulties in children. Six listening conditions This is an informal checklist (available in this docu-
are assessed in this 36-item checklist, including noise, quiet, ment) that may be used as a teacher questionnaire or inter-
ideal, multiple inputs, auditory memory/sequencing, and view. It takes into account a myriad of classroom concerns
auditory attention span. The observation assessment is done including listening/language processing, sustained attention,
by comparing the student to a reference population of other working memory, thinking/reasoning, academics, metacog-
children of similar age and background. Items are rated on nition, task initiation, organization, time management, self-
a scale from +1 (less difficulty) to –5 (cannot function at regulation, motor skills, and environmental conditions. It is
all). This instrument can be used as a pre- and posttreatment designed to identify specific areas that may be impacting
evaluation. auditory access in the classroom.
Fisher’s Auditory Problems Checklist Evaluation of Children’s Listening and

Fisher, L. I. (1985). Educational Audiology Association, Processing Skills (ECLiPS)
11166 Huron Street, Suite #27, Denver, CO 80234 (800- Barry J. G., & Moore D. R. (2014) Evaluation of Children’s
460-7322). https://edaud.org Listening and Processing Skills (ECLiPS). London, UK: MRC-T
This checklist is used by educators and other school sup The ECLiPS is a 38-item questionnaire used to evalu-
Chapter 6
port personnel to assist in identifying behaviors that char- ate a wide range of listening difficulties in children. It was
acterize children as at risk for APD. It includes many developed based on research regarding the nature of listen-
components of auditory processing, including attention, ing difficulties and the relationship to disorders of language,
auditory-visual integration, comprehension, figure-ground, literacy, and social communication. The questionnaire looks
and memory. A score is derived by multiplying by four each at five factors: speech and auditory processing, language/
item not identified on this 25-item checklist. Normative data literacy/memory and attention, pragmatic and social skills,
are available for kindergarten through sixth grade. environmental and auditory sensitivity.
The Listening Inventory Auditory Processing Domains

Geffner, Donna, PhD, & Ross-Swain, Deborah, EdD. (2006). Questionnaire (APDQ)
Academic Therapy Publications, 20 Commercial Blvd., No O’Hara, B., & Mealings, K. (2018). Developing the Audi
vato, CA 94949 (800-422-7249). https://www.academicther tory Processing Domains Questionnaire (APDQ): A differ
apy.com ential screening tool for auditory processing disorder. Int J
This is an informal behavior observation completed by Audiol. 57(10), 764–775. https://edaud.org
parents and teachers. It can be used as a starting point to This is a 52-question checklist developed as a differen-
determine the need for further testing and as a discussion tial screening tool for auditory processing disorder. It is to
tool. It consists of 103 statements (0 to 5-point scale) to as- be completed by parents and/or teachers to review and rate
199

200 Chapter 6
observations of students age 7 to 17 years in everyday lis- Note. Revised from Colorado Department of Education,
tening skills. Three scales are presented that rate competent Exceptional Student Leadership Unit, (Central) auditory
performance in hearing-auditory processing (AP), attention processing deficits: A team approach to screening, assess
control (ATT), and cognitive-language skills (LD-NOS). It ment and intervention practices, 2008. Reprinted with per-
takes approximately 15 to 20 minutes to complete. mission. http://www.cde.state.co.us/cdesped/rs-edaudiology
Chapter 6

APPENDIX 6–B
Referral for Auditory Processing Assessment
Student Name School Date
Date of Birth Grade ID# Sex IEP Date
Referred By Position Phone #
Name and Phone # of person with whom to schedule the appointment
When referring for an auditory processing assessment, the following must occur PRIOR to the assessment and should be
considered only after the diagnostic evaluations have been conducted and examined. Please check and complete the
following information. All information will be kept confidential. Feel free to attach any additional information that you think
may be helpful. Thank you.
REFERRAL CRITERIA
Please confirm ALL of the following:
 The student has passed a hearing screening in the past year.
 The student is 7 years of age or older.
 The student is English proficient; APD assessments are normed on native English speakers.
 The student has intelligible speech; if speech is not intelligible, it will be difficult to differentiate a production error
from a processing error.
 The student’s cognitive function (nonverbal scales) is within the average range.
 The student has participated in at least two RtI interventions without measurable progress; or the student is already on
an IEP but demonstrating limited progress.
REFERRAL CHECKLIST
All of the items below must be ATTACHED to this referral. Please do not submit until all items have been checked off.
Chapter 6
 APD Referral Checklist (this form)
 Auditory checklist completed by the classroom teacher, special educator, and parent
 Current speech/language assessment
 Current educational assessment
 Current psychological assessment
 Current health history
Please state specific referral concerns

Note. From Colorado Department of Education, Exceptional Student Leadership Unit, (Central) auditory processing deficits:
A team approach to screening, assessment & intervention practices, 2008. Reprinted with permission. http://www.cde.state
.co.us/cdesped/rs-edaudiology
201

APPENDIX 6–C
Auditory Processing Case History
Date: ______________________
General History
Student’s Name: Date of Birth: Age:
Person completing form: Relationship to student:
Mother’s Name: Father’s Name:
Home Address: Phone:
City: State: Zip code: Email:
Languages spoken in the home:
Student’s primary language: Is the student right- or left-handed?
Please list the # and ages of student’s siblings:
Does anyone in the family (parents, siblings, aunts, uncles, etc.) have a similar problem? If yes, please
describe
Has the student been seen in this department before? If yes, when?
Educational Information
Grade: School: Teacher or school contact:
Classroom type: traditional portable open pod
Is the student’s school performance: Above average Average Below average
Has student repeated a grade? Which grade(s)? Is student frequently absent from school?
Does the student struggle in any subjects? If yes, please list
Does the student excel in any subjects? If yes, please list
Does the student receive any special education services? If yes, what services?

Chapter 6
Does the student have any learning problems? If yes, please explain

Does the student have any speech-language problems? _____ If yes, please explain

Processing Concerns
Does the student have a problem listening or understanding? _____ If yes, please describe the problem:

202

203 Auditory Processing Deficits 203
When was the problem first noticed?

What treatment has the student received for this problem?

What questions would you like answered about the student’s problem?

Developmental/Medical History
Please indicate if the student has experienced any of the following:
____ Premature Birth ____ Currently takes medication
____ Problems before, during or after birth ____ Known hearing problems
____ Hyperbilirubinemia/Jaundice ____ Speech-language difficulties
____ Bacterial Meningitis ____ Sensory Integration Issues
____ Congenital or perinatal infections ____ Autism Spectrum Disorder
____ Asphyxia/lack of oxygen at birth ____ Attention Deficit Hyperactivity Disorder
____ Mechanical ventilation ____ Syndromal abnormality
____ Head or neck abnormalities ____ Serious illness or accidents
____ Fetal Alcohol Syndrome ____ Ear problems (Including: infections, eardrum
____ Delays in development perforations, wax, drainage, ear pain)
____ Fever over 104 degrees ____ Ear surgeries (i.e. tubes, etc.)
If your child has experienced any of the above, please explain (include specific treatment and medications):

Behaviors and Characteristics

Please indicate if the student exhibits any of the following:
____ Sensitive to loud sounds ____ Temper tantrums
Chapter 6
____ Appears to be confused in noisy places ____ Shy
____ Easily upset by new situations ____ Anxious
____ Difficulty following directions ____ Lacks self confidence
____ Restless/problems sitting still ____ Lacks motivation
____ Hyperactive ____ Uncooperative
____ Short attention span ____ Disobedient
____ Impulsive ____ Inappropriate social behavior
____ Easily distracted ____ Does not complete assignments
____ Daydreams ____ Easily frustrated
____ Forgetful ____ Tires easily
____ Asks for repetition ____ Irritable
____ Reverses words, numbers or letters ____ Dislikes school
____ Prefers to play with older children ____ Difficulty understanding the meaning of words
____ Prefers to play with younger children ____ Difficulty learning new concepts
____ Prefers to play alone ____ Difficulty with reading
____ Seeks attention ____ Difficulty expressing idea
____ Disruptive or rowdy

204 Chapter 6
Please provide any additional information to help us understand the student’s strengths and challenges.
Note. From the Colorado Department of Education, Exceptional Student Leadership Unit, (Central) auditory processing
deficits: A team approach to screening, assessment and intervention practices, 2008. Reprinted with permission. http://www
.cdce.state.co.us/cdesped/rs-edaudiology
Chapter 6

APPENDIX 6–D
Auditory Processing Assessment Resources
Acoustic Pioneer: Feather Squadron Pearson Clinical: SCAN-3: C/A

Feather Squadron is an iPad app designed to measure a range (Children/Adolescents and Adults)
of auditory processing abilities. It was designed for children The SCAN-3 is a widely used battery of screening and di-
(from age 5 years) but is also normed and can be used for agnostic subtests offered in a version for children (5 to 12
adults. A 5-minute parent or teacher screening is available, years) and an adolescent/adult version (13+ years). The tests
as well as an extended screening tool for a speech-language are offered on a CD and can be administered in a sound
pathologist (SLP) or psychologist to use. An audiologist is booth or with a portable audio device and headphones. Sub-
required to administer the full diagnostic evaluation that tests include temporal (gap detection), binaural (dichotic),
takes about 30 minutes. Results of the assessment are au- and speech (figure-ground, closure) processing tests, and
tomatically sent to a profile on the website where a profes- the diagnostic tests offer standardized scores and percentile
sional report including recommendations can be viewed and ranks. https://www.pearsonassessments.com
downloaded. The test is automated based on student age,
adaptive based on student performance, and includes up to
10 subtests that assess lateralization, temporal processing, Phonak: Listening in Spatialized Noise—
dichotic listening, speech-in-noise, and degraded speech Sentences Test (LiSN-S)
(time compressed) as well as auditory memory. The test is Developed by the National Acoustic Laboratories and dis-
designed to be given in its entirety rather than by individual tributed in the United States exclusively by Phonak, the
subtest. https://acousticpioneer.com LiSN-S is an adaptive, virtual-reality, speech test that mea-
sures speech perception ability in noisy environments. Im-
portantly, it also measures the ability of children to use the
Academic Therapy Publications: Multiple
spatial cues that normally help differentiate a target talker
Auditory Processing Assessment (MAPA-2) from distracting speech sounds. An inability to use this in-
The MAPA-2 is a comprehensive assessment of auditory formation has been found to be a leading cause of difficulty
processing and listening skills for ages 7 to 14 years. It may understanding speech in noisy environments, such as the
be used as a screener to be followed by other behavioral or classroom. https://www.phonakpro.com
physiological tests, or it may be used for a preliminary di-
agnosis in the auditory area. The test is administered via CD
and can be used in a clinical setting or a sound booth. The
Precision Acoustics: Central Test Battery
MAPA-2 includes eight different subtests in three domains (Katz)
Chapter 6
(monaural, temporal, and binaural) along with the Scale of Also known as the Buffalo Battery, the subtests of the Cen-
Auditory Behaviors, a 12-item parent- or teacher-completed tral Test Battery include very well-known and widely used
questionnaire of listening behaviors. https://www.academic tests such as the SSW (Staggered Spondaic Words) and
therapy.com W-22 in noise. Developed by Dr. Jack Katz several decades
ago, the SSW and other tests in this battery continue to be
popular, especially with those who use the Buffalo Model of
Auditec, Inc APD. http://precisionacoustics.org
Auditec has produced quality recordings for the audiology
community since 1972. Many of the earliest recorded APD
tests as well as newer tests are offered in their catalog. In
Pro-Ed: Differential Screening Test for
addition to individual test recordings pioneered by Dr. Frank Processing (DSTP)
Musiek, such as the dichotic digits and pitch patterns tests, The DSTP is a screening test designed to differentiate
Auditec also offers the MAPA-2 and the SCAN-3 as well as among the various levels of auditory and language process-
a recorded battery of several of the most widely used tests. ing and identifies areas for referral or further evaluation. The
Descriptions of each of the tests can be found on their web- DSTP is a screening instrument to assist professionals in
site. https://auditec.com determining if additional diagnostic assessment is warranted
205

206 Chapter 6
and the specific areas of focus for further testing. The subtest Note. Adapted from Colorado Department of Education,
areas of the DSTP represent the neurological continuum of Exceptional Student Leadership Unit, Guidelines for edu
processing acoustic stimuli. Critical skills are evaluated in cational evaluation and intervention of auditory processing
three major levels: acoustic, acoustic-linguistic, and linguis- deficits (2019 revision in process). Used with permission.
tic. https://www.proedinc.com
Chapter 6

APPENDIX 6–E
Supplemental and Multidisciplinary Tests of Auditory Processing
Full understanding of the ramifications of APD for the individual requires a multidisciplinary assessment to determine the
functional impact and to guide treatment and management of the condition and associated deficits. Cross-discipline analysis
of APD results, with results from nonaudiological disciplines, may assist audiologists and related professionals in differen
tially diagnosing APD from disorders having overlapping behavioral attributes (e.g., ADHD, language disorder, cognitive
disorder, learning disorder) (ASHA, 2005). Included is a partial list of available assessments across a continuum of auditory
processing.
LINGUISTIC AND PHONEMIC ASSESSMENTS

Organized below by various auditory skill areas; most speech-language tests measure auditory-language, and higher-order
components of auditory processing. Adapted from Geffner, D. S., & Ross-Swain, D. (Eds.). (2007). Auditory processing
disorders: Assessment, management and treatment. San Diego, CA: Plural Publishing.
Auditory Perception and Discrimination

■■ The Goldman-Fristoe-Woodcock Test of Auditory Discrimination (GFWTAD; Goldman, Fristoe, & Woodcock 2000)
Subtests of Quiet and Selective Attention
■■ Lindamood Auditory Conceptualization Test, Third Edition (LAC-3; Lindamood & Lindamood, 2004)
■■ Test of Auditory Processing Skills, Third Edition (TAPS-4; Martin & Browness, 2005)
■■ Wepman’s Auditory Discrimination Test (Wepman & Reynolds, 1997)
Auditory Association/Receptive Vocabulary

■■ The Comprehensive Receptive and Expressive Vocabulary Test–Revised (CREVT-2; Wallace & Hammill, 2002)
■■ The Clinical Evaluation of Language Function, Fourth Edition (CELF-4; Semel et al., 2003)
■■ The Comprehensive Assessment of Spoken Language (CASL; Carrow-Woolfolk, 1994)
■■ The Peabody Picture Vocabulary Test (PPVT; Dunn & Dunn, 1997)
■■ The Receptive One-Word Picture Vocabulary Test (ROWPVT; Brownell, 2000)
■■ TOLD P:3 Subtest 1
Auditory Memory
■■ The Auditory Processing Abilities Test (APAT; Ross-Swain & Long, 2004) Subtests 2, 6, and 9
■■ CELF-4 Subtests of Understanding Concepts and Following Directions; Number Repetition; and Familiar Sequences,
Recalling Sentences
Chapter 6
■■ The Comprehensive Test of Phonological Processing (CTOPP; Wagner et al., 1999) Subtest 3
■■ TOLD-P:3 Subtest 5
■■ The Token Test for Children, Second Edition (TTFC-2; McGhee, Ehrer, & DiSimoni, 1978)
■■ TAPS-4 Subtests of Number Memory Forward; Number Memory Reversed; Word Memory and Sentence Memory
■■ Wepman’s Auditory Memory Battery (Wepman & Morency, 1985)
■■ The Wide Range Assessment of Memory and Learning – Second Edition (WRAML-2; Sheslow & Adams, 2003)
Phonemic Awareness Skills

■■ APAT Subtest 1
■■ CELF-4 Subtest of Phonological Awareness
■■ CTOPP Subtests 1, 2, 8, 10, 11, and 12
■■ LAC-3
■■ The Phonological Awareness Test (PAT)
■■ TOLD-P:3
■■ TAPS-4 Subtests of Phonological Segmentation and Phonological Blending
■■ Phonemic Synthesis Test Subtest of Katz Central Test Battery
207

208 Chapter 6
Auditory Closure Skills

■■ CASL Subtest of Meaning from Context
■■ Test of Language Competence (TLC; Wiig & Secrord, 1989) Subtest 3
Auditory Comprehension and Auditory Cohesion Skills

■■ APAT Subtests 7, 8, and 10
■■ CELF-4 Subtests of Linguistic Concepts, Sentence Structure, Understanding Concepts and Following Directions, and
Understanding Spoken Paragraphs
■■ CASL Subtests of Sentence Comprehension, Paragraph Comprehension, Nonliteral Language, Ambiguous Sentences,
and Inference
■■ The Listening Test (Barrett et al., 1992)
■■ TAPS-4 Subtests of Auditory Comprehension and Auditory Reasoning
■■ TLC Subtests 1 and 4
■■ WRAML-2 Subtests 1 and 6
Expressive Vocabulary Skills

■■ CREVT-2
■■ CELF-4 Subtest of Expressive Vocabulary and Word Definitions
■■ The Detroit Test of Learning Abilities, Fourth Edition (DTLA-4) Subtest of Story Construction
■■ The Illinois Test of Psycholinguistic Abilities, Third Edition (ITPA-3; Hammill et al., 2001) Subtest 3
■■ The Expressive One-Word Picture Vocabulary Test (EOWPVT; Browness et al., 2000)
■■ TOLD P:3 Subtest 3
■■ The Expressive Vocabulary Test (EVT; Williams, 1997)
Word Retrieval Skills

■■ CELF-4 Subtests of Word Associations and Rapid Automatic Naming
■■ CASL Subtests of Antonyms, Synonyms, and Sentence Completion
■■ CTOPP Subtests 4, 6, 7, and 9
■■ ITPA-3 Subtest 1
■■ TOLD-P:3 Subtests 2 and 6
■■ The Test of Word Finding, Second Edition (TOWF-3; German, 1999)
■■ The Boston Naming Test
Auditory/Speech Perception Under Degraded Listening Conditions

■■ GFWTAD Subtest of Selective Attention
■■ TAPS-4 Subtest of Auditory Figure-Ground
Chapter 6
COGNITIVE AND EXECUTIVE FUNCTION ASSESSMENTS

Test patterns to consider are those observed deficiencies specific to the auditory modality. Those that are more pervasive in
the overall functioning may suggest a more generalized cognitive or emotional challenge.
■■ WISC-IV (Wechsler Intelligence Scale for Children)
■■ DAS-II (Differential Ability Scales)
■■ WJ-III (Woodcock-Johnson III Tests of Cognitive Abilities)
■■ BASC-2 (Behavior Assessment System for Children)
■■ CRS-R (Conners’ Rating Scales, Revised)
■■ BRIEF (Behavior Rating Inventory of Executive Functioning)
■■ KABC-II (Kaufman Assessment Battery for Children)
■■ UNIT (Universal Nonverbal Intelligence Test)
■■ VMI (Beery Test of Visual Motor Integration)
■■ ACPT (Auditory Continuous Performance Test)

EDUCATIONAL ASSESSMENTS
Tests and measures specific to academic skills and current level of academic performance.
■■ WJ-III (Woodcock-Johnson III Tests of Achievement)
■■ Benchmark Tests (DRA, DIBELS, etc.)
■■ State Academic Standards Assessments
■■ District Assessments
Note. Revised from Colorado Department of Education, Exceptional Student Leadership Unit, (Central) auditory processing
deficits: A team approach to screening, assessment & intervention practices, 2008. Reprinted with permission. http://www
.cde.state.co.us/cdesped/rs-edaudiology
Chapter 6

APPENDIX 6–F
Auditory Processing Assessment Profile
Name: DOB: Age: Date:
Auditory Acuity:  Normal  See Audiogram Acoustic Reflexes:  Normal  Abnormal OAEs:  Normal  Abnormal
Below Average Average Above Average

Standard Deviation –3 –2 –1 0 +1 +2 +3
Standard Score 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
55 70 85 100 115 130 145
Percentile Rank 1 5 10 20 30 40 50 60 70 80 90 95 99
ACOUSTIC:
LINGUISTIC:
Chapter 6
COGNITIVE:
210

Below Average Average Above Average

Standard Deviation –3 –2 –1 0 +1 +2 +3
Standard Score 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
55 70 85 100 115 130 145
Percentile Rank 1 5 10 20 30 40 50 60 70 80 90 95 99
SOCIAL/:
EMOTIONAL
EDUCATIONAL:
OBSERVATIONS/COMMENTS:
Note. © C.D. Johnson 2002. Updated 2019. Revised from Colorado Department of Education, Exceptional Student Leader-
ship Unit, (Central) auditory processing deficits: A team approach to screening, assessment and intervention practices, 2008.
Reprinted with permission. http://www.cde.state.co.us/cdesped/rs-edaudiology
Chapter 6

APPENDIX 6–G
Accommodations and Modifications Checklist for
NAME DOB DATE

SCHOOL ID GRADE
The following accommodations and modifications are recommended for this student to improve access to auditory informa-
tion and are specific to the student’s APD profile. Accommodations are in regular print; modifications are italicized.
ENVIRONMENT MATERIALS

Quiet, acoustically appropriate classroom
Use supplementary materials

Reduce/minimize distractions:
Provide note taking assistance; copy of notes from
Visual ______ Auditory ________ another student
Spatial ______ Movement _______

Appropriate seating SELF-MANAGEMENT/FOLLOW-THROUGH

Use visual daily schedule and calendars
PACING
Train students to “look and listen”

Decrease rate of speaking and delivery of instructions;
Check often for understanding/review
use pauses before and after important points, emphasize
Have student repeat directions
critical information
Use study sheets to organize material

Extend time requirements for processing, responding
Design/write/use long-term assignment timelines
and task completion
External organizational aids (e.g., lists, outlines,

Send school text, materials home for preview/review planners)
PRESENTATION OF MATERIALS TESTING ADAPTATIONS

Obtain student’s attention prior to delivery of information
Use pictures

Monitor student for fatigue/length of attending time;
Read test to student
provide breaks if necessary
Paraphrase instructions and test items

Present demonstrations (model)
Preview language of test questions

Utilize manipulative/hands-on instruction
Administer test by resource person
Chapter 6

Pre-teach vocabulary
Extend time frame

Use visual sequences/pictorial directions
Vary amount to be tested

Use outlines, overheads, graphic highlighting, organiz-
Vary grading system
ers (e.g., highly structured)
Vary response expectations

Provide animated, expressive teaching

Repeat; do NOT rephrase information SOCIAL INTERACTION SUPPORT

Rephrase; do NOT repeat information
Provide peer partners

Incorporate cooperative learning group
ASSIGNMENTS
Utilize home-school communication notebook

Give directions in small, distinct steps

Use written back-up for oral directions HEARING ASSISTANCE TECHNOLOGY

Give extra cues or prompts
Use personal system _________________

Adapt worksheets, packets according to student’s
Use classroom system ________________
capabilities
212

OTHER STRATEGIES Note. From Colorado Department of Education, Exceptional

Student Leadership Unit, (Central) auditory processing

deficits: A team approach to screening, assessment & inter
vention practices, 2008. Reprinted with permission. http://
www.cde.state.co.us/cdesped/rs-edaudiology
Chapter 6

APPENDIX 6–H
Computer-Based Auditory Training Programs
Computer-mediated auditory training programs are growing in popularity and have many advantages. They are convenient,
they hold the interest of young children, there is a standardization of control of the stimulus, and the programs are adaptive.
Thus, the stimulus or level may change based on the child’s correct or incorrect response. It is important to recognize the
individual’s specific auditory deficit(s) and remember that no one single program will target every underlying auditory pro-
cessing skill. New programs are introduced to the market continuously, so it is important for the clinician to be aware of new
additions. Below is a brief description of some current programs available (see for a list and sources).
Program Source
Acoustic Pioneer Acoustic Pioneer
http://acousticpioneer.com/home1.html
BrainTrain BrainTrain, Inc.

http://www.braintrain.com
CAPDOTS The Listening Academy, Inc.

http://capdots.com
Earobics Houghton, Mifflin, Harcourt

http://www.hmhco.com/shop/education-curriculum/intervention/reading/earobics
Fast ForWord Scientific Learning

http://www.scilearn.com/products/fast-forword
HearBuilders Super Duper Publications

http://www.hearbuilder.com
Laureate Learning Systems Laureate

http://www.laureatelearning.com
LiSN and Learn National Acoustics Laboratory

http://shop.nal.gov.au/store/lisn-learn.html
Sound Auditory Training Plural Publishing

http://pluralpublishing.com/publication_sat
Chapter 6
Acoustic Pioneer
Another web-based program specifically designed for individuals with auditory processing concerns is Acoustic Pioneer.
Acoustic Pioneer incorporates a diagnostic component along with direct intervention to address temporal processing, nonlin-
guistic auditory memory, nonlinguistic dichotic ability, rapid tonal processing, linguistic auditory memory, linguistic dichotic
ability, time-compressed degraded speech, and speech-in-noise. Activities to address these areas are presented in animated
games and increase in complexity as the individual progresses.
Brain Train
Brain Train is another software program useful in aiding underlying language-processing skills, such as attention, sequenc
ing, processing speed, and memory. Efficacy studies of this product have been limited to children with ADHD. This program
is designed for patients age 6 years to adult.
CAPDOTS
CAPDOTS (The Listening Academy) is an online auditory training program that focuses on dichotic training. CAPDOTS
Integrated emphasizes exercises to improve binaural integration deficits. For these tasks, varied information presented to each
214

hear must be interpreted and repeated. CAPDOTS Selected incorporates exercises to improve binaural separation skill that
require interpreting information presented to one ear while disregarding auditory input into the opposite ear. Training can be
started in children as young as 5 years of age.
Earobics
The Earobics family of software products are another popular program for improving phonemic awareness, auditory process
ing, and phonics, as well as cognitive and language skills that may benefit auditory and listening comprehension. Earobics is
available for home, clinic, and school use. It is available in three levels—prekindergarten, school age, and adolescents and adults.
Fast ForWord
Fast ForWord (FFW) is one popular software program based on the underlying temporal processing research of Tallal et al.
(1996) and Merzenich et al. (1996). The Fast ForWord program is designed to develop temporal and acoustic skills to detect
rapid transitions of speech. The exercises in the Fast ForWord program use acoustically modified speech. It is important to
note an individual may not fit into one particular profile and may have characteristics of more than one profile or subtype.
For this reason, some clinicians will focus rehabilitation efforts on the specific areas of auditory weakness. In the beginning
of the program, the exercises prolong and emphasize the sounds and are easier to distinguish. As the listener progresses,
speech sounds approach the rate of normal speech. As the listener improves, the exercises become more challenging, and the
participant develops enhanced language awareness and comprehension.
HearBuilders
HearBuilders incorporates multilevel activities centered around specific auditory language objectives for following direc-
tions, phonological awareness, auditory memory, and sequencing. Tasks increase in complexity from visual with auditory to
auditory alone. The program is appropriate for pre-K through eighth grade.
Laureate Learning Systems

The Laureate Learning Systems include programs that address language-processing skills. The programs contain exercises
for preverbal children up to adults. Exercises include categorization and syntax training, auditory discrimination, reading,
and spelling.
LiSN and Learn

The LiSN and Learn computer-based program is specifically designed to help improve the perception of speech in the pres-
ence of background noise. A three-dimensional auditory environment is produced under headphones where speech is spatially
separated in noise. The tasks are presented in a game-like format where the child identifies a target word from a sentence.
Chapter 6
Sound Auditory Training
Sound Auditory Training (SAT) is an auditory training program designed to address a variety of auditory skills. Preformat-
ted auditory tasks train in the areas of intensity, frequency, and temporal discrimination, identification, and recognition,
gap detection and identification, frequency and duration pattern recognition, binaural interaction (500 Hz tone or speech),
speech recognition in noise, and dichotic listening. It is specifically designed for children and adults with auditory process-
ing disorders.
Other Programs
Several other computer-mediated programs have been developed for individuals with hearing loss. These programs are ap-
propriate for a wide variety of ages, from preschoolers through adults, and include exercises in sound identification, auditory
discrimination, and speech-in-noise training. New software programs targeting AP skills are continuously introduced into
the market. Clinicians need to routinely search for new product launches to remain current.
Note. From McNamara, T. L., & Hurley, A. E. (2017). Diagnosis and treatment of auditory processing disorders: A collab
orative approach. In D. R. Welling & C. A. Ukstins (Eds.), Fundamentals of audiology for the speech-language pathologist
(pp. 439–463). Burlington, MA: Jones & Bartlett Learning. Used with permission.

APPENDIX 6–I
Instructional Interventions for Students With
Instructional Interventions
Instructional accommodations consist of purposeful adaptations made by the educator to improve the student’s opportunity
to learn. All students, including those with auditory processing deficits (APDs), require an optimum listening environment.
Classroom management suggestions identified for a student with an APD should be based on the student’s individual profile
of auditory processing strengths and weaknesses. The audiologist should select those strategies most appropriate for the
student’s needs.
UNIVERSAL LEVEL
STRATEGY BENEFIT
Teach and cue students to “look and listen” ■■ Improves students’ comprehension by watching person who is
speaking
Check students’ comprehension of verbal ■■ Determines students’ level of understanding information

information by asking open-ended questions ■■ Identifies information that needs to be restated
■■ Verifies when students are ready to move into new material
S = state the topic to be discussed ■■ Provides a mnemonic device for highlighting basic strategies dealing
P = pace your conversation at a moderate speed with with attending, memory, and receptive language deficits
occasional pauses to permit comprehension
E = enunciate clearly, without exaggerated lip movements
E = enthusiastically communicate, using body language and
natural gestures
CH = check comprehension before changing topics
Provide multisensory instruction ■■ Increases instructional access through the use of multiple learning
modalities
■■ Allows sustained reference to instruction when visual supplements
are utilized
Chapter 6
TARGETED LEVEL
(includes all of the above plus those below)
STRATEGY BENEFIT
Seat student near teacher or speaker with ■■ Provides louder, less reverberant signal
full face to face view ■■ Provides advantage of visual instruction aids
■■ Provides access to visual spoken language
■■ Helps maintain attention and interest to task
Decrease distance and obtain eye contact while redirecting ■■ Improves audibility
■■ Gains auditory attention
Obtain student’s attention through visual, auditory, or tactile ■■ Prepares student for listening
cues as appropriate
216

STRATEGY BENEFIT
Provide earmuffs or quiet study areas that are free from visual ■■ Helps to minimize problems with auditory and visual distractions in
distractions during independent work time the environment to improve concentration and productivity
Monitor student for fatigue and length of attending time, pro- ■■ Permits student to have “downtime” and then redirects attention
viding breaks when necessary
Assign peer note-taker ■■ Permits student to have access to additional student notes
INTENSIVE/INDIVUALIZED LEVEL
(includes all of the above plus those below)
STRATEGY BENEFIT
Use classroom or personal FM under direction of the educa- ■■ Allows for direct access to teacher’s voice
tional audiologist
Make available computer-assisted note-taking ■■ Provides student with notes of lectures
Note. Revised from Colorado Department of Education, Exceptional Student Leadership Unit, (Central) auditory processing
deficits: A team approach to screening, assessment & intervention practices, 2008. Reprinted with permission. http://www
.cde.state.co.us/cdesped/rs-edaudiology
Chapter 6

APPENDIX 6–J
A Multitiered Model of Auditory Processing Deficit Interventions
Chapter 6
218

CHAPTER 7
Classroom Acoustics and
Other Learning Environment
Considerations
CONTENTS
Learning Environments and At-Risk Students

Listening and Learning Challenges ■ Lighting and Learning Challenges ■ At-Risk Students
Universal Design for Learning
Properties of Classroom Acoustics
Noise ■ Signal-to-Noise Ratio ■ Reverberation ■ Inverse Square Law and Critical Distance
Chapter 7
High school students’ descriptions of strategies for hearing access in the classroom.
219

Classroom Acoustics and Speech Perception

Effects of Noise on Speech Perception ■ Effects of Reverberation on Speech Perception
Combined Effects of Noise and Reverberation on Speech Perception ■ Effects of Classroom
Acoustics on Teachers
Classroom Acoustics Standard
History and Development of the Standard ■ Current Standard Status ■ Classroom Audio
Distribution Systems ■ Conformance and Tolerance Verification ■ Standard Adoption
Classroom Acoustics Resolutions and Guidelines
Measuring Classroom Acoustics
Classroom Observation ■ Instrumentation and Software Programs ■ Classroom Noise Measurements ■ Classroom
Reverberation Measurements ■ Estimating Critical Distance
Role of the Educational Audiologist
Management of the Learning Environment
Summary
Suggested Reading and Resources
Appendices
7–A Classroom Acoustics Screening Survey Worksheet (Text/Online)
7–B Using the Student, Environments, Tasks, and Tools Framework to Identify Assistive Technology and
Interpreting Services for Students Who Are Deaf or Hard of Hearing (Text/Online)
7–C Resources (Text)
KEY TERMS The classroom environment is a gatekeeper to learn-

ing. Even when the best teacher delivers the best instruc-
Classroom acoustics, reverberation, noise, universal design tion, the student’s ability to access that instruction is lim-
for learning, lighting, SETT framework, noise, signal-to- ited when the classroom environment is poorly constructed.
noise ratio (SNR), reverberation, learning environment, Good classroom environments benefit all students and their
accommodations teachers. Learning environments should be free from exces-
sive noise and reverberation and have appropriate lighting
and space to achieve effective communication and positive
KEY POINTS educational outcomes. Students should be educated in facili-
ties that allow them to focus their efforts on thinking and
■■ When direct sound energy and early reflections are learning rather than struggling to listen and see. National
maximized in the learning environment, there should attention has been focused on these concerns, and standards
be no interference with speech perception and learning. and guidelines have been developed to provide the neces-
Chapter 7
■■ Light matters; research shows that students perform sary acoustic qualities in classrooms to allow for effective
better in classrooms with daylight. communication between students and teachers (American
■■ The principles of Universal Design for Learning (UDL) Academy of Audiology [AAA], 2008; American Speech-
should guide learning for all students. Language Hearing Association [ASHA], 2005b; 2005c;
■■ The SETT framework is a key tool for analyzing stu- ANSI/ASA, 2010; U.S. Green Building Council, 2009).
dent needs for hearing assistance technology and other In addition to physical barriers to learning, Universal
accommodations. Design for Learning (UDL) promotes accessibility to instruc-
■■ Critical distance is determined based on room size and tion and the curriculum to engage all learners through mul-
the reverberation time. Listeners who are seated beyond tiple modalities of instruction and recognizing multiple ways
the critical distance in the learning environment may of expression. UDL’s strengths-based approach accommo-
experience difficulty listening, and as a result, learning dates learners with a variety of strengths and needs. Today’s
opportunities may be missed. classrooms utilize instructional trends, methodologies, and
220

Classroom Acoustics and Other Learning Environment Considerations 221
technologies that have produced changes in both teaching Historically, acoustic considerations in the design of
and learning. Digital Immigrant teachers (i.e., late adopters schools have been described as the “forgotten variables” to
of digital technology) have been challenged to creatively ensuring students’ academic success, particularly students
meet the demands of their Digital Native students for whom with unique communication or educational needs (Crum &
digital technologies already existed when they were born and Matkin, 1976). Poor classroom acoustics and lighting can
who have grown up with access to digital technology (Pren- compromise academic, communicative, psychosocial, and
sky, 2001). Implementation of innovative, specialized, and psychoeducational performance in children and place teach-
interactive teaching and learning strategies designed to en- ers at risk for developing vocal problems. Focus on acoustic
hance the learning process can produce additional classroom performance requirements has emerged as a national agenda
noise that contributes to the acoustic complexity of many item in educational facility planning and design. New ap-
learning environments. Differentiated instruction, coopera- proaches to curriculum development and facility design
tive learning, center-based learning, and a wealth of interac- have redirected emphasis from the more traditional teaching
tive technological advancements contribute to the acoustic places concept to the learning spaces concept. Many school
and lighting signature of the learning environment and in- districts are subscribing to the minimal acoustic and lighting
struction. This chapter addresses the following questions: performance requirements that are part of the indoor envi-
ronmental quality (IEQ) guidelines for new construction and
■■ Why is the acoustic environment important to learning?
major renovation projects to achieve a level of LEED (Lead-
■■ Why is the visual environment important to learning?
ership in Energy and Environmental Design) certification
■■ What are the parameters of classroom acoustics?
(U.S. Green Building Council). Based on the IEQ guide-
■■ What are the parameters of visual access in the
lines, the following strategies for improving comfort and
classroom?
control are recommended (https://www.usgbc.org/articles
■■ What standards dictate/guide classroom acoustic
/green-building-101-what-indoor-environmental-quality):
environments?
■■ How are classroom acoustic properties measured? ■■ use daylighting;
■■ What is the educational audiologist’s role in evaluat- ■■ install operable windows;
ing, monitoring, and modifying classroom acoustic and ■■ give occupants temperature and ventilation control;
visual environments? ■■ give occupants lighting control;
■■ Who should the educational audiologist collaborate ■■ conduct occupant surveys;
with to promote appropriate classroom acoustics and ■■ provide ergonomic furniture; and
visual access? ■■ include appropriate acoustic design.
Speaking and listening are the primary communication The educational audiologist can assist school districts
modes in auditory learning environments, where children and facility planning groups to improve acoustic conditions
are involved in listening activities for 60% to 75% of their in listening and learning environments as well as advocate
school day (Butler, 1975; Dahlquist, 1998). Teachers, ad- for appropriate lighting and visual access. Although many
ministrators, architects, engineers, audiologists, parents, and resources are available, the educational audiologist pos-
a host of other professionals are concerned about classroom sesses the knowledge and skills to provide information
acoustics. The U.S. General Accounting Office (1995) report about the benefits of good classroom acoustics, evaluate
addressed classroom acoustics, among other environmen- educational acoustic environments, and advocate for en-
tal factors, and estimated that approximately 22,000 U.S. dorsement of the classroom acoustics standard and related
schools attended by 11 million students had unsatisfactory guidelines and requirements.
acoustics for noise control. The survey revealed that teachers
in 28% of schools reported unsatisfactory acoustic environ-
ments. A decade later, the U.S. Department of Education LEARNING ENVIRONMENTS
Chapter 7
(2005) surveyed school principals on similar environmental
factors. The survey was mailed to 1,205 of 84,000 princi- AND AT-RISK STUDENTS
pals of elementary and secondary schools and yielded a 90%
return rate. Principals rated acoustics and noise control as Listening and Learning Challenges
very satisfactory or satisfactory for classrooms in 86% of High levels of classroom noise have been shown to nega-
permanent buildings (86%) and 77% of portable or tempo- tively affect reading comprehension, auditory and visual
rary classrooms. Principals estimated that acoustics or noise attention, short-term memory, behavior, and social skills
control would be more likely to interfere with instruction in all children (Ferguson, Cassells, MacAllister, & Evans,
in portable buildings (18%) than in permanent buildings 2013; Howard, Munro, & Plack, 2003). Specifically, noise,
(12%). Differences in the outcomes of these two studies may reverberation, distance, and directionality are elements in
be the result of the perceptions and experiences of the two the classroom that can affect a listener’s speech perception
groups of respondents. abilities (see Figure 7–1). Students, particularly those in

222 Chapter 7
FIGURE 7–1 Noise, reverberation, distance, and directionality interact in a synergistic manner and can interfere with
speech perception in learning spaces.
the early grades, are more vulnerable to the effects of poor Nelson (2003) presented five theories that support these
classroom acoustics requiring a quieter environment and differences: (a) inefficient, broadband listening strategy;
signal clarity in order to hear, listen, and comprehend (Berg, (b) inefficient auditory closure; (c) immature weighting of
Blair, & Benson, 1996; Crandell, 1993; Nelson, 2003; Papso acoustic information; (d) increased susceptibility to distract-
& Blood, 1989; Yacullo & Hawkins, 1987). The youngest ers; and (e) immature ability to segregate concurrent sig-
students, whose classrooms are very often the noisiest due nals from noise. These theories are not independent. For in-
to activity levels, are the most vulnerable to the effects of stance, as students become more sophisticated listeners, they
noise (Jamieson, Kranjc, Yu, & Hodgetts, 2004; Picard & learn weighting strategies to help them attend to acoustic
Bradley, 2001). properties that provide contextual information to assist with
There are differences between the acoustic require- auditory closure. They also are more distracted by noise than
ments for children and adults regarding the effects of noise are adults, even if the noise is irrelevant.
and reverberation on speech perception. Adults are more There are five acoustic factors most likely to affect
mature and skillful listeners who rely on their language and speech perception in a dynamic classroom: (a) background
life experiences to assist with auditory closure and gain- noise, (b) signal-to-noise ratio (SNR), (c) reverberation time,
Chapter 7
ing meaning in less than optimal acoustic conditions. Con- (d) speaker-listener distance and directionality, and (e) inter-
versely, children are more adversely affected by noise and action among these variables. The interaction among these
reverberation as the central auditory pathways, specifically elements can affect the degree to which information-carrying
interhemispheric organization and neural synchrony, do not components of the speech signal are preserved (Crandell &
reach maturity until adolescence (Anderson, 2004; Bellis, Smaldino, 2000b; Palmer, 1997; Smaldino, Crandell, Kreis
2005; Elliott, 1979; Soli & Sullivan, 1997). Children, whose man, John, & Kreisman, 2009). Variables that affect the lis-
auditory systems are still developing, are constantly chal- tening process in the classroom include acoustic signals,
lenged to resolve the competition for speech perception and potential barriers in the listening environment, and listener
localization between a sound source and noise or reverbera- constraints (Bellis, 2005; Crandell & Smaldino, 2000b; Nel-
tion (Litovsky, 2002). As a result, they perform more poorly son & Soli, 2000). In addition to the teacher and student,
than adults during complex listening tasks such as trying to the intensity level and clarity of other instructional audio
understand speech in noisy or reverberant rooms. sources (e.g., LCD projector, computers, streaming media,

video, podcasting) must be considered. Additional factors rooms with more daylight had higher average achievement
that can influence speech recognition include linguistic test scores after taking into account the free or reduced-price
elements (e.g., word and vocabulary familiarity, context, lunch variable and other aspects of the school facility design
number of syllables in words, linguistic competency of the (Tanner, 2008). Similarly, a study of 102 schools in Cali-
listener), articulatory factors (e.g., speaker gender, dialect, fornia, Colorado, and Washington found, and confirmed in
articulatory abilities of the speaker), and auditory attention a follow-up study, that students in the classrooms with the
and memory (e.g., classroom disruptions that interfere with most daylight increased their test scores overall about 21%
access to instruction). The listening process in the classroom more than those students in rooms with the least amount of
is affected by acoustic and nonacoustic variables and a vari- daylight after taking into account additional information, in-
ety of listener constraints that are summarized in Figure 7–2. cluding teacher characteristics and grade levels (Heschong,
Elzeyadi, & Knecht, 2002).
What about when daylight is limited or not available?
Lighting and Learning Challenges Hathaway (1995) reported that average student test scores
Lighting also impacts learning. A study of 24 elementary in classrooms with full-spectrum bulbs increased their level
schools in Georgia found that third-grade students in class- of academic achievement by about two grade levels over the
Chapter 7
FIGURE 7–2 Variables that affect the listening process in the classroom include the acoustic signals, potential barriers
in the listening environment, and listener constraints (Bellis, 2005; Crandell & Smaldino, 2000a; Nelson & Soli, 2000).

224 Chapter 7
2-year study period, compared with 1.6 years for students in TABLE 7–1 At-Risk Populations for Learning in Poor Acoustical
classrooms with high-pressure sodium vapor bulbs. Environments
■■ Young children (<15 years old)
■■ Conductive hearing loss
At-Risk Students ■■ History of recurrent otitis media
■■ Language and/or articulation disorder
Some students are at greater risk for missed learning op-
portunities in the presence of excessive noise and rever- ■■ Learning disability or dyslexia
beration. Crandell, Smaldino, and Flexer (2005) provided a ■■ English as a second language
comprehensive overview of specific populations of students ■■ Auditory processing deficit
with normal hearing and reduced hearing who are at-risk ■■ Minimal bilateral sensorineural hearing loss
learners in poor acoustic conditions (see Table 7–1). Four ■■ Unilateral sensorineural hearing loss
basic concepts associated with classroom acoustics describe ■■ Developmental delays
these listening, learning, and educational design challenges ■■ Attentional deficits
(ASHA, 2005; Smaldino & Flexer, 2012;). ■■ Cochlear implants
1. In every classroom there are students who have either ■■ Auditory neuropathy dyssynchrony
permanent or fluctuant hearing loss or difficulty pro-
Note. Adapted from Bellis (2005), Crandell, Smaldino, and Flexer (2005).
cessing speech and language, and the incidence is more
prevalent with younger children.
2. Listening and learning are affected when students can-
not hear clearly, and subsequently, skills involved in opmental delays, auditory processing disorder, articulation
auditory processing and learning to read are impacted. and language disorders, and attentional deficits (Crandell &
3. Listening and learning problems can be intensified due Smaldino, 2000a; Flexer, Millin, & Brown, 1990). Students
to excessive noise and reverberation and the loss of in- with learning disabilities have been shown to demonstrate
tensity of the teacher’s voice over distance or change in poorer overall sentence-in-noise perception than normal
directionality. hearing peers, and they are more adversely affected as the
4. Improving classroom acoustics may require attention SNR decreases. Use of clear speech was found to help stu-
to architectural design principles and elements, and/or dents with learning disabilities perform better in the pres-
acoustic modifications, and in some situations, the use ence of noise but not to the level of age-alike peers (Bradlaw,
of hearing assistive technologies. Krause, & Hayes, 2003). Students with articulation disorders
are challenged in poor listening conditions that distort the
The prevalence of minimally reduced hearing in chil-
very speech signals they are attempting to model in the class-
dren is between 4.5% (Bess, Dodd-Murphy, & Parker, 1998)
room setting. As such, classroom noise masks target speech
and 12.5% (Niskar et al., 1998). Students with minimal-
sounds and can interact with speech to create misperception
to-mild hearing levels, when compared to normal hearing
of phoneme(s) not present in the target word (Jamieson,
peers, exhibit differences on speech perception tasks in the
Kranjc, Yu, & Hodgetts, 2004). The 10.9 million children
presence of competing noise that include (a) overall poorer
who are learning English as a second language represent
performance on speech perception tasks, (b) missing more
21% of the nation’s student population (NCES, 2010). Their
high-frequency consonant information, and (c) a greater
unfamiliarity with linguistic components of the English lan-
degree of degradation in performance as a function of less
guage and their need to communicate efficiently support the
favorable speech-to-competition ratios. In addition, these
need for learning environments that offer clear auditory input
students exhibit characteristics that include a higher degree
in a background of competing sounds (Crandell & Smaldino,
of psychosocial or physical health problems in the areas of
1996; Nelson, Kohnert, Sabur, & Shaw, 2005).
Chapter 7
energy, behavior, stress, self-esteem, and social support, and

lower performance on achievement tests. Among other stu-
dents with hearing or auditory deficits who have been found
to experience decreased speech perception in noise are those Universal Design for Learning
with auditory neuropathy dyssynchrony, cochlear implants, UDL is a framework for providing multiple means of engag-
unilateral hearing loss, and recurrent otitis media (Crandell, ing students in learning, representing content for learning,
1991, 1992, 1993; Crandell & Bess, 1986; Fetterman & and for students to express or demonstrate what was learned.
Domico, 2002; Finitzo-Heiber & Tillman, 1978; Johnson, Although UDL has been promoted and practiced for some
Stein, Broadway & Markwalter, 1997; Johnson, 2000; Pois- time, it has gained more attention since being referenced in
sant, Whitmal & Freyman, 2006; Zeng & Fui, 2006). the Every Student Succeeds Act (ESSA) (see text box). The
Other at-risk learners in less than optimal acoustic con- three key principles of UDL, engagement, representation,
ditions include students with learning disabilities, devel- and action and expression, are summarized in Figure 7–3.

FIGURE 7–3 Key features of universal design for learning guidelines. (From CAST [2018]. Universal Design for Learning
Guidelines version 2.2. Retrieved from http://udlguidelines.cast.org)
Every Student Succeeds Act and Universal Design for Learning

UDL references in ESSA include the following: and cognitive accessibility requirements for all students
States must assess all students, including offering ap- (Sec. 1111 & Sec. (e)(2)(vi)).
propriate accommodations for English-language learn- States must incorporate UDL principles in Student
ers and children with disabilities, and, to the extent Support and Academic Enrichment (SSAE) grants:
practical, must develop assessments using the principles States may use SSAE funds to support local educa-
of UDL, which intentionally reduce barriers and im- tional agencies in increasing access to personalized, rig-
Chapter 7
prove flexibility in how students receive information orous learning experiences supported by technology.
or demonstrate knowledge requirements (Sec. 1111 & The state’s technical assistance should address using
Sec. 1204). technology, consistent with the principles of UDL, to
States must incorporate the UDL framework into as- support the learning needs of all students, including
sessments addressing fundamental physical, sensory, children with disabilities and English learners.

226 Chapter 7
Relevance of UDL for educational audiologists primar- of speech is negatively affected by background noise. Ap-
ily focuses on the access levels of representation (i.e., recep- proximately 80% to 90% of the acoustic information neces-
tion) to ensure full access to spoken/auditory information sary for optimum speech perception is carried by consonant
and full participation in classroom learning activities. The phonemes (French & Steinberg, 1947). Three variables that
Student, Environments, Tasks, and Tools (SETT) framework contribute to speech masking by noise are (a) the long-term
(Zabala, n.d.) is a key tool for analyzing student needs for acoustic spectrum of the noise, (b) the average noise inten-
hearing assistance technology and other accommodations. sity relative to the intensity of speech, and (c) fluctuations in
SETT is discussed later in this chapter. noise intensity over time (Smaldino et al., 2009).
Signal-to-Noise Ratio
PROPERTIES OF CLASSROOM SNR is the relationship of the intensity of the auditory sig-
nal (e.g., teacher’s voice, other audio signal) and the back-
ACOUSTICS ground noise level. The effect of the SNR on speech per-
The educational audiologist must be able to clearly convey ception involves more than the average background noise
information about the properties of classroom acoustics and level and the intensity of the primary auditory signal. The
the effects on students and teachers when meeting with ar- relationship between the level of the background noise and
chitects, engineers, administrators, and educational design the level of the auditory signal as a function of frequency
teams. For a technical review of the foundations of room will provide the most useful information about the effects
acoustics, see ANSI/ASA (2010) and Smaldino and Flexer of noise on speech perception. This frequency-specific in-
(2012). Resources in Appendix 7–C offer examples and formation will also be useful in making recommendations
media to assist the educational audiologist in discussing the for acoustic modifications that involve treatments known to
acoustic properties of classrooms. be effective at specific frequencies (Smaldino et al., 2009).
Research has shown that young listeners need a quieter
listening environment, and the goal is to achieve a SNR of
Noise +15 dB (ASHA, 2005; Finitzo-Heiber & Tillman, 1978).
Noise is very simply defined as any auditory disturbance that For listeners with other challenges, such as hearing loss, En
interferes with what a listener wants or needs to hear. Inter- glish as a second language, and auditory learning problems,
nal and external classroom noise, reverberation, and SNRs a more favorable SNR may be required. The effective SNR
are the key components of classroom acoustics, in addition is the difference in decibels between the levels of the effec-
to distance from the primary signal (i.e., teacher or other tive signal and the effective noise, and the goal is to achieve
primary audio signal), that can impact student learning. In an effective SNR of at least +15 dB across a broad frequency
the classroom, background noise may include external noise range (Boothroyd, 2004a; 2004b) to theoretically achieve
from outside the building (e.g., construction, playground, 100% speech recognition. When the SNR is 0 speech rec-
traffic), internal building noise (e.g., corridors, plenum trav- ognition drops to 50%, and at –15 it is 0% (Boothroyd,
eling noise), and noise generated within the classroom (e.g., 2012). Bradley, Sato, and Picard (2003) demonstrated that
student-generated, instructional technology equipment). increased early reflection energy has the same effect on
The educational audiologist should suspect that class- increasing speech perception performance as an increase
room noise is a problem when (a) the heating, venting, and in direct sound level. This finding establishes the fact that
air-conditioning (HVAC) noise is clearly noticeable; (b) the the contribution of early reflections is to (a) increase direct
teacher needs to turn off mechanical equipment when de- speech level in rooms up by 9 dB, (b) increase as a function
livering important information or giving tests; (c) exterior of expanding distance from the speaker, and (c) increase the
noise (e.g., playground, traffic, construction) is constant; or effective SNR.
Chapter 7
(d) when sounds from adjacent rooms are clearly audible

with the HVAC system turned off (Maryland Department
of Education, 2006). The HVAC system tends to be the Reverberation
greatest contributor to background classroom noise levels Reverberation occurs when sound persists in a classroom
(Siebein, 2004). Noise masks acoustic and linguistic cues as a result of repeated reflection from surfaces in or sur-
and reduces the intensity of weaker consonant phonemes, rounding the enclosed space. Prior to reaching the listener,
thereby interfering with speech perception and learning due reflected sound strikes one or more objects or surfaces in
to the upward spread of masking produced by low-frequency the room. A portion of the acoustic energy in sound waves
classroom noise such as the HVAC system. can be reflected from barriers in the classroom, absorbed
Continuous noise sources contribute to the reduction of by them, transmitted into other learning spaces, or diffused
spectral-temporal characteristics of the speech signal. The by the sound and surface interaction. Speech intelligibility
inverse relationship between intelligibility and the power is enhanced by reflected speech sounds. The benefit is for

listeners the greatest distance from the speaker and when found in a narrow room. Sometimes this acoustic phenom-
the speaker changes directionality. Sound arriving at the enon will occur in carpeted classrooms with acoustic ceiling
listener’s ear is called direct sound. When direct sound is tile, particularly if one or more walls are primarily windows
combined with early reflections reaching the listener fol- (Siebein, Crandell, & Gold, 1997).
lowing only a few reflections (i.e., 50–80 ms), an effective Reverberation time (RT60) is a measurement in seconds
signal is achieved. Early reflections arrive soon enough to be of the time required for the level of a steady sound to decay
integrated with the direct signal and provide enhancement by 60 dB after the sound has occurred. The decay rate is de-
to speech audibility and should not interfere with speech pendent on the amount and properties of sound absorption in
perception. There is a variable 2 to 8 dB benefit from early the classroom, room volume and shape, and the frequency of
reflections, and the increase is a function of distance from the sound. In rooms with longer RT60 measurements, speech
the sound source (Bradley & Sato, 2004). perception is negatively affected, and learning opportunities
Effective noise is a combination of background noise may be missed.
and noise created by late reflections that reach the listener’s
ear after multiple reflections (i.e., greater than 50–80 ms)
and interfere with speech perception by smearing critical
Inverse Square Law and Critical Distance
temporal information such as gaps that are available in the When direct sound energy and early reflections are maxi-
effective signal (i.e., direct sound and early reflections). Re- mized in the learning environment, there should be no inter-
verberation also tends to produce increased noise levels in ference with speech perception and learning. Distance from
learning spaces (Boothroyd, 2012; Bradley, Sato, & Picard, the sound source has a significant effect on the SNR as the
2003; Smurzynski, 2007). direct sound level decreases in linear proportion to the dis-
“Useful-to-detrimental energy ratios” based on impulse tance between the speaker and the listener. This is known
response measurements describe the benefits of the intensity as the inverse square law, which is produced in a classroom
of direct sound and the contribution of early reflections si- where a 6 dB decrease in sound pressure level (SPL) occurs
multaneously with the harmful effects of reverberation and with each successive doubling of distance from the sound
background noise in classrooms. Following is a summary source (see Table 7–2). This inverse relationship between in-
of the useful portion of signal energy (i.e., direct sound and tensity and the square of the distance from the sound source
early reflections) and the detrimental energy (i.e., noise) occurs in free-field environments. Since classrooms are not
comprised of reverberation and background noise (Bradley, free-field environments, there is a departure from the inverse
1986a; 1986b; Lochner & Burger, 1961; Siebein, Gold, Sie- square law when obstacles (e.g., walls, ceilings) are present
bein, & Ermann, 2000). To summarize: in a sound’s pathway (Smurzynski, 2007). However, when
the educational audiologist shares information with design
■■ Effective Signal (i.e., useful energy) = Direct Sound + planning teams about the inverse square law and research
Early Reflections that corroborates the effects of noise, reverberation, and dis-
■■ Effective Noise (i.e., detrimental energy) = Reverberant tance on speech perception, it can be impressive. Adding
Energy (late reflections) + Background Noise an audio recording or a video, such as those available on
The educational audiologist may suspect that rever- many commercial acoustic consultant websites, can be used
beration could be, at least in part, a contributor to listening to demonstrate this relationship.
problems in learning spaces where the following features are An interaction occurs between reverberation and dis-
noted (ANSI/ASA, 2010; Maryland Department of Educa- tance; when the speaker-to-listener distance increases, rever-
tion, 2006; Smaldino et al., 2009): beration dominates the listening environment. Conversely,
when the listener is near the sound source, the direct sound
■■ hard ceilings absent of acoustic tiles; level exceeds the reverberation level. The critical distance
■■ high ceilings greater than 10 feet; for effective listening is the distance from a sound source at
painted ceiling tiles that reduce sound absorption
Chapter 7
■■
characteristics;
■■ a ceiling surface that is more than 10% occupied by
TABLE 7–2 Example Showing Signal Intensity and Distance
nonabsorptive surfaces (e.g., grilles, vents, light fix-
Relationship According to the Inverse Square Law Where the
tures, hard surfaces);
Noise Floor in a Classroom Is 45 dB
■■ hard surface flooring;
■■ lack of sound absorption materials; or Distance 3 feet 6 feet 12 feet 24 feet*
■■ irregular rather than traditional shape learning space Teacher’s 60 dB SPL 54 dB SPL 48 dB SPL 48 dB SPL
(e.g., narrow oblong). voice level
Flutter echoes often occur in long, narrow learning *Note that the room size and reverberation levels affect the actual measured
spaces. The flutter echo is the continued reflection of sound voice levels beyond the critical distance point; the resulting late reflections
waves between two parallel surfaces, such as would be maintain the loudness level of the teacher’s voice but reduce speech intelligibility.

228 Chapter 7
Key Points Regarding Acoustics and Speech Perception

■■ When the SNR is +15, speech recognition is 100%; sound and reverberant sound are at equivalent lev-
at 0 SNR, speech recognition drops to 50%; and els (Smurzynski, 2007).
at –15 SNR it is 0% (Boothroyd, 2012). ■■ Inverse square law (6 dB rule) is based on free
■■ Background noise and noise created by late reflec- field; in a classroom, the speaker voice level beyond
tions that reach the listener’s ear after multiple re- the critical distance is determined primarily by re-
flections (i.e., greater than 50–80 ms) interfere with flected sound and therefore remains fairly constant
speech perception by smearing critical speech cues. (Boothroyd, 2012).
■■ The critical distance for effective listening is the dis-
tance from the sound source at which the direct
which the direct sound and reverberant sound are at equiv- normative data (Papso & Blood, 1989). Bradley and Sato
alent levels (Smurzynski, 2007). When the listener is at a (2004) examined speech intelligibility in Grade 1, 3, and 6
distance of approximately one-third of the critical distance, classrooms and also documented the effects of maturation.
reverberation is generally not a concern as the direct sound is First-grade students were found to require at least a 7 dB
at least 10 dB stronger than the reverberant sound. The sound greater SNR than sixth graders in order to achieve the same
level is dependent on the directionality of the sound source level of speech intelligibility performance. Another study
and the orientation of the listener to the sound source. Criti- revealed similar findings in that younger children in kin-
cal distance is an important consideration in today’s dynamic dergarten and first grade were less tolerant of intermediate
classrooms where the back row may change depending on levels of noise (–6 dB SNR) than second and third graders
the learning activity. When the distance is at approximately during a monosyllabic word recognition task. Interestingly,
three times greater than the critical distance, direct sound is when trisyllabic stimuli were used, the maturational effect
reduced to a level at least 10 dB lower than the reverberant was not present (Jamieson, Kranjc, Yu, & Hodgetts, 2004).
sound. When this occurs, the contribution of the direct sig- These findings verify the maturational effects of listening in
nal is negligible as reverberation is predominant (Boothroyd, noise and implications for noise as an acoustic barrier in the
2005; Smurzynski, 2007). ANSI/ASA (2010) includes com- educational setting, particularly in the early grades.
prehensive design guidelines for controlling noise and re- Crandell and Smaldino (1996) investigated the effects
verberation in educational settings. Additional references of noise on English language learners (ELLs) by exam-
for procedures and suggestions for improving the acoustic ining speech perception at various SNRs (+6, +3, 0, –3,
environment in classrooms may be found in Appendix 7–C. –6 dB) that are similar to those encountered in typical class-
rooms. Outcomes of the study showed that ELL and their
English-speaking peers achieved excellent speech percep-
CLASSROOM ACOUSTICS tion scores for sentence stimuli presented in quiet. How-
ever, data showed that ELL were at greater risk than native
AND SPEECH PERCEPTION English-speaking students for the perception of sentence
stimuli under degraded listening conditions, and the differ-
Effects of Noise on Speech Perception ence between groups increased as the SNR increased as a
Effects of age and maturation on speech perception in noise function of increased speaker-to-listener distance. Nelson,
Chapter 7
have shown that while both children and adults are able to Kohnert, Sabur, and Shaw (2005) studied the impact of mul-
easily understand sentences and high predictability words titalker babble on the speech perception abilities of ELL and
in quiet, the introduction of a moderate level of competing found the effects to be more than four times greater than
noise negatively affects speech perception in children but that experienced by their English-speaking peers. This study
not in adults (Elliott, 1979; Johnson, 2000; Soli & Sullivan, evaluated the interaction between noise and phonemic fea-
1997; Stelmachowicz, Hoover, Lewis, Kortekaas, & Pittman, tures, that is, the perception of words containing phonemes
2000). Elliott (1979) found that normal hearing children up that are contrastive in English but not in Spanish, in the pres-
to 13 years of age performed poorer than older children and ence of competing noise. Findings showed that the ELL per-
young adults on speech perception tasks. Multitalker noise formance was poorest under this competing noise listening
was found to be a more difficult competing noise source for condition. Another interesting finding of this investigation
children when compared to adult listeners, and the research- was that ELL require a SNR greater than +10 dB to maxi-
ers emphasized the need for age-appropriate speech-in-noise mize their speech perception abilities.

In addition to the effects of noise on speech perception, dino et al., 2009). Finitzo-Heiber and Tillman (1978) iden-
classroom noise can influence and interfere with verbal in- tified the combined effects of noise and reverberation on
structions and interactions, reading comprehension, blood speech recognition ability in students with normal hearing
pressure, and cognitive tasks. Classroom discussions can and students with mild-to-moderate reduced hearing levels
quickly deteriorate and become ineffective in the presence under varying SNR (quiet, +12, +6, 0 dB) and reverberation
of excessive background noise as students struggle to hear (RT = 0.0, 0.4, and 1.2 s) conditions. Results showed that
their teacher and peers. Psychosocial effects may include (a) children with hearing loss performed significantly more
an inability to concentrate, a decrease in motivation, and a poorly than their normal hearing peers under the majority of
lack of sustained application to learning tasks. Another ef- the listening conditions and (b) as the listening conditions
fect is withdrawal from conversations due to the listener’s became less favorable (i.e., increased SNR and longer RT),
inability to hear clearly, which may result in misunderstand- the performance decrement between the groups increased.
ing information, responding inappropriately, and experienc- Yacullo and Hawkins (1987) investigated speech perception
ing embarrassment in these situations. Ultimately, there are in children with hearing loss and their normal hearing peers
distinctive linkages between the effects of poor classroom and found that (a) children with normal hearing require a
acoustics, academic performance, and effective communi- +4 dB SNR when RT increases from favorable (0.3 s) to
cation and socialization (Nelson & Soli, 2000; Schneider, poor (1.2 s) and (b) children with hearing loss require a SNR
2002; Smaldino, 1995; Smaldino & Crandell, 2005). of greater than +7 dB to achieve the same level of speech
perception in rooms under the same reverberant conditions.
As the signal-to-noise ratio in a learning space decreases
Effects of Reverberation on and the reverberation time increases, speech intelligibility
Speech Perception typically decreases. Crandell and Smaldino (2000a) reported
Children are more sensitive to negative effects of exces- that at a favorable SNR of +6 dB and a reverberation time of
sive reverberation levels than adults. Following is a sum- 0.4 s, speech intelligibility scores for children were at 71%.
mary of the effects of reverberation on speech perception By decreasing the SNR to 0 dB and increasing reverbera-
documented by research studies (Finitzo-Heiber & Tillman, tion to 1.2 s, their scores were at less than 30% accuracy.
1978; Johnson, 2000; Litovsky, 1997; Nabelek & Robin- Johnson (2000) found that for children listening in the pres-
son, 1982; Neuman & Hochberg, 1983; Siebein, Crandell, & ence of noise and reverberation, consonant identification
Gold, 1997). abilities do not mature until the late teenage years. However,
subjects were able to demonstrate adult-like performance
■■ Children under the age of 10 years may have more dif- under noise or reverberation independently by age 14 years.
ficulty with reverberation than noise. In another study, the combined impact of reverberation and
■■ Phoneme identification scores obtained under reverber- noise masking on speech perception for children with co-
ant conditions improve as a function of increased age chlear implants was profound. As noise was combined with
and decreased reverberation time. reverberation, speech understanding declined. There was a
■■ Children’s speech perception performance in reverber- significant effect for reverberation time, number of chan-
ant conditions does not reach adult-like performance nels, and noise, but no significant interaction effects were
until age 13 or 14 years. found (Poissant, Whitmal, & Freyman, 2006). Results of
■■ Young children are unable to demonstrate the prece- research on the combined effects of noise and reverberation
dence effect as efficiently as adults, and this contributes on speech intelligibility are consistent and convincing.
to reduced understanding in reverberant rooms.
■■ Persons with hearing loss require a shorter reverbera-
tion time (e.g., 0.4 to 0.5 seconds) to achieve maximum Effects of Classroom Acoustics on Teachers
speech recognition. Teachers are professional voice users who are more at risk
Chapter 7
■■ Speech perception in adults is not compromised until for voice problems than the general population due to the
reverberation time exceeds 1 seconds. vocal requirements of teaching. Teachers are at risk when
they must raise their voices and speak loudly for long peri-
ods of time to be heard in poor acoustic classroom condi-
Combined Effects of Noise and tions. At a minimum, the results of this occupational hazard
Reverberation on Speech Perception are vocal stress and fatigue. Approximately 10% of the U.S.
Noise and reverberation interact and can adversely affect workforce is classified as heavy occupational voice users,
speech perception and to a greater degree than the sum of with 3.3 million elementary and secondary teachers repre-
both effects independently (Crandell & Smaldino, 2000b; senting the largest group using their voice as a primary tool
Finitzo-Heiber & Tillman, 1978; Olsen, 1981). The synergy in practicing their profession. In a study of 2,500 persons,
between noise and reverberation results when reverberation half of whom were in the teaching profession, it was found
fills in the temporal gaps in the background noise (Smal- that 43% of teachers reported the need to reduce classroom

230 Chapter 7
and communication activities due to vocal problems, and zations and other advocacy group stakeholders participated
18% reported missing work each year due to voice-related in the Classroom Acoustics Working Group. In 2000, the
problems (Roy et al., 2004). Teachers may experience the American National Standards Institute (ANSI) Committee
Lombard effect when they attempt to raise their voices to on Noise, under the secretariat of the Acoustical Society
overcome background noise. This can result in escalation of of America (ASA), was tasked with drafting a classroom
classroom noise levels and require the teacher to exert even acoustics standard over a period of 2 years. The ASA’s Ac-
more vocal stress to be heard. credited Standards Committee S12, Noise and the Working
The significant work-related and economic impact of Group S12-42, Classroom Acoustics, collaborated to pro-
vocal health issues among teachers has gained the attention duce the classroom acoustics standard. The 56 participants
of professionals involved in school design and construction. included educational audiologists and professionals from
The National Research Council (2006) and the Center for facilities planning, acoustic engineering, architecture, and
Green Schools (Baker & Bernstein, 2012) have publications HVAC (heating-ventilation-air conditioning) industries;
addressing noise and acoustics in relationship to student and school administrators and educators; university professors;
teacher health. Issues related to noise and teachers’ vocal and laypersons. On June 26, 2002, ANSI/ASA S12.60-2002,
problems regarding health and productivity benefits of green Acoustical Performance Criteria, Design Requirements and
and LEED-certified schools is discussed in the National Re- Guidelines for Schools was officially approved. To encour-
search Council’s publication. The National Center for Voice age widespread implementation of the standard, the Access
in conjunction with the University of Iowa developed an on- Board approached the International Code Council (ICC) to
line Voice Academy to educate teachers about vocal health, support inclusion of the standard in the revision of the inter-
and the module addresses classroom acoustics as well as national building codes (IBCs). Some organizations claimed
other indoor environmental quality issues. (See Appen that compliance with the standard would significantly in-
dix 7–C for more information.) The societal costs for loss crease new construction and renovation costs, particularly
of work and treatment expenses due to teachers’ vocal health for HVAC-related noise control. For instance, the Air Con-
problems are estimated to be nearly $2.5 billion annually. ditioning, Heating and Refrigeration Institute sponsored
For persons who rely on their voice as a primary vocational an acoustics study in 16 Minnesota schools. Data revealed
tool, it was found that teachers constitute more than 20% of an estimated cost of $4.78 to $14.80 per square foot cost
the voice clinic load, or five times the number that would to renovate these schools and bring them into compliance
be expected by their prevalence in this segment of the U.S. with the ANSI standard (Larsen, Vega, & Ribera, 2008). Al-
workforce (Titze et al., 1996). though neither the original standard nor the 2010 revision
was accepted for inclusion in the IBC at that time, the goal
remained to establish design-to-achieve levels that would be
CLASSROOM ACOUSTICS included in the design requirements of the model building
codes. Classroom acoustics standards then would become
STANDARD a mandatory part of the building code in those states and
jurisdictions that use the IBC or its member codes. Other
History and Development of the Standard advocates hold the view that the standard is a civil rights
The Architectural and Transportation Barriers Compliance issue and strive to include the standard in the Americans
Board (aka Access Board) received a petition in 1997 from with Disabilities Act Accessibility Guidelines (ADAAG).
a parent of a child with reduced hearing, alleging that poor
classroom acoustics constituted an architectural barrier to
their child’s educational opportunities. The petition further Current Standard Status
stated that students with learning, developmental, auditory
The ASA approved a revision of the original classroom acous-
processing, speech, and language disabilities also were at
tics standard (ANSI S12.60-2002-2010), referenced as ANSI/
Chapter 7
a high risk. The following year, the Access Board issued

ASA (2010). The revised standard consisted of two parts:
a Request for Information (RFI) in order to receive infor-
Part 1: Permanent Schools and Part 2: Relocatable Classroom
mation and comment on classroom acoustics and the archi-
Factors. The rationale for revision of the classroom acoustics
tectural barrier issue. Based on evidence provided by many
standard was to provide more systematic measurement pro-
professional organizations and advocates, the Access Board
cedures as required by the ICC and to address some apparent
then determined that the acoustic environment is a key fac-
gaps in the original 2002 version. Following are the major
tor contributing to student learning, and acoustic barriers
changes in the standard (Johnson, 2010):
should be addressed in the classroom design phase. The
outcome of this recognition was the formation of the Class- ■■ There are two separate parts to differentially address
room Acoustics Working Group, with the Access Board and permanent and relocatable learning spaces.
the Acoustical Society of America assuming leadership in ■■ Maximum background noise levels are based on the
the efforts toward developing a classroom acoustics stan- “greatest 1-hour average” rather than on a “moment in
dard. Representatives from professional audiology organi- time” measurement.

■■ It addresses the reduction of exterior noise sources (i.e., Standards for physical education (PE) teaching envi-
outside the building and intrusive from other learning ronments, ANSI/ASA s12.60-2019/Part 4/, were developed
spaces) by conducting separate 1-hour background by the Classroom Acoustics Working Group and approved
noise level measurements of interior and exterior noise. July 29, 2019 by the American National Standards Institute,
This is achieved by specifying minimum (a) outdoor- Inc. According to the Acoustical Society of America, this
to-indoor transmission class (OITC) ratings and sound standard addressed the need for adequate speech intelligibil-
transmission class (STC) ratings and (b) impact insu- ity to deliver effective physical education programs by elim-
lation class (IIC) rating for the floor/ceiling assembly. inating acoustical barriers in gymnasia and outdoor learning
■■ It supports the requirement for classrooms to be de- spaces in which speech communication is an important part
signed and built to be readily adaptable to RT60 as low of the learning process. The PE standards are included in the
as 0.3 seconds if warranted by the listening needs of more detailed summary of criteria in Table 7–6.
students within that learning space.
■■ It specifies that when classroom audio distribution sys-
tems are used, they will not be considered as a substi- Classroom Audio Distribution Systems
tute for meeting the acoustic design requirements of the The revised standard defines classroom audio distribution
standard. system, which is an enhancement to replace our former
■■ Although procedures for conformance measurements reference of sound-field amplification. This definition de-
are recommended and described in the standard, con- scribing the full functionality of these systems is defined in
formance testing is not a requirement of the standard. ANSI/ASA S12.60 (2010, pp. 4–5) and in Chapter 8.
In the application section of the standard for relocat-
Parts 1 and 2 of the standard include five major areas: able classrooms, it is stated that sound reinforcement sys-
(a) scope and purpose, (b) normative references, (c) defini-
tems should not be used as a substitute for meeting acoustic
tions, (d) applications, and (e) acoustic performance criteria design requirements. Thus, evaluating classroom acoustics
and noise isolation design requirements and guidelines. Both always should be the audiologist’s first line of consider-
parts of the standard are downloadable from the ASA web- ation. In Part 1 of the standard, uniformity of coverage and
site at https://acousticalsociety.org/classroom-acoustics/. limitations on sound intrusion into adjacent learning spaces
The noise and reverberation levels documented in the are addressed. The standard states that these systems will
standard are summarized in Table 7–3. Part 1 of the stan- have coverage within ±2.5 dB at octave band frequencies
dard is consistent with long-standing recommendations for 500 through 4000 Hz. Furthermore, the systems should be
classroom acoustics and sets specific criteria for maximum adjustable to monitor and manage output to avoid intrusion
background noise at 35 dB and reverberation time (RT60) at into adjacent learning spaces.
0.6 to 0.7 seconds for unoccupied classrooms. The perfor-
mance criteria objective for the standard is to achieve a level
of speech that is sufficiently high relative to the background Conformance and Tolerance Verification
noise level for listeners throughout the room. However, there The standard recommends that conformance to acoustic per-
are no specific recommendations for SNRs in either part of formance criteria and noise isolation design requirements
the revised standard. Part 2 of the standard for relocatable should be verified by testing, although not required by the
classrooms contained a provision permitting a background standard. These tests would include conformance with the
noise level up to 41 dBA with a goal of matching the 35 dB background noise levels and reverberation times, the mini-
standard for permanent classrooms by 2017. The RT60 for mum sound transmission class requirements, and the impact
relocatable classrooms is slightly lower at 0.5 s. Tables 7–4 insulation class requirements. Field testing procedures for
and 7–5 provide summaries of the scope and overview of the each conformance measurement and the accompanying tol-
two parts of the revised standard. Annexes and reference ta erances are described in Part 1, Annex A, and Part 2, An
bles complement the acoustic specifications recommended for
Chapter 7
nex B. The educational audiologist may participate in some
permanent schools and relocatable classrooms. of these measurements, while an acoustic consultant would
have the full range of expertise and instrumentation to com-
plete all the conformance tolerance tests.
TABLE 7–3 Summary of ANSI/ASA S12.60-2010 Standards
Reverberation Standard Adoption

Noise (RT60) International Code Council
Part 1: Permanent 35 decibels (dBA) 0.6 to 0.7 seconds The Access Board proposal to the ICC to adopt the 2010
Schools: classroom acoustics standards as part of the International
Building Code was finally successful in 2017. The ICC
Part 2: Relocatable 35 decibels (dBA) 0.5 seconds
A117.1-2017 Accessible and Usable Buildings and Facilities
Classroom: (as of 2017)
added technical criteria for enhanced classroom acoustics.

232 Chapter 7
TABLE 7–4 Scope and Overview of ANSI/ASA (2010), Part 1—Permanent Schools
Section Description
1.1.1 Applies to core learning spaces and classrooms with interior volumes not exceeding 566 m3 (20,000 ft3) and
Learning Space Size other ancillary spaces of any volume; does not apply to music rooms, other large area learning spaces, or special
education classrooms such as those where students with hearing loss are educated
1.1.2 Specified by limits on maximum 1-hour A-weighted and C-weighted background noise levels and limits on
Acoustical maximum reverberation times when students are expected to be present.
Performance Criteria
1.1.3 Achieved by specifying (a) minimum outdoor-to-indoor transmission class (OITC) ratings and sound transmission
Control of class (STC) ratings, dependent on sound source, to reduce intrusive classroom noise from sources outside
Background Noise the building envelope; (b) minimum STC ratings for walls and floor/ceiling assemblies to reduce intrusive noise
generated within the school building; and (c) impact insulation class (IIC) rating for floor/ceiling assembly to
control noise from footsteps or other impacts on a floor above.
1.1.4 Standard applies to siting- and building design–dependent intrusive noise sources in schools (e.g., HVAC, building
Noise Generation services, exterior sounds such as vehicular traffic and aircraft); does not apply to noise generated by occupants,
classroom activities, or portable or permanent instructional equipment as long as equipment can be powered
down.
Annex A Verification of conformance by measurement
Annex B Commentary information on various parts of the standard (e.g., reverberation time, sound absorption and
reflection, sound transmission class, noise isolation design requirements, minimum STC ratings)
Annex C Design guidelines for controlling reverberation in classrooms and other learning spaces
Reference Tables – Limits on A- and C-weighted sound levels of background noise and reverberation times in unoccupied
furnished learning spaces
– Limits on 1-hour average A- and C-weighted sound levels from sources associated with building services and
utilities
– Minimum OITC rating for core learning spaces
– Minimum STC ratings for single or composite wall and floor-ceiling assemblies separating core learning spaces
from an adjacent space
– Minimum STC ratings recommended between ancillary and adjacent spaces
– Minimum surface area of acoustical treatment for different sound absorption coefficients, ceiling heights, and
reverberation times
TABLE 7–5 Scope and Overview of ANSI/ASA (2010), Part 2—Relocatable Classrooms
Section Description
1.1.1 Applies to relocatable classrooms and other relocatable modular core learning spaces of small to moderate size.
Chapter 7
Learning Space
Size
1.1.2 Specified by limits on maximum 1-hour A-weighted and C-weighted background noise levels and limits on
Acoustical maximum reverberation time.
Performance Criteria
1.1.3 Achieved by specifying (a) minimum outdoor-to-indoor transmission class (OITC) ratings and sound trans
Control of mission class (STC) ratings, dependent on sound source, to reduce intrusive classroom noise from sources outside
Background Noise the building envelope and (b) noise isolation for school building elements for noise generated within the school
building that intrudes to classrooms through walls, partitions, floor-ceiling assemblies, and HVAC systems.

TABLE 7–5 (Continued)
Section Description
1.14 Standard does not apply to noise generated by occupants, classroom activities, or portable or permanent
Noise Generation instructional equipment as long as equipment can be powered down.
Annex A Commentary information on various parts of the standard (e.g., background noise from instructional equipment,
sound absorption coefficient, reflection, RT, noise isolation design requirements, need for noise isolation)
Annex B Verifying compliance with background sound level requirements by measurement
Reference – A-weighted sound levels of background noise and reverberation times in unoccupied, furnished learning
Tables spaces
– HVAC system duty cycles
– OINIC rating for relocatable classrooms
– Minimum STC ratings required for single or composite interior wall and floor–ceiling assemblies that separate
an enclosed core learning space from an adjacent area
– Minimum STC ratings recommended for single or composite wall, floor–ceiling and roof–ceiling assemblies
separating an ancillary space from an adjacent space
TABLE 7–6 Summary of ANSI/ASA (2010) Maximum A-/C-Weighted Background Noise and Reverberation Times in Unoccupied,
Furnished Learning Spaces in Permanent (P) and Relocatable (R) and Physical Education (PE) (Adopted 2019) Learning Spaces
One-Hour Average
One-Hour Average A- and A- and C-Weighted Maximum Reverberation Time for
C-Weighted Sound Level of Sound Level of Sound Pressure Levels in Octave
Core Interior-Source Background Exterior-Source Bands With Midband Frequencies of
Learning Space Noise (dBA/dBC) Background Noise 500, 1000, and 2000 Hz
P R PE P R P R PE
Enclosed volume < 10,000 ft3 35/55 35/55 40/60 35/55 35 dBA 0.6 s 0.5 s .6
(<283 m3)
Enclosed Volume > 10,000 ft3 35/55 35/55 40/60 35/55 35 dBA 0.7 s 0.6 s .8
and ≤20,000 ft3 (>283 m3
and ≤566 m3)
Enclosed volumes >20,000 ft3 40/60 n/a 40/60 35/55 n/a No n/a
(566 m3) requirement
Enclosed volumes 20,000–40,000 ft3 (560–1120 m3) 40/60 1.0
Chapter 7
Enclosed volumes 320,000–640,000 ft3 (8960–17,920 m3) 40/60 1.8
Enclosed volumes >640,000 ft3 (>17,920 m3) 40/60 2.0
All ancillary learning spaces 40/60 40 dBA 40/60 35/55 40 dBA No No NA

requirement requirement

234 Chapter 7
The number of states, local jurisdictions, and boards

of education that have taken action on classroom acoustics
continues to grow. Several states, such as Maryland (2006)
and New Jersey (2007), developed web-accessible class-
room acoustics guidelines and design manuals that include
acoustic comfort guidelines, implementation specifications
for renovations and learning spaces such as portable class-
rooms, and suggestions for managing classroom acoustics
in new and existing classrooms.
School districts generally cite lack of funding as the
primary opposition to implementing the classroom acoustics
standard. Addressing acoustics as part of the design or reno-
vation process is more cost effective than retrofitting exist-
ing learning spaces. According to the Access Board (2003a),
only 10% of a school district’s budget is consumed by facility
design and construction costs. Addressing classroom acous-
tics in the design phase increases overall construction costs
by only 1% to 3% (Nelson, 2003), with retrofit costs being as
much as 30% higher to achieve improved classroom acous-
tics. The Access Board’s publication, Counting the costs of
noisy vs. quiet classrooms (2003a), provides a thoughtful
discussion of construction cost analysis and design criteria
and elements needed to produce a good acoustic environ-
ment for learning. The educational audiologist will find many
resources later in this chapter to assist in presenting to school
FIGURE 7–4 International Code Council (ICC) standards. planning groups on the rationale for dealing with classroom
acoustics in the design phase (as opposed to acoustic modifi-
cation costs) and the effects that poor acoustic environments
have on student learning and teacher’s vocal health.
The requirements set specific criteria for maximum class-
room size considered, maximum reverberation time, and
background noise in classrooms. Within this same section,
the ICC also instituted standards for sign language inter- CLASSROOM ACOUSTICS
preter stations (area to stand, viewing angle for audience,
illumination, backdrop).
RESOLUTIONS AND GUIDELINES
The American Academy of Audiology (AAA) and the Amer
Local and State Adoption ican Speech-Language-Hearing Association (ASHA) con-
School districts may specify compliance with the standard vened task forces to specifically develop position statements
as part of the construction design for new schools, thus mak- on classroom acoustics. ASHA approved a position state-
ing the design team responsible for addressing classroom ment and accompanying technical report and guidelines
acoustics. Parents may find the standard useful as a guide on acoustics in educational settings that endorse the ANSI
to classroom accommodations under the IDEA (Individuals standard in 2005. This document includes information on
with Disabilities Education Act). Among the early adopt- the roles of the audiologist as well as the acoustic consultant
Chapter 7
ers of ANSI/ASA (2010) were the New Hampshire Depart- while clearly delineating when it is more appropriate for the
ment of Education, New Jersey School Construction Board acoustic consultant to take the lead role. For instance, while
and State Board of Education, State of Connecticut, State both can recommend modifications, the acoustic consultant
of Minnesota, Maryland Department of Education, the is better trained to select the materials. The AAA passed
Ohio School Facility Commission, New York City Public a resolution in 2008 in full support of the ANSI standard.
Schools, and Arlington County (VA) Public Schools. These This position statement also supports national awareness
proactive entities effectively assigned the responsibility for and implementation of the standard and various efforts to
good classroom acoustics to school design teams. Interna- promote awareness of the standard as well as research on
tionally, classroom acoustic standards have been established the effects of classroom acoustics on educational outcomes
in the United Kingdom, Australia, New Zealand, Sweden, for all learners.
the Netherlands, Italy, Switzerland, Denmark, Finland, Ger- Classroom acoustics is a national agenda item for the
many, and the World Health Organization. U.S. Green Building Council (2009) as part of the LEED

rating system for new school construction and major reno- for documenting the acoustic parameters in classrooms and
vations. Many school districts are building educational fa- detailed directions for measuring classroom noise and rever-
cilities designed to meet the various levels of LEED cer- beration levels and estimating critical distance. The observa-
tification. Under these guidelines for sustainable building, tion section provides for a subjective appraisal of noise and
acoustic performance is included in the Indoor Environmen- reverberation characteristics and information about teaching
tal Quality (IEQ) section. The intent of the acoustic perfor- style and physical room characteristics. Charts are available
mance prerequisite is consistent with the ANSI/ASA S12.60 for recording noise (ambient noise, teacher voice levels) and
(2010) standards for classrooms and core learning spaces. reverberation measurements (room volume and RT) and for
The LEED IEQ standard for Minimum Acoustical Perfor- estimating critical distance by utilizing the Critical Distance
mance standard includes requirements for HVAC systems Chart. The survey form also includes sound absorption coef-
and options for acoustic treatment compliance. Educational ficients for common classroom facility materials (i.e., floor,
facilities that meet the requirement earn credit toward the walls, ceilings). In the following discussion of classroom
LEED certification and additional credit if the facility meets acoustic measurements, refer to this document for specific
the Enhanced Acoustical Performance criteria for effective measurement procedures designed for the needs of the edu-
acoustic design. Specific requirements for Minimum Acous- cational audiologist.
tical Performance address small (<20,000 ft3) and large
(≥20,000 ft3) learning spaces and include maximum back- Classroom Observation
ground noise level from HVAC systems (45 dBA), NRC
Conduct a classroom observation when concerns are ex-
of acoustic treatments (≥0.70), and reverberation time for
pressed regarding acoustic conditions in classrooms. When-
large rooms (≤1.5 s). The Enhanced Acoustical Performance
ever possible, observe under both the occupied and unoccu-
criteria address noise reduction from exterior to interior
pied conditions, prior to measuring noise and reverberation.
spaces, between spaces inside the building, and within the
Referrals for consultation about classroom acoustics gener-
learning space. At this level, both the Sound Transmission
ally emerge as (a) general concern about noise and reverbera-
Class requirements (≤35) and HVAC background noise level
tion levels; (b) student-specific concern related to hearing
(40 dBA) must be met to receive credit.
status, auditory processing, or the effects of noise and rever-
beration on academic achievement; or (c) concern expressed
by a teacher experiencing excessive vocal stress or fatigue.
MEASURING CLASSROOM Observational data are useful in making follow-up rec-
ommendations for acoustic modifications in the teaching
ACOUSTICS and learning environment. Classroom observation forms
designed for this purpose include space to note the footprint
The 21st-century dynamic classrooms are active learning en-
of the classroom and information collected when surveying
vironments where the acoustic parameters change as a func-
the classroom. Observation forms also include information
tion of time, the specific learning activity, and other factors
gathering for details such as classroom configuration includ-
(Smaldino, Crandell, & Kreisman, 2005). Prior to measur-
ing classroom acoustics (i.e., noise and reverberation), the ing arrangement of furniture; wall, ceiling, and floor sur-
faces; noise sources (e.g., external, internal, HVAC, instruc-
educational audiologist should conduct an observation of the
tional equipment); teaching style; special student needs; and
specific learning space(s). The following overview of class-
the recording of noise and reverberation measurements. In-
room acoustics measurements can be supplemented with re-
terviewing the teacher provides the educational audiologist
sources found in Appendix 7–C and selected references that
with information about general classroom acoustics con-
provide specific protocols for measuring classroom acous-
cerns and those specific to student learning and the teacher’s
tics. The ANSI/ASA standard (2010) and the AAA Clinical
vocal health. At times it may also be necessary to observe
Practice Guidelines for Remote Microphone Hearing As-
a specific student who has been referred due to concerns
Chapter 7
sistance Technologies for Children and Youth Birth to Age
about a possible listening problem. The Classroom Acous-
21 Years (2008)–Supplement B, Classroom Audio Distribution
tics Screening Survey Worksheet includes an observation
Systems identify specific procedures to be used in measuring
section as previously described.
classroom acoustics that include (a) measuring background
noise levels in dBA, (b) measuring or estimating reverberation
Classroom Acoustics Observation Tools
time, and (c) measuring or estimating the SNR. In addition,
the estimation of critical distance should be included as part ■■ Classroom Acoustics Documentation Form (Smaldino,
of the classroom survey and acoustic measurements. Crandell, & Kreisman, 2005).
The Classroom Acoustics Screening Survey Worksheet ■■ Classroom Acoustics Screening Survey Worksheet
located in Appendix 7–A is an excellent tool for the edu- (Johnson. Adapted from Acoustic measurements in
cational audiologist to use for data collection. This com- classrooms by Smaldino, Crandell, & Kreisman, 2005)
prehensive worksheet includes four essential components (Appendix 7–A).

236 Chapter 7
Student and Classroom Observation and Assessment ■■ an initial classroom survey and observation;
Instruments ■■ a classroom survey worksheet to record the floor plan
diagram, classroom features (e.g., sound-absorbing
■■ Children’s Auditory Perception of Speech (CHAPS)
materials, noise sources), and a subjective appraisal of
(Smoski, Brunt, & Tannahill, 1998).
classroom acoustics;
■■ Fisher’s Auditory Problems Checklist (Fisher, 1985).
■■ unoccupied and occupied ambient noise levels;
■■ Screening Instrument for Targeting Educational Risk
■■ instrumentation for conducting noise and reverberation
(S.I.F.T.E.R.) (Anderson, 1989).
measurements;
■■ Classroom-at-a-Glance Observation Checklist (Appen-
■■ specified locations in the room for conducting noise
dix 9–G).
measurements;
■■ reverberation time measurements;
Instrumentation and Software Programs ■■ an estimation of critical distance;
Consult the ANSI and Electrotechnical standards for sound ■■ a specified time for collecting measurements;
level meter specifications and procedures for measuring ■■ determination if the teacher’s voice level will be mea-
noise levels. These standards identify the features of sound sured from various locations; and
level meters that will assist the audiologist in selecting the ■■ intended outcomes of the classroom acoustics survey.
appropriate instrument for use in the schools. There are two The ANSI/ASA standard, Annex 3, provides a system-
classes of sound level meters: atic approach and clearly written rationale to support the
Type 1, integrating-averaging type capable of measuring measurement of classroom noise as shown in the following
time-average sound levels, and reference summary:
Type 2, conventional sound level meter capable of mea- ■■ E3.6 Selecting measurement locations.
suring slow time-weighted sound levels. ■■ E3.7 Measuring background noise.
■■ E3.7.1 Steady background noise.
In most educational audiology facilities supported by local ■■ E3.7.2 Unsteady background noise from transportation
education agencies, a Type 2 general-purpose sound level noise sources.
meter that is capable of measuring both A- and C-weighting ■■ E3.7.3 Disturbing sounds from building services and
filter networks will be adequate for conducting classroom utilities.
noise measurements. Some phone/iPad apps are now suffi- ■■ E3.8 Verifying conformance to background noise limits.
ciently sophisticated to obtain noise levels (A and C scales),
reverberation time, dosimeter measurements, among other There may be some situations where it is important to
measurements. Routine calibration should be observed to know more precise information about the spectral character-
ensure the accuracy of measurements. istics of background noise. Here the audiologist can utilize
noise criteria (NC) to further examine the frequency content
of background classroom noise. While obtaining NC ratings
Classroom Noise Measurements may not be a common practice by some educational audiolo-
The Classroom Acoustics Survey Worksheet (Appen gists, it is important to understand their value. Noise criteria
dix 7–A) includes directions for classroom sound level ratings utilize one-third octave band SPLs to evaluate noise
measurements. Systematic classroom noise measurement in a learning space. The SPLs obtained from sound level
guidelines are available in the ANSI standard and in refer- measurements for the learning space are plotted within each
ences cited earlier in this section. There are many online frequency band relative to the established NCC. The lowest
resources, including worksheets, that can be produced by an NCC that is not exceeded by the plotted noise is the NC
online search. The educational audiologist needs to develop rating of the noise in the learning space (Smaldino et al.,
a plan when setting out to measure classroom noise. Clearly 2009). Pugh, Miura, & Asahara (2006) used NCCs to exam-
Chapter 7
establishing the purpose for the classroom noise survey will ine noise levels in elementary classrooms. These investiga-
allow the audiologist to provide valuable information that tors indicated a preference for using NCC ratings as the data
can serve to improve the listening and learning environment. are useful for implementing engineering and administrative
Determining all details in advance will yield more produc- controls to noise level mitigation at their source, along its
tive results, for after the point in time has passed, additional path, and at the receiver.
information cannot be easily or credibly obtained. Important
considerations and items for the educational audiologist’s
toolkit include Classroom Reverberation Measurements
■■ a clearly identified purpose for taking the measurements; Educational audiologists will find that it is generally easier
■■ support from school or district administration for the to collect classroom noise measurements than reverberation
acoustic survey; measurements. However, classroom reverberation measure-

ments also are necessary in order to thoroughly describe is for a given classroom. Listeners who are seated beyond
and manage the listening environment, particularly when the critical distance in the learning environment may experi-
both noise and reverberation are perceived problems and ence difficulty listening, and as a result, learning opportuni-
to determine critical distance. In brief, the average RT of a ties may be missed. Critical distance is dependent on the di-
classroom is calculated by averaging the RTs at 500, 1000, mensions of the learning space (i.e., volume), reverberation
and 2000 Hz. All classrooms with the same RT are not the time, and directionality of the auditory signal. Boothroyd
same acoustically. For instance, two classrooms may have (2004) provided detailed information and an estimated criti-
similar reverberation times, but the acoustics of the room cal distance chart to assist the audiologist in quickly esti-
may be very different with respect to the predominant type mating critical distance as a function of room volume and
of reverberation or the frequency characteristics of the re- reverberation time. This chart is incorporated in the Class-
verberation. Therefore, the impact on speech perception will room Acoustics Survey Worksheet. Including critical dis-
vary in these two environments. If the audiologist does not tance information in the classroom acoustics measurement
have equipment available to measure reverberation, then the summary provides valuable information about the impact of
use of estimating software is a good alternative. room acoustics on student learning and can offer convincing
The Classroom Acoustics Survey Worksheet (Appen support when offering suggestions for acoustic modifica-
dix 7–A) includes a chart for recording the room volume tions, room arrangement, seating options for students with
and a Sound Absorption Coefficient reference for recording special needs, and other strategies to enhance the listening
wall, ceiling, and floor areas and accompanying ratings for and learning environment for students and teachers.
each surface area. This method is an alternative to obtaining
RT measurements using a reverberation meter. Whenever
possible, it would be useful to record notes about the type
of sound absorption materials. The amount of sound absorp- ROLE OF THE EDUCATIONAL
tion is dependent on three factors: (a) thickness of the mate-
rial, with greater thickness absorbing more low-frequency
AUDIOLOGIST
energy; (b) manner of mounting the material (e.g., flat mount Educational audiologists and audiologists who contract with
or furring strips to allow an airspace); and (c) the porosity school districts have a unique opportunity to influence and
of the material, with higher absorption coefficients being promote good classroom acoustics in their district or ser-
more effective in the mid and high frequencies (Siebein vice area. Major areas of responsibility for the educational
et al., 1997). This information will be useful later in plan- audiologist include (a) advocating, (b) providing informa-
ning effective management of the learning space. tion resource, (c) performing observations and acoustic
In some situations, it would be important to obtain in- measurements in classrooms and other learning spaces,
formation about the Noise Reduction Coefficients (NRCs) of (d) collaborating with educational facility planning teams
materials in the learning space. The NRC is a single-number and the multidisciplinary school team, (e) ensuring acoustic
index determined in a lab test and used for rating the absorp- and visual access for special populations, and (f) conducting
tive quality of a specific material. The NRC is the mean sound efficacy measurements to determine the need for and bene-
absorption coefficient for 250, 500, 1000, and 2000 Hz oc- fits from acoustic treatments and modifications. These areas
tave bands rounded to the nearest 5% (Siebein, Crandell & of responsibility are not necessarily independent activities
Gold, 1997). NRCs range from zero (perfectly reflective) to 1 and may currently be within the work scope of some educa-
(perfectly absorptive). Refer to the Suggested Readings and tional audiologists. For instance, advocacy and information
Resources section for an online industry standard reference. resource functions are essentially pervasive across all areas
The ANSI/ASA standard, Annex 3, provides a system- of responsibility related to classroom acoustics.
atic approach and clearly written rationale to support the
measurement of classroom reverberation:
Management of the Learning Environment
Chapter 7
■■ E4.1 Methods for verifying reverberation times.
Educational audiologists understand that hearing and see-
■■ E4.2 Reverberation time by calculation.
ing produces better outcomes than hearing alone. Therefore,
■■ E4.3 Reverberation time by measurement.
consideration for the lighting and line of sight visual access
are important components of the accommodations that are
recommended for the classroom. Distance from the talker di-
Estimating Critical Distance minishes both the auditory input as well as the visual input.
The fourth part of the classroom survey and acoustic mea- Sign language users frequently use the services of a sign
surements process is the estimation of critical distance. In language interpreter. Regardless of who the signer is, stu
today’s dynamic learning environments, the back row may dents must have full visual access. This section describes
change multiple times during the day as learning activities steps for educational audiologists to consider for optimizing
change, so it is important to know what the critical distance learning for deaf and hard of hearing students.

238 Chapter 7
Assessment
Assessment should include, and often begin with, a class-
room observation. Observing the classroom context helps Nuggets from the Field
ensure the assessment is relevant to individual students and
their presenting concerns. Observation includes the physi- Using Remote Mic Systems
cal classroom environment, how the teacher orchestrates in- Understanding peers’ contributions is almost im-
struction, and how the student navigates learning. The place- possible for students who are deaf or hard of
ment checklists of the Placement and Readiness Checklists hearing. Try these tips:
(PARC) located in Appendix 11–D provide a tool for a sys-
tematic wholistic observation. The observation section of ■■ Have peers always use the pass-around mi-
the Classroom Acoustics Survey Worksheet focuses specifi- crophone. Consider it your “talking-stick.”
cally on the acoustic parameters of the classroom. ■■ Create a classroom culture of one talker at a
A more formal assessment should follow the observa- time. This will benefit all students.
tion that includes classroom acoustics measurements and ■■ If not using the pass mic, paraphrase students’
functional listening. Assessment of the classroom environ- comments, questions, and answers, particularly
ment compliments the audiological and other assessment during fast-paced discussions. This will also be
data that are collected on students. A variety of assessment necessary when the conversation moves fast.
tools “to gather relevant functional, developmental, and aca- ■■ Jot key words on the board during class
demic information” is required under IDEA.1 Appendices discussions.
5–G, 5–H, and 5–I contain several examples of functional ■■ Make sure the whole class knows of topic
assessment protocols. changes.
■■ Please allow your student and his or her part-
Use of Remote Microphone Technology ner/small group to work in a quiet environment.
In addition to the assessment process detailed in Chapter 8,
Hearing Instruments and Hearing Assistance Technology, it
may be necessary to complete an analysis of the learning
recommendation. Considering that about 60% of communi-
environment to identify all factors that lead to a RM system
cation time is spent listening, access is essential. The SETT
framework (Zabala, n.d.) mentioned previously in this chap-
ter provides a systematic method for considering the student,
the student’s environment, learning tasks, and tools for this
discussion. An example of a student SETT analysis is in
Nuggets from the Field Table 7–7 and a guide in Appendix 7–B. As another compo-
nent on the SETT framework, be sure to include training for
I am an audiologist. By nature of that role, it is my the student and teachers to effectively implement the use of
responsibility to support and facilitate the use of any tools or technology. Training for parents is also recom-
hearing for learning. However, it is also my respon- mended so that they can support its use.
sibility to know when a given environment and task
may require supplementary communication tools. I Classroom Accommodations
find the SETT framework extremely helpful in guid- Accommodations are essential to accessing the educational
ing my work when considering the communication environment. They need to be used consistently and appro-
continuum, specific to curricular programming. priately; as early as possible, the student should advocate for
If we allow ourselves to consider the commu- himself.
nication continuum as fluid rather than static, and
Chapter 7
mode of communication as a tool within the SETT Following are suggestions to promote auditory access
framework, then we will be supporting students, (NASDSE, 2018):
not from a place of ego or bias but rather from ■■ Select classrooms away from the street, playground,
the informed and individualized needs of each stu- boiler room, and electrical transformers.
dent. This idea may seem contrary to the hearing- ■■ Situate the student away from noise-producing equip-
habilitation-bias innate in our roles as audiologists, ment such as air conditioners, fans, or computer stations.
but it is what our work in education requires of us. As an alternative, baffle the vents, mount compressors
on rubber pads, or insulate the equipment in some way.
1
[34 CFR §300.304(b)(1).

TABLE 7–7 Sample SETT Analysis Example: Sam
S tudent
■■ Fifth-grade student, average hearing level of 55 dB bilaterally resulting in speech barely audible in
typical conversation without hearing aids (audibility 0.05 bilaterally on SII count-the-dot audiogram)
and no access in distance listening situations; visual access to talker improves understanding via
speech reading.
■■ Hearing aids improve audibility and speech understanding in quiet but distance listening and
listening in noise still compromised; Sam describes listening effort and fatigue issues.
■■ Current academic performance is grade level in all areas except reading and written language that
are 1 year behind.
■■ Communication preference is listening-spoken language; however, Sam also knows some ASL from
association with other deaf and hard of hearing children at a summer camp.
■■ Sam expressed difficulty hearing and understanding what other students say in the classroom.
■■ Sam is the only one in school with reduced hearing levels. There are no reported social-emotional
or other concerns.
E nvironment
■■ Noise levels of the fifth-grade classroom, computer lab, and art classroom exceed ANSI classroom
noise standards (standard = 35 dBA, classroom range 40–52 dBA). The ventilation system is a
significant noise source; student computers, smartboard add to noise. Computer lab has highest
noise levels.
■■ Windows add light but also glare to whiteboard.
■■ Classroom teachers mostly consistent to face Sam when speaking and utilize priority seating but
have difficulty repeating what other students say.
T asks
■■
■■
Classroom instruction (large group teacher presentation and discussion, small group activity with
discussion)
Independent work assignments
■■ Assessments
■■ Media (videos, YouTube videos, web content)
■■ Extracurricular activities: sports
T ools
■■ GOAL: To achieve at least 90% speech understanding for access to communication and instruction
in all classroom settings. Options under consideration:
Remote Mic HAT system with pass-around mic
Sign language interpreter
Captioning of media
■■ Conduct functional listening assessment to compare performance with and without RM HAT
system to validate benefit of 90% performance.
■■ Assess ASL benefit by assessing accuracy of understanding a series of signed sentences.
■■ Discuss with Sam results of both assessments as well as captioning of media to determine
preferred access supports based on the learning and/or communication task.
Note. From NASDSE (2018). Used with permission.
Chapter 7
■■ Utilize carpets, acoustic ceiling tiles, and rubber seals ■■ Use remote microphone hearing assistance technology
around the doors and drapes. Angled room corners to improve the SNR.
cause less reverberation than squared corners. Modify ■■ Monitor pacing of information, instruction, and discus-
hard surfaced walls with bulletin boards, drapes, cloth, sion. Students say “I can’t hear fast enough” and fre-
wallpaper, or any other absorbing medium. quently feel out of step with classroom participation.
■■ Where possible, situate the student in a classroom with
Following are suggestions to promote visual access (NASDSE,
walls and doors. Avoid an open environment such as
2018):
more than one class sharing the same space.
■■ Shuffling of chairs, coughing, opening/closing of doors, ■■ Adequate lighting is essential for the students to be able
background music, or any environmental sound in the to discern facial expressions, lip movements, signs, body
classroom can disrupt a student’s attention, interfering movements, and gestures. Controlled lighting through
with a student’s ability to hear and track conversations. such strategies as nonglare lighting, curtains, blinds,

240 Chapter 7
and shades promote visual concentration and reduce

eyestrain. Students benefit from solid and uncluttered
backgrounds for ease in speechreading and using sign Nuggets from the Field
language or cued speech.
■■ Sign language interpreters may require risers in large
RASA
rooms or special lighting, especially when rooms are
Sound expert Julian Treasure implored his TED au-
darkened for video.
dience to teach listening in schools. He offers a
■■ High contrast and large print are necessary for Power
mnemonic so educators can teach every student
Point or other text that is projected for classroom
to Receive (pay attention), Appreciate (nod at
instruction.
the speaker, smile, make eye contact), Summarize
■■ Visual graphics and pictures are helpful to support En
(so?), and Ask questions (about what was said)—
glish word concepts.
RASA. (https://www.ted.com/talks/julian_treasure
■■ Appropriate signage and other visual displays and
_5_ways_to_listen_better)
message boards provide continual access to daily an-
nouncements, critical messages, and other important
information.
■■ Flashing fire and smoke alarms are required by ADA
Suggestions for Access to Media
and other visual alerting and signaling devices (e.g.,
flashing lights and bells that begin and end classes) ■■ Use closed captions (CC) on all video content.
are important to support independence and personal ■■ Do not assess your student with recorded speech ma-
responsibility. terials—the student will require a live-voice reader.
■■ Deaf and hard of hearing students need to keep their (See Appendix 9–H, Reduced Hearing and Recorded
eyes on the talker, making note-taking extremely chal- Speech, for more on this topic.)
lenging (i.e., they cannot simultaneously listen, watch, ■■ Deaf and hard of hearing students generally cannot use
and write). Request for the student to be provided with headphones and will require an audio cord to listen to
teacher notes/slides of the classroom lesson so that they audio media (e.g., iPad, Chromebooks) through their
can highlight notes or mark up the slides, while primar- RM system.
ily maintaining visual contact with the talker. It also ■■ Provide video links to your student prior to showing the
helps students to video in class so that he can rewind and listen again, to
use a computer or notebook to give the student ac- what he misheard.
cess to Google Slide presentations; ■■ Listening to videos/recorded speech through hearing
have a hard copy of the notes (if not a slide presenta- aids or cochlear implants is much like listening to a
tion) ahead of time; and Wal-Mart speaker for a typically hearing person—it is
have a fill-in-the-blank style of notes. fragmented and very difficult to understand.
SUMMARY gist when new construction and major renovation projects

are on the table for discussion. Advocacy, knowledge, infor-
The educational audiologist plays a unique role in the promo- mation resources, a classroom acoustics toolkit, and a passion
Chapter 7
tion and marketing of appropriate learning environment con- for achieving appropriate learning environments for students
ditions. Educational audiologists recognize the importance who are deaf and hard of hearing are the educational audi-
of auditory and visual access for communication, classroom ologist’s greatest resources to ensure access to information
participation, and overall learning. Collaborating with other in the dynamic 21st-century learning environments.
professionals will be more productive for the educational
audiologist rather than launching a personal campaign to in-
fluence change. Audiologists, architects, engineers, acoustic SUGGESTED READING
consultants, specification writers, designers, and other mem-
bers of school facility planning teams each offer a specific
AND RESOURCES
knowledge and skill set that will contribute toward improv- Acoustical Society of America. (2009/2010). ANSI/ASA S12.60.
ing acoustics and lighting in the classroom. Facility planning 2010 American National Standard Acoustical Performance
teams will value the contributions of the educational audiolo- Criteria, Design Requirements, and Guidelines for Schools,

Part 1: Permanent Schools, and Part 2: Relocatable Class National Association of State Directors of Special Education
rooms Factors. Melville, NY: Acoustical Society of American. (NASDSE). (2018). Optimizing outcomes for student who are
Retrieved from https://global.ihs.com/home_page_asa.cfm? deaf or hard of hearing: Educational service guidelines (3rd ed.).
&csf=ASA. Alexandria, VA: Author.
Atcherson, S., Franklin, C., & Smith-Olinde, L. (2015). Hear- Smaldino, J., & Flexer, C. (Eds.). (2012). Handbook of acoustic
ing assistive and access technology. San Diego, CA: Plural accessibility. New York, NY: Thieme.
Publishing. Treasure, J. (n.d.). Ted talks: Why architects need to use their
Boothroyd, A. (2012). Speech perception in the classroom. In J. ears. Retrieved from https://www.ted.com/talks/julian_trea
Smaldino & C. Flexer (Eds.), Handbook of acoustic accessibil- sure_why_architects_need_to_use_their_ears/transcript?lan
ity. New York, NY: Thieme. guage=en
Chapter 7

APPENDIX 7–A
Classroom Acoustics Screening Survey Worksheet
Date Audiologist/Surveyor
School Room Teacher
Student Name (if applicable) Grade
This worksheet is intended to be used to screen for acoustical problems in classrooms. When noise and/or reverberation levels
exceed those recommended by ANSI/ASA S12.60-2009, 2010, the screening survey data is an indicator for further assessment.
This assessment may include a referral to an acoustical specialist who can perform a comprehensive acoustical analysis and
suggest solutions.
1. OBSERVATION INFORMATION
A classroom observation is a preparatory step for making classroom acoustics measurements. The observation provides infor-
mation about acoustic parameters of the classroom as well as the style of instruction, seating arrangement and the status of
communication access.
Background Noise
Listen in the classroom and check for the following; a “yes” is an indicator of potentially excessive levels of noise.
Classroom Features Yes No
Heating and ventilation system is audible
Mechanical equipment must be turned off during important lessons
Noise from playground is audible
Noise from automobile traffic is audible
Noise from air traffic is audible
With heating and ventilation system turned off, sounds from other classrooms, learning spaces or
hallway are audible
Reverberation
Overall reverberation is determined by the volume of the room and the absorptive characteristics of the materials making up
the classroom walls, floors and ceilings. Check the classroom for the following surfaces; a “yes” is an indicator of potential high
reverberation times.
Chapter 7
Classroom Features Yes No
A hard surface, flat ceiling without acoustic ceiling tiles
Ceiling height is over 11 feet
Acoustic ceiling tiles have been painted
Walls are constructed of sound reflective materials (e.g., plasterboard, concrete, wood paneling)
Floors are constructed of sound reflective materials (e.g. concrete, tiles, wood)
242

Current Technology in the Classroom (if used)

 Personal FM Number of students ___ Type
 Targeted Area Audio Distribution System Type
 Classroom Audio Distribution System Type
Teacher to Listener Distance: Nearest ____ Ft Farthest ____ Ft

Classroom Style:  Traditional  Open  Portable/Relocatable
Primary Instruction Style:  Lecture  Large Group  Small Group  Individual Other
Seating Arrangement:  Clusters  Rows  U-shape or Circle Other
Classroom schematic diagram: see attached
2. NOISE MEASUREMENTS
Sound Level Meter: Make/Model#
Method Used:  One Hour Average  Short-Term: __ second average
Ambient Noise + Teacher Voice Levels (dB):

Ambient Noise Levels (dBA, dBC) 0ccupied Classroom
Condition: U=unoccupied; O=occupied;  Hon  Hoff with Classroom Audio
Hon=HVAC on; Hoff=HVAC off Distribution System
Condition ______ ______ ______ ______ Level S/N ratio Level S/N ratio
Weighting A C A C A C A C A C A C A C A C
A*
B
Average:
* Target Student
3. REVERBERATION TIME
Chapter 7
Measured: Sound stimulus used: ___________________________________________
RT-60 average @ 500 Hz: _____sec
RT-60 average @ 1000 Hz: _____sec RT-60 Classroom Average: ______ seconds
RT-60 average @ 2000 Hz: _____sec

244 Chapter 7
Estimated:
Note: Online RT-60 calculation programs may also be used for this calculation (e.g., http://www.mcsquared.com/homerteng.htm).
Room Volume (V) = cubic feet
Area Floor × ABS. Coef. = A Floor
Area Ceiling × ABS. Coef. = A Ceiling
Area Side Wall 1 × ABS. Coef. = A Wall 1
Area Side Wall 2 × ABS. Coef. = A Wall 2
Area End Wall 1 × ABS. Coef. = A End 1
Area End Wall 2 × ABS. Coef. = A End 2
Total A
Average RT-60 of classroom = 0.049 × (V)/ (A) = seconds
4. CRITICAL DISTANCE: Estimated level from Critical Distance Chart: ____ Ft
Recommended Classroom Acoustic Standards for Core Learning Spaces <10,000 ft volume
(ANSI/ASA S12.60-2009, 2010):
Permanent Classrooms: Ambient Noise Level: 35dBA/C; Reverberation Time: 0.6 seconds
Relocatable Classrooms: Ambient Noise Level: 41dBA/C, 38 dBA/C by 2013, 35 dBA/C by 2017
Reverberation Time: 0.5 seconds
*Note: These core learning spaces shall be readily adaptable to allow reduction in reverberation time to 0.3 seconds to accommodate
children with special listening needs.
Chapter 7

Directions for Classroom Sound Level level during an instructional period. If measure-
Measurements ments can only be taken in an empty classroom,
you may estimate occupied classroom levels by
Equipment needed: Type 2 sound level meter (SLM), 20 ft converting the unoccupied noise levels to occupied
measuring tape or laser tape, standard reading material (e.g., by adding 10 dB to each unoccupied measurement.
rainbow passage or similar). This conversion is roughly equal to the known dif-
1. Draw a schematic of the classroom on the back of the ference in noise level between average unoccupied
form and mark the locations of the measurements (A–F). and occupied classrooms.
Generally, measurements should be taken from student d. Calculate and record the average ambient noise
desks at the four corners of the instructional area and level for each condition measured. Compare to the
the middle and the middle back of the room. If there is ANSI/ASA standards for the type of room (perma-
a target student, use location A to mark that student’s nent or portable).
position and eliminate the middle back of the room. Ad- 5. Teacher Voice Levels:
ditional positions can be added if necessary. a. Position the teacher in the typical instructional
2. Identify the make and model of the SLM used as well as position in the classroom. The students should
the averaging time frame. The ANSI/ASA standard re- be seated in their normal seats for instruction. It
quires a 1-hour average of the noisiest time period dur- is important that the measurements are made at a
ing learning instruction to capture maximum internal time that represents the noisiest time of instruction,
(inside the classroom) as well as external (outside the especially if there is significant external noise, to
classroom and building) noise. When it is not possible capture the acoustic conditions that are represen-
to perform a 1-hour average, indicate, under the short- tative of the average maximum noise periods of
term option, the number of seconds/minutes that the av- the day.
erage was based on. Type 2 SLMs contain an averaging b. Orient the SLM to approximate the center of each
function to determine this value and often recommend selected student’s head while he/she is seated at
a time frame. his/her desks. Point the SLM toward the teacher
3. Weighting: Ideally sound level measurements should be position, taking care to avoid placing your body in
taken in both A- and C-weighted conditions. A-weighting the sound path between teacher and student, which
will capture a better estimate of speech information can produce inaccurate measurements.
as received by the listener, while the C-weighting will c. Ask the teacher to begin reading the standard pas-
address HVAC and other low-frequency noise in the sage, and record the teacher voice levels on the
classroom. Indicate which weighting(s) you are using form at the various locations and weightings using
by recording the values in the appropriate columns for the same procedures outlined in 4c. These mea-
each of the measurements taken. surements provide an estimate of the signal level
4. Ambient Noise Levels: during an instructional period.
a. Turn on the SLM; set to the A- or C-weighted scale d. Determine signal-to-noise (S/N) ratio of the class-
and on slow response. If you can set the range of the room by subtracting the ambient noise level from
meter, set it to accommodate 40–60 dB SPL to begin. the teacher voice level at the selected student lo-
b. Ambient noise levels should be measured for the cations. For example, a student location with a
unoccupied and occupied conditions at several lo- teacher voice level of 60 dB and an ambient noise
cations in the classroom as levels may vary accord- level of 50 dB would have a S/N ratio of +10 dB.
ing to distance from noise sources. Indicate condi- One with a teacher level of 60 dB and a noise level
tion, U = unoccupied, O = occupied, Hon = HVAC of 70 dB would have a S/N of –10 dB. Be sure to
on, Hoff = HVAC off (e.g., U/Hon = unoccupied note the A- or C-weighting used.
Chapter 7
with HVAC on), on the line provided above each e. Averaging all teacher voice levels and subtracting
set of A- and C-weighted measurements in the con- from the average ambient level for the various con-
dition box. Perform as many conditions as possible. ditions will calculate an average S/N level.
c. If the room is occupied, have the students quiet. 6. Teacher Voice Levels with Classroom Audio Distribu-
Measure the ambient noise level at the selected tion System:
student locations and record it on the classroom a. Repeat Steps 5a–e above.
documentation form. If the noise level fluctuates b. Compare results to the condition without the sys-
when taking short-term measurements, take three tem to determine the benefits of the audio distribu-
measurements at 1-minute intervals and average tion system. The goal is even distribution of the
the readings to record on the form. These measure- teacher’s voice throughout the classroom demon-
ments will provide an estimate of the ambient noise strating an improvement of 8–10 dBA.

246 Chapter 7
Directions for Classroom Reverberation V = volume room, and A = total absorption of the room
surfaces in Sabins.
Measurements
The most common formula for predicting reverberation time 1. All of the reverberation estimates can be conducted in
is the familiar Sabine equation (RT-60 = 0.049 × Volume/ an unoccupied classroom. Because a formula is used, no
Surface area × Average Absorption). This equation can be improvement in accuracy is obtained with students and
used to make paper and pencil estimates of RT-60 as de- teacher present. During more detailed measurements,
scribed later. Instrumentation is also available to estimate the presence of the room occupants would be desirable.
RT-60. Each method is outlined next. 2. Calculate the volume of the classroom by measuring the
length, width, and height of the classroom in feet and
Directions for making RT-60 measurements: multiplying them together (volume = length of room ×
Equipment needed: Reverberation instrument or sound level width or room × height of room).
meter with reverberation measurement capability, noise gen- 3. Record the resulting room volume in cubic feet on the
eration source such as a balloon or two boards that can be classroom documentation form.
clapped together. 4. Multiply the volume of the room by the constant 0.049
to obtain the numerator for the RT = 0.049 V/A equa-
1. Make separate RT-60 measurements at 500 Hz, 1000 Hz, tion. Record the results on the form.
and 2000 Hz. 5. To obtain the denominator of the equation, the area of
2. These measurements require an impulse sound to be the walls, floor, and ceiling of the room must first be
generated that is at least 25 dB louder than the back- calculated in square feet. If the walls, ceiling, or floor
ground noise in the room. The impulse sound can be are irregularly shaped, each section must be measured
produced by dedicated sound generators, or more often, separately. The area of the floor and ceiling is deter-
breaking balloons or slapping boards. mined by multiplying the length of the floor or ceiling
3. Measurements at each frequency should be made in times its width. The area of the walls can be obtained
the four corners and the middle of the room. The five by multiplying the length of each wall by its height.
measurements at each frequency should be averaged to Enter the values for the area of each on the classroom
obtain the best estimate of the RT-60 for that frequency documentation form.
in the room. Record this average on the form for each 6. The absorption coefficient (Abs. Coef.) is a measure of
frequency. the sound reflectiveness of different construction mate-
4. An overall RT-60 estimate in the classroom for the rials. The coefficient, expressed in Sabins, must be de-
speech frequencies is obtained by averaging the RT-60 termined for the material composing the walls, ceiling,
estimates obtained for 500 Hz, 1000 Hz, and 2000 Hz. and floor. Average absorption coefficients are given in
Record this as the room average RT-60. the table for the most common construction materials.
If a different construction material is encountered and
Directions for calculating estimated reverberation time using the you use another absorption coefficient table, average
Sabine formula: the coefficients given in the other table for 500, 1000,
Equipment needed: 20-ft measuring tape or laser tape and and 2000 Hz for the purpose of these calculations. Enter
calculator. the average absorption coefficient in the appropriate
Formula to estimate classroom reverberation time: place on the documentation form.
RT = 0.049 V/A, where RT = reverberation time in seconds,
Sound Absorption Coefficients for Common Classroom Materials

Chapter 7
Average Average Average

Absorption Absorption Absorption
Material Coefficient Material Coefficient Material Coefficient
WALLS: FLOORS: CEILINGS:
Brick 0.04 Wood parquet on concrete 0.06 Plaster, gypsum, or lime on lath 0.05
Painted concrete 0.07 Linoleum 0.03 Acoustic tiles (5/8”), suspended 0.68
Window glass 0.12 Carpet on concrete 0.37 Acoustic tiles (1/2”), suspended 0.66
Plaster on concrete 0.06 Carpet on foam padding 0.63 Acoustic tiles (1/2”), not suspended 0.67
Plywood 0.12 High absorptive panels, suspended 0.91
Concrete block 0.33
Adapted from Berg, F. (1993) by J. Smaldino and C. Crandell (1995). In Sound-field FM Amplification, Crandell, Smaldino, & Flexer (Eds.) p. 78. Singular Publishing.
Reprinted by permission. See RT60 websites for a more comprehensive list of materials.

7. Multiply the area of each floor, ceiling, and wall times Directions to Determine Approximate
the absorptive coefficient of the material composing the
Critical Distance
surface. Add up all of the resultants of the multiplica-
tions to obtain the A (total absorption of the room in Using the following table, match the room volume and esti-
Sabins) in the RT = 0.049 V/A formula for the room and mated reverberation time; the resulting value is the critical
record it on the form. distance. Up to and including this distance from the speaker,
8. Take the numerator from Step 3 (0.049 × V) and the de- reflections from the sound reverberating in the room will
nominator from Step 6 (A = total absorption in Sabins enhance the speech signal; beyond this distance the speech
for the room) and divide them in order to determine signal will be degraded by the later reflections of the sound
the estimated reverberation time of the room in seconds reverberations. For example, for a room of 10,000 cubic feet
(RT = 0.049 V/A). Enter the estimate on the documenta- and a reverberation time of 0.4 seconds, the critical distance
tion form. Compare the results to the ANSI/ASA stan- is 10 feet. It is important that students with special listen-
dards for the type of room (permanent or portable). ing requirements are not positioned any further than 10 feet
from the speaker in this situation.
ESTIMATED CRITICAL DISTANCE TABLE1
Room Volume Reverberation Time (seconds)

(Cubic Ft)
0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0
2000 5.2 4.5 4.0 3.7 3.4 3.2 3.0 2.8
4000 7.3 6.3 5.7 5.2 4.8 4.5 4.2 4.0
6000 8.9 7.7 6.9 6.3 5.9 5.5 5.2 4.9
8000 10.3 8.9 8.0 7.3 6.8 6.3 6.0 5.7
10,000 11.5 10.0 8.9 8.2 7.6 7.1 6.7 6.3
12,000 12.6 11.0 9.8 8.9 8.3 7.7 7.3 6.9
14,000 13.7 11.8 10.6 9.7 8.9 8.4 7.9 7.5
16,000 14.6 12.6 11.3 10.3 9.6 8.9 8.4 8.0
18,000 15.5 13.4 12.0 11.0 10.1 9.5 8.9 8.5
20,000 16.3 14.1 12.6 11.5 10.7 10.0 9.4 8.9
Critical Distance (feet)

1
© Arthur Boothroyd, used with permission.
Note. Adapted by C. D. Johnson & J. Smaldino (2010) from Acoustic measurements in classrooms by J. Smaldino, C. Crandell, & B. Kreisman, 2005. In Sound Field
Amplification, Crandell, Smaldino, & Flexer (Eds.) p. 131. Thomson Delmar Learning. Reprinted by permission.
Chapter 7

APPENDIX 7–B
Using the Student, Environments, Tasks, and Tools Framework
to Identify Assistive Technology and Interpreting Services for Students
Who Are Deaf or Hard of Hearing
The Student, Environments, Tasks, and Tools (SETT) framework (Zabala, n.d.1) is four-part process designed to help analyze
various considerations that impact assistive technology, interpreting,2 and other access options in the educational setting.
The SETT framework begins with considering the language, communication, and learning preferences of the student, the
characteristics of the environment where the activity is occurring, and the learning task. Once these areas are discussed, tool
and service options are considered. Prior to selection, analysis through a trial may be recommended. This process should
address the varying classroom and communication environments that are part of the student’s educational experience, includ-
ing extracurricular activities.
Considerations for Students Who Are Deaf or

Questions to Consider Hard of Hearing
The Student ■■ What is the functional area(s) of concern? What Functional areas to consider:
does the student need to be able to do that is ■■ Language competence
difficult, or impossible, to do independently at ■■ Communication preferences
this time?
■■ Accessibility in each of the environments
■■ What are the student’s special needs related to
■■ Social/emotional/identity status
the area of concern?
■■ Academic levels
■■ What are the student’s current abilities (related
■■ Connection to deaf/hard of hearing peers
to area of concern)?
■■ Motivation
■■ What are the student’s expectations and
concerns?
■■ What are the student’s interests and
preferences?
The Environments ■■ What is the classroom or environment and ■■ Physical/Instructional: acoustics (reverberation,
arrangement (instructional, physical)? noise levels) and speech-to-noise ratios; lighting,
■■ What support is available to the student and seating arrangements and visual proximity to
the staff ? talker’s faces, interpreters and/or captioning
■■ What materials and equipment are commonly ■■ Current educational technology used in the
used by others in the environment? classroom that may present a barrier (e.g., video,
■■ What are the access issues (technological, computers, white boards, website) to assistive
physical, instructional)? technology use
■■ What are the attitudes and expectations of the ■■ Web content that is perceivable, operable,
staff, family, or others? understandable, and robust (WCAG)
Chapter 7
■■ Communication access accommodations for

educational technology and instruction (UDL)
Speech-to-text
Interpreters
Hearing Assistance Technology (HAT)
Talking stick
■■ School staff understanding and use of
communication accommodations for effective
communication and language support
248

Considerations for Students Who Are Deaf or

Questions to Consider Hard of Hearing
The Tasks ■■ What specific tasks occur in the student’s ■■ Classroom instruction (large group teacher
natural environments that enable progress presentation and discussion, small group activity
toward mastery of IEP goals and objectives? with discussion)
■■ What specific tasks are required for active ■■ Independent work assignments
involvement in identified environments related ■■ Assessments
to communication, instruction, participation, ■■ Extracurricular: theater (memorizing lines for
productivity, environmental control? part); sports (signs, cues)
■■ Media (videos, web content)
The Tools How is the S-E-T information used to think about ■■ Discuss access tool and interpreting options with
tools? student (e.g., speech-to-text, hearing assistance
■■ Which tool(s) and/or interpreting services technology, Smartpens, interpreting)
can provide communication access that is as ■■ Provide training on the tools and interpreting
effective as for non-deaf or hard of hearing services: how to use, what they do and do not do
students? ■■ Develop a plan to trial selected tools/interpreting
■■ Is it expected that the student will not be services—identify when, how long, criteria to
able to make reasonable progress toward evaluate the effectiveness of each tool
educational goals without assistive technology ■■ Identify best tool(s)/services for each instructional
devices and services? or participatory situation
■■ Brainstorm specific tools/interpreting that could
be included in a system that addresses student
needs.
■■ Select the most promising tool(s)/interpreting
services for trials in the natural environments.
■■ Plan the specifics of the trial (expected changes,
when/how tools/interpreting services will be
used, cues, etc.)
■■ Collect data on effectiveness
1
http://www.joyzabala.com/uploads/Zabala_SETT_Leveling_the_Learning_Field.pdf
2
Interpreting services include oral language, cued language and sign language transliteration, transcription (speech to text) services, and tactile interpreting
(IDEA 34 CFR §300.34(c)(4)).
Note. Adapted from NASDSE (2018). School Environment Access Accommodations (Chapter 6) in Optimizing outcomes for students who are deaf or hard of hearing
(pp. 48–49).
Chapter 7

APPENDIX 7–C
Resources
In this section, resources are provided to assist the educa- Enhanced Acoustical Performance are part of the commis-
tional audiologist in supporting healthy acoustic conditions sioning and credentialing program where school districts
in classrooms. Resources are provided according to the fol- can achieve various levels of LEED certification. Require-
lowing categories: classroom acoustics observation forms ments address strategies and technologies for reducing and
and checklists, guidelines and standards, informational managing classroom acoustics with specifications for HVAC
publications and media, observation and assessment instru- background noise, NRC ratings of acoustical treatments, and
ments, organizations, software and calculation programs, STC ratings for classroom partitions. The 2009 LEED for
treatment and modification resources, and websites. Schools: New Construction and Major Renovations guide-
lines are available at https://new.usgbc.org/leed
Guidelines and Standards Informational Publications and Media

American National Standards Institute (ANSI) Acoustical Society of America (ASA)
■■ ANSI S12.60-2002, Acoustical performance criteria, The ASA has published two manuals on classroom acoustic
design requirements and guidelines for schools. (2002) design for architects as well as other resources.
Available for download at https://global.ihs.com/home ■■ Classroom acoustics I: A resource for creating learn-
_page_asa.cfm?&csf=ASA. ing environments with desirable listening conditions
Annex B: Design guidelines for noise control for build- (Seep, B., Glosemeyer, R., Hulce, E., Linn, M., Aytar,
ing services, utilities, and instructional equipment P., & Coffeen, R., 2003). This supplemental resource is
Annex C: Design guidelines for controlling rever- designed for architects, educators, and school planners
beration in classrooms and other learning spaces for use in new construction or in renovation of existing
Annex D: Design guidelines for noise isolation learning spaces and is available at https://acousticalso
Annex E: “Good architectural practices” and proce- ciety.org/classroom-acoustics/
dures to verify conformance to this standard ■■ Classroom acoustics II: Acoustical barriers to learn-
■■ ANSI S1.4-1983 (R 2006), American National Standard ing (Nelson, P., Soli, S., & Seltz, A., 2003). Volume II
Specification for Sound Level Meters. (2006) Available provides an overview of the need for quiet classrooms,
for purchase and download at https://global.ihs.com with emphasis on high-risk children (e.g., English as a
/home_page_asa.cfm?&csf=ASA second language, otitis media, permanent hearing loss)
and includes an extensive topic-organized reference
American Academy of Audiology list. Available at https://acousticalsociety.org/classroom
-acoustics/
Position Statement on Classroom Acoustics (2008). Avail-
able at http://www.audiology.org/resources/documentli
brary/Pages/PSclassroomacoustics.aspx TED Talks: Julian Treasure, Why Architects
Need to Use Their Ears
Chapter 7
American Speech-Language-Hearing A must view for administrators, teachers, parents, students,

Association and other audiences to learn about the effects of poor acous-
Guidelines for addressing acoustics in educational settings tics in classrooms, health facilities, and the community; just
[Guidelines] (2005). Available at https://www.asha.org under 10 minutes. Available at https://www.ted.com/talks
/public/hearing/Classroom-Acoustics/ /julian_treasure_why_architects_need_to_use_their_ears
/transcript?language=en
LEED Green Building Certification Program
The U.S. Green Building Council has included classroom Classroom Acoustics: Listening Versus Learning
acoustics as part of the Indoor Environmental Quality sec- (DVD)
tion of its LEED Green Building Certification Program. This 9½-minute program provides valuable information
Requirements for Minimum Acoustical Performance and about the issues and problems associated with noisy class-
250

rooms. The intended audience is educators, parents, and World Health Organization
other interested individuals. Available through the Educa- The World Health Organization (WHO) developed several
tional Audiology Association at http://edaud.org publications on classroom acoustics topics that include use-
ful charts, photographs, and illustrations. Topics of interest
Classroom Acoustics Video include Noise and Health (No. 36), Acoustic Measurement
(No. 37), Noise in Schools (No. 38), and other noise-
This 10-minute video offers a quick and informative over-
related topics. WHO recommendations are provided at the
view of classroom acoustics problems and solutions includ-
conclusion of each module. Publications may be ordered
ing construction materials and classroom design. Available
at no charge from the website at http://www.euro.who.int
at http://www.schoolfacilities.com
/en/health-topics/environment-and-health/noise/publications
Listening for Learning Technical Assistance

Documents Observation and Assessment Instruments
The Access Board (2003) developed five technical assis- Children’s Auditory Performance Scale (CHAPS)
tance documents. English and Spanish versions of these (Smoski, Brunt, & Tannahill, 1998). Available for purchase
helpful tools may be requested from the Access Board’s through Educational Audiology Association at http://edaud
website at http://www.access-board.gov/acoustic/index.htm. .org. The Children’s Auditory Performance Scale (CHAPS)
The English version is posted on the Quiet Classrooms web- was developed as a scaled questionnaire to systematically
site that can be accessed at http://www.quietclassrooms.org collect and quantify listening behaviors observed in children
/ada/ada.html. aged 7 years and older. The CHAPS is a 36-item check-
list divided into six listening conditions and functions (i.e.,
■■ Listening for learning 1: The importance of good class-
noise, quiet, ideal, multiple inputs, auditory memory and se-
room acoustics
quencing, auditory attention span). Each listening condition
Key points: listening in noise, children at risk, classroom
is described on the checklist, and items that follow the con-
acoustics standard, suggestions for parent advocacy
dition are designed to examine practical listening demands.
■■ Listening for learning 2: Will our new classrooms meet
Response choices (i.e., degrees of listening difficulty) are as
the standard?
follows: +1 (less difficulty), 0 (same amount of difficulty),
Key points: acoustic design issues and practices class-
–1 (slightly more difficulty), –2 (more difficulty), –3 (con-
room audio distribution systems, signal-to-noise ratio,
siderably more difficulty), –4 (significantly more difficulty),
cost-benefit analysis, language of acoustics
5 (cannot function at all). The CHAPS also can be used to
■■ Listening for learning 3: Counting the costs of noisy vs.
help evaluate the effectiveness of acoustic modifications
quiet classrooms
or interventions for a single student or groups of students
Key points: classroom acoustics construction cost anal-
(available from http://edaud.org).
ysis, up-front versus acoustic modifications costs, case
studies
■■ Listening for learning 4: A checklist for classroom Fisher’s Auditory Problems Checklist
acoustics (Fisher, 1976). Available for purchase from the Educational
Key points: noise, reverberation, HVAC noise, external Audiology Association at http://edaud.org. This 25-item broad-
noise, adjacent noise based checklist can be used easily by classroom teachers, other
■■ Listening for learning 5: Retrofitting a noisy classroom. school support personnel, and parents as a pre-/postobserva-
Key points: solutions for noise and reverberation; spe- tion checklist to assist in determining if there have been behav-
cific suggestions for windows, doors, self-noise, and ioral changes following implementation of acoustic modifica-
equipment tions. The checklist can be completed in less than 5 minutes.
Chapter 7
A score is derived by multiplying by four the number of items
Noise Reduction Coefficients (NRCs) for not checked. Normative data are available as mean percentage
scores for individual grade levels, kindergarten through sixth
Common Building Materials
grade. A Group Mean Score, which is the cut-off score sug-
NRCratings.com provides an online chart that lists the gesting need for further evaluation, is given along with stan-
NRCs for common building materials. This information dard deviations (SD) (available from http://edaud.org).
will be useful as it provides an indication of the amount of
mid- and high-frequency sound that will be absorbed by the
material. It is a good alternative when the precise manufac- Scale of Classroom Listening Behaviors
turer and specifications are unknown and that may be the (Schow & Seikel, 2006). Twelve auditory-related behaviors
situation in older learning spaces. Available at http://www are rated on a 5-point scale. Norms are available for two
.nrcratings.com/nrc.html age groups (8–9 years, 10–11 years) for ratings completed

252 Chapter 7
by both parents and teachers. The scale could be used as a students, and other details about the room configuration and
pre- or postobservation checklist following acoustic modifi- acoustic features. The program will estimate reverberation
cations in the learning environment. if that measurement is unavailable. Estimates of speech re-
ception are provided using the Speech Audibility Index, and
Screening Instrument for Targeting Educational estimates of speech perception are shown in terms of word
Risk (S.I.F.T.E.R.) recognition in sentences. These estimates can be shown by
simply slicking on any student in the classroom. Calcula-
(Anderson, 1989, 2004; Anderson & Matkin, 1996). Three tion worksheets may also be downloaded from the program.
versions of the S.I.F.T.E.R. (original, preschool, secondary) Available at http://www.arthurboothroyd.com
are tools the educational audiologist can use to monitor
the efficacy of acoustic improvements and modifications
in classrooms. These 15-item checklists designed for use Odeon Room Acoustics Software
by classroom teachers categorize student behaviors in the ODEON is PC software for simulating the interior acous-
areas of academics/pre-academics, attention, communica- tics of buildings. By using the geometry and properties of
tion, class participation, and school behavior. Items are rated surfaces, room acoustics can be calculated, illustrated, and
on a 5-point scale and normative data are available for each listened to. This is helpful in the planning, retrofit, and mod-
version. The preschool version provides further analysis of ification stages of design for optimum classroom acoustics.
results in the areas of expressive communication and so- Available at http://www.odeon.dk
cially appropriate behavior, which are two areas that could
be affected by classroom acoustics (available at https://suc Reverberation Calculator
cessforkidswithhearingloss.com)
McSquared provides an online reverberation calculator for
estimating reverberation time in a room at octave band fre-
Organizations quencies 125 through 4000 Hz. This calculator is based on
Acoustical Society of America, https://global.ihs.com/home the Sabine reverberation equation, which makes certain as-
_page_asa.cfm?&csf=ASA sumptions about the distribution of acoustic treatment or
A.G. Bell Association for the Deaf and Hard of Hearing, absorptive surfaces. The user inputs the room dimensions
http://www.agbell.org and the additional acoustic finishes. This quick estimation
American Academy of Audiology, http://www.audiology.org process is only applicable to rooms with carpeting. The au-
American Institute of Architects, http://aia.org thors caution that the reverberation calculator is provided for
American Speech-Language-Hearing Association (ASHA), educational purposes only, with no warranty of its accuracy
http://asha.org or applicability. They also encourage engaging the services
Architectural Engineering Institute (AEI), https://www.asce.org of an acoustical consultant. Available at http://www.mc
/architectural-engineering/architectural-engineering-institute/ squared.com/homerteng.htm
Council of Educational Facility Planners, International
(CEFPI ), http://www.cefpi.org
Educational Audiology Association, http://edaud.org Studio Six Digital
International Code Council, http://www.iccsafe.org Check this website for Audio Tools, a suite of applications for
Institute of Noise Control Engineering of the USA (INCE), smartphones. Applications can be purchased individually or
http://www.inceusa.org/ as modules. These tools are not intended to replace the diag-
National Council of Acoustical Consultants, http://www nostic meters and instrumentation used to measure noise and
.ncac.com/ reverberation. However, having the applications available on a
National Hearing Conservation Association, http://www smartphone enables the audiologist to quickly take measure-
.hearingconservation.org ments in educational settings. Examples of applications include
Chapter 7
U.S. Green Building Council, http://www.usgbc.org/ SPL meter (traditional or digital display), RTA (for octave and
World Health Organization (WHO), http://www.euro.who.int/ one-third octave analysis), audio signal generator, and various
calculators. Available at http://www.studiosixdigital.com/
Software and Calculation Programs
Modeling Classroom Acoustics (2006) Treatment and Modification Resources
This interactive program developed by Arthur Boothroyd, Acoustical Panels, Baffles, and Fabrics
PhD, was designed to illustrate the effects of noise and re- Many manufacturers offer acoustic panels, baffles, and fabrics
verberation on speech reception and perception at various that could be applied to attenuate classroom noise and rever-
positions in a classroom and to show the potential benefits of beration. An Internet search will produce abundant informa-
classroom audio distribution systems. Users of the program tion and resources. Consult with the district’s facilities and
input data on room dimensions, noise levels, RT, number of maintenance department to determine if there is a preferred

vendor for these types of solutions. Collaboration with other ■■ Smurzynski. (2007). Acoustic foundations of signal en-
decision-makers in the district is generally the safest way to hancement and room acoustics.
proceed with major purchases for acoustic treatment. Most
vendors will provide onsite or phone consultation to ensure
that the products are an appropriate match for the desired
Websites
acoustic treatment. A listing of qualified acoustic consultants Acoustical Surfaces
across the nation may be obtained from the National Council http://www.acousticalsurfaces.com
of Acoustical Consultants (http://www.ncac.com). Many useful reference tools, resource documents on class-
room acoustics topics (e.g., crash course in classroom
Chair Slipper acoustics, taking sound level readings, retrofitting a noisy
classroom) developed by Mike Nixon, acoustic consultant
Chair Slippers are applied similar to the tennis ball solution and advocate for improving classroom acoustics.
to reduce classroom noise. The rubber core felt ball-shaped
chair slippers are available in a variety of sizes and colors,
and latex test results show that there is no antigenic protein Hands and Voices
present in these sound attenuators. Samples are available at http://www.handsandvoices.org
http://chairslippers.com. Hands and Voices is an organization dedicated to supporting
families with children who are deaf or hard of hearing. On-
HUSHH-UPS line articles focus on topics such as approaching the school
district to request acoustic modifications in the classroom,
These specially designed, air-inflated tennis balls are spe-
acoustics and socialization, and advocacy.
cifically manufactured for durability and sound attenuation
in the classroom. HUSHH-UPS carry a 2-year warranty and
are available through Sound Listening Environments, Inc. McSquared
(http://hushups.com). http://www.mcsquared.com
Useful online calculators for critical distance, inverse square
law, and other estimations are provided on this website, as
QuietFeet
well as demonstrations of classroom speech intelligibility
Durable adhesive chair and desk feet attenuators are avail- in classrooms.
able through Acoustic Resources (http://www.acousticre
sources.net). The company was founded by an educational
audiologist in order to help create better classroom listening National Clearinghouse on Educational
environments. Facilities
http://www.edfacilities.org/rl/acoustics.cfm#11473
Selected References The NCEF’s website offers an extensive resource listing
of links, books, and journal articles on acoustic standards,
The following publications contain suggestions for improv-
research studies, media articles, and methods of calculat-
ing the acoustic environment of classrooms. Consult the ref-
ing acoustic quality in school classrooms and other school
erence list for complete citations.
spaces.
■■ ANSI/ASA. (2010). Design guidelines for noise con-
trol, design guidelines for controlling reverberation,
and design guidelines for noise isolation. Quiet Classrooms
■■ Boothroyd. (2004). Room acoustics and speech perception. http://www.quietclassrooms.org/
Chapter 7
■■ Crandell & Smaldino. Room acoustics for listeners Quiet Classrooms is an alliance of nonprofit organizations
with normal-hearing and hearing impairment (2000b), working to create better learning environments in schools
Classroom acoustics: Understanding barriers to learn- by reducing noise. This website offers resource information
ing (2001) and Acoustical modifications in classrooms about classroom noise, management of classroom acoustics,
(2005). and design considerations for audiologists, schools, school
■■ Siebein, Crandell, & Gold. (1997). Principles of class- boards, PTAs, principals, parents, teachers, students, and
room acoustics: Reverberation. school architects.
■■ Siebein, Gold, Siebein, & Ermann. (2000). Ten ways to
provide a high-quality acoustic environment in schools.
■■ Smaldino, Crandell, Kreisman, John, & Kreisman. School Facilities Design, Construction,
(2009). Room acoustics and auditory rehabilitation Maintenance, and Management Resources
technology. https://www.schoolfacilities.com/

254 Chapter 7
Articles related to classroom acoustics and the consideration U.S. Green Building Council (USGBC)
of acoustics in the design and maintenance of schools are http://www.usgbc.org/
published on this website. The USGBC provides useful information about green and
sustainable facility design. Classroom acoustics is addressed
United States Access Board in the LEED for Schools Guidelines under the Indoor Qual-
http://www.access-board.gov/acoustic/index.htm ity Environment Section.
The Access Board provides regular updates on the imple-
mentation of the classroom acoustics standard, a classroom
acoustics factsheet, archival information, and links to help-
ful resources.
Chapter 7

CHAPTER 8
Hearing Instruments
and Remote
Microphone Technology
With Erin C. Schafer
CONTENTS
Rationale for Hearing Instruments and Remote Microphone Technology

Recent Trends and Regulatory Considerations
Regulations ■ The Role of Case Law ■ Professional Practice Standards and Scope of Practice Considerations
■ The Responsibility of Public Education ■ Keeping Up With Technological Advancements ■ Equipment and
Space Requirements
Chapter 8
“This is my hearing aid/FM daily check procedure.”
255

256 Chapter 8
Assessment of Hearing Instrument and Remote Microphone Technology in Children and Youth
Candidacy and Candidacy Considerations ■ Device Selection Considerations for Remote Microphone Technology
Personal Hearing Instruments and Remote Microphone Technology Options
Hearing Aids ■ Cochlear Implants ■ Remote Microphone Technology
Implementation and Management of Hearing Technology
Fitting and Verification ■ Orientation and Training ■ The Usage Plan ■ Validation
■ Monitoring and Equipment Management ■ Strategies to Implement the American Academy of Audiology
Hearing Assistance Technology Guidelines

Other Assistive Technologies
Summary
Suggested Readings
Appendices
8–A Student Amplification Listening Evaluation (Text/Online)
8–B Pediatric Amplification Listening Evaluation (Text/Online)
8–C Personal Amplification Monitoring Plan (Text/Online)
8–D Instructions for Hearing Aid Checks (Online)
8–E Instructions for Cochlear Implant Checks (Online)
8–F Instructions for Osseointegrated Bone Conduction Implant Checks (Online)
8–G Instructions for Personal Remote Microphone System Checks (Online)
8–H Hearing Technology Monitoring Chart (Online)
8–I The Ling Six Sound Check (Text/Online)
8–J Tips to Enhance Remote Microphone Use (Text/Online)
8–K Remote Microphone Hearing Assistance Technology Implementation Worksheet: In-School Form
(Text/Online)
8–L Remote Microphone Hearing Assistance Technology Implementation Worksheet: Out-of-School Form
(Text/Online)
KEY TERMS ■■ Personal RM HAT requires fitting, verification, and val

idation from a licensed audiologist.
Hearing assistance technology (HAT), remote microphone ■■ RM HAT must be maintained and monitored by school-
(RM) system, frequency modulation (FM) system, digitally based personnel.
modulated (DM) system, remote microphone accessory,
candidacy verification, validation, guidelines, regulations. Universal newborn hearing screening supports early
intervention efforts in many children with congenital hear-
ing loss. Ideally, children who are identified with congeni-
KEY POINTS tal sensorineural hearing loss will receive hearing aids with
advanced, digital signal processing within the first weeks
■■ Guidelines and federal regulations support the use of of identification. Children whose hearing levels are in the
remote microphone hearing assistance technology (RM severe to profound range will be monitored closely to deter-
HAT) in children with hearing loss who have educa- mine if hearing aids provide adequate audibility to achieve
Chapter 8
tional need. expected developmental speech and language milestones.

■■ Candidates for RM HAT include children with hearing When this does not occur, most children will be referred to a
loss, auditory processing disorders, autism spectrum cochlear implant program or center for monitoring and pos-
disorder, auditory neuropathy spectrum disorder, learn- sible cochlear implantation by or before 12 months of age.
ing disabilities, language deficits, attention deficits, and Despite these early intervention efforts to ensure audibil-
English-language learners. ity of speech and other environmental sounds, children and
256

Hearing Instruments and Remote Microphone Technology 257
adults with reduced hearing, regardless of level, have poorer 8–B may assist in the determination of the need for a hearing
speech perception abilities in noisy listening situations rela- aid or other technology by documenting listening abilities and
tive to quiet situations than their peers (Bistafa & Bradley, difficulties in the classroom and home/community.
2000; Boothroyd, 2004a, 2004b; Crandell & Smaldino, Almost all personal hearing technologies may be cou-
2000a; Leavitt & Flexer, 1991; Nelson & Soli, 2000; Nel- pled to RM technology. Use of RM technology is particularly
son, Soli, & Seltz, 2002). In addition, younger children, even important in school environments due to the expected levels
those with normal pure-tone hearing sensitivity, have poorer of noise, reverberation, and distance from the teacher (Cruck-
speech perception in noise than older children and adults ley, Scollie, & Parsa, 2011; Knecht, Nelson, Whitelaw, &
(children) due to the developmental aspects of speech-in- Feth, 2002; Nelson, Smaldino, Erler, & Garstecki, 2007). As
noise performance (Neuman, Wroblewski, Haijcek, & Ru- discussed later in this chapter, there is a large body of evi-
binstein, 2010). However, hearing assistance technology dence to support the use of RM technology for children with
(HAT) systems and accessories have the potential to address reduced hearing as well as children with normal pure-tone
the negative impact of noise and distance from the talker of hearing sensitivity who may benefit from an improved SNR,
interest, and reverberation in everyday environments, as well including those with auditory processing deficits (APDs), at-
as allow listeners to hear important environmental informa- tention deficit hyperactivity disorder (ADHD), autism spec-
tion (i.e., fire alarms, doorbell, ringing phone). One form of trum disorder (ASD), and language disorders.
HAT, remote microphone (RM) technology, is designed to
improve the signal-to-noise ratio (SNR) in a child’s ear via
wireless transmission of the talker’s voice directly to the
child’s personal hearing technology. RECENT TRENDS AND
The purpose of this chapter is to establish a strong ratio REGULATORY CONSIDERATIONS
nale for the use of RM technology with children as well as to
define candidacy, device selection, fitting, and management Most advanced hearing technologies contain digital signal
processes. Following are several important questions that processing algorithms and directional microphones that aim
this chapter addresses: to address listening issues in noisy situations. Despite con-
tinued technological improvements, children and adults still
■■ What are the potential benefits of RM technology, and report difficulty and perform poorly on speech perception
who is a candidate? tasks in noisy listening situations (Bistafa & Bradley, 2000;
■■ Who is licensed to fit hearing instruments and RM tech- Boothroyd, 2004a 2004b; Crandell & Smaldino, 2000a;
nology, and who maintains and manages hearing devices? 2000b; Leavitt & Flexer, 1991; Nelson & Soli, 2000; Nel-
■■ What are the school’s responsibilities for providing person, Soli, & Seltz, 2002). As described in detail in this chap-
sonal hearing instruments and RM technology? ter, the most effective strategy to address difficulties in noise
■■ Who provides devices for infants and toddlers in early is to use RM accessories, which are designed for use with
childhood programs? only one device, or RM systems that are designed for use
■■ What role does amplification have for children who with multiple listeners. Figure 8–1 illustrates the relation-
have normal pure-tone hearing sensitivity but who dem- ship of the various RM options under HAT. The following
onstrate attention, learning, or listening problems? sections discuss legislation, case law, and school-based con-
■■ How can we maximize the use of our audiologic ser- siderations regarding personal and RM technology.
vices to support children and their families in both
home and educational settings?
Regulations
Chapter 1 discusses each of the laws listed and how they
impact students with disabilities. Each of these laws has im-
RATIONALE FOR HEARING plications related to personal hearing instruments and RM
INSTRUMENTS AND REMOTE technology as services that provide access to a student’s
free and appropriate public education (FAPE). [See Appen
MICROPHONE TECHNOLOGY dix 1–C for the text of the Individuals with Disabilities Edu-
cation Act definitions].
Following the identification of reduced hearing status, children
must obtain the personal hearing technology most appropriate The Individuals with Disabilities Education Act (IDEA)
Chapter 8
■■
for their type and level of hearing. The most common devices 2004, Regulations:
for children with sensorineural hearing loss include digital 34 CFR 300.34(vi) Definition of Audiology (Part B)
hearing aids, cochlear implants, or a combination of both a 34 CFR 303.13(b)(2) Definition of Audiology (Part C)
hearing aid and implant. Also, some children may use bone 34 CFR 300.5-.6/34 CFR 303.13(b)(1)(i) Assis-
conduction or osseointegrated bone conduction implants. The tive Technology and Assistive Technology Services
Amplification Listening Evaluations in Appendix 8–A and (Part B and Part C)

258 Chapter 8
FIGURE 8–1 Remote microphone options as part of hearing assistive technology.
34 CFR 300.105(a)(2) Assistive Technology used at of 2003. The court upheld a New Hampshire Department
home or other settings of Education independent hearing officer’s decision that the
34 CFR 300.113 Routine checking of hearing aids local school district was responsible for providing cochlear
and external components of surgically implanted implant mapping services as part of the audiology services
medical devices under IDEA (Stratham Sch. Dist. v. Beth and David P., 103
34 CFR 300.324(2)(v) Development, Review and LRP 4317 [02-135-JD, 2003 DNH 022]). While there was
Revision of Individualized Education Program no disagreement that mapping a cochlear implant was part
(IEP), Consideration of Special Factors of audiology services, there were many concerns regarding
■■ Every Student Succeeds Act of 2015. the implications for providing this service for a personal
■■ Section 504 of the Rehabilitation Act of 1973. hearing device within the school setting. In response to
■■ The Americans with Disabilities Act (ADA) of 1990 concern from educational and clinical audiologists, parents,
(PL 101-336) and the most recent ADA Amendments and school staff and administrators regarding this ruling,
Act of 2008. IDEA regulations for related services and routine checking
of hearing aids were amended in 2004 to exclude “external
To ensure appropriate recommendations for RM and
components of surgically implanted medical devices.” Other
other assistive technologies, it is critical that pediatric and
case law has upheld the school responsibility for monitor-
educational audiologists are knowledgeable about state
ing personal hearing technology used by students in school,
and federal legislation, state and district eligibility require-
Section 504 plan services for remote mic HAT, and student
ments, and other public school regulations related to hearing
access to multiple means of communication access under
technology. RM technology is not classified by the Food and
both IDEA and ADA. The case law summary in Appen
Drug Administration (FDA) as durable medical equipment,
dix 11–G includes a chronology of special education case
and as a result, oversight of this technology is limited, and
law pertaining to hearing aids and assistive devices.
audiologists must be involved in their selection and fitting.
Chapter 8
The Role of Case Law Professional Practice Standards

Regulations are developed by federal and state govern- and Scope of Practice Considerations
ment, but the interpretation of these regulations may be Professional practice standards and guidelines reflect best
determined through case law. One example occurred in a practice procedures for all fields of practitioners. Within
U.S. District Court of New Hampshire ruling in February audiology there are professional guidelines for hearing in-

TABLE 8–1 Audiology, Speech-Language Pathology, and Teacher of the Deaf Scope of Practice Responsibilities for Amplification and
Remote Microphone Technology
Professional Scope of Practice Citation Source

Audiologist The audiologist is responsible for the evaluation, fitting, and verification of AAA Scope of Practice (January
amplification devices, including assistive listening devices. The audiologist 2004), https://www.audiology.org
determines the appropriateness of amplification systems for persons with
hearing impairment, evaluates benefit, and provides counseling and training
regarding their use. Audiologists conduct otoscopic examinations, clean ear
canals and remove cerumen, take ear canal impressions, select, fit, evaluate,
and dispense hearing aids and other amplification systems.
As part of the comprehensive audiologic (re)habilitation program, ASHA Scope of Practice –

audiologists evaluate, select, fit, verify, validate, and monitor the performance Audiologist (2018), https://
of a variety of technology interventions for hearing, balance, and other www.asha.org
related disorders. Audiologists provide individual counseling and public
education about the benefits and/or limitations of various different classes
of devices. Treatment utilizing technology interventions include but are not
limited to other emerging technologies:
■■ Auditory brainstem implants (ABIs)
■■ Assistive listening devices
■■ Balance-related devices
■■ Classroom audio distribution systems
■■ Cochlear implants
■■ Custom ear impressions and molds for hearing devices, hearing

protection, in-ear monitors, swim plugs, communication devices, stenosis
stents, and so forth
■■ Hearing aids
■■ Hearing assistive technology
■■ Hearing protection
■■ Large-area amplification systems
■■ Middle ear implants
■■ Over-the-counter (OTC) hearing aids
■■ Osseointegrated devices (OIDs), bone‑anchored devices, and bone

conduction devices
■■ Personal sound amplification products (PSAPs)
■■ Remote microphone systems
■■ Tinnitus device (both stand‑alone and integrated with hearing aids)
Speech-Language Providing services to individuals with hearing loss and their families/ ASHA Scope of Practice –
Pathologist caregivers (e.g., auditory training for children with cochlear implants and Speech-Language Pathologist (2007),
hearing aids; speechreading; speech and language intervention secondary to https://www.asha.org
hearing loss; visual inspection and listening checks of amplification devices
for the purpose of troubleshooting, including verification of appropriate
battery voltage).
Teacher of the Assist with routines related to assistive technology used by individuals CEC-DCD Initial Standards Deaf and
Deaf and Hard of who are deaf or hard of hearing to enhance access to the environment. Hard of Hearing (2018)
Hearing (Standard 2: Learning Environments [DHH.2.S2]) https://www.cec.sped.org
Chapter 8

260 Chapter 8
struments and HAT from both the American Academy of ual professional ethics, and adherence to the professional
Audiology (AAA) and the American Speech-Language- standards. Typically, educational audiologists are the most
Hearing Association (ASHA). These important documents informed about this practice, as it is one of the primary re-
are intended to guide our daily practice and can also be used sponsibilities for supporting auditory access to information
in legal situations to identify the standard of practice should in the classroom, in school activities, and in communication
our own practices ever be under scrutiny. Pediatric amplifi- with others in and outside of school.
cation practice standards that should undergird our practice Schools that do not employ audiologists will need to
in the schools are contract with a qualified audiologist to perform RM technol-
ogy fittings. If this type of audiology expertise is not avail-
■■ AAA (2013) Pediatric Amplification Guidelines and
able locally, an educational audiologist with a state school
■■ AAA (2008) Clinical Practice Guidelines: Remote Mi-
for the deaf outreach program or other state or regional pro-
crophone Hearing Assistance Technologies for Chil-
gram could fulfill this service. RM technology recommen-
dren and Youth from Birth to 21 Years.
dations will need to be addressed in the child’s Individual
It is important to note that the 2008 guidelines for RM Family Service Plan (IFSP) or the Individualized Education
technology do not reflect current devices or fitting protocols, Program (IEP) so that all members of the planning team
and as a result, this chapter provides evidence-based guid- understand and are informed of the necessity for a qualified
ance regarding contemporary devices. Scope of practice is- person to perform this service.
sues continue in the fitting of RM technology, and concern
has escalated as the complexity of devices has increased.
Do nonaudiologists (or nonlicensed hearing aid dispensers) The Responsibility of Public Education
legally fit hearing aids? Typically, not. RM devices are as Hearing instruments and RM technologies are included
complicated as hearing instruments, and the coupling of the under several sections of IDEA. An important distinction
two technologies requires specific expertise. This problem must be made for personal hearing instruments, which most
is confounded by the fact that RM technology is not regu- often include hearing aids, cochlear implants, and osseoin-
lated by the FDA. The audiology scope of practice for both tegrated bone conduction implants. Public education is not
AAA and ASHA clearly identifies the audiologist as the pro- required to provide, nor provide for, personal hearing in-
fessional with the necessary knowledge, skills, and formal struments beyond routine checking that the device is turned
training to conduct HAT fittings. While speech-language on and functioning properly (34 CFR 300.13) (see text box
pathologists (SLPs) and teachers of the deaf (TODs) are the discussion regarding hearing aids and cochlear implants).
other professionals most likely to fit these devices to chil- The exception would be if a hearing aid were determined by
dren in schools, the scope of practice documents for these the IEP team to be the assistive technology device required
professions do not support this practice. Table 8–1 compares for a child/youth to have a free and appropriate public edu-
the current scope of practice descriptions for each of the cation (FAPE).
professions. Funding for RM technology is the obligation of the
Ensuring that RM technology fittings are conducted school district or the agency designated by the school dis-
by a qualified and licensed audiologist must be addressed trict. IDEA permits states to “use whatever State, local,
through legislation, professional scopes of practice, individ- Federal, and private sources of support that are available in
The AAA Clinical Practice Guidelines for HAT (2008) sum- 3. A udiologists fitting hearing aids and RM HAT on chil-
marize these considerations in the following statements: dren and youth should have the expertise and the
test equipment necessary to complete all tests for
1. A udiologists are the professionals singularly qualified
device selection, evaluation, and verification proce-
to select and fit all forms of amplification for children
dures described herein.
and youth, including personal hearing aids, RM sys-
4. Audiologists must adhere to procedures consistent
tems, and other HAT. Audiologists also program and
with current standards of practice to assess auditory
manage cochlear implant fittings. Audiologists have a
Chapter 8
function in children and youth.7.

master’s and/or doctoral degree in audiology from a
5. Audiologists must be knowledgeable about federal
regionally accredited university.
and state laws and regulations impacting the identifica-
2. Audiologists must meet all state licensure and/or
tion, intervention, and education of children and youth
regulatory requirements.
who are deaf and hard of hearing (AAA, 2008, p. 5).

Office of Special Education Programs (OSEP) Comments Regarding

Hearing Aids and Cochlear Implants, Final IDEA Regulations, August 14, 2006
A cochlear implant is an electronic device surgically im- system such as an audio loop. For services that are not
planted to stimulate nerve endings in the inner ear (co- necessary to provide access to education by maintaining
chlea) in order to receive and process sound and speech. the health or safety of the child while in school, the distin-
The device has two parts, one that is surgically implanted guishing factor between those services that are not covered
and attached to the skull and, the second, an externally under the Act, such as mapping, and those that are cov-
worn speech processor that attaches to a port in the im- ered, such as verifying that a cochlear implant is functioning
plant. The internal device is intended to be permanent. Op- properly, in large measure, is the level of expertise required.
timization or “mapping” adjusts or fine tunes the electrical The maintenance and monitoring of surgically implanted
stimulation levels provided by the cochlear implant and is devices requires the expertise of a licensed physician or
changed as a child learns to discriminate signals to a finer an individual with specialized technical expertise beyond
degree. Optimization services are generally provided at that typically available from school personnel. On the other
a specialized clinic. As we discussed previously regarding hand, trained lay persons or nurses can routinely check an
§300.34, optimization services are not a covered service externally worn processor connected with a surgically im-
under the Act. However, a public agency still has a role in planted device to determine if the batteries are charged
providing services and supports to help children with co- and the external processor is operating. (As discussed be-
chlear implants. Particularly with younger children or chil- low, the Act does require public agencies to provide those
dren who have recently obtained implants, teachers and services that are otherwise related services and are neces-
related services personnel frequently are the first to notice sary to maintain a child’s health or safety in school even
changes in the child’s perception of sounds that the child if those services require specialized training.) Teachers and
may be missing. This may manifest as a lack of attention or related services providers can be taught to first check the
understanding on the part of the child or frustration in com- externally worn speech processor to make sure it is turned
municating. The changes may indicate a need for remap- on, the volume and sensitivity settings are correct, and the
ping, and we would expect that school personnel would cable is connected, in much the same manner as they are
communicate with the child’s parents about these issues. taught to make sure a hearing aid is properly functioning. To
To the extent that adjustments to the devices are required, allow a child to sit in a classroom when the child’s hearing
a specially trained professional would provide the remap- aid or cochlear implant is not functioning is to effectively
ping, which is not considered the responsibility of the public exclude the child from receiving an appropriate education.
agency. In many ways, there is no substantive difference Therefore, we believe it is important to clarify that a public
between serving a child with a cochlear implant in a school agency is responsible for the routine checking of the exter-
setting and serving a child with a hearing aid. The external components of a surgically implanted device in much
nally worn speech processor connected with the surgically the same manner as a public agency is responsible for the
implanted device is similar to a hearing aid in that it must proper functioning of hearing aids. The public agency also is
be turned on and properly functioning in order for the child responsible for providing services necessary to maintain the
to benefit from his or her education. Parents of children health and safety of a child while the child is in school, with
with cochlear implants and parents of children with hearing breathing, nutrition, and other bodily functions (e.g., nurs-
aids both frequently bring to school extra batteries, cords, ing services, suctioning a tracheotomy, urinary catheteriza-
and other parts for the hearing aids and externally worn tion) if these services can be provided by someone who has
speech processors connected with the surgically-implanted been trained to provide the service and are not the type of
devices, especially for younger children. The child also may services that can only be provided by a licensed physician.
need to be positioned so that he or she can directly see (Cedar Rapids Community School District v. Garret F.,
the teacher at all times, or may need an FM amplification 526 U.S. 66 (1999))
Chapter 8

262 Chapter 8
the State to meet the requirements [of FAPE]” (300.103). them. The definition of assistive technology is broad, and
Furthermore, IDEA states that “nothing in this part [Subpart the responsibility of the educational program is compre-
B-State Eligibility] relieves an insurer or similar third party hensive. Under IDEA, the use of a device and service must
from an otherwise valid obligation to provide or to pay for be determined on an individual basis as part of the devel-
services provided to a child with a disability.” These regula- opment of a student’s IEP and must be necessary for the
tions allow states to use a variety of funding sources so long student to “receive reasonable benefit” from his or her edu-
as there is no cost to the family, and they do not permit insur- cational environment. RM technology is used by students
ance companies to abrogate their responsibility just because when required to access the educational program, but spe-
a child receives special education services. cialized instruction is not needed under a Section 504 plan
and ADA.
Part C
Use of HAT Outside of School
Responsibility for personal hearing instruments under Part C
varies by state depending on the designated state lead agency The use of RM systems, especially personal RM devices,
and that agency’s policies. While a growing number of states purchased by school systems for use outside of school is
require private insurance coverage for children’s hearing addressed in IDEA (see text box). Nonacademic settings
aids, other states may provide funding through Part C, or by (e.g., extracurricular activities, meals, and recess) are also
other agencies. Part C providers are, at a minimum, required covered by IDEA. Schools must ensure that each student
to assist families in obtaining funding for hearing aids. Sur- with a disability has the supports and services necessary
gically implanted devices typically are covered by public or to participate in these activities and settings. Audiologists
private insurance, and manufacturers typically maintain cur- need to be prepared to address the use of RM technol-
rent information on reimbursement sources and procedures. ogy on the playground, on athletic fields, and in theater
When children are not eligible for public funding, do productions.
not have insurance that covers hearing aids, or are unin- Increasingly, parents choose to purchase RM technol-
sured, the resulting funding maze for families and the au- ogy for use at home, particularly given the affordability of
diologists who support them can delay hearing aid fitting wireless streaming accessories designed for many hearing
for months. Many states have loaner programs that provide aids and cochlear implants. RM wireless streaming acces
hearing aids on a short-term basis until funding is secured sories, designed for use with one child, may be used at
or as temporary amplification until a child is old enough to school with a school-purchased transmitter. Receivers for
receive a cochlear implant. Educational audiologists should the child’s hearing aids or implants are not necessary with
maintain a current list of funding options that includes com- streaming accessories because the receivers are built into the
munity, state, and national organizations and entities. (See personal technology. Use of a RM accessory is not ideal in
Appendix 15–B for resources.) classrooms with more than one student because, at this time,
the accessory transmitters are unable to stream information
to multiple users. Parents may also purchase RM systems
The Hearing Aid as Assistive Technology consisting of frequency modulation (FM) or digital modula-
A 1994 U.S. Department of Education, Office of Special tion (DM) receiver(s) for the child’s personal hearing tech-
Education Programs (OSEP) interpretation of a hearing aid nology and a transmitter for the primary talker. These joint
as an assistive technology device remains: if a hearing aid is ownership situations require agreements that outline issues
identified as a need on a student’s IEP to receive a free and such as cost and maintenance responsibilities. Two potential
appropriate public education (FAPE), it may be considered situations are as follows:
assistive technology and, therefore, would be required to be
provided by the district. Examples of where a hearing aid ■■ The school purchases the transmitter, and the par-
has been provided include the existence of special circum- ents purchase the receiver(s). In this case, each owner
stances for accessing a school program, such as a special would be responsible for maintenance of the units they
moisture-resistant hearing aid that can be worn under a foot- own. Problems may arise if the student’s receiver is not
ball helmet or a specially designed football helmet with a
built-in hearing aid.
The issue of the responsibility of education to provide
hearing aids has raised concern from audiologists and spe-
Chapter 8
2004 IDEA (300.105(a)(2): On a case-by-case basis,

cial education directors. For audiologists, concerns include the use of school-purchased assistive technology de-
a shortage of educational audiologists to meet existing needs vices in a child’s home or in other settings is required
of students, difficulty securing funds to purchase and main- if the child’s IEP team determines that the child needs
tain RM technology and other necessary audiology-related access to those devices in order to receive FAPE.
equipment, as well as keeping abreast of hearing instrument
advancements and securing the equipment necessary to fit

repaired in a timely manner or is lost. The school may ■■ materials for measuring or estimating reverberation
provide a backup system or consider paying for repairs time;
when parents do not or cannot afford them. ■■ otoscope;
■■ The cost of purchasing the entire system is shared. In ■■ electroacoustic analysis equipment;
this case, a contract or memorandum of understanding ■■ Real-Ear measurement equipment;
(MOU) should be developed to delineate each party’s re- ■■ battery testers, stethoscopes, hearing aid checking de-
sponsibility for purchase and maintenance of the system. vices, and cochlear implant monitoring earphones;
■■ visual aids and materials for training and classroom
Again, the joint ownership combinations are more com-
presentations;
plicated than using school-owned equipment. However, the
■■ age-appropriate test materials for selection, verification,
positive aspects of shared responsibility include parent in-
and validation; and
volvement and an established partnership to address hearing
■■ backup RM accessories or systems.
needs at school and home.
The space for this equipment should be properly venti-
lated and located away from noise sources as well as accom-
Keeping Up With Technological modate the audiologist and the child/youth being assessed.
Space for servicing and maintaining RM accessories and
Advancements
systems as well as storing equipment during periods of non-
Manufacturers release new models of hearing instruments use (e.g., summer) must also be available.
and RM technology continuously, and staying up to date on To effectively implement RM technology, educational
these advances may be a challenge. It is critical for educa- audiologists need sufficient time in their schedules to per-
tional audiologists to be aware of advances in personal hear- form these procedures. Protocols also must include monitor-
ing technology as well as RM technology advances that may ing and evaluating the effectiveness of RM technology.
significantly improve speech perception. A frequently asked
question concerns the school’s responsibility for maintain-
ing state-of-the-art equipment. The school’s mandate is to
provide assistive technology that meets the child’s individ- ASSESSMENT OF HEARING
ual needs for FAPE. Schools are not obligated to provide INSTRUMENT AND REMOTE
specific brands of equipment, only assistive technology that
works properly and effectively meets the student’s needs. MICROPHONE TECHNOLOGY
Parents cannot demand that a school purchase a certain IN CHILDREN AND YOUTH
brand of FM or DM system for their child. Fortunately, al-
most all FM and DM systems may be attached to hearing Every child/youth with reduced hearing, including those with
aids and cochlear implants with specific adaptors. The key minimal, unilateral, and high-frequency losses, should be
for determining the most appropriate hearing assistance considered a candidate for amplification. Decisions regard-
technology is to use a valid process that is individualized. ing the type of amplification (i.e., hearing aids, specialized
The AAA clinical practice guidelines: Remote microphone hearing instruments, RM technology, or some combination)
hearing assistance technologies for children and youth from must be based on individual hearing and listening needs. Re-
birth to 21 years (AAA, 2008) provides the framework for cent evidence suggests that candidates also include students
the device selection, fitting, and management process (from with normal hearing who have listening problems that can be
this point forward referred to as the AAA HAT guidelines). mitigated by RM technology. A thorough analysis of the stu-
More recent peer-reviewed publications (since the AAA dent’s auditory and listening abilities along with a functional
HAT guidelines were published) and advances in hearing evaluation in the student’s primary classroom (i.e., custom-
technology must be considered and are discussed later in ary environment) can be conducted to document educational
this chapter. need for the RM technology. As summarized in Johnson
(2010) and Schafer (2014b), a functional evaluation may in-
clude an assessment of classroom acoustics, classroom ob-
Equipment and Space Requirements servation, student/parent interview, student/teacher question-
naires about classroom listening abilities, speech perception
The AAA HAT guidelines (p. 6) recommend the following
scores in background noise, review of other assessments and
Chapter 8
equipment and materials to conduct appropriate assess-

IEP goals/objectives, and posttrial assessments following the
ment, selection, fitting, verification, and validation of RM
use of RM technology. This type of evaluation is the essence
technology:
of the role of the educational audiologist and helps to fulfill
■■ sound booth with diagnostic 2-channel audiometer and our responsibility to provide the most appropriate services
sound-field capabilities; that support communication access for hearing, listening, and
■■ sound level meter (Type 2 or 3); learning. The assessment individualizes and authenticates

264 Chapter 8
TABLE 8–2 Summary of a Selection of Studies That Support the Use of Remote Microphone Technology in Children and Adults With
Hearing Aids or Cochlear Implants
Authors, Year Participant Information Summary of Results

Schafer et al., 2006 22 children with CIs ■■ Improved speech-in-noise thresholds with FM on first
■■ Ages 3–12 years implanted side or both sides relative to the second implanted
12 bilateral CI side.
10 bimodal: CI and HA ■■ Children who use bilateral or bimodal arrangements may
receive significant benefit when using FM-system input on both
ears.
Schafer & Kleineck, 2009 Meta-analysis of 9 studies ■■ Personal FM systems provided greater improvement than
(35 experiments) CADS and desktop FM systems.
Thibodeau, 2014 Moderate-to-severe ■■ Adaptive digital technology resulted in significant improvement

hearing impairment in speech recognition in noise than adaptive FM technology.
■■ 11 adults who wore ■■ Adaptive digital technology was preferred over adaptive FM.
bilateral HAs
■■ 15 adults with normal
hearing
Wolfe et al., 2009 25 adults with CIs ■■ Adaptive-gain (Dynamic FM) analog FM systems resulted in
better speech recognition in noise compared to fixed-gain
traditional FM systems.
Wolfe et al., 2013b 37 subjects with a CI ■■ Adaptive digital FM systems resulted in better performance
■■ 17 Advanced Bionics than fixed-gain and adaptive analog FM systems.
■■ 20 Cochlear
Wolfe et al., 2015 Subjects had unaided ■■ Adaptive digital remote microphone technology resulted in
high-frequency pure-tone greater improvement than remote microphone accessory in
average of 50 dB HL in the speech recognition in moderate- to high-level noise.
better ear ■■ Remote microphone accessory still resulted in improvement in
■■ 17 adults: bilateral HAs speech recognition in quiet and noise.
Note. CI, cochlear implant; FM, frequency modulation; HA, hearing aid.
our recommendations for accommodations including RM is for an RM accessory or system. Knowing the current lim
technology. The following sections review the selection and itations of personal hearing technology to compensate for
fitting of RM technology for various school populations. noise, distance, and high reverberation as well as the chal-
lenges of students with normal hearing sensitivity who have
listening problems, RM technology candidacy should be
Candidacy and Candidacy Considerations considered for the following populations:
Every child/youth with reduced hearing should be consid-
ered a candidate for personal hearing instruments. 1 This de ■■ reduced hearing;
cision typically is a personal choice between the student, ■■ auditory processing deficits;
parents, and dispensing audiologist with collaboration from ■■ autism spectrum disorder;
the educational audiologist if the child/youth is part of a ■■ auditory neuropathy spectrum disorder (ANSD);
school program. On occasion, an educational audiologist fits ■■ learning disabilities;
personal hearing instruments for use at school. Regardless ■■ language deficits;
Chapter 8
of the personal instrument decision, the next consideration ■■ attention deficits; and
■■ English-language learners.
1
The decision to recommend RM technology must be
Current guidelines from the American Academy of Audiology caution that
hearing aid amplification should be deferred in children with auditory neu-
tied to evidence of hearing, listening, or learning prob-
ropathy until minimum responses or behavioral hearing thresholds can be lems whether in or out of school (i.e., educational access
established (AAA, 2013). needs for RM technology). When available, recommenda-

TABLE 8–3 Summary of a Selection of Studies That Support the Use of Remote Microphone Technology in Children and Adults
With Normal Hearing and Listening Problems
Authors, Year Participant Information Summary of Results

Hornickel et al., 2012 Dyslexia ■■ Improvements after a year of FM use
■■ 38 subjects ■■ FM group had significantly improved neural consistency
■■ 19 used FM
■■ 19 controls with dyslexia
Johnston et al., 2009 APD ■■ Use of FM significantly better than no FM

■■ 10 APD ■■ SIFTER and LIFE showed an improvement with FM
■■ 13 controls
Rance et al., 2014 ASD: ■■ Average improvement of 17% from no-FM to FM for ASD group
■■ 10 ASD with FM ■■ Both child APHAB and Teacher LIFE showed an improvement
■■ 10 controls with FM
Purdy et al., 2009 Reading Delay: ■■ Use of FM improved listening abilities in the classroom setting for
■■ 23 children with reading delay children with a reading delay
■■ 23 controls ■■ Teacher and student LIFE showed an improvement with FM
Schafer et al., 2013 ASD/ADHD ■■ Performance significantly worse than controls with no-FM
■■ 7 ASD (2 ADHD; 2 APD) ■■ CHAPS showed an improvement with FM
■■ ADHD (2 APD)
■■ 11 controls
Schafer et al., 2014 ASD, ADHD, LD, or SLI ■■ Use of FM significantly better than no-FM
■■ 12 subjects ■■ Student LIFE-R, CHILD, and Parent CHILD showed an
improvement with FM
Schafer et al., 2016 ASD ■■ RM system improved speech recognition for children with ASD
■■ 12 subjects relative to no RM system
■■ LIFE-R, CHAPS, CHILD, and SSP showed an improvement with
DM
Note. ADHD, attention deficit hyperactivity disorder; APD, auditory processing disorder; APHAB, Abbreviated Profile of Hearing Aid Benefit; ASD, autism spectrum dis-
order; CHAPS, Children’s Auditory Performance Scale; CHILD, Children’s Home Inventory for Listening Difficulties; LD, language disorder/delay; LIFE, Listening Inventory
for Education; SIFTER, Screening Instrument for Targeting Educational Risk; SLI, specific language impairment; SSP, short sensory profile.
tions should be based on evidence-based, peer-reviewed gleaned from a routine hearing evaluation. IDEA2 states that
research (Tables 8–2 and 8–3). The next step is to con- the evaluation for assistive technology must include a func-
sider the social-emotional, functional, and support impli- tional evaluation of children in their customary environment,
cations for use of RM technology (Table 8–4). Issues that and a classroom listening assessment may be necessary to
arise should be addressed through counseling with the stu- establish individual SNR needs and other student charac-
dent and family members, or through discussion with school teristics that will affect the type of RM technology recom-
personnel. If contraindications exist, the situation should be mended. Factors to consider include audiological status,
monitored by the educational audiologist so that the situa- developmental issues, the listening environment at school,
tion can be reassessed as needs and circumstances change. at home, and in the community, technology, and funding.
Chapter 8
Audiological Status
Device Selection Considerations for
As outlined in the AAA HAT guidelines, there are three
Remote Microphone Technology groups of potential RM HAT candidates: (a) potential or
Once candidacy has been established, information should
be collected that details the hearing and communication
abilities of the student. Much of this information cannot be 2
34 CFR §300.6.

266 Chapter 8
TABLE 8–4 Key Considerations for Determining Candidacy for Remote Microphone Technology
Area Decision Considerations for Implementation of Remote Microphone (RM) Technology

Acoustical environment: Classroom, home, and other communication environments sufficiently quiet and free from
■■ American National reverberation to permit close 1:1 and small group conversation at comfortable talking levels and
Standards Institute with listening ease; RM technology may be required to reduce or eliminate noise and/or distance
(ANSI) standards for factors to make communication more accessible.
noise and reverberation
■■ Transient noise
Social-emotional:
■■ Motivation of student Motivation of the student, teacher, and family members will determine success of RM technology
and teachers, child and fitting and implementation; motivators and reinforcers may be needed to encourage RM technology
family members use.
■■ Attention and fatigue, Inattention and fatigue provide evidence for RM technology candidacy; the increased signal-to-noise
listening and looking ratio from RM technology may improve focus and reduce listening strain.
■■ Self-image The self-image of the student, teacher, and family members may affect success with RM technology.
Student, family member, and/or teacher may need counseling or assistance to encourage positive
acceptance of wearing and using additional technology.
■■ Self-advocacy Good self-advocacy skills will increase the child/youth’s likelihood of success with RM technology. If
self-advocacy skills are low, teaching self-advocacy skills should be included in goals on the Individual
Family Service Plan (IFSP)/Individualized Education Program (IEP). Skills should include
self-monitoring of hearing technology and how to report suspected malfunction.
■■ Social acceptance A student who is well-accepted by his/her peers and who has made one or more friends in school
may be more likely to tolerate and embrace the benefits that RM technology can offer.
■■ Classroom culture A classroom that celebrates diversity, embraces technology and alternative learning opportunities,
and values the unique gifts of everyone will more quickly and efficiently adapt to and support the
use of RM technology. Where these are lacking, extensive classroom inservice activities may be
needed and should be included in the IFSP/IEP goals.
■■ Family support Parents should receive training regarding the benefits and limitations of RM technology, including
suggestions for how to encourage and support their child in RM technology use. Family-to-family
support should be included and documented in the IFSP/IEP.
Functional
■■ Age: Age of implementation of RM technology will be impacted by mobility and safety concerns. Once an
chronological/ infant/child spends time at distances away from the talker or in noisy situations (e.g., car, restaurant),
developmental RM technology use should be considered.
■■ Academic Academic considerations include the learning environment as well as the student’s language and
academic skill level. When considering the benefits of RM technology, consider its impact on access
to the curriculum as well as associated skills such as ease of communication by improving attention
and decreasing response time and fatigue. Further, use of RM technology outside of school may be
necessary to support language and learning goals in the student’s IEP.
■■ Communication skills Consider the student’s communication skills with and without RM technology, including ease of
communication and the potential for enhancing communication access.
■■ Home communication Understanding communication access needs in the home environment is important to assist family
environment members in determining situations in which RM technology should be implemented as well as
situations where it would not be appropriate. Car, meals,TV/movies/theater, and recreation all present
opportunities for listening and communication that can be enhanced by appropriate use of RM
technology.
Chapter 8

Area Decision Considerations for Implementation of Remote Microphone (RM) Technology

Support
■■ Awareness Awareness of the student’s communication needs, and the potential benefits of RM technology are
important for parents/caregivers and educational personnel.
■■ External acceptance Willingness of family members and/or educational personnel to utilize the equipment improves
the likelihood of successful RM technology implementation. In addition, administrative support is
necessary for the use, updating, and maintenance of equipment in academic settings.
■■ Ability to use and Successful implementation requires that the family, with professional support, can understand and
manage technology manage the technology. A qualified person should be identified as responsible for monitoring
and maintaining the equipment. In addition, the user’s physical and developmental status must be
addressed.
■■ Financial resources For out-of-school plans, the family should be aware of RM technology costs and available funding
sources for purchase. Final implementation decisions may depend on the amount of available funding
(e.g., monaural versus binaural RM). For in-school plans, appropriate financial resources must be
allocated for purchase and maintenance.
■■ Section 504/Americans Families should be made aware of current federal regulations regarding RM technology as well as
with Disabilities Act services and equipment to provide communication access under Section 504 and ADA. Families
obligations and students that self-advocate for access needs increase the likelihood of successful RM technology
implementation.
Note. AAA HAT guidelines. Reprinted with permission from the American Academy of Audiology (2008).
actual hearing aid users, (b) cochlear implant users, and tion or instruction that is not transmitted by the teacher or
(c) children with normal pure-tone hearing sensitivity hav- speaker.
ing special listening requirements. The standard recommen- Under IDEA, schools are only required to consider
dation for the first two groups should be bilateral, wireless, settings and activities that impact the student’s ability to
ear-level technology. Ideally, the third group would also receive FAPE, and to meet their IEP goals. However, as
use bilateral, wireless, ear-level technology. However, there professionals, we may want to guide families to consider
may be children who will not tolerate ear-level technol- RM technology options on their own for the same acousti-
ogy. Possible contraindications to the recommended fitting cal access reasons stated previously. In many cases, wireless
are identified and alternatives suggested as summarized in streaming accessories, included a RM, may be available for
Table 8–5. the child’s hearing aid or cochlear implant. Use of the RM
accessory only requires the parent to purchase the micro-
Developmental Considerations phone while the receiver is built into the personal hearing
Age, academic performance, and additional learning prob- technology (Tables 8–7 and 8–8).
lems are developmental components considered by the AAA
HAT Guidelines and are summarized in Table 8–6. Technology
Individual technology options and possible interference and
The Listening Environment compatibility issues must be considered when selecting the
The listening environment is everywhere. It extends be- best RM technology option. The school may have a func-
yond school to the home and community activities and is tional device to use, but if it is not user friendly for the stu-
one of the most critical areas affecting communication ac- dent and teacher or it makes the student stand out, it may not
cess. Appropriate classroom acoustics (see Chapter 7) are be utilized. When classroom speech enhancement systems
essential to the effectiveness of the RM technology choice. are the option of choice, interference may be resolved by
Chapter 8
Children need to be able to access their own voice as well switching from FM to DM systems. In addition, interference
as the voices of others, requiring that the environmental in personal FM may be mitigated by switching channels or
microphone of the personal hearing technology remain by upgrading to a digital system (almost never affected by
active while using RM technology. Classrooms with poor interference). For every new wireless technology introduced
acoustics will negate the effectiveness of the person’s own in the classroom (e.g., Smart Boards with built-in speech
hearing instrument, leaving that person left out of conversa- enhancement systems), a challenge can result for students

268 Chapter 8
TABLE 8–5 Reduced Hearing Groups, Types of Reduced Hearing, Default Contraindications, and Alternatives
Possible Contraindications
Group Hearing Status/Type to Default Fitting Alternatives
Group 1. Children and Conductive/sensorineural/mixed ■■ Ear drainage 1. Alternate amplification use
youth with reduced ■■ External otitis between ears (fit with caution
hearing who are actual relative to gain setting and
or potential hearing monitor fitting frequently)
aid users 2. Targeted area audio distribution
system
3. Classroom audio distribution
system
Unilateral or asymmetric loss ■■ Clinically or functionally 1. Fit ear-level, RM-only receiver

significant threshold and/ to normal ear
or speech perception 2. Fit poorer ear if functional
differences between ears benefit can be demonstrated
3. Fit to both ears
4. Targeted area audio distribution
system
system
Auditory neuropathy spectrum ■■ Normal peripheral hearing 1. Fit ear-level, RM-only receiver
disorder ■■ Variable, uncertain, and or to one or both ears (fit with
near-normal behavioral caution relative to gain setting
responses and monitor fitting frequently)
system
system
Group 2. Children and ■■ Unilateral/bilateral ■■ Inability to increase RM 1. Fit unilaterally or bilaterally
youth with cochlear ■■ Bimodal (HA/CI) gain or volume setting (requires evaluation
implants ■■ Electroacoustic/hybrid (HA/ within electrical dynamic to determine the best
CI in same ear) range of cochlear implant arrangement)
system
system
Group 3. Children and ■■ Auditory processing deficits ■■ No default HAT Options

youth with normal ■■ Autism spectrum disorder 1. Fit nonoccluding, ear-level RM
hearing sensitivity who ■■ Learning disabilities receivers bilaterally (fit using
have special listening real ear measures)
■■ Language deficits
requirements 2. Targeted area audio distribution
■■ Attention deficits
system
■■ English-language learners 3. Classroom audio distribution
system
Note. Portions of the AAA HAT guidelines. Reprinted with permission from the American Academy of Audiology (2008).
Chapter 8

TABLE 8–6 Developmental Considerations and Their Impact on Device Selection
Area Selection and Implementation Considerations

Age Age will affect many decisions, including the style of receiver, wearer acceptance, where
■■ Chronological and in which activities the RM technology will be used (e.g., IDEA makes provision
■■ Developmental for RM technology use in the “natural environment,” which may be interpreted as
home use), the type and amount of inservice training that will be needed, the amount
of monitoring needed, and by whom. Infants and toddlers may require special RM
technology style considerations, including size and weight of hearing aid/implant
processor with RM receiver connected, tamper-proofing, etc.
Academic Performance The degree of academic delay may influence the type of RM technology considered
■■ At or above grade level (e.g., the better the student’s academic classroom performance, the more flexible the
■■ Below grade level
choice of device options).
Additional Problems Multiple disabilities in addition to hearing loss may further support RM candidacy
■■ Attention and may also require special considerations. Students with low cognition may require
■■ Hyperactivity
additional support and monitoring, and device style considerations may apply. Students
with low vision may also be considered a high priority for RM technology, and special
■■ Sensory integration
style considerations may apply (e.g., devices with tactually identifiable components and
■■ Behavior switches, etc.). Other deficits in addition to hearing loss, including sensory integration
■■ Cognition and auditory processing, may impact decisions about speech-to-noise requirements,
■■ Mobility device style, or inservice training needs. Students and/or teachers/adults with limited
■■ Auditory processing mobility or dexterity problems will need special device style considerations, additional
support, assistance, and monitoring.
■■ Learning
■■ Vision
■■ Fine motor
Note. Portions of the AAA HAT guidelines. Reprinted with permission from the American Academy of Audiology (2008).
TABLE 8–7 Listening Environment Considerations—School

School Learning Environment: The amount and type of exposure to challenging listening environments during
■■ Lecture academically focused interaction may influence the type and duration of use of RM
■■ Discussion
technology. Each environment will need to be assessed with consideration for the
location of the teacher in relation to the student, the amount of student-to-student
■■ One on one
interaction, and any change in physical environment during the academic instruction.
■■ Team teaching
■■ Single group
■■ Multiple groups
School Access Needs: Student’s access needs to be evaluated to accommodate the specific types of
■■ Teachers sound input required. The number of teachers interacting with the student as well
■■ Peers
as potential student-to-student interaction and potential external sound inputs (e.g.,
computers or TV) influence the number of transmitters and types of microphones
■■ Single talker
necessary to provide adequate access. Appropriate microphone setup is dependent
■■ Multiple talkers on the specific needs for the environment but may include individual transmitters
■■ Structured learning working together with a pass-around or conference microphone.
■■ Unstructured learning
■■ Technology (computer, TV)

Chapter 8
School Acoustic Needs: The acoustical quality of the learning environment will influence RM candidacy and
■■ Signal sources (intensity and spectrum) technology. An acoustic environment that compromises the signal-to-noise ratio,
■■ Noise sources (spectrum and time)
environmental influences, room size or shape, or student position will support RM
candidacy for the student. Sound-field amplification may not provide optimal signal
■■ Reverberation
quality in environments with compromised room acoustics.
■■ Room size and shape
■■ Student position
(Continues )

270 Chapter 8
Current RM Technology in Use at School: Appropriate teacher support is critical to successful RM-technology use in the
■■ Teacher support classroom. Good support can foster consistent and appropriate use of RM
■■ Peer support
technology. Peer support is also a critical component to successful use from both
social emotional and technology competency perspectives.
Other School Locations: The learning environment that requires accessibility for the student should include
■■ Auditorium/theater all the locations the student travels in the course of his/her school experience. Each
■■ Therapy areas
environment may have its own technology needs and should be evaluated for each
student.
■■ Gymnasium
■■ Cafeteria
■■ Extracurricular activity sites
■■ Library
■■ Specials: music, computer, resource
TABLE 8–8 Listening Environment Considerations—Home and Community
Selection and Implementation Considerations
Home Activity Needs: Remote microphone (RM) candidacy for specific home environments are influenced
■■ Meals by the type of activities in the listener’s routine that result in a compromised signal
■■ Play—structured activities (e.g., reading,
from the sound source. Evaluation of the use of RM technology during specific
table games) activities helps identify needs and promotes successful implementation.
■■ Play—unstructured (e.g., single/multiple
groups)
Home Access Needs: The listener’s access needs to be evaluated to accommodate the specific types of
■■ Family, friends, peers sound input required. The number of individuals interacting with the listener as well
■■ Single/multiple talkers
as possible external sound inputs (e.g., computers or TV) influence the types of
microphones and receivers necessary to provide adequate access.
■■ Structured activities
■■ Unstructured activities
■■ Audiovisual technology (TV, DVD,

stereo, computer)
■■ Electromagnetic and Bluetooth
technology
Home Acoustic Needs: The acoustical quality of the home environment influences RM candidacy and
■■ Signal sources (intensity and spectrum) technology. An acoustic environment that compromises the signal-to-noise ratio,
■■ Noise sources (spectrum and time)
environmental influences, room size or shape, or listener position will support RM
candidacy for the listener in those environments.
■■ Reverberation
■■ Room size and shape
■■ Child position
■■ Wireless interference
Chapter 8
Other locations: Accessibility in other locations in the listener’s environment may become accessible
■■ Recreation with the use of RM technology. The listener’s environments should be explored to
■■ Church
identify where communication could be enhanced with the use of RM technology.
■■ Community
■■ Therapy

who are utilizing RM instruments, particularly with FM trans

mission. Technology-related considerations for RM selec-
tion include the following:
■■ convenience ■■ compatibility with com-

■■ wearability puters, phones, and other
■■ reliability devices
■■ maintenance ■■ signal interference
■■ ease of monitoring ■■ multiple FM frequencies
■■ manufacturer/dealer ■■ digital transmission
support ■■ Bluetooth compatibility
electromagnetic FIGURE 8–2 Situation: Twenty-eight students (one has reduced
■■ compatibility with ■■
compatibility hearing) are seated in groups of four at lab tables. The teacher
existing amplification gives a brief lecture, often turning to the board to diagram chemi-
cal properties, and then gives group assignments to be completed
during the remainder of the class period.The assignments generate
Funding a substantial amount of discussion among students in their groups,
While funding should not dictate the recommendation for significantly raising the noise level of the room. The teacher con-
use of or type of RM technology, it can be a deterrent. RM tinues to address the class periodically to clarify questions that
technology is categorized as an assistive technology under are asked.
IDEA, so it must be considered and then included in the
IFSP or IEP if determined to be a student need. Once edu-
cational need for the RM technology is documented, the ■■ In addition to or in place of the student’s personal hear-
school has a responsibility to provide the recommended de- ing aids, what type of amplification should be recom-
vice under their obligation to provide FAPE. mended for this situation?
Schools are also obligated to provide RM technology ■■ How are the problems of group communication handled
to students served by a Section 504 plan. In these situations, when the teacher is also speaking?
the funding source is the schools’ general fund rather than ■■ What if the student does not want a personal RM system
designated federal or state special education. See Chapter 1 because of concerns about peer acceptance and being
for additional considerations for hearing assistance technol- different?
ogy under Section 504 and ADA.
Funding under Part C is less clear; some public and Sometimes the best arrangement may not be possible
private insurance policies that cover hearing aids will cover when the student is not willing to use it. How is a compro-
RM technology, especially when purchased as part of the mise reached? Often the solution may have to be the second
personal instrument (the same would be true for anyone or third option, and it is crucial that the student be a partner
with hearing aid coverage). As discussed earlier, Part C is in the discussion throughout the process.
administered differently in each state, making it important
for audiologists to be aware of and understand the relevant
policies for funding in their state. Part C is designated as a PERSONAL HEARING
last resort funder where their role would be to help families
access funds for needed assistive technology. Local service INSTRUMENTS AND
clubs and organizations are good sources of funding for in- REMOTE MICROPHONE
dividual technology needs (see Chapter 15).
TECHNOLOGY OPTIONS
Device Determination The array of options for amplification can be daunting for
The decision for the most appropriate device (Figure 8–1) even the audiologist. Tables 8–9 and 8–10 summarize the ma
is made once all of the previously mentioned considerations jor personal and RM technology options, including a brief
have been discussed. A RM accessory includes only the RM description, advantages, and problems associated with each
Chapter 8
microphone (or transmitter), while a RM system includes instrument or system. Estimates of the SNR advantages
the receiver, transmitter/microphone, and any necessary measured in previous RM technology studies are also pro-
accessories. On rare occasions, an intermediary device will vided in Table 8–10 (Anderson, Goldstein, Colodzin, & Igle-
be required for a RM accessory. To summarize this discus- hart, 2005; Boothroyd & Iglehart, 1998; Hawkins, 1984; Lar
sion on device determination, consider the typical junior high sen & Blair, 2008; Schafer & Thibodeau, 2003; Schafer &
school science classroom situation described in Figure 8–2. Kleineck, 2009; Schafer, Sanders, et al., 2013; Schafer &

Chapter 8
TABLE 8–9 Personal Hearing Instruments Options
272
Type of Technology Description Advantages Limitations
Type of Hearing Air conduction Amplified sound delivered into ear canal ■■ Maximizes sound quality ■■ Limited use with external ear
Instrument ■■ Multiple signal processing strategies available malformation
■■ Limited use with chronic ear drainage
Bone conduction Amplified sound delivered directly into ■■ Bypasses external and middle ear for ■■ Limited available signal processing options
inner ear (cochlea) by way of vibration external ear malformation and chronic ■■ Requires headband to hold firmly in place
of skull from transducer placed on ear drainage on mastoid
bone behind the ear
Cochlear implant Surgically implanted device with ■■ Improved audibility of sound for ■■ FDA approved for 12 months of age and
externally worn processor that individuals with limited benefit from older
converts acoustic energy into electrical hearing aids ■■ Only for severe and profound hearing loss
energy; stimulates the auditory nerve ■■ Positive language outcomes with ■■ Requires surgical procedure
appropriate intervention ■■ Requires programming, close follow-up,
■■ Possible to obtain hybrid implant (short and auditory habilitation by CI specialists
electrode array) or use residual hearing for
electroacoustic stimulation in the same ear
Osseointegrated bone Surgically implanted device with ■■ FDA approved for age 5 years and up ■■ Requires surgical procedure
conduction implant externally worn processor that ■■ Prevents need for headband
converts acoustic energy into
mechanical energy; directly stimulates
cochlea
Behind-the-ear (BTE) Sits behind the ear, coupled directly ■■ Flexible as child grows ■■ Retention may be issue on very small ears
Style– bilateral
fitting is preferred to the ear canal via a slim tube and a ■■ Durable, some models water resistant
to facilitate and custom-fit earmold ■■ Available in a variety of colors and designs
localization of to match hair or express oneself
sound listening
BTE open fit Amplified sound is delivered into ear ■■ Cosmetically appealing ■■ Retention may be issue on very small ears
in noise unless
canal from BTE aid via slim tubing ■■ Best for high-frequency losses; low- ■■ May have more feedback
there are specific
without an earmold frequency sounds are not amplified
contraindications
BTE receiver in the Amplified sound is delivered from BTE ■■ Cosmetically appealing ■■ Retention may be issue on very small ears
canal to receiver placed in the ear canal ■■ Best for mild to severe hearing losses ■■ Wax problems are more common
■■ Feedback problems are reduced because ■■ Fewer options for FM/DM coupling
microphone and receiver are separated ■■ May not be appropriate during very
aggressive athletic activities
All in-the-ear All components in the ear ■■ Inconspicuous ■■ Not appropriate for young children due
■■ Effective for mild to severe hearing to feedback from ear growth
losses ■■ Wax problems are more common
■■ Fewer options for FM/DM coupling
■■ May not be appropriate during very
aggressive athletic activities
2/25/2020 4:31:01 AM
Amplification Multiple memories/ Memories/programs can be accessed ■■ Added flexibility; good for fluctuating ■■ Some models may require physical
Features programs through push button or remote hearing loss manipulation to change programs
control; some models automatically ■■ Can access multiple processing strategies ■■ Programs usually changed on personal
switch programs based on or microphones to improve performance preference/may not be practical for young
environmental conditions or listening across environments children
situations ■■ Automatic program switching available
Multiple microphones The capability of the hearing aid’s ■■ Enhanced signal-to-noise ratio in noisy ■■ Reduces input of environmental sounds
microphones to reduce incoming environments and incidental listening
signals from the back and sides of the ■■ Some models permit the listener to
listener choose the speaker or event on which
they want to focus
Nonlinear frequency Compresses high frequencies to range ■■ Improves access to high-pitched sounds ■■ May not be beneficial for some children
compression of audibility for listener that may be outside the range of audibility who are able to access high-frequency
information
Wide dynamic range Automatically adjusts the gain for ■■ Automatically adjusts gain for all input ■■ Less gain at high intensities may be
Digital Signal
Processing compression (WDRC) different input loudness levels intensities perceived as less powerful to experienced
Strategies ■■ Increased audibility of soft speech sounds users
■■ Less gain at high intensities may help limit
overamplification
Output limiting The general term used to describe the ■■ Limits loudness level to avoid additional
control of the maximum loudness level hearing damage
a hearing aid will provide
Multiple channels Frequency-shaping capabilities of the ■■ Ensures audibility and avoids loudness
hearing aid permit better matching of discomfort for conversation inputs
different pitches to individual hearing
loss
Feedback control Digital processing reduces acoustic ■■ Automatically detects and reduces ■■ Some methods may reduce gain that can
feedback (whistling) excessive feedback cause loss of audibility for soft speech
■■ More advanced methods allow signals
cancellation of feedback without any
reduction in audibility
Noise reduction/ The use of digital processing to reduce ■■ Allows access to audibility of speech ■■ Too much reduction may limit important
speech enhancement nonspeech background noise and signals in the presence of some information, including speech
enhance speech inputs background noise
■■ Enhances sound quality
273
2/25/2020 4:31:01 AM
Chapter 8
274 Chapter 8
TABLE 8–10 Types of Remote Microphone Technologies
Personal Sound-field/CADS Personal SF
Description Transmitter delivers signal to the Transmitter delivers signal to a Transmitter delivers signal to a
child’s personal hearing technology loudspeaker(s) to provide uniform small loudspeaker that is placed
(e.g., hearing aid) distribution of sound on a desk or close to the child
Modes of Electromagnetic induction, FM, digital RF, infrared, hard wired FM, infrared
Delivery digital RF, FM, NFMI infrared
SNR ~15–25 dB ~2–5 dB ~5–10 dB

Improvements
Advantages Greatest SNR improvements Benefit to all children in class Likely better SNR improvement
than CAD
Disadvantages -Most expensive -Least SNR improvement -Benefit to one to two children
-Benefit for only one child -Cumbersome or impossible to in class
move to another classroom -Difficult to gain optimal
-Cannot use for extracurricular placement in every situation
most activities -Cumbersome to move to
another classroom
-Cannot use for extracurricular
most activities
Note. CADSs, classroom audio distribution systems; FM, frequency modulation; NFMI, near-field magnetic induction; RF, radio frequency; SF, sound-field; SNR, signal-to-
noise ratio. From E. Schafer & J. Wolfe. (2019). Pediatric audiology (3rd ed.). Used with permission.
Thibodeau, 2006; Wolfe et al., 2013a, 2013b). For more ing aid may be lost due to the smaller size. Moisture and
detailed information, readers are encouraged to access the water-resistant options are also important considerations.
many texts and articles available on hearing instruments and Traditional bone conduction hearing aids may also
instrumentation. be used with many children who have microtic or atretic
malformations that prohibit BTE fittings. There are an as-
sortment of headband options that now make fitting bone
Hearing Aids conduction transducers more practical for young children.
Although hearing aids are generally considered a child’s pri- Osseointegrated bone conduction implants offer sig-
mary amplification system, they may not be the preferred nificant improvement in hearing over traditional bone con-
choice for very mild, unilateral, or profound hearing losses. duction hearing aids due to the direct bone conduction con-
Hearing aids have made great technological advancements nection. Bone conduction implants also may be an option
but still cannot fully offset the effects of background noise, for mixed hearing losses and single-sided deafness. At this
high reverberation, and distance listening. Digital features time, there are three FDA-approved manufacturers of osseo-
offer flexibility and an array of options for all users, and for integrated bone conductions systems: Cochlear Americas,
infants, hearing aids typically are the initial primarily am- Oticon Medical, and Sophono (Medtronic). An example of
plification choice. Most interactions with infants are at close one device is the Cochlear Baha® 5 implant system, which
range and in the home where distance listening, noise, and consists of an external processor, an abutment or magnetic
reverberation can be minimized, but RM technology may be attachment, and one of two internal implants. The Baha®
considered for infants in the car and in noisy listening situa- connect is a titanium implant that is placed in the mastoid
tions outside of the home (e.g., shopping, daycare). bone. Over time, the implant osseointegrates (fuses) with the
Although behind-the-ear (BTE) hearing aids are still living bone. The small external sound processor located be-
most common for children, improving technology has re- hind the ear picks up the sound vibrations and transmits them
Chapter 8
sulted in more in-the-ear (ITE), completely in the canal through an abutment that connects the sound processor on the
(CIC), and receiver-in-the-canal (RIC) fittings, particularly outside with the implant embedded in the mastoid bone.
for older students. Considerations for determining the ap- The second implant, the Baha® attract, is still implanted into
propriateness of these styles include RM capability (size and the mastoid bone, but it does not have an abutment. Instead,
strength of telecoil or direct connectivity), the child’s ability similar to a cochlear implant, it uses internal and external
to manipulate the controls, and the possibility that the hear- magnets to provide a link between the implant and sound

processor. Until children are old enough for the surgical of age had quadrupled over the previous 4 years, and this
procedure (currently the FDA requires 5 years of age), the estimate is expected to be even higher today. Use of bilat-
Baha® Softband version can be used, which places the pro- eral implants is fairly prevalent, and the two devices may be
cessor in an elastic headband and operates like a conven- surgically placed at the same time (simultaneously) or dur-
tional bone conduction hearing aid. ing two surgeries months or even years apart (sequentially).
Some hearing aid manufacturers have programs and Bimodal stimulation using a cochlear implant and a hearing
materials specifically targeted to pediatric markets. Part of aid also has become more common, with success reported
their goal is to improve the image of hearing aids for chil- when both instruments are programmed to work in concert
dren/youth as well as to provide research and technical sup- (Lotfi, Hasanalifard, Moossavi, Bakhshi, & Ajaloueyan,
port for their products. Hearing aids and earmolds now come 2019). Some children who have some remaining residual
in a wide variety of colors and designs, and accessories such hearing after cochlear implant also may benefit from the use
as Ear Gear (https://www.gearforears.com) are attractive as of an electroacoustic processor on the implant ear (Wolfe
well as functional options for children/youth to personalize et al., 2017). This type of processor utilizes low-frequency
their hearing instruments. acoustic amplification for the areas of residual hearing as
well as electrical stimulation for the higher frequencies.
The role of the educational audiologist with children
who already use cochlear implants will vary, depending
Cochlear Implants on the involvement with and access to the child’s implant
Cochlear implants have become an increasingly common center, but a need for close collaboration is imperative both
option for children with severe–profound hearing loss, in- during and following transition to the formal school environ-
cluding those with ANSD, who do not benefit from tradi- ment. Sample forms to facilitate communication between
tional hearing aids. In the future, cochlear implantation may schools and impant centers are in Appendix 15–I.
also be a FDA approved option for children with single- Cochlear implants, coupled with intensive postimplan-
sided deafness (Zeitler et al., 2019). Cochlear implants con- tation therapy, can facilitate access to spoken language,
sist of the implanted receiver-stimulator and electrode array but outcomes may vary depending on a variety of factors
as well as the external sound processor and transmitting coil. including:
Internal (under the skin flap) and external magnets are used
to connect the internal receiver-stimulator to the external
■■ age at implantation;
transmitting coil. Sound processors are either BTE or off the
■■ presence of co-occurring learning challenges;
ear. The BTE processors, which look similar to BTE hearing
■■ physical status of the cochlea;
aids, contain the microphone, digital sound processor, and
■■ appropriate sound processor mapping;
batteries. BTE processors are connected to the transmitting
■■ educational programming;
coil, which contains a magnet and is worn on the head. In the
■■ motivation/time of device use; and
off-ear options, the small processor encompasses the micro-
■■ family expectations/involvement.
phones, digital sound processing, batteries, and transmitting
coil with magnet into one device.
Although initial assessment and programming of co- Research on educational methodology and cochlear im-
chlear implants require equipment and expertise typically plant use has been mixed, but there is general agreement that
not found in school-based audiology programs, educational programs must include auditory-skill development for posi-
audiologists must be knowledgeable about current candi- tive outcomes to occur (Niparko et al., 2010; Percy-Smith
dacy, devices, and postimplant programs both within and et al., 2018; Svirsky, Robbins, Kirk, Pisoni, & Miyamoto,
outside the school setting. Whether a school-aged child al- 2000). Additional information and resources for educational
ready uses or is being considered for a cochlear implant, programming for students with cochlear implants can be
the educational audiologist needs to be an active member of found in Chapter 9, Case Management and Habilitation.
the implant team. Potential roles and responsibilities are de- As with other hearing assistive devices, technology
lineated in EAA’s Position Statement on Cochlear Implants changes quickly. An increasing number of cochlear implant
(http://www.edaud.org/position-stat/5-position-5-05.pdf ) devices are compatible with device-specific, wireless stream-
At a minimum, the school is responsible for monitoring the ing accessories including RMs, phone devices, and televi-
functioning of the external part of a cochlear implant (IDEA sion streaming devices. In addition, some processors may be
Chapter 8
2004, §300.113[b]). connected directly to smartphones and apps. In most cases,

The FDA has approved implantation for children as RM systems instead of RM accessories will need to be used
young as 12 months of age, and as a result, many more chil- in schools because systems allow transmitters to connect to
dren are now entering the educational system with cochlear multiple students/receivers at a time. As a result, the RM ac-
implant devices already in use. Pitt (2009) reported that the cessories likely will be more appropriate for home use or in
number of children with cochlear implants under 5 years cases where it is used with only one child in a classroom.

276 Chapter 8
Given the complexity of RM device connection options to Wolfe (2018) all RM technologies utilize one of the follow-
contemporary cochlear implant sound processors, the educa- ing transmitter microphones: 1) a lavalier that is clipped to
tional audiologist is a critical member of the cochlear implant a shirt or a lanyard, 2) a boom or cheek worn on the head,
team. Although the RM technology has evolved, the AAA 3) hand-held to pass around or place on a table, and 4) built-
HAT guidelines (2008) section on selection and fitting HAT into transmitter. Modes of transmission and types of RM
with cochlear implants is still relevant today. devices vary across manufacturers and models.
Cost, surgery risks, and the intensive (re)habilitation
program typically are the primary concerns discussed when Modes of Transmission
considering an implant for children/youth. Families as well
The transmission modes for RM technologies include elec-
as implant teams need to understand thoroughly all aspects
tromagnetic, near-field magnetic induction (NFMI), digital
of deafness and its impact on language and education as
radio frequency or DM, frequency modulation (FM), or in-
well as have clear expectations of what the implant can and
frared (IR) (Table 8–11). The most common types of trans-
cannot do. Educational audiologists can assist by providing
mission in school-based RM technology include FM and
accurate and unbiased information concerning implants, im-
DM, with the latter becoming more common in schools.
plant use, auditory-skill development, and communication
Most FM systems transmit over the 216 to 217 MHz
opportunities to families and educators during all phases
frequency spectrum, dedicated frequencies for auditory as-
of the cochlear implant process, from eligibility through
sistance devices and low power uses by the Federal Com-
(re)habilitation.
munications Commission. Problems with FM signal trans-
mission are primarily due to signal interference and set-up
difficulties when two or more concurrent transmissions are
Universal Amplifiers
desired (common with team-teaching situations). However,
Universal amplifiers are generic moderate-gain amplifica- the team-teaching situation has been resolved by the cre-
tion devices (e.g., Pocketalker, Comfort Duett). Although ation of networks that permit multiple transmitters to oper-
there may be some ability to adjust the loudness to each ear ate at the same time (Table 8–12).
in the stereo versions, and some simple hi–lo tone settings, As described in Table 8–11, DM may include digital RF
they are not known for their sound reproductive quality. or NFMI. Digital RF with a 2.4 GHz and 900 MHz carrier
Mostly available through Radio Shack and mail-order cata- frequency is advantageous because it is immune to inter-
logues, these units are usually body-worn with headphones ference and may result in significantly better speech rec-
or earbuds. These devices may be useful as a last resort in ognition in the presence of high background noise when
a few situations (e.g., temporary amplification for children compared to FM systems (Wolfe, Morais, Schafer, et al.,
with mild or moderate hearing losses such as those associ- 2013). In addition, many digital RM systems contain ad-
ated with otitis media). The fact that they are relatively in- vanced noise management strategies. NFMI transmission
expensive and readily available should not justify their use is used by some intermediary devices (i.e., small receiv-
as permanent, primary amplification. Universal amplifiers ers worn around the neck). Bluetooth signals from external
have extreme variability in gain and output and should only sound sources may be synched to the intermediary device
be used after electroacoustic analysis demonstrates that the that then sends an NFMI signal to the user’s hearing aid or
amplification is appropriate for the individual using it. cochlear implant. More recently, some manufacturers have
eliminated the need for the intermediary devices by develop-
ing digital RF (2.4 Gz and 900 MHz) antennas that are built
Remote Microphone Technology directly into hearing aids or cochlear implants. These anten-
nas will receive signals from associated RM, television, or
The fitting goals for RM technology are to provide excel-
phone devices. However, at present, use of these antennas
lent speech recognition, ensure audibility of self and others,
results in increased battery consumption.
and decrease the effects of distance, noise, and reverberation
(AAA, 2008). Consistency of the signal from the RM and
consistent use of the device are critical to ensure optimal lis- Personal RM Technology
tening in environments in which the RM technology is used. Personal RM technology delivers a signal from a transmit-
In recent years, RM technology has improved and ad- ter directly to the individual’s ear. As listed in Table 8–10,
vanced to include devices with various transmission modes, personal RM technology may use any mode of transmission
Chapter 8
types of receivers, and signal processing characteristics. and offer the greatest improvements in SNR at the child’s
RM technologies may be categorized as personal, sound- ear. As shown in Figure 8–3, personal RM technology may
field, or classroom audio distribution systems (CADSs), and be subcategorized into two major types: systems and ac-
personal sound-field (i.e., targeted area) (see Table 8–10). cessories. RM systems require the use of a transmitter and
All systems consist of a transmitter and microphone as well compatible receiver, while RM accessories may only require
as a receiver for the student. As described by Schafer and the use of a device-specific RM when children are using

TABLE 8–11 Overview of Types of Transmission
Description How It Works Advantages Disadvantages

Electromagnetic Induction loop Signal from transmitter -Relatively inexpensive -Installation expense
induction system delivers converted to electrical -Room: does not require -Requires telecoil
signal to telecoil of current, amplified, and individual receivers -Interference
personal hearing delivered to conducting -Available to all with -Telecoil frequency
technology wire (i.e., loop) around telecoil response may differ
room or around neck; -Lower power consumption from personal device
magnetic flux travels -Signal strength may
through loop, is detected vary: listener location,
by telecoil in personal telecoil orientation, and
device, which converts distance
and processes the signal
Near-Field Digital audio Receiver captures -Allows for RM, binaural -Requires a neck or
Magnetic streaming accessory Bluetooth signal from streaming, and phone body-worn interface
Induction delivers wireless transmitter, converts applications -No long-range
(NFMI) signal to user’s it to DM signal, and -Minimal interference transmission with NFMI
hearing technology delivers it as electrical -Low power consumption (requires Bluetooth)
pulses to neckloop; loop -Transmission delays
creates magnetic field
that is detected by NFMI
receiver in users’ hearing
device
Digital Radio Audio signal to Uses ultra-high-frequency -Immune to interference -Not universally
Frequency (RF) RM converted to carrier (2.45 GHz or -Enhanced precision and available in public
a digital code and 900 MHz) waves to sound quality of audio settings like induction
delivered to user’s deliver digital information signal -May have signal
hearing technology via RF transmission using -Wider bandwidth than FM dropouts outside
frequency/channel- -Connectivity to phones, and around reflective
hopping; bidirectional tablets, computers, etc. surfaces
exchange occurs once -Phone connectivity
paired limited to certain
models of phones
FM Frequency- Electromagnetic radio -Documented benefit with -Susceptible to

modulated (FM) wave with a carrier personal hearing devices interference
radio wave delivers frequency delivered -Good transmission range -High power
wireless signal to from transmitter and -Can be used outside consumption
receiver connected captured by receiver, -Does not require -Larger antenna than
to user’s hearing which demodulates signal direct line of sight with DM receivers
technology or and delivers it to the transmitter
loudspeakers users’ hearing device or to
loudspeakers
Infrared Delivers infrared Transmitter converts -No interference across -Signal dropouts in
light signal to the audio signal to infrared rooms bright environments
receiver coupled light, sends it to stationary -Benefits multiple listeners, -Requires direct
to the user’s receiver, which converts especially when using line-of-site between
hearing technology, it to an electrical signal loudspeakers transmitter and
earphones, or that is processed and receiver, making it
loudspeakers delivered to listener difficult to use in
Chapter 8
through hearing classrooms

technology, earphones, or
loudspeakers
Note. DM, digitally modulated; RF, radio frequency; RM, remote microphone. From E. Schafer and J Wolfe. (2019). Pediatric audiology (3rd ed.). Used with permission.

278 Chapter 8
TABLE 8–12 Troubleshooting for Signal Interference Problems
Problem Solution
Intermittancy or short-range The likely source is signals generated by computers and electronic equipment or
interference appliances located nearby the user. Move to another room or outside to see if
the interference disappears. If so, switch off the equipment in the room one by
one until the source is identified.
■■ If a frequency is occupied by another FM user, change the frequency of one of
the FM systems.
■■ Some computers are not sufficiently shielded and will cause interference
requiring a frequency change.
Static from power stations or he FM receiver cannot differentiate between the signal from the transmitter and
T
high-voltage power lines the signal from a high-voltage line on the same frequency.
■■ Relocate to another area or change the frequency.
Short-range operation deficiency The FM system is designed for an operational range of 13–32 ft:
■■ Distances in excess of this range may not have adequate reception.
■■ Check the batteries; weak batteries will result in diminished reception and
increased static and interference.
Note. Adapted from Interference Issues, Phonak, https://www.phonak.com
hearing aids, cochlear implants, or osseointegrated bone However, the directionality of the microphones (i.e., om-
conduction devices that encompass built-in receivers (e.g., nidirectional or directional) as well as the signal process-
2.4 GHz radio antenna). These RM accessories are small ing within transmitters vary. Transmitters that encompass
rectangular transmitters with built-in omnidirectional or di- directional microphones as well as adaptive-gain technology
rectional microphones that should be worn near the mouth (e.g., Phonak Dynamic; Oticon VoicePriority) result in sig-
(i.e., clipped on a lapel or lanyard). nificantly better speech recognition in noise relative to RM
Figure 8–3 highlights the basic four types of personal accessories and systems without these features (Wolfe et al.,
RM systems. Two of the most important considerations 2009, 2015; Wolfe, Morais, Schafer, et al., 2013b). In addi-
when selecting an RM system are to (a) ensure the trans- tion, the shape and functionality of transmitters differ and
mitter and receiver are compatible and (b) when possible, may include pass-around transmitter microphones; small,
use the systems that will provide the greatest benefit for the clip-on transmitters coupled to lapel/boom/cheek micro-
student. At the same time, sometimes it is necessary to use phones; and pen- or disc-shaped transmitters with built-in
backup equipment when a transmitter or receiver is inoper- microphones. Some transmitters (e.g., Phonak Roger Select
able. In these cases, a listening check and, when feasible, or Roger Touchscreen Mic) may be used by an individual
electroacoustic testing will need to be conducted to ensure talker as well as during group activities via different mi-
an appropriate fit. crophone modes. Also, many transmitters allow for one or
As discussed previously, all RM technologies utilize more additional inputs from external audio sources such as
similar types of microphones that connect to transmitters. projectors, smartboards, tablets, and computers. User manu-
als and manufacturer representatives help to ensure the best
approach to connect to external audio sources.
When considering each type of RM technology (Fig
ure 8–3), design-integrated and stand-alone receivers are the
easiest to implement because they require the least amount
Nuggets from the Field of equipment: one transmitter and one or two receivers.
However, design-integrated receivers are not cost effective
Chapter 8
Mixing transmitters and receivers from different for schools, given that they only work with one personal
manufacturers can lead to signal interference and hearing device, and most stand-alone, nonoccluding receiv-
poor function. Therefore, as a general rule, it is ers are only intended for use with children who have normal
best to use transmitters and receivers from the pure-tone hearing thresholds. As a result, the most common
same manufacturer. RM system for school-aged children with reduced hearing
is a transmitter coupled to universal receivers. Coupling

FIGURE 8–3 Types of personal RM technology.
universal receivers to personal hearing devices requires an the most common. The term “amplification” has been one
adaptor often in the form of an audio shoe, special battery of the barriers to acceptance of these systems by acousti-
door, earhook, or adaptor piece. Given the necessity for cians. Acoustical engineers prefer to focus on improvement
most children to connect and remove universal receivers on of the acoustical characteristics of the classroom rather than
a daily basis, couplers are susceptible to malfunction and technology to overcome poor classroom acoustics, and there
often need to be replaced over a period of use. is no disagreement with this position by audiologists (see
An older and less common type of RM system, not in- Chapter 7 for more information on classroom acoustics).
cluded in Figure 8–3, is a personal body-worn FM system The premise of these classroom audio systems is to either
(formerly referred to as a self-contained FM or auditory distribute the teacher’s voice equally throughout the class-
trainer). These body-worn FM receivers can be coupled to room so that every child has full access to what is being spo-
hearing aids with direct audio and also used with earbuds/ ken or to direct the signal to a particular student. The revised
earphones. Depending on the arrangement, they can func- ANSI/ASA Acoustical Guidelines for Schools (ASA, 2010)
tion both as a hearing aid (e.g., amplifier) and as an FM used the term CADS for the classroom systems, and, to
when used with a transmitter. This option may be useful for begin to standardize terminology, we have chosen to pro-
temporary amplification or when FM is desired for speech mote this term.
signal enhancement. CADS utilizes either DM, FM, or infrared technol-
Chapter 8
ogy (Table 8–10) to send the signal from a transmitter

and microphone to one of the following receivers: (a) a
Classroom Audio Distribution Systems fully installed multiple speaker system, (b) a one- or two-
and Personal Sound-Field Systems speaker portable system placed on a stand or shelf, and (c) a
There is no standard term for these systems, but “class- small, single portable speaker, also known as a targeted
room amplification and “sound-field systems” have been area audio distribution system (aka desktop speaker), for

280 Chapter 8
Definition: Classroom Audio Distribution System

A system for which the primary design goal is to electro- signed for public address purposes (such as building-wide
acoustically distribute the audio portion of curricular con- announcements) or the delivery of alert or warning signals,
tent throughout a learning space. This content may include, though they may include these capabilities. Classroom au-
but is not limited to, live voices from teachers and peers, dio distribution systems may also include provisions to as-
as well as prerecorded or streaming media content from sist persons with low-amplitude voice levels or those with
various sources, or both. The systems are not typically de- certain hearing conditions. (ASA, 2010, pp. 4–5)
use by one student. The evidence is clear that a variety of summarized in Table 8–13. Price, ease of installation, and
listening and attention problems common among children durability will also influence which model is chosen. Pur-
can be improved using HAT including CADS. Rosenberg chasing CADS is a good project for school parent organiza-
(2005) summarized 20 studies published between 1986 and tions or service clubs, because so many students have the
2003 supporting increased speech recognition, 12 studies potential to benefit from them.
published between 1984 and 2003 demonstrating improve-
ment in academic achievement, and 12 studies published Induction Loop Systems An induction loop system
between 1989 and 2003 demonstrating improvement in operates with wire that encircles an area or room creating an
attending, listening, and learning behaviors all as a result induction/electromagnetic field like an oversized neckloop
of CADS technology. Teacher preferences and benefits (see Tables 8–10 and 8–11). The wire is connected to an
regarding use of CADS were reported in 12 studies pub- amplifier. Hardwire systems require that the microphone
lished between 1993 and 2003. Reported teacher benefits be connected to the amplifier, while FM induction systems
included less physical fatigue at the end of the school day, transmit the talker’s voice to the amplifier using a wireless
fewer teacher absences, and reduction of vocal strain. Given microphone. Both types deliver the talker’s voice via the
this strong evidence, the use of CADS has increased sig- induction loop wirelessly to the student through the telecoil
nificantly over the past decade and is now included in many of hearing aid(s). The induction loop system is relatively
school design plans. However, because of the limited gain portable, inexpensive, easy to maintain, and can have some
achieved by CADS and personal sound-field systems (Ta interesting applications, such as looping the inside of a car.
ble 8–11), children with reduced hearing should use personal The best feature, again, is that students do not wear any
RM technology. device except their own hearing aids, cochlear implants, or
Once the decision is made to optimize classroom listen- bone conduction device. However, their personal hearing
ing, and classroom acoustics have been addressed, there are devices must have a telecoil to use an induction loop system.
a number of considerations regarding the type and arrange- The biggest challenges are setup time if the system needs to
ment of CADS, further justification for why audiologists be portable and the strength and clarity of the individual’s
should be involved in these discussions. These issues are hearing aid telecoil.

Personal RM systems should not be integrated with ■■ patching cables act as antenna creating possible
CADS. While the practice of “patching” personal sys- interference;
tems to classroom systems was accepted years ago, it is ■■ loss of advanced features (e.g., disables “dynamic”
no longer recommended due to features); and
Chapter 8
■■ inability to easily monitor the student’s transmitter.

■■ compatibility concerns between personal DM/FM
systems and CADS;
■■ the use of a patch cord degrades the primary signal,
resulting in a sound quality that is not adequate for
a student with hearing loss;

TABLE 8–13 Issues to Consider When Choosing a Classroom Audio Distribution System
Area Issues Considerations
System DM, FM, or infrared DM:

■■ Limited or no interference
■■ Unlimited channels for transmission
■■ Can be integrated with most personal RM systems
FM:
■■ Interference/static possible from other users of FM,
computers, and electronic equipment
■■ Limited number of transmission frequencies
■■ Dead spots not a common problem
IR:
■■ Interference/static possible from light or other infrared
sources
■■ Possible dead spots
■■ No spillover from adjacent users
■■ Can be integrated with most personal FM/DM systems
Portable versus installed Portable:
■■ Movable
■■ Capabilities vary
■■ Often a battery-operated option
Installed:
■■ Multiple speakers may provide better coverage
■■ May require wiring of speakers to receiver/amplifier
Integration with multimedia ■■ Needs audio input ports for integration to audio sources
(computers, TV/DVD/VCR) including personal FM/DM
systems worn by students in the same class
Quality ■■ Is the sound reproduction clear and free of distortion of
speech sounds?
■■ Is the system to be used to transmit music and nonspeech
sounds?
Speaker Cone, flat, or array Cone:

■■ Single speaker covers limited range
■■ Multiple speakers required for full classroom
■■ Has better quality for nonspeech transmission
Flat:
■■ Single speaker design covers entire classroom
■■ Portability is increased
■■ Installation is simple
Array:
■■ Multiple-speaker array to improve uniform distribution of
sound
Number/placement ■■ How many speakers for even sound distribution across
classroom?
Chapter 8
■■ What space is available to accommodate ceiling- or wall-

mounted speakers?
(Continues )

282 Chapter 8
Area Issues Considerations
Microphone Single versus multiple Options:

■■ Team-teaching
■■ Handhold for pass-around
■■ Lapel, cheek, lavalier
Features:
■■ Comfort
■■ Ease of use
■■ Sound quality
Output Amplify or not What is the ambient room noise level?

What is the activity range that the voice needs to be
transmitted to?
How loud is the speaker’s voice?
Note. DM, digital modulation; FM, frequency modulation; IR, infrared transmission.
IMPLEMENTATION AND signal for both hearing microphone and FM/DM sys-
tem. With today’s advanced test systems, the use of a
MANAGEMENT OF HEARING calibrated real speech signal is preferred over speech-
TECHNOLOGY weighted noise inputs.
■■ True estimates of the maximum output of the system are
Fitting and Verification obtained from the hearing aid microphone, not the FM/
The AAA Clinical Practice Guidelines for Pediatric Ampli- DM microphone, due to the presence of input automatic
fication (2013) address fitting and verification for hearing gain control in the FM/DM system.
aids. Although the AAA HAT guidelines, Supplement A ■■ Speech perception measures with FM/DM can be com-
(2008), focus primarily on fitting personal ear-level FM sys- pleted as a behavioral verification option, with priority
tems, the majority of the recommendations are also relevant given to testing in noise under the FM/DM + hearing
for fitting and verification for personal DM systems. The aid condition.
discussion that follows is a cursory overview of fitting and
verification considerations. Electroacoustic Verification and Real-Ear Measurements
A basic premise for RM technology is that “all verifica-
Electroacoustic measures are necessary to verify that the
tion measures of the relationship between the FM/DM and
instrument is functioning according to the manufacturer’s
hearing aid microphones are based on the assumption that
specifications. Electroacoustic equipment that meets current
the hearing aid portion of the system has been adjusted to
ANSI S3.22 (2014) specifications is required to perform these
provide appropriate audibility and output for the individual
measures. While it is assumed that new instruments, as
child” (AAA, 2008, p. 54). The AAA HAT guidelines iden-
well as those returning from repair, are working prop-
tify the following fitting priorities as necessary components
erly, it is crucial to check functioning prior to fitting. The
of the process:
key is to determine that there is transparency between both
■■ Under normal conditions of use, the FM/DM system devices; that is, when the same input is given to the hearing
should increase the level of the perceived speech, in the aid microphone and, then, to the FM/DM transmitter micro-
listener’s ear, by at least 10 dB relative to reception by phone, the outputs measured through the hearing aid and 2-cc
hearing aid only. coupler should be identical. Of course, during the use of the
If simultaneous use of the FM and hearing aid micro- FM/DM system in real-world situations, the FM/DM system
Chapter 8
■■
phone is the rule for a given individual (which is recom- is expected to result in a higher output than the signals pro-
mended by these authors), the assessment of the FM/ cessed by the hearing aid. However, the electroacoustic test
DM and hearing aid should be performed in the FM/ measures will ensure an appropriate fitting by using the hear-
DM + hearing aid condition. ing programming as a guide for FM/DM programming. Any
■■ It is advisable to assess performance electroacoustically differences in output will require adjustments of FM/DM gain
with a speech-weighted input, using the same type of or volume before continuing with the verification process.

Although most FM/DM fittings are accomplished with ized training. The AAA HAT guidelines (2008) identify the
electroacoustic test measures of transparency, real-ear mea- following topics for orientation and training:
surement procedures may also be used to verify optimal
audibility and maximum output of the FMDM system, par-
ticularly for personal stand-alone FM/DM receivers. Scha-
fer, Bryant et al. (2014) describes a fitting procedure for Topics for Teachers/Parents/
Topics for Children/Youth Others
stand-alone, nonoccluding FM/DM procedures for children
with normal pure-tone thresholds and listening or process- ■■ Implications of reduced ■■ Basic implications of
ing problems. The procedure involves measuring hearing hearing reduced hearing
thresholds and conducting real-ear measures to ensure an ■■ Basic function of device(s) ■■ Basic function of device
appropriate fitting for this type of device. ■■ Appropriate use of device ■■ Appropriate use of device
and features and features
Behavioral Verification ■■ Expectations: benefits and ■■ Expectations: benefits and
When behavioral verification is not achievable in infants and limitations of the device limitations of the device
young children, real-ear measurements can help to validate including when to use and including when to use and
fittings based on estimated thresholds from auditory brain- when not to use when not to use
stem responses, optoacoustic emissions, and behavioral ■■ Care and maintenance ■■ Listening check and basic
assessments for very young children. Use of a prescriptive ■■ Basic troubleshooting and troubleshooting
fitting procedure designed for children, such as the Desired reporting of a suspected
Sensation Level (DSL) (Seewald, Moodie, Sinclair, & Scol- malfunction
lie, 2000), together with a comparison of unaided and aided ■■ Self-monitoring of function
awareness for speech and behavioral observations of the ■■ Self-advocacy
child at the test facility, in preschool, and in the home, can
provide relevant information for the amplification selection
and fitting process. Chapter 9, Case Management and Habilitation, and Chap
The purpose of behavioral verification is to determine ter 13, Supporting the Educational Team, discuss training
expected performance following a RM system fitting. Per- and staff support related to personal amplification and RM
formance with the FM/DM in an ideal listening condition technology in more detail.
(e.g., sound booth) should be as good as or better than per- In addition to HAT, the educational audiologist may
formance with the hearing aid alone in the same condition. also need to provide support and training for parents of chil-
Testing in noise to compare the performance with a hearing dren who are first-time hearing aids users. Home support
aid alone to performance with the FM/DM microphone en- for hearing aid orientation and listening skill development
gaged is also necessary to determine the benefit provided can facilitate the adjustment to the use of hearing aids and
by the RM technology. Behavioral verification completed promote proficiency with amplification.
across test sessions also provides data regarding the stability
of the child/youth’s responses and verifies that the FM/DM
continues to perform as intended (AAA HAT guidelines). The Usage Plan
The IEP or 504 team, with guidance from the audiologist
and input from the student (when age appropriate), needs to
Orientation and Training develop a usage plan that identifies when the RM technology
A key component of successfully implementing RM tech- will be used. If part-time usage is recommended, discussion
nology use involves orientation and training for the child, should identify the specific classes and environments as well
teachers, parents, and others who provide support. These in- as activities (e.g., assemblies, therapy, classroom discussion,
dividuals must all be knowledgeable and comfortable using organized sports) targeted for RM technology use. Out-of-
the devices. As a service required under IDEA (2004), ori- school events, such as therapy, education classes, and orga-
entation and training activities for assistive devices should nized extracurricular activities, should also be considered,
be included in the IEP for each child and should be provided although school-owned RM technology would only be used
as part of the audiologist’s consultation time. If school- if the IEP team determined it was necessary for FAPE. For
purchased RM technology, such as FM/DM systems, is used
Chapter 8
infants and toddlers, this discussion should occur as part of

at home, training for caregivers is also necessary and should the IFSP.
be provided under the related service of parent counseling
and training (34 CFR §300.34[8]). Several manufacturers
include instructional booklets written for teachers and par- Validation
ents with their products. Although informative and helpful, The purpose of validation is to determine that the hearing
they should never be substituted for face-to-face, individual- instruments we have fit, prepared the student to use, and

284 Chapter 8
TABLE 8–14 Assessments for Remote Microphone Technology Validation and Developmental Listening Skills
Hearing Assistance
Tool Developmental Technology Validation
Self-Assessment
■■ Listening Inventory for Education (LIFE) X
■■ Classroom Participation/Ease of Communication (Classroom Participation X
Questionnaire-CPQ)
Observation Questionnaire
■■ Early Listening Function (ELF) X
■■ Children’s Home Inventory of Listening Difficulties (CHILD) X
■■ FM Listening Evaluation for Children X
■■ Listening Inventory for Education (LIFE) X
■■ Screening Instrument for Targeting Educational Risk (SIFTER), Preschool X
SIFTER, Secondary SIFTER
■■ Meaningful Auditory Integration Scale (MAIS), Infant-Toddler Meaningful X
Auditory Integration Scale (IT-MAIS)
■■ Functional Auditory Performance Indicators (FAPI) X
■■ Children’s Auditory Processing Scale (CHAPS) X
Evaluation
■■ Functional Listening Evaluation (FLE) X
■■ Ling Six-Sound Test X X
trained the teachers, caregivers, and staff to support, result in pendices 8–C and 8–D, are particularly useful to guide the
the intended outcomes in classrooms, home, and other set- fitting process as well as trial periods to help determine if a
tings. The outcomes include an assessment of audibility of child benefits from amplification and which type or combi-
speech input from others and self. Validation should identify nation of amplification use is most effective.
the strengths and limitations of the RM technology and be
an ongoing process that begins immediately after fitting and
verification. Further evidence for validation is contained in Monitoring and Equipment Management
IDEA, which requires “a functional evaluation of the child Development of the monitoring plan is the last step in the
in the child’s customary environment.”3 RM technology selection and implementation process. As
Validation measures can be considered in three catego- the numbers of pieces of equipment and their variety in-
ries: self-assessment, observation, and behavioral assess- creases, the time required to monitor, troubleshoot, repair,
ment (Schafer, Florence, et al., 2014). It is recommended test-check, clean, and catalogue also increases, which often
that the validation process includes a tool from each of the presents significant challenges for educational audiologists.
three categories so that the student’s perspective is consid- The assistance of a technician or aide can be invaluable in
ered as well as a key teacher or person involved with the stu- the management of equipment.
dent plus a behavioral assessment that provides actual per-
formance data on what is heard and understood in simulated Monitoring
listening environments. The AAA HAT guidelines identify The monitoring of hearing instruments and RM technology
several tools listed in Table 8–14 that can be used to address is not an option. While IDEA 34 CFR §300.113 specifies
RM technology validation as well as developmental listen- that monitoring must occur, it does not state the frequency
ing skills. Validation data have a further role by providing or procedure with which monitoring should occur. However,
Chapter 8
evidence that justifies use of RM technology for the IEP and the Michigan Department of Education cited a school dis-
for purchase of the recommended device(s). trict for failing to document daily FM system checks, in this
In addition to the validation tools, amplification pre- case as specified in this student’s IEP (Detroit City School
post rating scales and fitting protocols, such as those in Ap- District v. Michigan State Education Agency, 2015). IDEA
3
34 CFR §300.6(a).

34 CFR 76.731 requires records that show compliance with personnel, nurse, speech-language pathologist). A hearing
this requirement. (See Appendix 11–G for more information aid/RM test kit should be available that includes these items:
regarding this case.)
Incidental reports continue to show that hearing aid ■■ battery tester;
and RM system malfunctions are frequent, pointing to the ■■ listening stethoscope;
need for daily amplification checks; more comprehensive ■■ extra batteries;
monitoring may be warranted for certain students who are ■■ cleaning brush;
younger or who are prone to more problems. The monitor- ■■ wax loop;
ing plan must be designed to address the individual needs of ■■ earmold puffer (air blower);
each student (e.g., the procedures would be very different for ■■ diagram of hearing aid with parts labeled;
a first grader who was just recently fit with hearing aids/RM ■■ directions for conducting a physical and listening
and a high school student who has a history of consistent check; and
use and proper functioning of his/her hearing aids/RM). A ■■ whom to call when a problem is identified.
monitoring plan can be as simple as the sample in Table 8–15 Instructions for checking hearing aids, cochlear im-
or as comprehensive as the sample plan in Figure 8–4 (see plants, bone conduction devices, and FM/DM systems are
Appendix 8–C for a blank form). Monitoring also carries located in Appendices 8–D through 8–G. Appendix 8–H
long-term consequences because the process demonstrates contains a monitoring chart. Younger students tend to enjoy
to the student the value of working amplification and the using a charting system with a reward plan when they con-
importance of the listening checks. In the interest of product their own checks. The Ling Six-Sound Check is a quick
moting goals of individual independence, self-advocacy, and and common procedure that is part of the check process;
personal responsibility, all students with personal hearing Appendix 8–I contains a full description of this procedure.
aids and RM technology who have an IEP should have goals Dave Sindrey (https://HearingJourney.com) has developed
and objectives regarding these skills until they are achieved a Ling Six-Sounds Screen that provides a creative solution
(Table 8–16). to conducting this procedure with young children. Appen-
dix 8–J contains a teacher handout of tips for enhancing
Hearing Aid and Cochlear Implant Check Procedures FM, DM, and infrared system use with hearing aids and
Daily hearing aid, cochlear implant, and RM system checks cochlear implants. The daily check should include the fol-
are usually necessary for children from preschool through lowing components:
the early elementary school years. The educational audi
ologist should not have the direct responsibility of the daily 1. Visual check
monitoring but rather should provide training and support ■■ Are hearing aid(s)/FM/DM worn?
to a designated staff member in the school (e.g., special ■■ Are hearing aid(s)/FM/DM turned on and set
or general education teacher, special instructional support appropriately?

■■ Are there defects or problems with the earmold, tub-
ing, or case?
2. Listening check
■■ Is there amplification of sound?
■■ Is volume set correctly?
■■ Is the FM/DM signal present?

IDEA 2004 (34 CFR 300.113) requires schools to
■■ Conduct Ling Six-Sound Check while listening for
“ensure that hearing aids worn in school by children
the following:
with hearing impairments, including deafness are
satisfactory sound quality;
functioning properly” and that “each public agency
intermittent sound; and
must ensure that the external components of surgi-
interference from another source (FM/DM only).
cally implanted medical devices are functioning prop-
erly.” This regulation goes on to say, “For a child with Comments and actions taken should be recorded on the
a surgically implanted medical device who is receiving monitoring form, and the educational audiologist should be
special education and related services under this part, contacted for problems that cannot be resolved by the person
a public agency is not responsible for the post-surgical responsible for monitoring, Parents must be notified when
Chapter 8
maintenance, programming, or replacement of the problems exist that require repairs that cannot be made onsite.
medical device that has been surgically implanted (or More comprehensive procedures may be necessary
an external component of the surgically implanted when there is a need to analyze the type of equipment
medical device). problems, or to collect data. This level of monitoring usu-
ally requires more knowledge of the equipment and may
be reserved for the educational audiologist, teacher of the

286 Chapter 8
TABLE 8–15 Basic Monitoring Plan for Hearing Instruments and Remote Microphone Technology
1. Procedures used to monitor HI/HAT:  Ling Six-Sounds

2. Person who will monitor:
 Other _______________________
3. Location of monitoring:
4. When and how often will HI/HAT be monitored:
5. Procedure to follow when HI/HAT malfunctions:
6. Child/Youth with HAT:
Meeting personal auditory/listening goals?  Yes  No
Achieves communication access with teachers and school staff?  Yes  No
Achieves communication access with peers?  Yes  No
TABLE 8–16 Sample Individualized Education Program Long-Term Goal and Short-Term Objectives for Amplification
Long-Term Goal:
(Name of student) will be able to manage his/her (hearing aids and/or FM/DM system).
Short-Term Objectives (use one or more of the following as appropriate):
Objective 1. To identify when hearing aids and FM/DM system are nonfunctioning by student conducting a self-check and recording results
on a chart with 75% accuracy.
✓ identify when hearing aids are not producing sound
✓ identify when FM/DM system is transmitting teacher’s voice
Objective 2. To conduct simple troubleshooting to determine cause of problem by student conducting a self-check and recording results on a
chart with 75% accuracy.
✓ check earmold to see if it is plugged with wax
✓ check hearing aid battery to see if it is dead
✓ check FM/DM to see if signal is transmitting
Objective 3. To correct simple problems with hearing aid and FM/DM by student troubleshooting problems with 75% accuracy.
✓ clean earmold
✓ replace hearing aid battery
✓ charge FM/DM receiver (shoe) connection
Objective 4. To contact the audiologist when additional assistance and support is required with 75% accuracy as determined by contacts
made and spot checks of amplification devices.
✓ use telephone, e-mail, or text message to contact audiologist to report problem and explain the troubleshooting and correction
steps that have been tried
deaf/hard of hearing, or a specially trained aide or tech- rectly is an ongoing and sometimes aggravating problem.
nician. Comprehensive monitoring may be done less fre- Students who are active and distractible are particularly hard
quently than the daily monitoring and may include probe- on equipment; at times the listening device may become a
microphone and electroacoustic measurements done on-site new “gadget.” Other students may respond initially to the
to identify specific hearing aid or RM technology problems novelty of the instrument and wear their device(s) consis-
Chapter 8
and verify amplification settings. tently. Then, 2 or 3 weeks later, when the newness has worn
off, these students may have to be reminded to put on their
Adjustment and Acceptance equipment or may even begin to refuse. Some students may
Everyone who has worked with students and their amplifi- be reluctant to use the equipment at first, fearing something
cation recognize the challenges to wearing and using their new or feeling unsure of how they will be viewed by their
devices properly. Ensuring that amplification functions cor- peers. Helping students demonstrate their systems to their

Student’s Name: Aiden Hears Date: August 15, 2018

Teacher: Mrs. Nice Grade: 2
Hearing Aid Brand/Model: RE Phonak Sky B SP LE Phonak Sky B SP _
Cochlear Implant: Brand/Model: ❑RE ❑LE
Hearing Assistance Device: Brand/Model: Phonak Roger Touchscreen Mic, Roger X, & audio shoe AS18
1. Individual responsible for basic monitoring of device(s):

❑Teacher [ ] ❑Nurse [ ]
Aide [ Mrs. Health Aide] ❑Audiology Asst [ ]
Self-monitoring by student ❑Other [ ]
2. Where will device(s) be monitored? ❑General education classroom ❑Special education classroom
Nurse’s office ❑Other:
3. When will device(s) be monitored (daily/weekly and time of day)? Daily at

beginning of school day and after lunch
4. Procedures used to monitor device(s):

◼ Basic Check:
By: Aiden Hears 1. Verify that HA/RM is turned on and working.
2. Check batteries.
By: Mrs. Health Aide 1. Verify that HA/RM is turned on and working.
2. Conduct Ling 6 sounds test.
◼ Troubleshooting Hearing Aid: battery, earmold, tubing, intermittency and static

Strategies: RM System: battery, RM connection and channel, intermittency
By: Mrs. Health Aide and static
◼ Audiologist Advanced
1. Verify status using basic troubleshooting strategies.
Check: 2. Conduct electroacoustic check.
By: Dr. Audiology
5. What will occur if device is malfunctioning? Audiologist will send hearing aid home with note
indicating problem so that parents can take it to their dispensing audiologist for repair; school will
continue to provide amplification access with RM system by using a school-owned receiver until a
loaner hearing aid is available from dispensing audiologist or aid is repaired
Parent Approval of Plan:

 I agree with amplification monitoring plan. Initials WH Date 8/15/18
FIGURE 8–4 Sample personal amplification monitoring plan.

Chapter 8

288 Chapter 8
classmates and providing time to adjust to wearing them Database software programs provide various options for
often helps students adapt to the devices, provided improve- managing this information. As a school district audiology
ment in listening has been experienced. Other students may program acquires more equipment, it is increasingly impor-
respond positively from the beginning but may still want to tant that a good system be developed. Loss from theft or
demonstrate their amplification systems to teachers and/or damage, inventory for insurance purposes, tracking repair
classmates. histories, and separating equipment purchased by general
education versus special education are common issues that
The School’s Role Regarding Earmolds can benefit from data contained in such a management sys-
The educational audiologist’s role with earmolds will vary tem. Information concerning date of purchase, amount of
depending on the individual school’s involvement with hear- purchase, and repair history is invaluable for budget pro-
ing aids and other HAT devices. School districts are respon- posals that specify addition or replacement equipment and
sible for providing earmolds necessary for FM/DM or other that address the need for repair contracts through extended
school-owned devices. Some educational audiologists also warranties.
provide a service to parents by making earmolds for per-
sonal devices worn for school. Parents, or third-party payers,
may be billed for these earmolds depending on the schools’ Strategies to Implement the American
policies. Benefits to providing this earmold service include
Academy of Audiology Hearing
■■ increased efficiency for students’ schedules by elimi- Assistance Technology Guidelines
nating the time involved in an out-of-school appoint-
Implementation of professional standards can be daunting
ment to take impressions and returning to pick up the
and, when resources are limited, an exercise in frustration.
mold(s);
Deciding priorities with limited resources is a common
■■ decreased absenteeism because of these appointments;
occurrence in education today. The strategies identified in
■■ diminished fear regarding the impression process be-
Table 8–17 were generated from educational audiologists
cause earmolds can be made for several students within
attending the 2009 EAA Summer Conference as consider-
their classroom at the same time; and
ations to implement the AAA guidelines. These suggestions
■■ lower cost to parents.
continue to offer relevant options as we continue to address
these issues.
Equipment Management
A summary of all components involved in HAT imple-
Efficiency of equipment management is increased when mentation are illustrated in Figure 8–5 for the in-school plan
there is an electronic method for cataloging and tracking all and Figure 8–6 for the out-of-school plan. Appendices 8–K
pieces by serial number, date of purchase, funding source, and 8–L contain HAT Implementation Worksheets for both
service contract data, repair history, and current location. in-school and out-of-school use.
TABLE 8–17 Strategies for Implementing AAA Guidelines in the Schools
Area Strategies
1. Personnel ■■ Incorporate administrators (principals) into trainings so that they understand and can implement
Qualifications requirements of standards
■■ Enlist support of professional colleagues (teacher of deaf or hard of hearing, speech-language
pathologists [SLPs]) to adhere to professional scopes of practice and state licensure requirements
■■ Contract with a clinical audiologist
■■ Find an audiologist who can perform testing for minimal cost
■■ Work with clinical audiologists regarding the procedures that are needed
■■ Adhere to scope of practice standards
2. E quipment and Space ■■ Partner with clinical audiologists to share equipment and information
Requirements
Chapter 8
■■ Have a central location with a sound booth for testing

■■ Make nice with school staff, especially custodians to garner space
■■ Enlist resources for transportation
■■ Conduct real-ear measurements on-site
■■ Work closely with private audiologists
■■ Obtain information and implement measurements for room reverberation
■■ Contract for evaluations

Area Strategies
■■ Renovate school/classroom for a sound booth

■■ Tap into parent organizations for funds
■■ Work with funders (administrators) on guidelines regarding implementation
■■ Create a loaner bank for equipment
■■ Rent from equipment providers
3. Candidacy, ■■ Look at regulatory issues in your state related to who can select hearing assistance technology (HAT)
Implementation, ■■ Try to have good working relationships with clinical audiologists and physicians
and Device Selection ■■ Cultivate parent and student education and support
■■ Use YouTube training videos, websites, DVDs, PowerPoint slides
■■ Provide continuing education for audiologists to encourage wide knowledge base
■■ Develop protocol for functional testing for identifying need for remote microphone (RM) technology
(written procedures)
■■ Use questionnaires, teacher assessments of deaf or hard of hearing student (e.g., Screening Instrument
for Targeting Educational Risk [SIFTER])
■■ Follow written guidelines, e.g., target candidates (kids with hearing loss, implants, learning disabilities, and
auditory processing issues
■■ Use the Individualized Education Program (IEP) process
■■ Look at academic potential versus performance—how to qualify for IEP and RM technology
■■ Look at audiogram, academic, state testing, inventories, pre- and post-tests
■■ Test for speech-in-noise performance (e.g., BBK-SIN test and Functional Listening Evaluation with and
without HA and RM
■■ Use pre-post trials to provide more objective criteria
■■ Consider equipment warranties in RM technology selection
4. Fitting and Verification ■■ Secure more concise information from manufacturers and/or AAA about verification procedures as
Procedures technology changes
■■ Develop a protocol for functional testing
■■ Extend contractual services to add days prior to school starting to get frequency modulated (FM)/
digitally modulated (DM) HAs fitted
■■ Use previous year’s FM/DM fitting until schedule permits time to recheck
■■ Contract with clinical audiologist to perform procedures
■■ Seek public education or other funding
■■ Secure real-ear testing equipment
■■ Recruit AuD students to assist with procedures
■■ Maintain communication with dispensing audiologist
5. Implementation and ■■ Help students be “the boss” of their technology
Validation ■■ Create “leave behind” materials for teachers that are visual and easy to understand
■■ Ensure that RM technology is in the IEP and educate parents as advocates
■■ Ensure that school-based audiologist has time/resources to perform validation and training
■■ Assist clinical audiologist with performing validation procedures
■■ Use questionnaires completed by teachers (e.g., Listening Inventory for Education, pre-post FM protocol,
Functional Listening Evaluation, Children’s Home Inventory for Listening Difficulties, IT-MAIS, SIFTER)
■■ Conduct a school-wide inservice at faculty meetings (use hearing loss simulations and other real-world
activities)
Chapter 8
■■ Train teachers/SLPs/nurse to do daily checks

■■ Provide training on questionnaires
■■ Provide education for parents
■■ Ensure that these procedures are done as required by IDEA
■■ Perform HA and FM/DM validation at the same time
■■ Provide inservice for school personnel to assist with validation

290 Chapter 8
HAT In-School Implementation Plan

Audiological Considerations for Device Determination Listening Environment Considerations
Device Selection 1.Receiver 1. Classroom
 Ear level  Learning environment
 Hearing Status  Integrated Receiver - lecture/discussion
- conductive/sensorineural/both  Targeted-area Audio Distribution - solo/team teaching
- unilateral/asymmetrical System (ADS) - 1:1 in-class service
- neuropathy/dysynchrony  Classroom ADS - single/multiple groups
- normal other___________________  Access needs
 Audiogram 2. Ear Receiver location - teachers/peers
- auditory thresholds  Monaural __R __L - single/multiple talkers
- configuration  Binaural Alternating - structured/unstructured
3. Transmitter/Mic - technology (e.g., computer/video)
 Speech recognition in noise  Lapel mic  Directional  Acoustics
 Stability  Boom mic  Lavelier zoom - ambient noise level ____________
- stable/fluctuating/progressive  Conference/table mic - reverberation time _____________
4. Accessories _______________ - signal sources (intensity & spectrum)
 Special considerations 5. Recommended Device - noise sources (spectrum & time)
- e.g. drainage/allergy/atresia _______________________________ - room size and shape
 Current use of hearing technology - student position
Usage Plan  Current HATs in use at school
 Fulltime  Part-time -teacher support
Specific environments: ____________ -peer support
______________________________ 2. Other school locations
Developmental Considerations for Specific activities:  Auditorium/Theater  Therapy areas
Device Selection __assemblies __therapy  Specials – Music/Art/Computer/Resource
__classroom discussion  Gymnasium  Cafeteria
 Age
__PE & other organized physical  Library
-chronological/developmental
activities  Extracurricular activities
 Academic performance Other_____________________
-at or above grade level  Out of School
-below grade level Technology Considerations for Device
Orientation & Training
 Additional problems  Child/Youth/Teacher/School Staff Selection
- attention/hyperactivity - behavior  Convenience  Wearability
- sensory integration - learning Validation  Signal interference  Maintenance
- cognition - vision  Audibility & Intelligibility: self, teacher, peers  Ease of monitoring  Reliability
- mobility - fine motor  Manufacturer/dealer support
Monitoring Plan
- auditory processing  Multiple FM/DM frequencies
1. HAT function
 Compatibility with existing amplification
2. Child/youth performance with HAT
 Compatibility with computers and multimedia
FIGURE 8–5 HAT in-school implementation plan.
HAT Out-of-School Implementation Plan

Audiological Considerations for Device Determination Listening Environment
Device Selection 1. Receiver Considerations
 Ear level FM/DM 1. Home
 Hearing Status  Integrated Receiver
- conductive/sensorineural/both  Activities
 Targeted-area Audio Distribution - play
- unilateral/asymmetrical System (ADS)
- neuropathy/dysynchrony - structured activities (e.g.,
 Classroom ADS reading)
- normal  other___________________ - single/multiple groups
 Audiogram 2. Ear Receiver location  Access needs
- auditory thresholds  Monaural __R __L - family, friends, peers
- configuration  Binaural  Alternating - single/multiple talkers
3. Transmitter/Mic - structured/unstructured
 Stability  Lapel mic  Boom mic
- stable/fluctuating/progressive - audio/visual technology
 Lavalier  Table mic  Acoustics
 Speech recognition in noise 4. Accessories ______________ - noise sources
 Special considerations Usage Plan - reverberation
- e.g. drainage/allergy/atresia 1.  Fulltime - room size and shape
2.  Part-time - child position
 Current use of hearing technology - wireless interference
Specific environments:
__car other _____________ 2. Other locations
Specific activities:  Recreation  Church
__Group interaction  Community  Therapy
Developmental Considerations __large group presentation
__one:one interaction
 Age
__organized physical activities
-chronological/developmental
__informal activities Technology Considerations
 Academic performance/School Other_____________________  Convenience
Readiness  Wearability
Orientation & Training  Reliability
 Additional problems  Child/youth/parent/caregiver  Maintenance
-attention/hyperactivity
Validation  Ease of monitoring
- sensory integration
 Audibility and intelligibility: self, peers,  Manufacturer/dealer support
- behavior
 Compatibility with existing hearing
Chapter 8
- learning parents, others

technology
- cognition
Monitoring Plan  Compatibility with computers,
- vision
1. HAT function multimedia, and other devices
- mobility
2. Child/youth performance with HAT  Signal interference
- fine motor
 Multiple FM/DM frequencies
-auditory processing
FIGURE 8–6 HAT out-of-school implementation plan.

OTHER ASSISTIVE TECHNOLOGIES with RM technology, and IEP goals need to be included for
their use as well. These technologies include
A variety of other assistive technologies are utilized by
■■ speech-to-text tools such as Communication Access
deaf or hard of hearing individuals for connectivity to daily
Realtime Translation (CART), remote and live caption-
communications. A complete discussion of these options is
ing, text interpreting (C-Print, TypeWell), and voice
beyond the scope of this chapter. However, educational audi-
recognition software;
ologists should be familiar with other communication access
■■ apps to access video on phones and other electronic de
technologies, apps, and resources to educate students and
vices; and
their families. Partnering students with deaf or hard of hear-
■■ alerting devices (e.g., flashing and vibrating alarms,
ing adults may be one of the best ways to learn about these
telephones, emergency detectors).
access technologies and resources. Knowledge and training
with other assistive technologies is just as important as it is

This chapter provided essential information to implement American Academy of Audiology. (2008). Clinical practice guide-
hearing instrument and HAT procedures and practices in a lines: Remote microphone hearing assistance technologies
school setting. The decisions that must be made for students for children and youth from birth to 21 years. Retrieved from
regarding amplification provide some of the most compel- https://www.audiology.org
American Academy of Audiology. (2013). Pediatric amplification
ling justification for the necessity of school-based audiology
guidelines. Retrieved from https://www.audiology.org
services. Madell, J., Flexer, C., Wolfe, J., & Schafer, E. C. (2019). Pediatric
Technology growth will continue to result in more op- audiology diagnosis, technology, and management (3rd ed.).
tions for children/youth. However, without appropriate au- New York, NY: Thieme Medical Publishers.
diological services and technology support, students will not
have the opportunity to access information and participate
in their education as they deserve. As school-based audiolo-
gists, we must do our part by actively advocating for the
hearing, listening, and amplification needs of these children.
Chapter 8

APPENDIX 8–A
Student Amplification Evaluation
Name: Age: Grade:

Date Completed: Completed by:
Relationship:  parent  audiologist  teacher  other—specify
Personal Amplification used: (Hearing aid/CI/Osseo-integrated)
Remote Microphone (RM) System used:
DIRECTIONS:
1. Please rate listening skills based on the student’s behavior or performance on typical days. Enter the rating number ac-
cording to the 1 to 5 scale for applicable amplification conditions (no amplification, personal amplification, RM system).
2. Sum the total score and situation scores for each amplification condition; divide by the maximum number for each situ-
ation to get the percent correct for each amplification condition.
3. Plot the percent correct for each situation and amplification condition onto the graph.
4. Complete the amplification use questions at the end of this evaluation if amplification is used.
RATING SCALE
1 = NEVER 2 = SELDOM 3 = SOMETIMES 4 = USUALLY 5 = ALWAYS
1. Student responds to his/her name when spoken to: No Amp HA/CI/O-I + RM system
a. In a quiet room, within 3 feet
b. In a quiet room, at 10 feet
c. In a noisy room, within 3 feet
d. In a noisy room, at 10 feet
e. Without visual cues
f. Outside/in the community (e.g., playground, field trip)
2. Student attends to person speaking: No Amp HA/CI/O-I + RM system
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292

RATING SCALE
1 = NEVER 2 = SELDOM 3 = SOMETIMES 4 = USUALLY 5 = ALWAYS
3. Student distinguishes between words that sound alike

No Amp HA/CI/O-I + RM system
(e.g., bay for day, sink for think, or sun for fun):
4. Student responds accurately to spoken directions
No Amp HA/CI/O-I + RM system
and/or questions:
5. Student comprehends oral instruction and concepts: No Amp HA/CI/O-I + RM system
Total Score: ×/(150)

Situation Analysis:
Quiet (a,b) ×/(50)
Noise (c,d) ×/(50)
Chapter 8
Auditory Only (e) ×/(25)

Distance (b,d,f ) ×/(75)

294 Chapter 8
Performance by Situation and Amplification Condition
100
90
80
70
No Amplification
No Amplification
No Amplification
No Amplification
+ RM system
+ RM system
+ RM system
+ RM system
Percent Correct
HA/CI/O-I
HA/CI/O-I
HA/CI/O-I
HA/CI/O-I
60
50
40
30
20
10
0
Situation: Quiet Noise Aud Only Distance
Amplification Use Information (if used):
Device:  HA/CI/O-I  + RM system YES NO NOT SURE

1. Instrument(s) is easy to operate
2. Instrument(s) has remained in good working order
3. Instrument(s) is comfortable to use
4. Student turns instrument(s) off
5. Student understands benefit of instrument(s)
6. Feedback (whistling noise) is present with instrument
7. Indicate types of activities instrument(s) is used for:
 listening/language/speech therapy  storytime/reading  all academic classes  recess
 PE/Art/Music  lunch  extracurricular activities  other (describe)
8. For which of the above activities do you think the instrument(s) was most beneficial?
9. What do you think is the greatest challenge(s) with the instrument(s)?
10. What do you think is the greatest benefit(s) of the instrument(s)?
11. How has communication with the student changed when using the instrument(s)?
Chapter 8
Note. From © C.D. Johnson & A. Meagher (2016). Revised 2019.

APPENDIX 8–B
Pediatric Amplification Listening Evaluation
Part 1. Personal Hearing Device only
Name: Date of Birth:
Completed by: Date:
Rater: __parent __audiologist __teacher/EI provider other—specify

®
Type of device:  hearing aids  cochlear implants  Baha  combination(describe)
Device brand/model: Length of device use:
DIRECTIONS: Please rate the following skills based on the child’s behavior or performance on typical days. To
score, subtract any NA (not applicable) items from the total, and then determine percent for total performance and
for each situation. Enter scores in the Score Box in the column, Hearing Device Only, at the bottom of page 4.
SELDOM SOMETIMES USUALLY

1. Child responds to his/her name when spoken to:
a. In a quiet room, within 3 feet 1 2 3 4 5 NA
b. In a quiet room, at 10 feet 1 2 3 4 5 NA
c. In a noisy room, within 3 feet 1 2 3 4 5 NA
d. In a noisy room, at 10 feet 1 2 3 4 5 NA
e. Without visual cues 1 2 3 4 5 NA
f. From another room 1 2 3 4 5 NA
g. Outside/in the community 1 2 3 4 5 NA
2. Child attends to person speaking:

Chapter 8
295

296 Chapter 8
3. Child distinguishes between words that sound alike

4. Child responds accurately to spoken directions

and/or questions:
5. Child comprehends oral instruction and concepts:

Information on personal device use:

Personal device is easy to operate: 1 2 3 4 5 NA
Personal device has remained in good working order: 1 2 3 4 5 NA
Personal device is comfortable for child to use: 1 2 3 4 5 NA
Child tries to turn personal device system off: 1 2 3 4 5 NA
Feedback (whistling noise) is present with personal device: 1 2 3 4 5 NA
Indicate types of activities the personal device is used for?
__ snacks __ play __ storytime/reading __ playground __ walks

__ listening/language/speech therapy __ shopping __ car __stroller
other (describe)
For which of the above activities do you think the personal device was most beneficial?
Chapter 8
What do you think is the greatest benefit(s) of the personal device?

What do you think is the greatest challenge(s) with the personal device?
How has your communication with your child changed when using personal device?

Part 2. With Remote Microphone (RM) System
Name: Date:
Type of RM System:
RM System brand/model: Length of use:
DIRECTIONS: The rater should be the same as in the baseline condition and ratings determined under compa-
rable conditions. To score, subtract any NA (not applicable) items from the total, and then determine percent for
each situation and total performance. Enter scores in the Score Box in the column with RM system. Subtract the
scores for Hearing Instrument Only and with RM system to obtain the percent of change.
1. Child responds to his/her name when spoken to:

2. Child attends to person speaking:
3. Child distinguishes between words that sound alike

Chapter 8

298 Chapter 8
4. Child responds accurately to spoken

directions and/or questions:
5. Child comprehends oral instruction and concepts:

Information on RM system use:

RM system is easy to operate: 1 2 3 4 5 NA
RM system has remained in good working order: 1 2 3 4 5 NA
RM system is comfortable for child to use: 1 2 3 4 5 NA
Child tries to turn RM system off: 1 2 3 4 5 NA
Feedback (whistling noise) is present with RM
system: 1 2 3 4 5 NA
Indicate types of activities the RM system is used for?
__ snacks __ play __ storytime/reading __ playground __ walks

__ listening/language/speech therapy __ shopping __ car __stroller
other (describe)
For which of the above activities do you think the RM system was most beneficial?
What do you think is the greatest benefit(s) of the RM system?
What do you think is the greatest challenge(s) with the RM system?
How has your communication with your child changed when using RM system?
Score Box Analysis
Condition Personal Hearing Device Only With RM system Percent Change

Quiet (a,b): ____/(50) =  % ____/(50) =  % %
Noise (c,d,g): ____/(75) =  % ____/(75) =  % %
Chapter 8
Auditory only (e): ____/(25) =  % ____/(25) =  % %

Distance (b,d,f): ____/(75) =  % ____/(75) =  % %
TOTAL SCORE: _____/(175) =  % _____/(175) =  % %
Note. From Cheryl DeConde Johnson (2019).

APPENDIX 8–C
Personal Amplification Monitoring Plan
Student’s Name: Date:

Teacher: Grade:
Hearing Aid Brand/Model: RE LE _
Cochlear Implant or Bone-Anchored Device Brand/Model: RE LE
Remote Microphone System: Brand/Model:
1. Individual responsible for basic monitoring of device(s):

q Teacher [ ] qNurse [ _____ ]
q Aide [ ] qAudiology Asst [ ]
q Self monitoring by student qOther [____________________________]
2. Where will device(s) be monitored? qGeneral education classroom qSpecial education classroom
qNurse’s office qOther:
3. When will device(s) be monitored (daily/weekly and time of day)?

4. Procedures used to monitor device(s):
■■ Basic Check: 1.
By:
2.
1.
By: 2.
■■ Troubleshooting
Strategies: Hearing Aid: battery, earmold, tubing, intermittency and static
CI/Bone-anchored device: battery, processor intermittency and static
By:
RM System: battery, RM connection and channel, intermittency and static
1.
■■ Audiologist Advanced
Check: By: 2.
5. What will occur if device is malfunctioning?

Chapter 8
Parent Approval of Plan:

q I agree with amplification monitoring plan. Initials Date
299

Appendix 8–D
INSTRUCTIONS FOR HEARING AID CHECKS
Materials needed (should be assembled in kit such as a zipper pencil case):
o Stethoscope
o Battery tester
o Batteries
o Brush, wire loop
o Earmold “puffer” (air blower bulb)
o Instructions
o Picture of hearing aid with parts labeled
o Contact information for the audiologist
Instructions for conducting a hearing aid check:
• Check the Battery

1. Open the battery door.
2. Remove the battery, place in the appropriate slot of a battery tester, and check according to tester
instructions.
3. Obtain new battery if indicator on tester says battery is dead.
4. Replace battery into the hearing aid - the battery usually only fits one way; DO NOT FORCE THE DOOR
CLOSED.
• Listen to the Hearing Aid

1. Place the end of the stethoscope tube over the opening of the earmold.
2. Turn the hearing aid on (for some hearing aids “M” stands for microphone which means the hearing
aid is turned on).
3. Listening through the stethoscope, say the Ling sounds (“OO, EE, AH, S, SH, MM”). They should be
clear and the hearing aid should not cut off and on. No buzzing or hissing sound should be present.
Listen for any crackling sound, cutting in or out, or no sound at all. If the hearing aid has a volume
control, adjust the volume up and down and listen for any of the above distortions.
4. Shake and squeeze the hearing aid case to see if the aid cuts off.
5. Check for cracks in the case of the hearing aid and the earmold and tubing.
6. If the hearing aid whistles in the ear, feedback is occurring. Check to see if the earmold is inserted
into the ear properly. If not, reinsert. Check for gaps around the earmold and see if the whistle
decreases as you push on the earmold in the ear. If gaps are present or if the whistle decreases while
pushing on the earmold, the earmold might need to be replaced.
7. If any of the above problems exist, contact the audiologist.
• Check the Earmold

1. Examine the earmold to check for any build-up of wax in the canal end of the mold.
2. If there is wax build-up, insert the wax loop to remove the wax. The loop will collect wax from the
earmold. Wipe off the loop and insert again until all the wax is removed.
3. Wipe off any foreign materials from the earmold. The earmold may be washed in warm soapy water.
Disconnect the earmold from the hearing aid prior to placing in water. Do not use any alcohol to
clean the earmold or hearing aid case. Use the earmold puffer to remove moisture from the tubing,
earhook and earmold before inserting back onto the hearing aid.
4. If the earmold or hearing aid case still looks dirty after the above cleaning, send a note home to notify
parents of the problem or contact the audiologist.
Appendix 8–E
INSTRUCTIONS FOR COCHLEAR IMPLANT CHECKS
o Monitor headphones
o Battery tester
o Batteries
o Instructions
o Picture of cochlear implant processor with parts labeled
Instructions for conducting a cochlear implant check:
• Check the Battery

1. Remove the battery pack
2. For disposable batteries, remove the batteries, place in the appropriate slot of a battery tester, and
check according to tester instructions. Obtain new batteries if indicator on tester says battery is dead.
3. For rechargeable batteries, replace with fully charged backup battery.
• Listen to the Processor

1. The microphone can be checked by using the proper monitor headphones for the sound processor
you are troubleshooting. Turn off the sound processor, attach the monitor headphones, turn the
sound processor back on, and do a listening check (Ling sounds “OO, EE, AH, S, SH, MM”, running
speech).
2. Your voice will not be amplified but should be clear and without static.
3. As you speak, move the cables around and listen for crackling or static. If there is any crackling/static
sound, the cord may need to be replaced by either the audiologist or with a backup headpiece if
there is one available.
• Further troubleshooting
1. If the problem is not resolved by the above steps, there may be something wrong with the coil or
cable of the external device.
2. Place the coil on the student’s head and check the indicator light (if enabled) to ensure a proper
connection. Keep in mind that different manufacturers may have different indicators.
3. If the student’s processor has a remote control, you may use the remote control to check the status
of the battery and the connection.
4. You may also ensure that the processor is functioning and there is a good connection by asking the
student to repeat back the Ling sounds or familiar words with your mouth covered.
Appendix 8–F
INSTRUCTIONS FOR OSSEOINTEGRATED BONE CONDUCTION
IMPLANT CHECKS
o Listening rod
o Battery tester
o Batteries
o Instructions
o Picture of bone conduction processor with parts labeled
Instructions for conducting a bone conduction implant processor check:
• Check the battery

1. Swing out or slide the battery door open (varies based on model).
2. Remove the battery, place in the appropriate slot of a battery tester, and check according to tester
instructions.
3. Obtain new battery if indicator on tester says battery is dead. NOTE: if the processor is working for 5-
10 minutes and then stops it likely means it is time to change the battery.
4. Replace battery - the battery usually only fits one way; DO NOT FORCE THE DOOR CLOSED.
• Listen to the bone conduction processor

1. Snap the processor onto the listening rod.
2. Ensure the processor is turned on (the volume on/off switch should be turned past “0” to “1”, “2”, or
“3”)
3. Listen through the test rod by holding the rod against the skull behind the ear (be sure not to touch
the processor). Plug your ears and say the Ling sounds (“OO, EE, AH, S, SH, MM”) or ask someone else
to speak to you. The sounds should be clear and the processor should not cut off and on. No buzzing
or hissing sound should be present. Listen for any crackling sound, cutting in or out, or no sound at
all. If the processor has a volume control, adjust the volume up and down and listen for any of the
above distortions.
4. If any of the above problems exist, contact the audiologist.
1. If the child complains that the sound is weak/distorted/intermittent/cracking, check that the
abutment (place where the processor attaches on the child’s head) is clean and clear of any debris.
2. If the sound is distorted, the child may need to use a Dri-Aid pack overnight to remove moisture in
the microphone.
3. If there is feedback or whistling: remove hats, ensure items such as eyeglasses/helmets/fingers/ear
are not coming into contact with the device, adjust the volume, and check that the abutment is clean
and clear of debris.
Appendix 8–G
INSTRUCTIONS FOR PERSONAL REMOTE MICROPHONE SYSTEM CHECKS
o Hearing aid and stethoscope or listening headphones

o Batteries (correct size for FM/DM transmitter)
o Instructions
o Picture of FM/DM system with parts labeled
Instructions for conducting RM system check:
• Pair the receiver and transmitter

1. Make sure that the receiver or neck loop and the transmitter are connected and on the correct
channel. Methods for pairing the receiver and transmitter will vary by manufacturer and model.
• Listen to the receiver

1. Connect the receiver or neck loop to a hearing aid and listening stethoscope, or connect the receiver
directly into a listening headset.
2. Turn the transmitter on.
3. Listening through the stethoscope or headphones, rub the microphone of the transmitter to make
sure that it is on and paired (you should hear a rubbing sound). Say the Ling sounds (“OO, EE, AH, S,
SH, MM”). They should be clear and the sound should not cut off and on. No buzzing or hissing sound
should be present. Listen for any crackling sound, cutting in or out, or no sound at all.
4. Using a partner, have someone carry the transmitter to the other side of the room and say a few
words. You should be able to hear the person’s voice directly through the listening scope or
headphones.
5. If any of the above problems exist or if you do not hear the transmitter signal, contact the audiologist.
1. If the transmitter will not turn on, try replacing the batteries (usually size AA).
2. If the transmitter is on but the receiver is not recognizing the connection, you may need to change
programs in the hearing aid.
3. Refer to the American Academy of Audiology hearing assistive technology guidelines for further
verification and troubleshooting techniques (“Remote Microphone Hearing Assistance Technologies
for Children and Youth from Birth to 21 Years”, April 2008).
Copyright © 2021 Plural Publishing, Inc. All rights reserved. Permission to print for clinical use is granted. The files are NOT
allowed to be hosted electronically without written permission of the publisher.
Appendix 8–H
HEARING TECHNOLOGY MONITORING CHART
STUDENT____________________________________ INSTRUMENTS Right Ear
Left Ear_____________
KEY: + = OK — = PROBLEM (enter letter code from problem chart)
DATE RT LT Ear- RM SOUND TEST COMMENTS ACTION

mold
Device Device oo ee ah sh ss mm
PROBLEM CHART FOR TROUBLESHOOTING
Earmold Personal Devices Problems FM/DM Problems

a. Lost CI/HA not worn: Receiver:
b. Poor fit g. Sensitive ear ee. No RMsignal
c. Dirty h. Refuses ff. Frequency not synched with
d. Plugged i. In pocket transmitter, if applicable
e. Damaged j. Left at home gg. HA/RM battery dead/weak
f. Tubing crimped or k. No battery hh. Wrong setting
damaged l. Lost ii. Interference
m. In for repair jj. Poor sound quality
n. Other kk. Audioshoe connection problem
ll. Other_________________
Problem:
o. Turned off Transmitter/Microphone
p. Dirty mm. Mic off
q. Mic opening blocked nn. Battery dead/weak
r. Distortion oo. Other__________________
s. No output
t. Low output
u. Battery compartment damaged
v. Dead/weak battery
w. Loose hook
x. Cracked/damaged case
y. Volume control
z. Excessive moisture
aa. Broken headpiece/cable
bb. Intermittent
cc. Internal feedback
dd. Unknown
APPENDIX 8–I
TOOLS for SCHOOLS
THe Ling Six Sound Check

What Is the Ling Six Sound Check?
A behavioral listening check to determine a cochlear implant’s effectiveness.
The sounds ah, ee, oo, sh, s, and mm indicate a child’s ability to detect all aspects of speech, as these six sounds encompass
the frequency range of all phonemes.
This check can be used to determine what sounds the student is able to detect, discriminate, and identify.
Task Description
Detection Recognizing the presence or absence of sound
Discrimination Discerning if two or more sounds are the same or different
Identification Reproducing a sound or pointing to a picture of the sound heard
If the child has the ability to hear to:

• 1,000 Hz—should hear the three vowel sounds ah, ee, and oo, spoken in a quiet voice at a distance of at least five yards.
• 2,000 Hz—should also hear the sound sh.
• 4,000 Hz—should detect s from a distance of at least one to two yards.
Six-Sound Speech Test Instructions

For Schoolchildren For a Very Young Child
1. Position the listener one to two yards from you and ask 1. For a child under the age of four you will need to teach
him/her to “listen.” detection through a behavioral response.
2. If this is the first time the person has completed the task, 2. Use of real objects to represent each of the Ling Sounds is
demonstrate what is expected. recommended, using the pictures on the cards as recom-
mendations (e.g., ghost, airplane).
3. Using a normal conversational level, present each of the 3. While giving the child a quiet distraction, provide a long
sounds through listening alone. baseline of silence and then make one of the Ling sounds
through audition alone and without any toys.
4. Occasionally say nothing while doing the test. This way, 4. If the child looks, repeat the sound without showing the
a listener learns that it is okay to say that he/she does object. When you have the child’s attention, first through
not hear anything. Remember to present the Ling Sounds listening, reinforce his attention by showing the
in a random order so the child doesn’t learn corresponding toy and then repeating the sound again;
Chapter 8
the pattern of presentation. provide waiting time so the child can process the sound.
5. If the child is able to detect the sounds, progress to a 5. After a few minutes, say another sound and present
discrimination task and then an identification task by the corresponding toy in the same way. Present all the
asking the child to point to the correct picture. The goal Ling Sounds as long as you can maintain the child’s
is to have the child naturally repeat the Ling Sound. attention. If attention is poor, change tasks and try again.
JUn09_ 3-01066-B-1
©2009 Advanced Bionics, LLc.
TOOLS for ScHooLS by Advanced Bionics 1 THe Ling Six Sound Check All rights reserved.
300

TOOLS for SCHOOLS
THE LING SIX Sounds
Chapter 8
JUN09_ 3-01066-B-2
©2009 Advanced Bionics, LLC.
All rights reserved.

APPENDIX 8–J
Tips to Enhance Remote Microphone Use
For All Remote Micorphone (RM) taking as well as facilitates the child’s ability to hear
each student, reducing your need to repeat what each
Technologies
child has said.
■■ Power Up: RM input is dependent on the child’s hear- ■■ Group Instruction With Classroom Amplification
ing aid(s) or cochlear implant working correctly. If bat- Systems: When you are doing individual or small
teries are low or the hearing aid or cochlear implant is group work, it is helpful to turn off the speakers that
not turned on, the system will not work. For children are not part of the instruction area to decrease disrup-
with hearing aids, earmolds must be free of wax and/ tion to other students.
or moisture. ■■ Patching to Media: For instructional media (smart-
■■ Performance Check: Complete a daily performance
board, computer, television), place the RM near the
check using the Ling Six-Sounds as a quick screen (ah, sound source or, if available, connect the transmitter
oo, ee, sh, s, m) to assure access to broad frequency directly to the media using a patch cord or the auxiliary
range of sounds using an auditory only condition; look input jack.
for any changes in the child’s responses. If the child ■■ RM/Environmental Microphone Ratio: Check with
utilizes personal hearing aids or a cochlear implant, per- the child’s audiologist to assure that the appropriate
form the check first with the personal device(s), then settings are made for the environmental microphone on
through the RM at a distance of 20 to 40 feet from the the hearing aid or cochlear implant in relation to the
child. Results should be the same for both situations. loudness of the RM signal.
■■ Teacher’s Microphone: Placement should be 6 inches
■■ Group Instruction: Often, instruction occurs in groups
from the speaker’s mouth with the microphone directed that may not include all of the children who use RM.
toward the mouth. Boom or collar-style microphones For those children who are not part of the active group
are preferable to lapel styles so that there is no reduction instruction, the receiving RM signal should be turned off
in the loudness of the speaker’s voice when head move- (or, if necessary, disconnected).
ment occurs. Any contact of the microphone with jew- ■■ Avoid Embarrassment: If you leave the room or do not
elry or clothing can create additional noise and therefore wish to transmit your conversation, remember to turn
interruption in the transmission of the communication. off the RM on your transmitter!
■■ Group Discussion: Pass the microphone to each child
who is speaking. This establishes etiquette for turn-

Chapter 8
Note. Adapted from The guide to cochlear implants for parents and educators, Advanced Bionics (2003, pp. 30–32).
302

APPENDIX 8–K
Remote Microphone Hearing Assistance Technology Implementation
Worksheet: In-School Form
Name Date
The HAT Implementation Worksheet is a five-step process to document eligibility, decision considerations for implementation
of HAT, device considerations and device selection, fitting and verification, and implementation and validation. There are
two forms, one for in-school and one for out-of-school. Depending on your local requirements for IFSP/IEP documentation,
portions of this form may be included in the IFSP/IEP.
STEP 1. Potential Candidacy for Remote Microphone HAT

HAT is known to benefit children/youth with hearing, language and/or learning problems by enhancing the teacher’s or
classmates’ voices and minimizing background noise.
This child/youth is a potential candidate for HAT based on documented evidence of hearing, listening, or learning
problems and has
 Normal peripheral hearing
 Abnormal peripheral hearing
STEP 2. Implementation Considerations for Remote Microphone HAT

Consider the following areas to identify any special challenges that may affect the decision to implement HAT.
1. Acoustical Environment 3. Functional
 meets ANSI standards  Age
 transient noise - chronological/developmental
2. Social-Emotional  Academic performance
 Motivation (student and teachers)  Communication skills
 Attention and fatigue 4. Support
- listening/looking  Awareness
 Self-image  External acceptance
 Self-advocacy  Ability to use and manage technology
 Social acceptance
 Classroom culture
Do these considerations result in any contraindications for fitting HAT?

■■ If no, then proceed to Step 3, Device Considerations and Selection.
Chapter 8
■■ If yes, then provide counseling, monitor the situation, and review the situation. When appropriate, reconsider the
use of HAT.
Step 2 Comments:
303

304 Chapter 8
STEP 3. Device Considerations and Selection

Remote Microphone HAT Goals
These goals represent recommended practice unless individual testing indicates otherwise.
■■ Audibility and intelligibility
– Speech recognition that is commensurate with performance in ideal listening conditions
– Full audibility of self and others
– Reduced effects of distance, noise, and reverberation
■■ Preferred practice to accomplish full audibility
– Consistent signal from the talker regardless of head movement
– Technology that will be worn consistently by the individual, parent, and/or teacher
– Technology that will provide full audibility according to listener group:
Group 1. Children and youth with hearing loss who are actual or potential hearing aid users: Bilateral ear
level wireless technology and fewest equipment adjustments
Group 2. Children and youth with cochlear implants: Bilateral wireless technology.
Group 3. Children and youth with normal hearing sensitivity who have special listening requirements: There
is not a default HAT arrangement for this population.
1. Audiological Considerations 3. Listening Environment Considerations

Hearing status: Measurements:
 conductive/sensorineural/mixed Ambient noise level (unoccupied classroom) _______
 unilateral/asymmetrical  Exceeds 35 dBA (ANSI S12.60-2002)
 auditory neuropathy spectrum disorder Teacher’s voice-to-noise ratio (occupied classroom)
 normal ______________________
Audiogram:  Is less than 15 dB
 auditory thresholds Reverberation time______
 configuration  Exceeds 0.6 s (ANSI S12.60-2002)
Speech recognition performance in noise: School learning environment:
(please describe)  lecture  discussion
Stability:  solo  team teaching
 stable  fluctuating  progressive  single group  multiple groups
Special considerations:  1:1 in-class service
 drainage  allergy  atresia  other School access needs:
Current use of hearing technology:  teachers  peers
(please describe current arrangement and  single talker  multiple talkers
consistency of use)____________________  structured learning  unstructured learning
 technology (computer, TV)
2. Developmental Considerations School acoustic needs:
Age:  signal sources (intensity and spectrum)
 chronological/developmental deficits  noise sources (spectrum and time)
 wearer acceptance  reverberation
Academic performance:  room size and shape
 at or above grade level  student position
 below grade level Current HATs in use at school:
Additional problems:  teacher support  peer support
 attention/hyperactivity Other school locations:
 sensory integration  auditorium/theater  therapy areas
Chapter 8
 behavior  learning  gymnasium  cafeteria

 cognition  vision  extracurricular activities  library
 mobility  fine motor  specials: music, computer, resource
 auditory processing

4. Technology Considerations
 convenience
 wearability
 reliability
 maintenance
 ease of monitoring
 manufacturer/dealer support
 compatibility with existing amplification
 compatibility with computers, phones, and
other devices
 signal interference
 multiple FM frequencies or use of digital
system
5. Device Determination
Receiver: Ear receiver location:
 Ear level FM/DM  Monaural __R __L
 HA + FM/DM Receiver  Binaural
 Targeted-area audio distribution system  Alternating
 Classroom audio distribution system Accessories:
 Other___________________
Transmitter/microphone:
 Proximity mic
 Boom mic
 Lavalier zoom
 Conference mic
 Directional mic
Recommended Device:
Step 3 Comments:
Chapter 8
STEP 4. Fitting and Verification—See Supplement A. Fitting and Verification

Procedures and Worksheet

306 Chapter 8
STEP 5. Implementation and Validation: Orientation, Training, Usage Plan,

and Validation
1. Orientation and Training
Child/youth: Teacher/school staff:
 implications of hearing loss  implications of hearing loss
 function of device  function of device
 appropriate use of device and features  appropriate use of device and features
 expectations—benefits and limitations  expectations—benefits and limitations
 care and maintenance  maintenance
 troubleshooting  listening check and troubleshooting
 self-monitoring  other _________________________________
 other_______________________________
2. Usage Plan Specific activities:

 Full-time  assemblies
 Part-time  therapy
Specific environments:___________________  classroom discussion
_____________________________________  PE and other organized physical activities
____________________________________  Other____________________________________
3. Validation
Does the HAT device meet the intended goals? What is the evidence for the following:
■■ Audibility and intelligibility of speech that is commensurate with best speech recognition in ideal listening conditions:
Speech recognition in ideal listening conditions _____%
Speech recognition in noise FM/DM _____%
Validation instruments used:_____________________________________________________________
■■ Full audibility confirmed for self: Yes No for others: Yes No
■■ Performance: Self-assessment____________________________________________________________
Observation questionnaire____________________________________________________
Evaluation_________________________________________________________________
4. Monitoring Plan
Remote microphone HAT function: Child/youth performance with HAT:
Procedure used to monitor HAT: Meeting personal auditory/listening goals?
 Ling Six-Sounds  Yes  No
 Other_______________________________ Achieves communication access with teachers and school
Person who will monitor: ______________________ staff?
Location of monitoring: _______________________  Yes  No
When and how often will HAT be monitored:_________ Achieves communication access with peers?
Procedure to follow when HAT malfunctions:  Yes  No
__________________________________________
__________________________________________
Step 5 Comments:
Chapter 8
Note. AAA Clinical Practice Guidelines: Remote Microphone Hearing Assistance Technologies for Children and Youth from Birth to 21 Years, Appendix B–1.
Reprinted with permission from the American Academy of Audiology. © 2008.

APPENDIX 8–L
Remote Microphone Hearing Assistance Technology Implementation
Worksheet: Out-of-School Form
Name Date
The HAT Implementation Worksheet is a five-step process to document eligibility, decision considerations for implementation
of HAT, device considerations and device selection, fitting and verification, and implementation and validation. There are
two forms, one for in-school and one for out-of-school. Depending on your local requirements for IFSP/IEP documentation,
portions of this form may be included in the IFSP/IEP.
STEP 1. Potential Candidates for Remote Microphone HAT

HAT is known to benefit children/youth with hearing, language, and/or learning problems by enhancing the parent’s,
caregiver’s, or peers’ voices and minimizing background noise.
This child/youth is a potential candidate for HAT based on documented evidence of listening or learning problems
and has
 Normal peripheral hearing
 Abnormal peripheral hearing
STEP 2. Decision Considerations for Implementation of Remote Microphone

HAT
Consider the following areas to identify any special challenges that may affect the decision to implement HAT.
1. Acoustical Environment 3. Functional
 Noise/reverberation levels in typical settings  Age
 Distance from speaker(s) - chronological/developmental
2. Social-Emotional  Communication skills
 Motivation (child and family members)  Communication environment
 Attention and fatigue 4. Support
- listening/looking  Awareness
 Self-image  External acceptance
 Self-advocacy  Ability to use and manage technology
 Social acceptance  Financial resources
 Family support  ADA obligations
Chapter 8
Do these considerations result in any contraindications for fitting HAT?

■■ If no, then proceed to Step 3, Device Considerations and Selection.
■■ If yes, then provide counseling, monitor the situation, and review the situation. When appropriate, reconsider the
use of HAT.
Step 2 Comments:
307

308 Chapter 8
Step 3. Device Considerations and Selection

Remote Microphone HAT Goals
These goals represent recommended practice unless individual testing indicates otherwise.
■■ Audibility and Intelligibility
– Speech recognition that is commensurate with performance in ideal listening conditions
– Full audibility of self and others
– Reduced effects of distance, noise and reverberation
■■ Preferred practice to accomplish full audibility
– Consistent signal from the talker regardless of head movement

– Technology that will be worn consistently by the individual, parent, and/or teacher
– Technology that will provide full audibility according to listener group:
Group 1. Children and youth with hearing loss who are actual or potential hearing aid users: Bilateral ear
level wireless technology and fewest equipment adjustments.
Group 2. Children and youth with cochlear implants: Bilateral wireless technology.
Group 3. Children and youth with normal hearing sensitivity who have special listening requirements: There
is not a default HAT arrangement for this population.
1. Audiological Considerations 3. Listening Environment Considerations
Hearing status: Measurements:
 conductive/sensorineural/mixed Ambient noise level (unoccupied room)______
 unilateral/asymmetrical  Exceeds 35 dBA (ANSI S12.60-2002)
 auditory neuropathy spectrum disorder Speaker’s voice-to-noise ratio (occupied
 normal room)
Audiogram:  Is less than 15 dB
 auditory thresholds Reverberation time______
 configuration  Exceeds 0.6 s (ANSI S12.60-2002)
Speech recognition performance in noise: Home activity needs:
(please describe)  meals
Stability:  play—structured activities (e.g., reading)
 stable  fluctuating  progressive  play—single/multiple groups structured
Special considerations: Home access needs:
 drainage  allergy  atresia  other  family, friends, peers
Current use of hearing technology:  single/multiple talkers
(please describe current arrangement and  structured activities
consistency of use)  unstructured activities
 audio visual technology (TV, DVD, stereo,
2. Developmental Considerations computer)
Age: Home acoustic needs:
 chronological/developmental deficits  signal sources (intensity and spectrum)
Academic performance/school readiness:  noise sources (spectrum and time)
 at or above grade/developmental level  reverberation
 below grade/developmental level  room size and shape
Additional problems:  child position
 attention/hyperactivity  wireless interference
 sensory integration Other locations:
 behavior  learning  recreation
 cognition  vision  church
Chapter 8
 mobility  fine motor  community

 auditory processing  therapy

4. Technology Considerations
 convenience
 wearability
 reliability
 maintenance
 ease of monitoring
 manufacturer/dealer support
 compatibility with existing amplification
 compatibility with computers, phones, and other
devices
 signal interference
 multiple FM frequencies, or use of digital system
5. Device Determination
Receiver:
 Ear level FM/DM Ear receiver location:
 HA + FM/DM Receiver  Monaural __R __L
 Targeted-area audio distribution system  Binaural
 Classroom audio distribution system  Alternating
 Other___________________ Accessories:
Transmitter/microphone:
 Proximity mic
 Boom mic
 Lavalier zoom
 Conference mic
 Directional mic
Recommended Device:
Step 3 Comments:
Chapter 8
STEP 4. Fitting and Verification—See Supplement A. Fitting and Verification

Procedures and Worksheet

310 Chapter 8
Step 5. Implementation and Validation: Orientation, Training, Usage Plan,

and Validation
1. Orientation and Training
Child/youth: Parent/caregiver:
 implications of hearing loss  implications of hearing loss
 function of device  function of device
 appropriate use of device and features  appropriate use of device and features
 expectations—benefits and limitations  expectations—benefits and limitations
 care and maintenance  maintenance
 troubleshooting  listening check and troubleshooting
 self-monitoring  other____
 other_____________________________
2. Usage Plan Specific activities:

 Full-time  group interaction
 Part-time  large group presentation
Specific environments:  one-to-one interaction
 car  organized physical activities
 other___________________________  informal activities
 other_____________________________
_____________________________
3. Validation
Does the HAT device meet the intended goals? What is the evidence for the following:
■■ Audibility and intelligibility of speech that is commensurate with best speech recognition in ideal listening conditions:
Speech Recognition in ideal listening conditions _____% Speech recognition in noise FM/DM _____%
Validation Instruments used:
■■ Full audibility confirmed for self: Yes No for others: Yes No
■■ Performance: Self-assessment
Observation questionnaire:
Evaluation:
4. Monitoring Plan
Remote microphone HAT function: Child/youth performance with remote microphone HAT:
Procedure used to monitor HAT: Meeting personal auditory/listening goals?
 Ling Six-Sounds  Yes  No
 Other Achieves communication access with teachers and school
Person who will monitor: staff?
Location of monitoring:  Yes  No
When and how often will HAT be monitored:___ ____ Achieves communication access with peers?
Procedure to follow when HAT malfunctions:  Yes  No
Step 5 Comments:
Chapter 8
Note. AAA Clinical Practice Guidelines: Remote Microphone Hearing Assistance Technologies for Children and Youth from Birth to 21 Years, Appendix B–2.
Reprinted with permission from the American Academy of Audiology. © 2008.

CHAPTER 9
Case Management
and Habilitation
CONTENTS
Planning Case Management and Habilitation

The Importance of Service Coordination ■ Facilitating Effective Case Management
Implementing Audiological Habilitation
Direct Services ■ Indirect Services
Services for Special Populations
Students With Unilateral Hearing Conditions, Single-Sided Deafness, or Minimal Hearing Loss ■ Students With
Auditory Processing Deficits and Auditory Neuropathy Spectrum Disorder ■ Students With Multiple Learning
Challenges ■ Students Using Cochlear Implants ■ Early Hearing Detection and Intervention
Inclusion
Summary
Chapter 9
“Why I like my hearing aids.”
311

Appendices
9–A Form to Facilitate Collaboration Between Teacher/School Provider and Physician (Text/Online)
9–B Auditory and Tactile Assessment and Curricula (Text)
9–C Listening Development Profile (Text/Online)
9–D Teaching Strategies and Classroom Activities for Selected Listening Difficulties (Text)
9–E Parent Letter on Speechreading (Text/Online)
9–F Speechreading Resources for Children (Text)
9–G Classroom-at-a-Glance: Observation Checklist (Text/Online)
9–H Reduced Hearing and Recorded Speech (Text/Online)
9–I Functional Auditory Performance Indicators (FAPI) (Text/Online)
9–J Language and Communication (Text/Online)
9–K Early Auditory Skill Development for Special Populations (Text/Online)
9–L Auditory Response Data Sheet (Text/Online)
KEY TERMS will not be the same for every deaf or hard of hearing stu-
dent. The availability and qualifications of additional service
Effective communication, direct educational audiology ser- providers, characteristics and needs of individual students,
vices, indirect educational audiology services, collaboration, school schedules, and locations to be served all impact the
educational team members determination of a cost-effective plan for case management
and service delivery. In addition, each of these factors may
vary over time and cause modification of the educational
KEY POINTS audiologist’s role as new resources become available, as stu-
dent needs are met, and as different needs arise. Flexibility is
■■ Case coordination requires flexibility, good listening the key if the educational audiologist is to be most effective
and communication skills, and the desire and ability to in the areas of case management and service delivery for
collaborate effectively with all service providers and students with hearing challenges.
educational team members. This chapter addresses the following questions:
■■ Case management by the educational audiologist
■■ What strategies facilitate case management for deaf and
should begin with a focus on the individual needs of
hard of hearing students?
each deaf or hard of hearing student followed by the de-
■■ What direct services are within the educational audiolo-
velopment of individualized goals, strategies, and staff
gist’s scope of practice?
to facilitate maximum access to communication in the
■■ What indirect services are the responsibility of the edu-
learning environment.
cational audiologist?
■■ As students with hearing and listening difficulties in-
■■ What are the educational audiologist’s roles and respon-
crease in numbers and diversity, consultation and col-
sibilities in habilitation for special populations?
laborative service provision become critical for educa-
■■ Ensuring access to communication for each child with
hearing and listening challenges regardless of educa- PLANNING CASE MANAGEMENT
tional placement remains the primary goal for educa- AND HABILITATION
■■ Educational audiologists can help facilitate improved The Importance of Service Coordination
student outcomes by providing critical information and
The educational audiologist is in a unique position to act as
support to parents and school staff, as well as to deaf
service coordinator for deaf and hard of hearing students.
and hard of hearing students and their caregivers.
Case coordination, by definition, implies communication
Chapter 9
The educational audiologist’s role in case management and collaboration with more than one service or service
and service delivery is affected by a number of factors and provider, often the case with students who are deaf or hard
312

Case Management and Habilitation 313
of hearing. Educational audiologists have knowledge and Facilitating Effective Case Management
training that cover the medical, audiological, educational,
Strategies recommended for initiating and implementing
communication, social-emotional, and vocational impact
case management include the following activities:
of hearing status. This knowledge and experience can fa-
cilitate communication among educational team mem- ■■ clarification of the needs and services for each deaf or
bers—service providers, family members, and the students hard of hearing student;
themselves. Communication breakdowns can occur among ■■ identification of currently available school personnel;
medical professionals and educators when family members ■■ arrangements for effective collaboration among service
are used for transmission of information from one provider providers; and
setting to another. Similar to the old “telephone game,” in- ■■ development and implementation of a written commu-
formation may get lost or modified each time an additional nication system for multiple providers and services.
person attempts to receive, remember, and then transmit
a message, especially when the message contains new or
Clarification of Needs and Services
unfamiliar content. Individuals tend to focus on informa-
tion they already understand, and this is the content that is The educational audiologist begins by identifying a student’s
remembered and transmitted most accurately. Educational needs and the individuals currently addressing these needs.
audiologists can facilitate communication by clarifying Areas to consider are listed in Table 9–1. It is also helpful
medical terminology for educators and family members, as to have this information available in an organized format
well as by providing the educational context for medical for each Individualized Education Program (IEP) meeting
or clinical personnel to incorporate in their evaluations and to facilitate the discussion of options, strategies, and staff
recommendations. to address each area of potential need (see Appendix 2–A
Educational audiologists can facilitate decision-making for an example).
by anticipating future educational challenges and sharing
strategies to help students to achieve access to communi- Identification of Personnel
cation in their learning environments, as well as in the at- Educational audiologists are trained and qualified to provide
tainment of specific educational outcomes. For example, direct habilitation services, but large caseloads, extensive
providing information concerning technological advances geographic territories, and other demands often preclude
to parents and students could change the direction of an
anticipated vocational choice and allow scheduling of
more relevant or necessary coursework. Educational audi-
TABLE 9–1 Areas of Potential Need for Students With
ologists who build flexibility into their schedules may be
Hearing and Listening Challenges
able to take advantage of opportunities to facilitate com-
munication among service providers and team members. ■■ Medical
Although not a typical service, the educational audiologist ■■ Audiological
occasionally may be able to accompany families to medical ■■ Educational
appointments and help describe educational needs in person ■■ Transitions
or to participate in conferences with teachers to help inter- ■■ Communication
pret medical reports that are in a student’s file. In addition, ■■ Access to instruction
the educational audiologist may be able to schedule office ■■ Personal amplification
time for contacts with service providers who are not school
■■ Remote microphone hearing assistance technology
based.
■■ Classroom amplification system
Knowledge of school schedules can lead to more ef-
■■ Visual technology and support
ficient scheduling of medical and clinical appointments and
fewer absences for students. Parents should be encouraged ■■ Special transportation
to ask for appointments after school, on a teacher work- ■■ Interpreting
day, or during a vacation break in order that missed school ■■ Notetaking
time is kept to a minimum. In addition, many physician of- ■■ Speech-to-text transcription
fices and clinics are happy to see siblings on the same day ■■ Tutoring
when prearranged. If the school is responsible for provid- ■■ Counseling and self-advocacy
ing transportation, a single appointment date for siblings ■■ Vocation and career planning
or classmates is more cost effective than making multiple ■■ After-school activities
trips. These logistical issues make the educational audiolo- ■■ Legal rights
gist the logical contact person among the educational and
Chapter 9
■■ Peers
medical personnel involved with deaf or hard of hearing
■■ Adult role models
students.

314 Chapter 9
availability to provide services on more than an indirect members for input. The educational audiologist should
or consultative basis. At best, most educational audiology credit those who provide input by including their names
schedules do not permit direct student service more fre- on any form adopted for use. This practice helps formalize
quently than once a week. If other service providers (e.g., a commitment to use this written communication system.
certified teachers of deaf and hard of hearing [TODHH] stu- Make time at team meetings for modification of either the
dents, speech-language pathologists [SLPs], counselors, in- oral or written communication system, especially if the pro-
terpreters, language facilitators, or other specialized instruc- cess does not appear to be facilitating effective interchanges
tional support personnel) could address some of the direct among team members (i.e., staff, support personnel, and
service needs of a student with reduced hearing on a daily caregivers). Be flexible when attempting to meet the needs
or collaborative basis, the case manager can facilitate the of service providers, as well as students. See Appendi
coordination of student needs with service provider exper- ces 9–A and 15–I for sample forms for communication
tise and availability. Viewing a list of all potential staff and among school and non-school providers, and Chapter 15
support personnel and their schedules can sensitize service for additional information on collaborating with community
providers and administrators to the need for service coordi- providers.
nation. Maintaining such a list can also facilitate case man-
agement decisions. The development of positive attitudes
toward collaborative interprofessional planning and service
delivery should lead to more flexibility on the part of indi- IMPLEMENTING AUDIOLOGICAL
vidual service providers when unplanned change is needed. HABILITATION
Arrangements for Effective Interprofessional Collaboration The educational audiologist’s primary purpose for being in-
volved in the habilitation of children and youth with hearing
Team coordination should be initiated during the preplan-
and listening challenges is to facilitate the optimal access to
ning process. However, schedules often change as new stu-
and use of auditory input during the learning process. Audi-
dents enroll and unanticipated needs arise, resulting in an
ologic habilitation includes provision and/or support of tech-
ongoing need for service coordination and collaboration.
nology, involvement with teaching and learning strategies, and
The educational audiologist, as case manager, can facilitate
knowledge of environmental acoustics (both classroom
the development of a system for working efficiently as a
and non-classroom) in any situation where communication
team throughout the school year. Each team member should
and learning take place. Although other educational service
be asked for input, and attempts should be made to incorpo-
providers may address auditory input, audition is the pri-
rate all input received. Service time and schedules are tight,
mary focus of educational audiologists. The educational au-
so alternate ways to participate should be explored and made
diologist may have responsibilities for this role in the form
available for those who cannot attend meetings in person
of direct service, indirect service, or in some combination
(e.g., written reports, audio or video conferencing). Effec-
of these two.
tive team collaboration requires that the service coordina-
tor clarify and disseminate in writing how and when team
members will communicate. Chapter 13 includes additional Direct Services
information and strategies for supporting educational team
When the educational audiologist provides direct services
members.
to deaf and hard of hearing children and youth, services
are usually specified and delivered on a formally scheduled
Efficient Written Communication
basis.
One of the most critical responsibilities for a service coordi- However, the length of time for these services often var-
nator is to facilitate the development of a workable system ies, depending on the content to be covered, the long- and
for simple written communication among team members. short-term objectives, and the availability of other personnel
When forms are devised, draft copies must be given to team to assist with some or all of these services. Table 9–2 identi-
fies direct service areas in which responsibilities typically
are assumed by an educational audiologist.
EFFECTIVE Management of Amplification

COMMUNICATION Most curricula now include a section on developing student
independence in managing their personal hearing instru-
Clear and concise communication is critical for ef- ments and remote microphone hearing assistance technol-
fective collaboration with multiple service providers. ogy (RM HAT) devices (an overview of direct services in-
Chapter 9
volving cochlear implants is provided in a separate section

in this chapter). The educational audiologist may want to

TABLE 9–2 Direct Service Areas for Educational Audiologists and Using Hearing and Hearing Assistance Technology and
■■ Management of personal hearing instruments, remote Personal Learning Planner (https://www.phonak.com/uk
microphone hearing assistance technology (RM HAT), /en/support/children-and-parents/guide-to-access-planning
or both .html) contains planning forms and checklists that can be
■■ Development of auditory and listening skills used to facilitate student independence in this area.
■■ Assistance with speechreading strategies and other visual Taking earmold impressions, electroacoustic analysis
supports and real ear measurement of hearing aid(s) or other assis-
■■ Communication repair coaching tive devices at the student’s school facility, and on-site ad-
justment of amplification parameters can also be considered
■■ Assistance with prevention of environmental barriers to
communication direct services by the educational audiologist, even though
they may be provided on an as-needed basis.
■■ Counseling to support wellness, self-advocacy, and social-
emotional learning Addressing the situations of students who are reluctant
to use either their personal hearing instruments or hearing
assistance technology is another critical, though more dif-
ficult, part of audiology habilitation. There are a variety of
use or modify one of these published programs or develop reasons why students are reluctant to use their devices that
and implement a more individualized program of hearing may need to be sorted through. Often, what students want
aid monitoring and maintenance, such as the one described is to be like their peers. Coaching may be necessary to help
in Chapter 8, Hearing Instruments and Remote Microphone students with self-identity, self-esteem, and self-advocacy
Technology (see also Appendix 8–C). Either approach issues that relate to acceptance and consistent use of tech-
should include the following objectives for each student, nology. Helping them understand that technology can facili-
depending on his or her needs and developmental ability: tate class participation and lead to more relevant communi-
cation with their peers may help them to see that their use of
■■ insertion of earmold(s);
technology can be an asset. It is important that we recognize
■■ basic power and volume control operation;
the desire and motivation to use amplification needs to come
■■ battery care;
from within each student rather than be dictated by someone
■■ identification of when a unit is or is not providing
else (e.g., parent, teacher, audiologist). Chapter 10, Support-
amplification;
ing Wellness and Social-Emotional Competence, addresses
■■ troubleshooting techniques and solutions as appropriate
this area in more detail.
for age and developmental level; and
■■ contact information/strategies for assistance when Development of Auditory and Listening Skills
problems cannot be solved on site.
For deaf and hard of hearing students to develop functional
For younger children, appropriate troubleshooting ac- and automatic use of their auditory potential, attention must
tivities might include checking and changing batteries, ear- be focused on auditory development throughout each day,
mold cleaning and maintenance, and acting out situations in and audition must be integrated into the child’s communica-
which a responsible adult is advised of a possible problem. tion environment by all participants. In addition, direct skill
The educational audiologist may want to arrange for older training on a regular basis should be considered for students
students to contact their hearing aid dispenser from school who are performing below expectations. Whether provided
using e-mail, text messaging, or phone (voice or video app) by the educational audiologist, SLP, TODHH, specialized
to describe the problem and determine possible solutions. instructional support personnel (SISP), or any combination
The more independent a student can become with his or of these providers, focus on use of auditory skills should
her own amplification (including digital modulation [DM]/ be included in any specific spoken language programming.
frequency modulation [FM] or other hearing assistance tech- The educational audiologist may work in collaboration with
nology), the more likely the equipment will be monitored other designated personnel (e.g. general education class-
and, as a result, be working appropriately on a regular basis. room teacher) to enhance auditory emphasis when time for
Chapter 8, Hearing Instruments and Remote Microphone direct services is limited. An example is for the educational
Technology, includes a more detailed discussion of daily audiologist to team teach a lesson with the teacher or the
monitoring of amplification. Use of the Ling Six-Sound SLP to model the inclusion of auditory skill development
Test (Appendix 8–I) is strongly recommended as a quick and auditory learning opportunities within the classroom or
daily amplification check for younger students, although the therapy environment. In this case, the direct service role of
educational audiologist may need to develop a more creative the educational audiologist should be to focus on the areas
approach for students who have been using this quick check identified in Table 9–3.
for many years (e.g., written responses, student uses screen A number of very good auditory curricula are available
Chapter 9
to “test” adult and judges adult response, etc.). Another that list auditory skills in developmental sequence along
helpful resource, MyGAP Self-Assessment: Understanding with suggested activities for each skill level. See Chapter 6,

316 Chapter 9
TABLE 9–3 Areas of Focus for Auditory and Listening Skill TABLE 9–4 Strategies to Facilitate Speechreading
Development
■■ Watch the speaker’s face as well as his or her mouth
■■ Development of goals and objectives movements.
■■ Introduction and modeling of activities to develop specific ■■ Notice gestures, posture, and body language.
skills (e.g., environmental sound awareness; following two- ■■ Try to position yourself so that light comes from behind you
step directions from auditory cues alone) and on the speaker.
■■ Monitoring and measurement of the use of specific skills in ■■ Provide information to the speaker about what helps you to
structured and unstructured settings understand spoken language.
■■ Development of techniques and strategies to target ■■ Know the topic of conversation.
objectives on a daily basis in the educational environment ■■ Pay attention to context clues.
■■ Try not to interrupt speakers in the middle of thoughts or
sentences, because this may provide you with additional cues.
p. 195, for several important principles of auditory training ■■ Recognize that speechreading may be more difficult at the
(Musiek et al., 2007). Ordering information for currently end of the school day, after long periods of concentration, or
available curricula is included in Appendix 9–B. Although at other times when you are fatigued.
the educational audiologist may suggest or initiate use of
one or more of these curricula, copies should be made avail-
able to all other personnel working with the student, as well
2. If a student does not make good eye contact during one-
as family members when requested (see section on Indirect
to-one conversation, work on visual communication in-
Services). Appropriate goals and objectives also should be
formation could be beneficial.
included on the IEP, Individual Family Service Plan (IFSP),
3. If a student is not aware of ways to enhance visual
or Section 504 plan. Examples of audiology goals and ob-
cues during more difficult communication situations
jectives for IEPs are included in Chapter 11, Developing
(e.g., when competing noise or poor lighting is pres-
Individual Plans. The Listening Development Profile (Ap-
ent), instruction for these skills together with self-
pendix 9–C), a checklist that includes student outcomes and
advocacy strategies could help to enhance communica-
performance indicators of progress in functional listening,
tion understanding.
can be helpful in developing auditory goals and objectives
for specific students, and suggested strategies for incorporat-
Some of the objectives for these situations might fall
ing listening goals in the classroom are in Appendix 9–D.
under the area of communication repair training or envi-
ronmental management strategies (see later sections in this
Speechreading
chapter for discussions of these topics). In addition, it is
Although there is no question of the importance of visual critical that specific skill training is reinforced in all other
cues to supplement audition for deaf and hard of hearing communication settings and activities. A coordinated effort
children and youth, agreement is not unanimous concerning of all team members, including parents and caregivers, is
the acquisition of visual skills in specific individuals. The necessary to determine appropriate daily opportunities for
emphasis placed on the use of visual training in programs learning. A sample letter to parents describing speechread-
using listening and spoken language (LSL) varies according is included as Appendix 9–E, and published speechread-
ing to the program philosophy and implementation. In some ing materials for children are listed in Appendix 9–F.
programs, the curriculum includes speechreading activities;
in others, it is assumed that the supplemental use of these
visual skills will be acquired naturally. Students who are Communication Repair Training
already using strategies such as those included in Table 9–4 At times, deaf and hard of hearing students may not be aware
in their learning and communication environments may not of communication breakdowns that occur during the school
need additional structured practice in speechreading. day and/or may be unaware of or uncomfortable with using
The most common current practice is to integrate various repair strategies. Anderson (2012), Unser (2017),
speechreading activities with language or combined audi- and Tye-Murray (2018) have addressed communication
tory and visual activities rather than to work on speechread- breakdown and repair in publications, and each publication
ing in isolation. Three situations during which speechread- gives specific suggestions on strategies for children. Elfen-
ing instruction might enhance learning are as follows: bein (1993) also developed a program for use with students
in a school environment that included the following five
1. If a student is involved in a phonetically based read-
steps that continue to be relevant today:
ing program, the educational audiologist may want to
encourage an emphasis on the visual aspects of specific 1. Understanding basic communication processes.
Chapter 9
speech sounds as an aid to decoding writing material 2. Understanding communication breakdowns.

(e.g., Visual Phonics, http://seethesound.org). 3. Message formulation.

4. Introduction of communication repair strategies. Indirect Services

5. Practice using communication repair strategies.
Indirect services, typically identified as consultation, may
These steps help students to acknowledge that com- be scheduled regularly by the educational audiologist, deliv-
munication breakdowns do occur and assists them in devel- ered on an as-needed basis, or provided as a combination of
oping appropriate ways to cope independently with these the two. The combined option is usually preferred because
breakdowns. regularly scheduled visits may not address problems rapidly
enough when they are developing. Also, consultation on an
as-needed basis frequently is perceived as “not being there
Management of Environmental Barriers
very often or at all” by parents and school personnel. As a
to Communication result, documentation for accountability related to consulta-
Educational audiologists have specific expertise for teach- tion services provided is crucial.
ing students about communication barriers that may arise Administrators may question the amount of time allot-
in a variety of environments. Information concerning the ted for indirect services by the educational audiologist, espe-
effects of noise, distance, reverberation, and poor lighting cially when funding is tied to reimbursement for direct ser-
should be provided to deaf or hard of hearing students as vices for students who are deaf or hard of hearing and who
well as to teachers. The sections covering teacher consulta- have services delineated in their IEPs. Figure 9–1 describes
tion and student activities in this chapter, as well as in Chap- factors that should be considered when building consultation
ter 7, Classroom Acoustics and Other Learning Environ- time into the educational audiology program.
ment Considerations, Chapter 10, Supporting Wellness and The following six areas of consultation and collabora-
Social-Emotional Competence, and Chapter 13, Supporting tion are those in which the educational audiologist has spe-
the Educational Team, provide more detailed information cific expertise:
regarding suggestions for environmental modifications.
■■ classroom audio distribution systems (CADS) and
other remote microphone hearing assistance technology
Fatigue
(RM HAT);
It bears repeating that students and teachers should be made ■■ teacher collaboration regarding classroom accommoda-
aware of the significance of fatigue that typically results tions and modifications;
from straining to listen in noise and attend visually to speak- ■■ selection of classrooms and teachers (barriers and ben-
ers or interpreters for extended periods of time. All students eficial characteristics);
experience fatigue at times, but for students who are deaf ■■ selection of auditory curricula and materials;
or hard of hearing, listening can be an exhausting task. And ■■ facilitation of auditory skill development with or with-
because children with compromised hearing need to allocate out visual support; and
more of their mental focus and attention to listening tasks, ■■ information concerning student hearing challenges and
fewer resources are available for higher-level thinking pro- auditory function.
cesses (Bess, Gustafson, & Hornsby, 2014; Madell & Flexer,
2018; McCreery, 2015). Both students and staff can benefit Classroom Audio Distribution Systems
from activities to help them develop and implement strate- and Other Assistive Technology
gies to manage specific environmental barriers encountered
The educational audiologist is the staff member in the school
in learning and communication environments.
environment who has the expertise to recommend the pur-
chase and facilitate the use of current technology available
Counseling for students with hearing and listening challenges in edu-
Counseling provides critical support to students for devel- cational settings. Although clinical audiologists may have
oping identity and self-confidence including learning how knowledge of the technology available, they cannot “match”
their hearing status affects them as individuals. These are these devices to specific classroom environments without
important components for developing positive attitudes and being on-site. This selection should be based not only on
self-determination for deaf and hard of hearing children and physical characteristics of the classroom (see Chapter 7,
youth. Educational audiologists have knowledge, resources, Classroom Acoustics and Other Learning Environment Con-
and expertise to provide these services. When other person- siderations, and Chapter 8, Hearing Instruments and Remote
nel are involved in counseling, educational audiologists Microphone Technology) but also on personal characteris-
should partner with them to ensure appropriate communica- tics of the student(s) and teacher(s) involved.
tion access and understanding of the potential deaf and hard Educational audiologists need knowledge of the edu-
of hearing perspectives. Detailed information on the educa- cational budget and timelines for technology requests. Fre-
tional audiologist’s role and responsibilities for counseling quently, manufacturers provide short-term loan of equip-
Chapter 9
deaf and hard of hearing students is included in Chapter 10, ment if payment must be delayed for budgetary reasons.
Supporting Wellness and Social-Emotional Competence. Lease-purchase agreements are another option available

318 Chapter 9
W H Y C ONSULTATION/COLLABORATION?
• Most students with varying hearing levels receive the majority of their education in the
general education classroom.
• Services go directly to the student rather than the student going to the program.
• Expanded at-risk preschool placements within community daycare and preschools create
more need for on-site supports.
• Many students with neurological or developmental disorders also have reduced hearing
levels that require specialized support and accommodations.
SKILLS NECESSARY TO PROVIDE ROLE OF EDUCATIONAL

CONSULTATION SERVICES AUDIOLOGIST AS A CONSULTANT
• Effective interpersonal communication 1. Advocacy for auditory access for all

skills students and particularly those with
• Accurate, current knowledge of all reduced hearing or auditory processing.
areas of hearing and hearing 2. Target efforts to those responsible for
differences including their implications educating students.
for communication and learning 3. Provide support (information, planning,
• Ability to troubleshoot personal and training) to staff, students, and parents
assistive amplification equipment in a collaborative manner, including:
• An understanding of the classroom • hearing processes
teacher’s teaching perspective • auditory learning
• Comfort working with a variety of • speech-language development
cultural backgrounds • cognition
• Ability to relate to a variety of ages and • social-emotional competence
situations • personal hearing instruments
• Ability to listen and understand the • assistive listening & other
student’s perspective technologies
• Permission to say “I don’t know. Let’s • classroom acoustics
find out” • classroom environment
• Ability to work with administrators for adaptations
support and program development • communication accommodations
• Ability to share tasks with the school • instructional modifications
team that are not solely under the • motivational strategies
audiology scope of practice • organizational strategies
• curricular modifications
4. Facilitate continued placement in most
appropriate setting:
• teacher collaboration
• classroom and teacher selection
OUTCOMES OF EDUCATIONAL AUDIOLOGY CONSULTING SERVICES
• School-based consultation results in individualized authentic support to teachers and

students.
• Teachers and other school personnel have increased capacity for meeting students’ needs.
• Students have increased access to the curriculum and other school activities.
Chapter 9
FIGURE 9–1 Factors to consider in the delivery of educational audiology.

when school systems prefer to spread payments over an ex- TABLE 9–5 Visual Technology for the Classroom Environment
tended period of time. A good relationship between educa- ■■ Signaling and alerting devices
tional audiologists and manufacturers’ representatives can
■■ Telecommunication devices for the deaf (TDDs)
lead to trials of new technology before release to the general
■■ Captioned TV monitors
public. Participation in research is also an avenue for ob-
■■ Captioned films, videos, and DVDs
taining equipment with grant funds and assisting with docu-
menting outcomes to help justify future technology requests. ■■ LCD information displays that inform students of daily
schedule of events
Remote Microphone Hearing Assistance Technology ■■ Speech-to-text notetaking (e.g., communication access
real-time translation [CART], C-Print [https://www.ntid.rit
Protocols for determining eligibility and selection of hear- .edu/CPrint], TypeWell [http://www.typewell.com], Auditory
ing assistance technology (RM HAT) are described in detail Sciences [http://www.auditorysciences.com/about/])
in Chapter 8 as well as in the American Academy of Au- ■■ Captioning/speech-to-text apps (http://www.ava.me, https://
diology’s Clinical Practice Guidelines: Remote microphone webcaptioner.com/, https://otter.ai/)
hearing assistance technologies for children and youth from ■■ Electronic mail and bulletin boards
birth to 21 years (2008). Even if not directly responsible for
■■ Computers with software appropriate for students with
the selection and fitting of RM HAT, the educational audi- hearing loss (e.g. streaming for laptop devices)
ologist needs to be available when personal DM/FM systems
■■ Smart Boards
and CADS are initially introduced to facilitate compatibil-
ity as well as to assist with ongoing maintenance and use.
Frequently, the initial orientation is not sufficient, and daily
use can lead to problems that were not anticipated. Although
an orientation should be provided at the beginning of each
school year, onsite follow-up with the student and primary
teacher should be scheduled within the first two weeks when Nuggets from the Field
user or equipment is new. After RM HAT has been used suc-
cessfully, the teachers may feel more comfortable helping Speech-to-text via machine learning is available,
one another with issues that arise later. but it’s yet to be decided in terms of efficacy and
The educational audiologist serves as an invaluable link accuracy from a research standpoint. The gold
between the classroom teacher and the manufacturer of any standard is still going to be a live captioner.
classroom equipment used in support of deaf and hard of
hearing students. Regular monitoring and maintenance of
classroom equipment, together with the development and
modification of quick and simple ways to verify that this is
Although educational audiologists may not be the des-
done, is discussed in Chapter 8, Hearing Instruments and
ignated managers for visual assistive devices, they can often
Remote Microphone Technology.
provide valuable input concerning sources for funding and
purchase. An overview of systems can be found at https://
Visual Assistive Technology
dcmp.org/, a site funded by the U.S. Department of Educa-
Technologies that can enhance the visual environment for tion, for information on and access to captioning resources.
deaf or hard of hearing children and youth are identified in Reviews of current speech-to-text systems can also be
Table 9–5. found online and by asking for experiences on the Educa-
tional Audiology Association (EAA) listserv. When technol-
ogies such as Smart Boards and e-readers are incorporated
into the classroom environment, the educational audiologist
will need to be alert for compatibility issues that can arise
Nuggets from the Field for students who use personal RM HAT.
One of Murphy’s laws for audiology is that equip- Teacher Collaboration Regarding
ment that is used will break down. One of our first Strategies for the Classroom
experiences with rechargeable batteries in FM sys- Although phrases such as “preferential seating” appear
tems led to learning that the maintenance person- routinely in audiology reports, there is no substitute for
nel had been instructed to turn off all appliances classroom observation to pinpoint suggestions appropriate
when they left the building overnight, resulting in for each teacher, classroom, and student to support more de
Chapter 9
uncharged units the next morning. scriptive actions such as strategic seating, flexible seating,
or priority seating. Questions to ask include the following:

320 Chapter 9
■■ Where is the best location for the student’s desk?

■■ Is this seating the best location for all types of teaching
activities? Legislation supporting use of accommodations and
■■ When there is lighting glare from one direction and modifications:
competing noise from another, how do you reconcile ■■ Every Student Succeeds Act (ESSA)
the two for the best advantage to the student? ■■ Section 504 of the Rehabilitation Act
■■ How well is the student following teacher instruction ■■ The Americans with Disabilities Act (ADA 2008)
and classroom discussion? ■■ Individuals with Disabilities Education Act
■■ Does the teacher alert the student with hearing chal- (IDEA) of 2004
lenges to changes in topic and supplement group in-
struction with individual checks to assess the student’s
comprehension of assignments and material covered?
■■ Would a student “buddy” be helpful?
■■ Would an oral or sign language interpreter be helpful, listed in the accompanying box. Examples of typical ac-
and for which classes? commodations and modifications that might be considered
■■ If an interpreter is used, is the student totally dependent for a student were compiled by the Families and Advocates
on this support for one-to-one instruction, or does the Partnership for Education (2001) and can be downloaded
student make an attempt to follow what is happening in from https://www.wrightslaw.com/info/fape.accoms.mods
the classroom? .pdf. In addition, most state departments of education now
■■ Is the interpreter’s location in the classroom appropriate maintain lists of accommodations for students with various
for maximum communication access for the student? learning challenges who receive instruction and assessments
■■ Should a language facilitator be considered to support in general education settings.
and enhance or enrich communication among the stu- If a deaf or hard of hearing student is included in gen-
dent, his peers, teachers, and other school personnel? eral education programs without assistance, observation
■■ Would a peer notetaker or use of captioning (e.g., by the educational audiologist can lead to valuable input
CART, C-Print, TypeWell) be helpful? (If so, the edu- that could help alleviate academic problems before failure
cational audiologist may be able to help in the selection occurs. In these cases, observations should be scheduled
and instruction of an appropriate student or system.) throughout the day to assess performance in a variety of
Teachers and program philosophies vary in their ap- instructional settings. Classroom observations are required
proach to support services in general education classrooms. more frequently during the beginning of a school year but
The current trend for full inclusion in general education has should be scheduled no less than once a month throughout
been perceived by many to imply that students should ad- the year. A classroom observation checklist, such as that
just to the classroom without special supports or instruction included in Appendix 9–G, can make these observations
(see Table 14–1 for placement trends for DHH students). In more efficient by pinpointing problem areas, documenting
reality, however, there may be many times classroom com- progress, and clarifying the need for additional classroom
munication is missed or misunderstood by deaf and hard of modifications. It can also be useful for teachers to complete
hearing students because visual supports, such as interpret- the same checklist and compare observations with those of
ers or notetakers, were not requested or available. As noted the educational audiologist.
in Chapter 1, Legislative and Policy Essentials, accommo-
dations and modifications to access the general educational Selection of Classrooms and Teachers
curriculum are supported by current educational legislation There is no substitute for on-site observation to match teach-
ers and classroom environments with the needs of each deaf
or hard of hearing student. Examples of questions to be an-
swered during the observation include:
The National Deaf Center on Postsecondary Out- ■■ What type of informal sound treatment is present? Are
comes has an online discussion page on speech- there multiple uncovered windows, or will reverbera-
to-text services (https://www.nationaldeafcenter tion be lessened because of walls covered with bulletin
.org/topic/speech-to-text). that is an information boards?
resource on all current speech-to-text systems for ■■ How many students are there in each classroom, and
consumers, service providers, and administrators are there any others who may require instructional
and can provide helpful information when consid- modifications?
ering this option. ■■ Is there a class available where the teacher might be
Chapter 9
able to give more one-to-one instruction or one that is

farther from the cafeteria or band room?

■■ What is the teacher’s traditional teaching style? Does he ress using step-by-step goals and objectives for daily situa-
stand in the front and lecture most of the day, or does tions. Whenever possible, suggestions should be given for
she move around a great deal? A moving instructor may ways that objectives can be phased into the general or spe-
be more difficult for the student who is deaf or hard of cial education curricula being used with individual students.
hearing, but this type of teaching style may lead to more Examples include vocabulary lists for listening activities,
individual instruction. taping sounds around the school facility for recognition of
■■ Does the teacher routinely use supplementary visual environmental sounds, and use of classroom directions for
aids, such as pictures, instructions on a Smart Board, auditory sequencing and comprehension.
written outlines, and assignments?
■■ Is the teacher flexible enough to use equipment that will
probably break at the most inopportune time, and does Implementation of Auditory Skill Development
he or she have a sense of humor? Together With Sign Language Use
■■ Does the teacher express herself with whole-body cues, Auditory skill development can be fostered within pro-
and does the teacher frequently give “mixed messages” grams that use a total communication approach, that is, an
by these cues? approach that encourages use of whatever sensory input is
■■ Is the teacher willing to take a risk, and does he rein- necessary for the specific activity at hand. If American Sign
force and help students who take the initiative? Language (ASL) is used, rather than a Manually Coded En
■■ Did these teachers volunteer to have students with spe- glish (MCE) system, there is an inherent language mismatch
cial needs in their classrooms? when attempting simultaneous communication (also known
as Sim-Com), where sign language and spoken language are
There are no absolute rules to follow in teacher selec-
used at the same time. As a result, students in most educa-
tion for deaf and hard of hearing students, but a teacher who
tional programs that use ASL may only use visual input dur-
has natural instincts to repeat and paraphrase material that is
ing the majority of communication situations throughout the
not easily understood and who routinely uses visual aids in
school day. Under these conditions, auditory skill develop-
teaching typically will be more effective in communicating
ment and progress may be slower, less automatic, minimally
with students with hearing and listening challenges. Teacher
reinforced, and less successful, bringing up communication
characteristics are included in Appendix 9–G, the classroom
issues that should be discussed thoroughly by parents, teach-
observation form described earlier, and placement check-
ers, and the students to see if auditory learning is a desired
lists that can be used by parents as well as professionals are
goal. Appendix 9–J includes an overview of communication
located in Appendix 11–D. Teachers who are sensitive and
options most commonly used to communicate with and edu-
focus on developing self-esteem in all of their students will
cate deaf and hard of hearing children, and the emphasis on
also make students who are deaf or hard of hearing feel more
audition is addressed within this overview for each option.
comfortable in acknowledging when they have missed or
Figure 9–2 contains a more graphic concept of receptive
misunderstood communication in the classroom.
and expressive communication on a continuum of communi-
cation modalities. Receptively, a child may rely exclusively
Facilitating Selection and Use of on visual or auditory information or use a combination to
Auditory Curricula and Materials assist with comprehension. Expressively, a child may rely
The advent of cochlear implant use in children has led to solely on sign language or spoken language (oral in this il-
the development of several auditory curricula that are ap- lustration) or use a combination of communication strate-
propriate for use with any deaf or hard of hearing child. As gies. Considerations that may affect the visual and auditory
mentioned previously, examples of currently available audi- strategies used by deaf and hard of hearing students can vary
tory programs and checklists are listed in Appendix 9–B. depending on communication and learning environments, as
It is recommended that this list be updated annually for cur- well as communication partners and preferred communica-
rent costs and distributors, as well as availability of newly tion mode.
published materials. Individual and classroom activities If the decision is made to initiate or continue with the
are incorporated with each curriculum guide, and most are development of auditory skills, a discussion should follow
available for 30-day loan before purchase. If school person- with clear recommendations for ways that audition can be
nel have access to a regional resource library, requests can integrated into the student’s communication system, both
be made to order specific curricula for review before indi- within and outside the formal classroom environment. The
vidual school or district purchase. Placement and Readiness Checklists for Students Who Are
Educational audiologists can make suggestions for spe- Deaf and Hard of Hearing (PARC; Appendix 11–D) con-
cific curriculum guides based on their experience with listen- tains a checklist for oral and manual instruction. In addition
ing and spoken language goals and objectives. The Functional to the traditional IEP forms, a written statement of commit-
Chapter 9
Auditory Performance Indicators (FAPI) (Appendix 9–I) ment to an auditory learning program may help to clarify
provides one way to measure current performance and prog- each participant’s desire to be involved in this program.

322 Chapter 9
ics of each student’s hearing parameters (level, type, config-

uration) and the impact on his or her ability to communicate
within the classroom setting. Results from audiology assess-
ments as well as protocols such as the Classroom Participa-
tion Questionnaire (Appendix 5–I) should be communicated
to all educational personnel who come in contact with the
student during the school day and should be made relevant
to each staff member’s role with the student involved. For
example, a school wide inservice might be held before the
enrollment of a deaf or hard of hearing child to outline basic
information on hearing conditions, personal hearing instru-
ments, RM HAT, and relevant communication performance
in academic and social situations. Questions addressed dur-
ing this inservice might include the following:
■■ Will the students be able to order for themselves in the
cafeteria, or will they have a full-time sign language
interpreter?
■■ Will the student be using specialized equipment on the
playground that will require explanations for other stu-
dents in the school?
■■ Should the student be wearing personal hearing instru-
ments or RM HAT on the bus, and, if so, who will be
responsible for managing them?
For additional discussion of topics such as those described
previously, see Chapter 13, Supporting the Educational Team.
When sharing information concerning specific stu-
FIGURE 9–2 Receptive and expressive communication continuums. dents, it is important to discuss the information with both
Adapted from McConkey Robbins, 2001 (receptive) and Nussbaum, the student and his or her parents before this is done. This
Waddy-Smith, and Koch, 2006 (expressive). serves to empower students by allowing them opportunities
to select the types of information they want to share with
others. Student participation should also be encouraged in
If a program uses a total communication approach, au- ways that are appropriate for their age and developmental
ditory input without supplementary visual cues (speechread- skill level. Parents may have specific ideas concerning areas
ing or sign language) should be incorporated into informal they would like to have covered and may want to attend or
communication, as well as formal instruction, throughout the participate in discussions concerning the specifics of their
school day if maximum progress is to be expected. The edu- child’s hearing. The educational audiologist is responsible
cational audiologist can assist with facilitating this approach for providing this information for the IEP, but specific com-
by sitting in on an activity suggested by the classroom teacher munication situations within the classroom or other parts of
and using coaching techniques on ways to incorporate each the school environment may require additional collabora-
student’s auditory goals (see suggested resources by Chute & tion between the teacher and audiologist. For example, a
Nevins, 2006; Cole & Flexer, 2019; Erber, 2011; Tye-Murray, child with more hearing when tested in a sound booth may
2018; and Chapter 13, Supporting the Educational Team). Ed- demonstrate no difficulty communicating with peers on the
ucational audiologists should be sensitive to potential goals playground but could have major problems hearing and fol-
for visual language input from other children in the class and lowing teacher instructions in a noisy computer lab. Materi-
collaborate with the classroom teacher in devising creative als from the Mainstream Center at Clarke Schools for Hear-
strategies for facilitating the use of audition for each student. ing and Speech (see Appendix 13–B) can be adapted easily
Without multiple opportunities for meaningful practice, use of for individual student-teacher collaboration, as well as for
the auditory channel for learning will be secondary for most a general inservice. A brightly colored 5 × 8 index card for
children or youth with significantly compromised hearing. placement on the teacher’s desk can be a helpful reminder
of the primary recommendations for a student with educa-
Information Concerning Student Hearing tionally significant hearing levels (see Appendix 13–C in
Status and Auditory Function Chapter 13, Supporting the Educational Team, for a sample
Chapter 9
A final area where educational audiologists have a primary card). The educational audiologist’s name and contact infor-
role is in the provision of information concerning the specif- mation should be included on the back of this card for easy

reference, and the student involved should sign the card to or not they have also been fit with a personal hearing in-
indicate awareness of suggestions that have been given to strument, Baha system, or use a cochlear implant (Abou-
the teacher. For ease of classroom use, we suggest highlight- ras, 2018; Gifford, 2017; Smith & Wolfe, 2018b). (See also
ing only the three or four most important considerations for Chapter 8 for more information on RM HAT for students
the specific student’s access to classroom communication. with mild or unilateral hearing conditions.)
If a student is not eligible for services under IDEA,
needed accommodations should be documented on a Section
SERVICES FOR SPECIAL 504 plan, and funding for equipment may need to be from
general education funds or an alternate source (see Chap-
POPULATIONS ter 8, Hearing Instruments and Remote Microphone Tech-
nology, and Chapter 15, Collaborative School-Community
The educational audiologist typically serves as an indirect
Partnerships, for nontraditional funding sources). The edu-
service provider or consultant for children or youth not
cational audiologist can be a resource for identifying and
placed in a program for deaf or hard of hearing students
pursuing funding options and should be involved in the se-
and for students whose hearing status is not considered to
lection and operation of any RM HAT that is recommended
be the primary learning challenge. This population might
as an educational accommodation.
include children and youth with unilateral, minimal, or high-
Strategies to reduce noise levels in the classroom should
frequency conditions; students with fluctuating hearing lev-
be a primary focus of educational audiologists for children
els; students with auditory processing difficulties; students
with unilateral, mild, or fluctuating hearing levels. Class-
with auditory neuropathy spectrum disorder (ANSD); and
room accommodations and modifications for all children
children or youth who have multiple learning challenges.
with listening difficulties regardless of the etiology are listed
The educational audiologist’s role with special populations
in the IEP checklist located in Appendix 11–A, and these
may include any or all of the indirect services listed pre-
modifications are summarized again in Table 9–6.
viously but typically targets four primary areas: amplifica-
Under No Child Left Behind (NCLB) (2004) and ESSA
tion and other technology recommendations, strategies for
(2015), states are required to maintain options for accom-
classroom management, development of auditory goals and
modations for standardized test procedures, and a list is
objectives, and monitoring student progress and outcomes
typically available from each state’s department of educa-
in auditory function.
tion. As mentioned previously, use of a classroom observa-
tion checklist, such as those included in Appendix 9–G and
Students With Unilateral Hearing Appendix 11–A, can also be helpful in determining which
Conditions, Single-Sided Deafness, accommodations are currently in use and which additional
ones may need to be considered. Many schools are now
or Minimal Hearing Loss
using computer-based curricula and assessments incorpo-
It has been well documented that students with unilateral rating recorded speech that can be difficult for deaf and hard
hearing losses of any level, single-sided deafness (SSD), of hearing students to understand and process. A handout
minimal or high-frequency losses, and fluctuating threshold providing information and suggestions for accommodating
levels related to otitis media can be at risk for academic these challenges is included in Appendix 9–H.
difficulties (EAA, 2017; Lieu et al., 2012; Lieu, 2013; Mc- Although students with unilateral, mild, or fluctuating
Creery et al., 2019; Smith & Wolfe, 2018a; 2018b; Tom- hearing status and no co-occurring conditions often do not
blin et al., 2015). Noise can be particularly detrimental to have IEPs with identified goals and objectives, these stu-
auditory learning for these students, and general education dents may be at increased risk for significant changes in
classrooms may be inaccessible to them on a daily basis hearing (Bess & Tharpe, 2006; EAA, 2017; Grandpierre,
(Bess et al., 2014; Hornsby et al., 2014; Hornsby, 2017).
These students may benefit from personal DM/FM systems
or CADSs, especially for large group instruction whether TABLE 9–6 Categories of School Accommodations and
Modifications for Children With Listening Difficulties
■■ Amplification
■■ Assistive technology devices
Even mildly elevated hearing thresholds can impact ■■ Communication
language, speech, social-emotional and academic ■■ Instruction
development. ■■ Physical environment
■■ Curricula
Source: Year 2019 JCIH Position Statement
Chapter 9
■■ Evaluation
■■ Other needs/considerations

324 Chapter 9
Fitzpatrick, Na, & Mendonca, 2018; Sabo, 2006; Tharpe, Students With Multiple
2006). The long-term educational impact of early otitis
Learning Challenges
media continues to be debated (Gravel et al., 2006; Ventry,
2006; Williams & Jacobs, 2009), but intermittent and incon- It is especially critical for the educational audiologist to be
sistent hearing levels may have significant short-term effects involved in the selection and evaluation of personal hearing
on a student’s ability to access classroom instruction. The instruments and RM HAT for students who have co-occurring
educational audiologist plays a critical role in the ongoing conditions, because these children may perform inconsis-
monitoring of hearing threshold levels for these students, as tently and not give their best responses during a single clinical
well as monitoring their listening performance in the educa- assessment. For this population, the educational audiologist
tional environment. The earlier a change in hearing is identi- will have opportunities to make classroom observations that
fied and addressed, the less likely such a change will impact are important to the equipment selection process and to com-
academic progress and long-term outcomes. plete a more comprehensive and functional evaluation.
Information on normal auditory development can be
helpful to teachers of children with multiple learning chal-
lenges, along with suggestions for activities in this area. Ap-
Students With Auditory Processing pendix 9–K is a handout for teachers covering developmental
Deficits and Auditory Neuropathy auditory skills with classroom strategies for each developmen-
Spectrum Disorder tal stage. In addition, educational audiologists can assist in
Habilitation of students with auditory processing deficits the development of IEPs for children who have co-occurring
(APDs) is discussed in detail in Chapter 6, although many learning issues by helping to clarify auditory goals and objec-
of the strategies noted in this chapter for students with other tives and related support services and technology for these
types of hearing conditions may also be appropriate for use students. Sample questions that will help structure the devel-
with students who have an APD. It is important to repeat that opment of appropriate goals and objectives are as follows:
best practices for the diagnosis and management of students ■■ If a student who has limited cognitive ability also has
with APD require a multidisciplinary approach with the reduced hearing, what should his or her teacher expect
educational audiologist as the primary member of the edu- in the area of auditory performance?
cational team (see Chapter 6, Auditory Processing Deficits). ■■ If a student has major motor involvement, is it realistic
Increasing numbers of children are being diagnosed to expect that student to insert his or her own earmold,
with auditory neuropathy/dyssynchrony (also known as or is there another strategy that will help to achieve in-
auditory neuropathy spectrum disorder or ANSD), and the dependence in hearing aid use?
educational audiologist is an important member of the edu- ■■ If the child with multiple learning challenges has severe
cational team responsible for planning and implementing to profound hearing levels, should an alternate or aug-
appropriate educational services for students with this di- mentative communication device be used instead of or
agnosis. A description of ANSD and its diagnosis can be as a supplement to speech or sign language?
found in Chapter 5, Assessment, and, as noted previously, ■■ Can this student respond appropriately to an emergency
this disorder can occur with or without peripheral hearing situation (e.g., a tornado drill) if a visual alerting signal
loss and can be present in one or both ears. The impact of is incorporated into the classroom?
ANSD on communication and learning can be quite varied ■■ What technology is available that might assist in devel-
(Hood, 2009), although one common difficulty appears to oping independent living and communication skills for
involve understanding spoken language in the presence of this student?
background noise (Hood, 2002). Typically, children with
ANSD benefit from a visual system for language learning The development of appropriate goals and objectives
(e.g., sign language). Auditory learning often is more diffi- for these students must take into account overall develop-
cult, although some children with ANSD have demonstrated mental level in nonauditory areas, as well as hearing levels
good outcomes with use of cochlear implants (Breneman, and auditory performance (see Chapter 11, Developing In-
Gifford, & Dejong, 2012; Guidelines Development Confer- dividual Plans, for more detailed information on this topic).
ence on ANSD, 2008; Harrison, Gordon, Papsin, Negandhi, & If a student has an identified etiology that includes the possi-
James, 2015). bility of progressive or fluctuating hearing thresholds, these
Again, educational audiologists can facilitate access factors should also be considered when developing func-
to communication in the classroom through selection and tional auditory goals and objectives.
monitoring of RM HAT, as well as helping to monitor prog- Finally, monitoring auditory performance is a critical
ress in auditory skill development. The sample questions role for the educational audiologist with students who have
included in the following section on students with multiple multiple learning challenges. Frequently, progress for these
Chapter 9
learning challenges may also be useful in developing appro- students cannot be monitored through traditional clinical as-
priate goals and strategies for students with ANSD. sessment techniques. Therefore, the monitoring of auditory

goals, as well as response to and management of personal noted in Chapter 8, Hearing Instruments and Remote Micro-
hearing instruments or RM HAT, becomes an important fac- phone Technology, candidacy has expanded, and an increas-
tor in decisions regarding communication mode, placement ing number of children at much younger ages are receiving
options, and future development of realistic yet challeng- and using cochlear implants. Bilateral implants are common
ing educational goals and objectives. These students should at younger ages, and many children with cochlear implants
receive monthly consultation from the educational audiolo- are beginning their formal education in general education
gist, with carefully written records maintained concerning settings with spoken language and auditory skills at or near
performance. A simple daily checklist should be devised in those of their peers with typical hearing (Nicholas & Geers,
collaboration with the classroom teacher to monitor auditory 2007; Sorkin, & Zwolan, 2004). Research suggests that age
responses and to ensure that amplification is working, if it is of implantation and parental involvement in communica-
used. Performance indicators, especially those included in tion development are the most critical factors in outcomes
the beginning and intermediate states of the Listening De- for children using cochlear implants, regardless of whether
velopment Profile (Appendix 9–C) and the Functional Audi- communication involves spoken or signed language systems
tory Performance Indicators (FÁPI; Appendix 9–I), can be or both (Wolfe, 2017; Kirk, Miyamoto, Ying, Perdew, & Zu-
used as a method of comparing student behavior with and ganelis, 2002). Students using cochlear implants can and do
without amplification and monitoring progress. Auditory re- have a variety of outcomes, however, and each student should
sponses such as those typically noted in behavioral observa- receive consideration of his individual needs for support in
tion audiometry can be incorporated into a chart to assist in the classroom (Yoshinaga-Itano, Baca, & Sedey, 2010).
monitoring students with severe developmental challenges, The educational audiologist’s role in the habilitation of
both with and without amplification (Appendix 9–L). students who use cochlear implants varies widely, and a num-
ber of potential responsibilities are identified in the Educational
Audiology Association Position Statement, Educational audi-
Students Using Cochlear Implants ologists and cochlear implants (see Online Resources). At a
This chapter would not be complete without mentioning the minimum, educational audiologists should be familiar with
impact that use of cochlear implants has had on the edu- typical auditory and spoken language benchmarks expected for
cation of children with severely compromised hearing. As children using cochlear implants, as summarized in Table 9–7.
TABLE 9–7 Auditory and Spoken-Language Benchmarks for Students Using Cochlear Implants*
Time Period Auditory or Spoken-Language Behaviors

1 month after activation ■■ Full-time implant use
■■ Detection of speech and environmental sounds
■■ May become increasingly quiet
3 months after activation ■■ Changes in vocalizations

■■ Discrimination of speech patterns
■■ Beginning speech understanding (familiar words in context)
■■ May continue or increase “listening attitude”
6 months after activation ■■ Spontaneous response to name

■■ Can indicate when cochlear implant not working
■■ Alerts to and may recognize loud, abrupt environmental sounds
■■ Increased recognition of familiar words and phrases (30–50 in closed sets)
■■ Beginning use of words and word approximations to indicate wants and needs
12 months after activation ■■ Increased comprehension of familiar words, phrases, and environmental sounds (75–100 words in
closed sets)
■■ Uses single words and common phrases to express thoughts, wants, and needs
■■ May increase repetition of less familiar words as if “practicing”
■■ Begins to pick up vocabulary and spoken language in less formal or structured settings
After 12 months of full-time ■■ Rapid increase in comprehension and functional use of spoken language (depending on age level)
cochlear implant use ■■ Regularly picks up vocabulary and spoken language in less formal settings
Chapter 9
*Note that the achievement of these benchmarks can be affected by a number of other factors, especially the age of implantation, language competency, and prior
use of amplification. While the sequence of benchmarks should remain essentially the same, the timing of accomplishment may vary.

326 Chapter 9
Although the sequence of these benchmarks should not to follow when routine troubleshooting does not correct any
vary a great deal, the time period for each student’s progress problems that occur. A great resource developed by Tina
can be and often is affected by the following factors: Childress, educational audiologist at the Illinois School for
the Deaf Outreach Program, is an interactive online guide
■■ chronological age at implantation;
(https://www.illinoisdeaf.org/Outreach/CI.html). One page
■■ use of residual hearing before implantation;
contains resources for all three of the manufacturers in a
■■ amount of language (spoken or signed) at time of
side-by-side format. The guide includes troubleshooting
implantation;
guides and educational resources, and the other page con-
■■ presence of co-occurring learning challenges such as
tains pictures of the various processors. A User Guide is
those involving motor or cognitive skills;
provided by clicking on a picture.
■■ motivation to access and use listening and spoken lan-
Collaboration with the implant audiologist for each
guage; and
student who uses a cochlear implant is a critical compo-
■■ expectations and involvement of caregivers and conver-
nent of support services for these students. (See Chapter 15,
sational partners for progress in listening and use of
Collaborative School-Community Partnerships, for more
spoken language.
information on this topic.) Students using cochlear implants
Educational settings that can foster progress in meet- often benefit from use of RM HAT in the classroom, and
ing auditory and spoken language benchmarks for students personal DM/FM technology has now been integrated into
who use cochlear implants (as well as those using traditional several ear-level cochlear implant devices. (See Chapter 8
amplification) should provide the following: for more information on RM HAT use with CIs.) Collabo-
ration between the educational audiologist and the implant
■■ access to a quality auditory environment that encour-
audiologist is critical for optimum programming for the use
ages and reinforces use of spoken language in all com-
of integrated RM HAT in the educational environment.
munication environments;
■■ consistent opportunities to develop functional auditory
skills; Early Hearing Detection and Intervention
■■ frequent opportunities to practice new and emerging
As noted earlier, a number of state early hearing detection
listening and spoken language skills; and
and intervention (EHDI) programs are administered by
■■ a systematic procedure for daily monitoring and trou-
state agencies other than the Department of Education. As
bleshooting of personal and classroom technology.
a result, educational audiologists may not be automatically
As mentioned earlier in this chapter, auditory cur- included as part of the intervention team for each deaf or
ricula and resources have been developed specifically for hard of hearing child from birth to 3 years of age. How-
students using cochlear implants (Appendix 9–B), and the ever, the educational audiologist can and should support all
educational audiologist can be an important team member EHDI programs and initiate collaboration for habilitation
for facilitating auditory and communication development in services in the following four areas as required under Part C
the school environment. For students who have been using of IDEA2:
sign language as their primary communication mode be-
■■ participating as a member of the multidisciplinary indi-
fore receiving an implant, use of the transition guidelines or
vidual family service plan (IFSP) team to plan services;
readiness checklists for planning and developing goals and
■■ assisting the IFSP team in developing functional out-
objectives such as those included in a booklet developed by
comes around the priorities the family has identified;
the Laurent Clerc National Deaf Education Center and the
■■ providing parents with information about service
Deaf and Hard of Hearing Program of Boston Children’s
agency options; and
Hospital (2015) is highly recommended.
■■ assisting family in transition from Part C to Part B
IDEA (2004)1 regulations mandate equipment moni-
(school) services.
toring and maintenance for the external parts of cochlear
implants, as well as for other personal hearing instruments, Collaboration with EHDI team members prior to transi-
and the educational audiologist is the key school profes- tion from a home-based and family driven model under Part C
sional to design and coordinate a system for daily equipment to educational services under Part B can support and ease
checks (instructions and a worksheet for checking cochlear this change for caregivers and their deaf and hard of hear-
implants are located in Appendices 8–G and 8–H). Each ing children. Transition planning begins 6 to 9 months prior
cochlear implant company has a troubleshooting guide for to a child’s third birthday, and a transition plan should be
each model they manufacture, typically available online, and included in the child’s IFSP and requested as a part of the
these guides should be on hand, as well as a written system audiology records for any deaf or hard of hearing student.
Chapter 9
1 2
CFR §300.113. CFR 303.13(b)(2).

general education classrooms using identical curricula as

Special Communication that used for students with typical hearing5 (see Table 14–
Factors 1). The importance of including all children in academic
and social activities cannot be overlooked, but the effect of
■■ Child and family’s primary language communication access on full participation also needs to
■■ Child/family’s communication mode be recognized. As such, we need to recognize the impor-
■■ Supports for increasing family communication tance of interactions with peers and adult role models who
proficiency themselves are deaf or hard of hearing. Not every person
■■ Opportunities for adult role models perceives inclusion of deaf and hard of hearing students in
■■ Opportunities for direct instruction in child’s the same way. Although a thorough discussion of this topic
primary language is beyond the scope of this handbook, Chapter 1, Legislative
■■ Opportunities for direct communication with and Policy Essentials; Chapter 14, Educational Consider-
peers ations for Students Who Are Deaf or Hard of Hearing; and
■■ Needs for support personnel and assistive Chapter 11, Developing Individual Plans, provide an over-
technology view of the legal history of inclusion and current research
and philosophical perspectives surrounding the education of
deaf and hard of hearing students. There is now evidence
that children whose hearing status is identified early, who
participate in specialized early intervention programs, who
Critical issues to be addressed include audiologic follow-up, participate in extracurricular school activities, who are mo-
communication needs, and assistive technology. tivated and able to advocate for themselves, and who have
IDEA Part B3 requires that special communication fac- friends and appropriate social skills are more likely to have
tors be discussed during IEP meetings for a deaf or hard better outcomes than those who do not have those experi-
of hearing child (see Box), and the development of a com- ences and skills. Regardless of our personal philosophies,
munication plan to address these needs during the transition it is important to facilitate equal access for students who
planning period is crucial to the educational team as a key are placed in general education environments and to assist
factor in discussions of eligibility for services and place them to function as effectively and independently as pos-
ment for a free and appropriate public education (FAPE). sible within that setting. The educational audiologist is a key
Despite increasing numbers of deaf and hard of hearing team player for these students in accomplishing these out-
children who have been enrolled in EHDI programs arriving in comes. The PARC located in Appendix 11–D provides guid-
school settings with improved language outcomes, their strug- ance for determining the readiness of children and youth for
gles with noisy classrooms and fatigue continue (Bess et al., a recommended placement (i.e., General Education Inclu-
2014; Hornsby, Werfel, Camarata, & Bess, 2014; McCreery, sion Checklist) and an evaluation of how well the placement
2015). For these reasons as well as others related to com- is suited to support the communication and learning needs
munication needs, the educational audiologist should always of the student (i.e., Placement Checklist for Children/Youth
be a key member during the transition period for all deaf and Who Are Deaf and Hard of Hearing).
hard of hearing children. (See Chapters 2, Roles and Respon- Chapter 10, Supporting Wellness and Social-Emotional
sibilities of Educational Audiologists, and 11, Developing In- Competence, discusses a number of strategies for student
dividual Plans, the EHDI e-book, and Seaton, 2017, for more development of social-emotional competence and advo-
information on the educational audiologist’s role in EHDI.) cacy in educational situations. Knowledge about school and
classroom rules can also help students assume responsibil-
ity for their own behavior and avoid unnecessary miscom-
INCLUSION munication with teachers and/or peers. Often, classroom
requirements are communicated incidentally, and the deaf
We cannot conclude this chapter without a brief discussion and hard of hearing student may miss or misunderstand this
of the inclusion philosophy as it applies to deaf and hard of information. Answers to the following questions can assist
hearing students. The terms “mainstreaming” in the 1970s the student in acting appropriately to achieve equal access
and “integration” in the 1980s, were used when discussing without calling attention to himself or herself.
academic participation in general education classrooms by
children with disabilities. With current educational practices ■■ What are the most important rules in your classroom(s)?
guided by the ESSA 2015,4 most deaf and hard of hearing ■■ What are the rules for the cafeteria?
students are now educated the majority of the time within
Chapter 9
5
U.S. Department of Education, Office of Special Education Programs
3
CFR §300.324(a)(2)(iv). (2018). 40th Annual Report to Congress on the Implementation of the In-
4
Every Student Succeeds Act. Public Law 114–95, 20 U.S.C. §6301 et seq. dividuals with Disabilities Education Act.

328 Chapter 9
■■ What are the playground or school campus rules? dren with identified learning challenges. The educational
■■ What is the first thing you should do when you get to audiologist is an important resource for setting students up
school? to be successful and to facilitate acceptance and satisfactory
■■ What is the last thing you should do before you go performance of deaf and hard of hearing students in today’s
home at the end of the day? typical learning environments.
■■ How do you know when your teacher wants you to be
quiet?
■■ How do you know when your teacher is annoyed?
■■ How do you know your homework assignment? Most deaf and hard of hearing students are edu-
■■ How do you know when you are allowed to talk in cated the majority of the time within general edu-
class? cation classrooms using identical curricula as that
used for all other students.
Participation in general education for most of the school
day has become common practice for the majority of chil-
SUMMARY Erber, N. (2011). Auditory communication for deaf children: A

guide for teachers, parents and health professionals. Adelaide,
In summary, the educational audiologist’s primary focus in Australia: ACER Press.
habilitation, whether service is direct or indirect, is on fa- Estabrooks, W., MacIver-Lux, K., & Rhoades, E. (2016). Auditory-
verbal therapy: For young children with hearing loss and their
cilitating maximum access to communication with emphasis
families and the practitioners who guide them. San Diego, CA:
on the use of auditory input with or without visual support. Plural Publishing.
To achieve this outcome involves knowledge and dissemi- Functional Auditory Performance Indicators (FAPI). A fillable,
nation of information regarding current technology, school autocalculating form. Retrieved from https://www.phonakpro
operations, learning environments, instructional strategies, .com/content/dam/phonakpro/gc_hq/en/resources/counseling
and content to be learned, as well as knowledge of individual _tools/
deaf and hard of hearing children or youth and the poten- Guidelines Development Conference. (2008). Guidelines for identifi-
tial impact of each student’s hearing status on performance cation and management of infants and young children with audi-
within the educational setting. tory neuropathy spectrum disorder (ANSD). Colorado Children’s
Hospital. Retrieved from http://www.coloradochildrens.org
Hornsby, B., Werfel, K., Camarata, S., & Bess, F. (2014). Subjec-
tive fatigue in children with hearing loss. Some preliminary
findings. American Journal of Audiology, 23(1), 129–134.
SUGGESTED READINGS LaSasso, C., Crain, K., & Laybaert, J. (2010). Cued speech and
AND RESOURCES cued language for deaf and hard of hearing children. San
Diego, CA: Plural Publishing.
Anderson, K. (2012). Student Communication Repair Inventory Laurent Clerc National Deaf Education Center and the Deaf
and Practical Training. Butte Publications. Retrieved from and Hard of Hearing Program of Boston Children’s Hospi-
https://www.successforkidswithhearingloss.com tal. (2015). Students with cochlear implants: Guidelines for
Childress, T. (n.d.) Tina Childress Resources. Retrieved from educational program planning. Washington, DC: Clerc Center
http://bit.ly/TinaChildressResources Publications.
Chute, P., & Nevins, M. (2006). School professionals working Lieu, J. (2013). Unilateral hearing loss in children: Speech-
with children with cochlear implants. San Diego, CA: Plural language and school performance. B-ENT, Suppl 21, 107–115.
Publishing. Lieu, J., Tye-Murray, N., & Fu, Q. (2012). Longitudinal study of
Clarke Schools. (2006). Oral transliterating: An educational children with unilateral hearing loss. Laryngoscope, 122(9),
guide. Northampton, MA: The Mainstream Center. Retrieved 2088–2095.
from http://www.clarkeschools.org/uploads/files/professionals National Association of State Directors of Special Education, Inc.
/OTorder.pdf (2006). Meeting the needs of students who are deaf or hard
Cole, E., & Flexer, C. (2019). Children with hearing loss: Develop- of hearing: Educational services guidelines. Alexandria, VA:
ing listening and talking birth to six (4th ed.). San Diego, CA: Author.
Plural Publishing. Perigoe, C., & Perigoe, R. (Eds.). (2004). Multiple challenges—
Educational Audiology Association (EAA). (2017). Minimal, mild Multiple solutions: Children with hearing loss and special
and unilateral hearing loss/single-sided deafness (approved needs [monograph]. The Volta Review, 104(4).
Chapter 9
August 2017). Retrieved from http://www.edaud.org/pdf Phonak, Inc. (2017). Unilateral Hearing Loss in Children Confer-
/MMUSSD-2017.pdf ence Proceedings. International Pediatric Conference, Octo

ber 22–24, 2017. Philadelphia, PA. Retrieved from https:// Unilateral Hearing Loss in Children. (2017). Phonak Conference
www.phonak.com Proceedings. Retrieved from https://www.phonakpro.com/us
Seaton, J. (2017). Ready or not, here they come! The educational /en/training-events/events/past-events/2017/uhl-in-children
audiologist’s role in transition from Part C to Part B. Educa- -conference-philadelphia.html
tional Audiology Review, Fall, 6–7. Unser, J. Self-advocacy skills and conversational repair strategies:
Tharpe, A. (2019). Unilateral hearing loss in children: Current Keys to successful communication. Retrieved from https://
perspectives. Retrieved from http://hearingreview.com/2019/10 cid.edu/2017/05/23/self-advocacy-skills-and-conversational
/unilateral-hearing-loss-children-current-perspectives/ -repair-strategies/documents/child_hearing_assessment_func
Tomblin, B., Walker, E., McCreery, R., Arenas, R., Harrison, M., & tional_auditory_performance_indicators_fapi_2017.pdf
Moeller, M. (2015). Outcomes of children with hearing loss.
Ear & Hearing, 36(1), 14S–23S.
Tye-Murray, N. (2018). Foundations of Aural Rehabilitation: Chil-
dren, adults, and their family members (5th ed.). San Diego,
CA: Plural Publishing.
Chapter 9

APPENDIX 9–A
[Name of Program]
Form to Facilitate Collaboration
Between Teacher/ School Provider and Physician
The student identified below is in my class, and it would be helpful if you would provide information on your examination
and recommendations. Included are my primary concerns/questions concerning this student. Thank you.
STUDENT NAME: DATE OF BIRTH:
SCHOOL PLACEMENT:
MY THREE PRIMARY CONCERNS ABOUT THIS STUDENT ARE:
1.
2.
3.
SIGNATURE AND TITLE OF PERSON REQUESTING INFORMATION:
Please complete the following information and send back to school with
(Student’s name)
RESULTS OF EXAMINATION COMPLETED BY

(Physician’s name)
DATE OF EXAM:
 The student above has medical clearance to use amplification.
 The student above is currently receiving medical treatment for the following ear condition:
 The student above has a follow-up appointment scheduled for: ____________________

(Date)
SIGNATURE: _____________________________________________
CONTACT INFORMATION: _________________________________
THE BEST TIME AND WAY TO CONTACT ME IS:____________________
[When completed form is returned to school, please cc all service providers.]

Chapter 9
Note. Copyright © 2000 Singular Thomson Learning.
330

APPENDIX 9–B
Auditory and Tactile Assessment and Curricula**
Auditory Skills Checklist (2005). A 35-item checklist of auditory DASL II (1992). Developed by Gayle Stout, Jill Windle, & the Hous-
skills. Developed by the Center for Hearing and Deafness Re- ton School for Deaf Children. Distributed by Cochlear Ameri-
search at Cincinnati Children’s Hospital Medical Center, 3333 cas, 400 Inverness Parkway, Suite 400, Englewood, CO 80112-
Burnet Avenue, Cincinnati, OH 45229-3039. Free download 5128. (800) 523-5798. https://www.cochlearamericas.com. Also
from https://www.researchgate.net/publication/5773214. Also available from https://successforkidswithhearingloss.com
available from https://successforkidswithhearingloss.com
ESP: Early Speech Perception Test (2012 update). For children
Auditory perception test for the hearing impaired, 3rd ed. (2016). 3 years and above, kit contains revised manual, low-verbal and
Developed by Susan G. Allen. Published by Plural Publishing, standard scoring forms, toys and picture cards, and accompany-
5521 Ruffin Road, San Diego, CA 92123. https://www.plural ing CD. https://www.successforkidswithhearingloss.com
publishing.com
Listen, learn, and talk. Available from Cochlear Americas (see earlier).
AuSpLan (Auditory, speech and language): A manual for profes-
Making the connection: Adult and adolescent rehab workbook.
sionals working with children who have cochlear implants or
Workbook and audio CD available from Advanced Bionics
amplification (2009). Developed by Adeline McClatchie &
Corporation (see earlier).
MaryKay Therres. Available from Advanced Bionics Corpora-
tion, Mann Biomedical Park, 25129 Rye Canyon Loop, Valen- TARGO: Tactaid reference guide and orientation (1993). Devel-
cia, CA 91355. (800) 678-2575. https://www.bionicear.com oped by Amy Robbins, Linda Hesketh, & Cindy Bivins in co-
operation with the Indiana University School of Medicine. Pub-
Bridge to better communication. Program with materials developed
lished by Audiological Engineering Corporation, 35 Medford
and distributed by MED-EL Corporation, 2511 Old Cornwallis
Street, Somerville, MA 02143. (617) 628-1435.
Road, Suite 100, Durham, NC 27713. (888) 633-3524. https://
www.medel.com/us/rehabillitation Word associations for syllable perception. Developed by Mary E.
Koch. Order from Advanced Bionics Corporation (see earlier).
CHATS: The Miami cochlear implant, auditory and tactile skills
curriculum (1994). Edited by Kathleen C. Vergara & Lynn W. **Although the information was checked for accuracy at the time
Miskiel. Published by Intelligent Hearing Systems, 10689 of this publication, we recommend that you recheck the follow-
North Kendall Drive, Miami, FL 33176. http://www.ihsys.com ing websites for current availability of auditory skill assessment
/site/CHATS.asp?tab=4 and curricular materials:
CASLLS: Cottage acquisition scales for listening, language and
speech (1999). Order from Sunshine Cottage School for the Cochlear Implant Manufacturers:
Deaf, 103 Tuleta Drive, San Antonio, TX 78212. (212) 832- Advanced Bionics Corporation. https://advancedbionics.com
8696. https://edproducts.sunshinecottage.org/store/?product
=caslls-manual-pdf. Electronic version available for purchase Cochlear Americas. https://www.cochlearamericas.com
from https://www.ecaslls.com contains CASLLS, CASLLS
Med-El Corporation. https://www.medel.com
Companion, and Informal Speech Evaluation.
http://www.morgan.k12.il.us/isd/Outreach_Services_CISupport
CID SPICE for Life Auditory Learning Curriculum. Functional au-
.html Excellent website maintained by Tina Childress, educa-
ditory development for children 5 years and above. Developed
tional audiologist at the Illinois School for the Deaf, with mul-
by Julia West & Jennifer Manley. iPad version available from
tiple links for cochlear implant manufacturers, device informa-
the Apple store.
tion, care, and habilitation/rehabilitation resources.
CID SPICE: Speech perception instructional curriculum and eval-
uation, 2nd ed. Developed by Jean Moog, Jill Biedenstein &
Lisa Davidson at Central Institute for the Deaf, 825 S. Taylor
Avenue, St. Louis, MO 63110. (314) 977-0133. https://cid.edu
Chapter 9
331

APPENDIX 9–C
Listening Development Profile
Name DOB Age at ID
Age at beginning intervention Age at initial amplification Type/model
Amplification:
Date
Unaided AI
Aided AI
Hours/day of
HA use
ALD used/
freq of use

Rating: 1 = skill introduced Mode: AVQ = auditory-visual/quiet

2 = skill emerging AQ = auditory/quiet
3 = skill in progress AVN = auditory-visual/noise
4 = skill established AN = auditory/noise
Stage 1: Beginning Listener
RATING:
MODE/DATE
STUDENT OUTCOMES PERFORMANCE INDICATORS
1 2 3 4
■■ Increases auditory detection/ ■■ Can differentiate the presence or absence of sound

awareness
■■ Responds to sounds around the home, e.g., doorbell,
telephone (response may be voluntary or involuntary)
■■ Responds to people’s voices
■■ Increases time on listening task
■■ Directs attention to sound ■■ Turns head in response to sound
(auditory localization) ■■ Turns directly to sound source
■■ Increases linguistic interaction ■■ Parents use appropriate communication strategies
(turn-taking, eye contact, child-initiated conversation)
■■ Child begins to demonstrate age-appropriate conversation
behavior
■■ Increases auditory attention ■■ Child indicates desire to wear hearing aids or amplification
device and demonstrates a listening attitude
Chapter 9
Note. Adapted with permission from Towards excellence in listening, by Z. R. Rizack, 1994, formerly with Waterloo County Board of
Education, Kitchener, Ontario, Canada (now deceased).
332

Stage 2: Intermediate Listener

RATING:
MODE/DATE
1 2 3 4
■■ Identifies when amplification is ■■ Child reports that equipment is not working without
not working prompting
■■ Demonstrates benefit of listening ■■ Student enjoys listening tasks, initiates desire to hear
■■ Responds to loud/quiet sounds ■■ Startle response (loud sounds)
■■ Says “huh” or looks puzzled (quiet sounds)
■■ Demonstrates use of appropriate loud versus quiet sound
■■ Responds to fast/slow sounds ■■ Moves appropriately to speed of sound
■■ Demonstrates fast and slow through vocalizations
■■ Responds to high/low sounds ■■ Matches pitch of voice
■■ Demonstrates high and low through vocalizations
■■ Understands rhythm of songs ■■ Follows rhythmic patterns of songs
■■ Understands words in songs ■■ Performs action, i.e., demonstrates understanding of words
■■ Increases linguistic interaction ■■ Uses more complex sentence forms and vocabulary
■■ Discriminates words with similar speech sounds (bat versus pat)
■■ Uses language for a variety of purposes
■■ Uses appropriate intonation patterns
Stage 3: Advanced Listener

RATING:
MODE/DATE
1 2 3 4
■■ Participates in groups ■■ Takes turns

■■ Listens in groups ■■ Uses appropriate clarification strategies for misunderstood
■■ Uses appropriate language messages
and conversation rules ■■ Uses discussion to complete assignments
■■ Uses phrases appropriately for content
■■ Increases awareness of ■■ Asks for auditory representation or repetition of
pronunciation of words, phrases, words so that he/she can internalize auditory images
sound and symbol connections (modeling)
■■ Increases use of words/concepts ■■ Discriminates/self-corrects between correct and incorrect
in various contexts productions
■■ Increases responsibility for ■■ Follows multistep instructions
understanding oral messages ■■ More frequent interactions with teachers, peers
■■ Reduce frequency of conversation repair (“huh,” “what,”
“I didn’t understand’)
■■ Begins to troubleshoot ■■ Reports dead battery or static sounds, intermittency, spillover
amplification systems of signal, clogged mold
■■ Advocates for services ■■ Asks teacher to check transmitter using appropriate language
Chapter 9

334 Chapter 9
Stage 4: Sophisticated Listener/Communicator

RATING:
MODE/DATE
1 2 3 4
■■ Demonstrates knowledge of ■■ Explains audiograms in terms of degree and configuration

audiograms (shape)
■■ Knowledge of various types of ■■ Discuss characteristics of various hearing aids, cochlear
amplification and assistive implants, and assistive devices
devices (HA, ALD, TDD, ■■ Demonstrates appropriate use of ALD, TDD, captioner,
captioner, phone) phone
■■ Uses amplification equipment ■■ Reports malfunctioning equipment and conducts basic
appropriately troubleshooting
■■ Increases awareness of ■■ Requests appropriate physical accommodations (seating,
communication/listening sound system, etc.)
environment and appropriate ■■ Requests appropriate support services (interpreter,
accommodations captioning, written materials, notetaker)
■■ Utilizes professionals and ■■ Identifies roles of professionals and community agencies
agencies appropriately ■■ Uses professionals and community services appropriately
(audiology, ENT, SLP, interpreter,
relay systems, vocational
rehabilitation, etc.)
■■ Able to educate others about ■■ Selects target audience for presentation on hearing and
hearing loss and its implications communication
■■ Does presentation to peers, other schools
■■ Explains listening needs in work situations
Chapter 9
Note. Educational audiology handbook. DeConde Johnson, Benson, & Seaton (1997), Singular Publishing.

APPENDIX 9–D
Teaching Strategies and Classroom Activities
for Selected Listening Difficulties
Area of difficulty: Difficulty listening in large group teaching

Goal: Improve listening environment for student
Strategies:
■■ Use seating close to teacher in circle or at desks
■■ Use seating away from constant noise sources (pencil sharpener, hallway, windows, etc.)
■■ Close classroom door to reduce noise from hallway entering classroom
■■ With older students, encourage them to choose and/or
■■ request seating close to the speaker
Area of difficulty: Difficulty listening in small group teaching

Strategies:
■■ Where possible, use library, adjacent rooms, or hallways (if quiet) for project work
■■ Encourage student to clarify misunderstanding or missed information
Area of difficulty: Difficulty listening in independent work at desk

Goal: Improve listening situation for student
Strategies:
■■ Experiment with earplugs or headphones to block out surrounding noise
■■ Encourage student to ask other students to be quiet when appropriate
Activity:
Have a student assigned daily to the role of “noise officer,” where he or she is given permission to monitor the
noise levels and tell the students to be quiet as necessary.
Area of difficulty: Listening in the gym

Goal: Improve listening situation for student
Strategies:
■■ Have the student stand beside or near the teacher for instructional time
■■ Give student permission to ask other students for repetition of instructions
■■ Provide prearranged gestures to signal various instructions during games, where necessary
Area of difficulty: Listening in noisy situations

Strategies:
■■ Close the classroom door
■■ Situate student away from noise sources in classroom
■■ Put tennis balls on the bottom of desk chair legs to reduce chair noise; this improves the listening environment signifi-
cantly for all students (contact support staff for more information)
Chapter 9
■■ Provide a lesson on noise in the classroom
335

336 Chapter 9
Activities:
For primary students, have them make colorful “Listening Hats” in an art lesson. Store the hats in the classroom,
and then have the students wear their hats when they are doing quiet work and do not wish to be disturbed.
■■ For junior level, have students audiotape the noise levels in the class before and after introducing the tennis balls on the
bottom of the chair legs and compare the results.
■■ Have students measure noise levels using Radio Shack sound level meter at different times during the day, during dif-
ferent lessons, in different parts of the school to determine the noisiest times and locations.
■■ Model requests for reducing the noise level for students so that students ultimately become responsible for requesting
that everyone get quieter (it is helpful when teachers also indicate when it is difficult for them to understand well).
Area of difficulty: Difficulty following directions

Goal: Increase understanding of directions
Strategies:
■■ Simplify directions to single steps
■■ Write instructions on the blackboard
■■ Have one of the students repeat the teacher’s instructions for the whole class after the teacher has given the initial in-
struction; this is good practice for listening for the whole class and allows the student in need to hear the instruction a
second time
■■ Use the buddy system where a student can ask an assigned student for repetition of instructions
Area of difficulty: Does not respond to instructions

Goal: Increase responsiveness to directions
Strategies:
■■ Use a visual/auditory cue to get student’s attention before initiating instructions
■■ Where possible, situate child near you in circle teaching situations
■■ Where possible, touch child on shoulder to get his/her attention
■■ Use the same phrase each time instructions are presented, such as “Get ready to listen for my instructions,” so students
can prepare themselves to listen before actual instruction is delivered
■■ Present instructions in a designated part of the classroom
■■ Encourage student to watch the speaker’s face
Area of difficulty: Student appears to listen (has good eye contact and appears to attend) but work suggests misunderstanding
Goal: Increase student’s recognition of comprehension difficulties and develop systematic checks of comprehension
Strategies:
■■ Encourage the student to say when did not understand (“I don’t know”) and ask for help from teacher
■■ Do comprehension check in private—ask student to repeat back instructions so that you can see what has been understood
■■ Encourage student to request repetition of instructions from classmates and/or teacher
Area of difficulty: Student frequently asks for repetition

Goal: Develop systematic changes in clarification strategies
Strategies:
■■ At the beginning, repeat the whole instruction for the student
■■ Get the student to rehearse the instruction to retain it better
■■ At later date when student is ready for next step, ask the student to repeat what he/she did hear
■■ At later date, ask the student to paraphrase what he/she heard
■■ At a higher level of mastery, ask the student to ask questions about what he/she missed
Chapter 9

Areas of difficulty: Student does not understand appropriate listening expectations of the classroom or does not have good
speaker listener strategies such as turn-taking, good listening behaviors, good speaker behaviors, etc.
Goal: Develop understanding of effective communication strategies
■■ Give class a lesson on speaker listener strategies; it is useful to ensure that all of the students recognize good speaker
listener strategies so they can support students with difficulties in this area
Activity: For primary students, create listening mobiles or draw pictures about the rules of listening (listener looks at the
speaker, does not talk, and stays still) or use puppets to demonstrate good listeners or poor listeners. Students
love to show aspects of poor listening!
■■ For junior students, have them create a list of behaviors that represent effective listening; then have each student rate his
or her own listening habits and select a behavior to work on and improve.
■■ Use of a classroom talking stick teaches the students that only the person with the talking stick can speak and everyone
else must listen. Then when someone else is ready to speak, he or she will ask for the talking stick.
Area of difficulty: Student’s listening skills are noticeably poorer later in the day
Goal: Provide strategies to address listening fatigue
Strategies:
■■ Build in more breaks or rest periods from active listening during the earlier parts of the school day, where possible (e.g.,
reading, research, working on the computer, listening to tape recorder etc.)
■■ Suggest to parents that student may need to have a rest or do activities that do not require communication with others
when they arrive home from school in the afternoon
Check Off Areas of Listening Difficulty for This Student

During large group teaching
During small group teaching
During independent work at desk
During gym class
During noisy situations
Following directions
Does not appear to listen
Appears to listen but work suggests misunderstanding
Frequently asks for repetition
Does not understand classroom listening expectations
Has not developed good speaker-listener strategies
Fatigues toward the end of the day
Chapter 9
Note. Carolyne Edwards, MClSc, Auditory Management Services, Toronto, Canada. Reprinted by permission.

APPENDIX 9–E
[Name of Program]
Parent Letter On Speechreading
Dear Parents:
Lipreading is the term commonly used to describe when a listener focuses on the speaker’s lips to interpret a message.
Through lipreading alone, a person can distinguish between the words man and fan but not between man and pan. More
information is needed. Speechreading is the more accurate term that accounts for how facial expressions, gestures, other
body language, and context contribute to overall understanding.
Speechreading is not used only by people who are deaf or hard of hearing. Everyone, especially people in difficult listening
situations, benefits from the additional information received from visual cues. The following activities can be used to improve
the natural speechreading skills of all children. Remember, speak using natural speech/lip movements. Exaggerated move-
ments or slowed speech makes speechreading more difficult.
■■ Develop vocabulary lists, phrases, or sentences that are related to a specific topic. For example, practice speechreading
the vocabulary of school subjects and activities, common classroom instructions, predictable situations, or the names of
family members, classmates, and school personnel.
■■ Use familiar speech found in nursery rhymes, commercial jingles, commonly used phrases, or sayings. Ask the listener
to identify the title or product.
■■ Tell a short story or riddle with everyone watching and listening. Periodically drop your voice while saying certain words
or phrases that must be speechread.
■■ Play word games, such as hangman or Scrabble. Write spelling words or key vocabulary words with some missing letters
to practice the skill of visualizing a whole word by seeing only part of it
■■ Point out commonly understood gestures, such as those used for, “Come here,” “Wait a minute,” and “Stop.” Identifying
gestures and the related phrases without gestures can be an entertaining form of family charades.
Remember: understanding usually does not come from visual cues alone. Use a soft voice, and do not make it too loud or
have competing noise in the background. Simply mouthing words may result in exaggerated movements that are difficult to
understand.
If you have any questions or would like more information on speechreading, feel free to contact me at____________________.
Sincerely,
Chapter 9
338

APPENDIX 9–F
Speechreading Resources for Children
Deyo, D. (1997). Speechreading in context. Washington, Pluznik, N., & Sobel, R. (1986). Messy monsters, jungle
DC: Gallaudet University, Pre-College Programs. Free pdf joggers, and bubble baths. Washington, DC: Gallaudet
download from Gallaudet University Bookstore, 800 Florida University Press. Also available from Gallaudet University
Avenue NE, Washington, DC 20002-3695. Bookstore.
Teacher guide including speechreading activities for el- Children’s workbook that lends itself to speechreading ac-
ementary and middle school. tivities for elementary children.
DeFilippo, C., & Scott, B. (1978). A method for training and Tye-Murray, N. (2020). Speechreading training. Founda-
evaluating the reception of ongoing speech. Journal of the tions of Aural Rehabilitation (5th ed.). San Diego, CA: Plu-
Acoustical Society of America, 63, 1186–1192. ral Publishing.
Article that describes connected discourse tracking, an ap-
proach used to develop speechreading skills in both children Yoshinaga-Itano, C. (1988). Speechreading instruction for
and adults. children. Volta Review, 90, 241–259.
Chapter in monograph on speechreading that briefly de-
Kaplan, H., Bally, S., & Garretson, C. (1995). Speechread- scribes a holistic approach for use with children. Includes
ing: A way to improve understanding (2nd ed.). Washington, annotated bibliography.
DC: Gallaudet University Press. Order from http://gupress
.gallaudet.edu
Kleeman, M. (1995). See what you say. Distributed by Hear-

ing Visions, 3427 Sequoia Street, San Luis Obispo, CA
93401. http://www.lipreading.com
Manual plus video or DVD.
Chapter 9
339

APPENDIX 9–G
Classroom-at-a-Glance: Observation Checklist
Student: Age: Grade: Date:
School: Teacher: Observer:
I. Physical Characteristics
1. Type of School 6. Lighting 10. Ceiling Surface
 open space  adequate  acoustical tile
 modified open space  inadequate  other
 traditional
7. Windows 11. Writing Boards
 other
 complete wall  chalkboards
2. Room Size  individual windows  whiteboards
 large  window/glare treatment  combination
 medium  other________________  accessible to student
 small
8. Floor Surface 12. Room Location
3. Number of Students in Class ____  rubber tile  near external noise sources
 concrete
4. Number of Teacher Aides 13. Room Noise Level
 hardwood
Part-time____ Full-time____  high ¨ average ¨ quiet
 carpeting
SPL________dBA
5. Type of Seating
9. Wall Surface
 desks 14. Classroom Technology
 concrete/brick
 tables and chairs  Smart Board
 wood
 combination  video monitor
 wallboard
 other_________________  computers (#_____)
 other_______________
 captioning
 other
II. Teacher-Student Characteristics

15. Student’s Seating 18. Student’s Attention to Speaker/ 21. Student’s Class Participation
 appropriate and flexible Interpreter  volunteers information
 inappropriate  always  answers questions accurately
 usually most of the time
16. Teacher’s Speech/Voice
 sometimes  answers questions inaccurately
Level:  loud  average  soft
 rarely most of the time
Modulation:  good  problem
 varies—describe  asks questions when he/she does
Articulation:  good  problem
not understand
Voice quality:  good  problem
 pretends to understand when he/
Speechreading:  good  problem 19. Student’s Speech/Voice
she does not understand
Intelligibility:  good  problem
17. Teacher’s Speaking Manner  does not participate
Loudness:  loud  average  soft
 faces student when speaking
22. Friends of Student
 moves while speaking 20. Student’s Speechreading Skills
 none
 uses hand gestures  does not speechread
 some
 talks with back to class  skills are effective
 skills are emerging
Chapter 9
340

23. Student’s Social Interactions 24. Student’s Attendance 25. Amplification

 tries to interact with other  regular  none
students  irregular  personal hearing instrument:
 other students try to interact with  # of days missed this year____  HA  CI
student  other_________
 joins group activities  HAT:
 plays alone  remote Mic
 classroom (CADS)
 targeted area
 used consistently
 used inconsistently
Chapter 9

APPENDIX 9–H
Reduced Hearing and Recorded Speech
An increasing number of educational resources are being Listening Effort

delivered through recorded speech, inclusive of, but not lim-
■■ The everyday listening effort required of students who
ited to, reading comprehension programs (e.g., Raz Kids), in
are deaf or hard of hearing is substantially greater than
the younger grades, listening centers and even examinations.
their peers and often results in fatigue and attention
When a student requires the accommodation of a
challenges and reduced retention abilities.
“reader” for examinations, rather than a live voice reader,
■■ When hard of hearing students must listen to recorded
they are often provided with a recorded version of the exam.
speech, they lose visual and vocal intonation and inflec-
While recorded speech may be an adequate delivery method
tion cues that decrease optimal listening rates as well
for a student with normal hearing sensitivity, it creates a bar-
as opportunities for repetition. Additionally, the way
rier for students who are deaf or hard of hearing. Rather than
speech is recorded decreases its quality. Due to these
recorded speech, deaf and hard of hearing students require
issues, recorded speech is not optimal for most students
a live voice reader for examinations. The rationales behind
with reduced hearing.
this accommodation are as follows:
■■ All of these factors create gaps that need to be “filled
in” by deaf and hard of hearing students, which, in
Compressed Speech
turn, increases the required listening effort relative to
■■ The recording process compresses speech to a narrower their peers.
band, whereas people with reduced hearing require a ■■ Sound exhausting? It is; and deaf and hard of hearing
broader frequency band for optimal understanding. students must do this while still engaging in the pro-
cessing of complex questioning, the retrieval of infor-
Speech-Reading mation, as well as the stress of test-taking.
■■ Listening to recorded speech does not allow the student
Examination Accommodations Checklist
to use speechreading to fill in gaps in his or her hearing.
Listening to recorded speech through hearing aids or co-
■■ Not being able to speechread creates a barrier to
chlear implants is much like an individual with normal hear-
understanding/comprehension.
ing listening through the Wal-Mart speaker. Speech is frag-
mented and difficult to understand.
Intonation/Inflection
To ensure that your deaf and hard of hearing students
■■ Subtle intonations and inflections are often not captured have equitable exam-taking opportunities, the following ac-
in recorded speech. commodations must be discussed and, when appropriate,
■■ While students with normal hearing may still be able to stated in each student’s IEP or Section 504 plan:
understand the message, students who are deaf or hard of
■■ writing all tests/exams in a quiet room;
hearing may struggle as they rely on intonation and inflec-
■■ additional time for the writing of exams;
tions of speech to enhance their speech understanding.
■■ a live voice reader in place of recorded speech (digitally
or computer-generated voice or CD-ROM format);
Rate of Speech
■■ use of the student’s remote microphone system by the
■■ Students who are deaf or hard of hearing require a live voice reader for the exam, including opening and
slower rate of speech than is often offered on recorded closing remarks; and
materials. ■■ use of a scribe.
■■ A live reader can accommodate a reduced rate of speech
Source: Krista Yuskow, AuD, RAuD
where a recording cannot.
Educational Audiologist/Doctor of Audiology
Repetition
Inclusive Learning/Edmonton RCSD
■■ Students who are deaf or hard of hearing do not have
equal access to spoken information; therefore, they will
Chapter 9
likely require the repetition of some exam questions to

ensure equal access.
342

APPENDIX 9–I
Functional Auditory Performance Indicators (FÁPI)
An Integrated Approach to Auditory Skill Development

FÁPI Overview measures the ways in which audition is used to se-
quence language, to learn and use morphemes, to learn
The Functional Auditory Performance Indicators (FÁ PI)
and use syntactic information, and to understand spoken
assesses the functional auditory skills of children with hear-
language.
ing loss. It can be used by parents, therapists, early inter-
ventionists, and teachers. The profile lists auditory skills in
A profile of a child’s functional auditory skills is gener-
an integrated hierarchical order. There are seven categories.
ated after administrating all items on the profile. The seven
1. Awareness and Meaning of Sounds: The child is categories are hierarchical. In addition, auditory perfor-
aware that an auditory stimulus is present. The child mance indicators in each category are listed in hierarchical
may demonstrate awareness of loud environmental order. Please note that while this scale is hierarchical, it is
sounds, noisemakers, music, and/or speech. The child appropriate for a child to be working on many skills at the
further demonstrates that sound is meaningful by as- same time. Approximately 4–8 skills can be addressed si-
sociating a variety of auditory stimuli with their sound multaneously. By working on multiple skills from different
source. The stimuli include loud environmental sounds categories, the child will be learning an integrated approach
or noisemakers, music, vocalizations (non-true words) to auditory skill development.
and speech stimuli. Performance is plotted on the profile sheet located at the
2. Auditory Feedback and Integration: The child beginning of the checklist. Based on careful review of this
changes, notices, and monitors his/her own vocal pro- profile, goals for enhancing auditory skills can be determined.
ductions. A child may demonstrate this skill by re-
sponding to sound when amplification is turned on, by Format of the Functional Auditory
vocalizing to monitor when amplification is working, Performance Indicators
and/or by noticing his/her own vocalizations. Further-
Each category has specific skills. Some categories have one
more, the child uses auditory information to produce
specific skill, others have a short list of skills. Furthermore,
an oral spoken utterance that approximates or matches
each skill can be assessed in a variety of conditions. These
a spoken stimulus.
conditions provide a qualitative report on the child’s success
3. Localizing Sound Source: The child searches for and/
with each skill. The conditions are specific to each category.
or finds the auditory stimulus. Searching is a prereq-
Some of these conditions are:
uisite skill for localizing. Children with hearing in
only one ear may not be able to localize to the sound ■■ responses to auditory stimuli that are paired with visual
source. cues contrasted to responses to an auditory stimulus
4. Auditory Discrimination: The child distinguishes alone
the characteristics of different sounds including envi- ■■ responses to auditory stimuli that are presented in close
ronmental sounds, suprasegmental characteristics of proximity to the child versus responses to stimuli that
speech (e.g., intensity, duration, pitch), non-true words, are presented far away
and true words. ■■ responses to auditory stimuli that are given in a noisy
5. Auditory Comprehension: The child demonstrates situation versus responses to stimuli that are given in a
understanding of linguistic information that is heard by quiet room.
identifying what is said, identifying critical elements in ■■ responses to auditory stimuli that are observed when
the message, and by following directions. the child is prompted to listen versus spontaneous re-
6. Short-Term Auditory Memory: The child can hear, sponses to auditory stimuli
remember, repeat, and recall a sequence of numbers.
This skill is developmentally appropriate for children
who are two years of age and older. Numbers are used Reporting Functional Skills
in order to isolate the skill—auditory memory—that is The FÁ PI is administered over time. At any point in time,
Chapter 9
being tested. the FÁ PI can be scored. The FÁ PI is scored by measur-

7. Linguistic Auditory Processing: The child utilizes au- ing a child’s performance on each skill in each category.
ditory information to process language. This category The scores are calculated and then transferred to the profile
343

344 Chapter 9
page that is found at the beginning of the test protocol. ■■ Notice the child’s strengths. Which categories have the
The scored profile provides the interventionist, therapist, highest score? Which skills within a category has the
or teacher with information that identifies a child’s unique child acquired?
strengths and needs. The profile is used to create goals for a ■■ The results of the FÁPI are used to identify goals for in-
child’s individualized program. tervention, for therapy, and/or for classroom instruction.
The percentage scores in each category and the weighted
■■ There are seven categories. Each category receives a
scores for each skill identify skills that need improve-
percentage score. This percentage score identifies the
ment. All items in the “not present” (0%–10% and
child’s listening skills for the items in that category.
“emerging” (11%–35%) categories need improvement.
When the score in a category is in the “acquired” range
(80%–100%), the child has mastered the skills for that
category. Skills that are “in process” (36%–79%) are
also strengths. Procedure for Administration and Scoring
■■ It is important to identify the conditions for each skill 1. Each skill can be assessed by direct observation of a
that make listening easier for the child and the condi- child’s response to specific stimuli and/or parent report.
tions that make listening more challenging. Easier lis- Each skill is evaluated according to the specific condi-
tening conditions include auditory stimuli paired with tions noted on the form. There is a section for “Observa-
visual cues, quiet listening conditions, stimuli that are tions & Comments” that can be used to enter informa-
presented close to the child, and prompted responses. tion about the child’s performance.
More difficult listening conditions include auditory- 2. A four-tiered scoring paradigm has been created. The
only stimuli, distance hearing, listening in noisy situ- skill is ranked by the person administering the check-
ations, and spontaneous responses. It is appropriate to list by indicating the level of attainment (not present,
work on several skills in each category until the child emerging, in process, acquired) for each skill. The level
can listen in both easy and difficult listening conditions. of attainment is determined by the following criteria:
Level of Skill Attainment Corresponding Occurrence Value Given

a. The skill is not present (NP) = 0–10% occurrence (Score value = 0)
b. The skill is emerging (E) = 11–35% occurrence (Score value = 1)
c. The skill is in process (P) = 36–79% occurrence (Score value = 2)
d. The skill is acquired (A) = 80–100% occurrence (Score value = 3)
3. In the scoring column, compute the score for each skill. 5. Associates vocalizations with speaker
Do this by multiplying each skill by a factor of 1, 2, or 6. Associates discourse with speaker.
3, as indicated. If the skill is rated between 0 and 10%,
it is considered “not present” and should be scored as The first skill is “responds to loud environmental sounds
“zero” (0). or noisemakers”. The child demonstrates different levels of
4. Compute the score for a category by adding the competence in eight different conditions:
weighted scores for all skills in that category. Compute
■■ 5 conditions are “acquired”
the percentage for that category.
■■ 2 conditions are “in process”
5. Transfer the scores for each category to the profile at the
■■ 1 condition is “emerging”
bottom of the Performance Profile page.
The weighted scores for the specific conditions are cal-
culated. The scores are determined as follows:
Sample Scoring
■■ 5 conditions are “acquired”. An acquired score re-
The category is “Awareness and Meaning of Sounds”. There
ceives a weight of 3 points. 5 skills × weighted score of
are 6 skills in this category. The skills are:
3 = 15
1. Responds to loud environmental sounds or noisemakers ■■ 2 conditions are “in process”. An in process score re-
2. Responds to music ceives a weight of 2 points. 2 skills × weighted score of
3. Responds to speech 2=4
Chapter 9
4. Associates loud environmental sounds or noisemakers ■■ 1 condition is “emerging”. An emerging score receives
with their source a weight of 1 point. 1 skill × weighted score of 1 = 1

Categories Scoring
of Auditory N=0–10%, E=11–35%, Observations &
Development Auditory Performance Indicators P=36–79%, A=80–100% Comments
responds to loud environmental sounds 0 not present = 0
(vacuum) or noisemakers (drum, bell) 1 emerging x 1 = 1
A with visual cues A auditory only 2 in process x 2 = 4
A close (3’) P far (10’) 5 acquired x 3 = 15
A in quiet E noise Skill Score 20
A prompted P spontaneous
Awareness and Meaning of Sounds
responds to music 0 not present = 0

A with visual cues A auditory only 1 emerging x 1 = 1
A close (3’) P far (10’) 1 in process x 2 = 2
A in quiet E noise 6 acquired x 3 = 18
A prompted A spontaneous Skill Score 21
responds to speech 0 not present = 0_
A with visual cues A auditory only 0 emerging x 1 = 0_
A close (3’) A far (10’) 0 in process x 2 = 0_
A in quiet A noise 8 acquired x 3 = 24
A prompted A spontaneous Skill Score 24
associates loud environmental sounds
(vacuum) or noisemakers (drum, bell) with
their source 0 not present = 0
A with visual cues A auditory only 1 emerging x 1 = 1
A close (3’) P far (10’) 2 in process x 2 = 4
A in quiet E noise 5 acquired x 3 = 15
Skill Score 20
associates vocalizations with speaker
0 not present = 0
A with visual cues A auditory only
1 emerging x 1 = 1
A close (3’) E far (10’)
2 in process x 2 = 4
A in quiet P noise
5 acquired x 3 = 15
Skill Score 20
associates discourse with speaker
0 not present = 0_
A with visual cues A auditory only
2 emerging x 1 = 2_
A close (3’) E far (10’)
1 in process x 2 = 2_
A in quiet E noise
A prompted P spontaneous 5 acquired x 3 = 15
Skill Score 19
Category Score: 124/144 86%
The weighted scores are added together.

15 + 4 + 1 = 20.
The child’s score for this specific skill, “responds to loud environmental sounds or noisemakers”, is 20 points.
The same procedure is used to obtain a skill score for the next 5 skills. The child received scores for the 6 skills in this category.
■■ responds to loud environmental sounds or noisemakers = 20 points
■■ responds to music = 20 points
■■ responds to speech = 18 points
■■ associates loud environmental sounds or noisemakers
with their source = 20 points
Chapter 9
■■ associates vocalizations with speaker = 20 points

■■ associates discourse with speaker = 19 points
The points for the 6 skills are added together to obtain a total score of 117 points for the category “Awareness and Meaning of Sounds”.
There is a possible score of 144 points. By dividing the earned score (117 points) by the total number of possible points (144 points) the
child receives a percentage score of 81% for this category.

Chapter 9
346
Functional Auditory Performance Indicators: An Integrated Approach to Auditory Skill Development
Performance Profile
Name Luke DOB 3 Yrs. Old Date Examiner 3 Mos. Post Implant
Auditory Short-term Linguistic
Awareness and Feedback and Localizing Sound Auditory Auditory Auditory Auditory
Meaning of Sounds Integration Source Discrimination Comprehension Memory Processing
1. Responds to loud 1. Changes 1. Searches 1. Discriminates non-linguistic information: 1. Identifies single words 1. Memory 1. Sequencing
environmental vocalizations when for loud ■■ loud vs soft ■■ body parts ■■ 1–2 digits 2. Closure
sounds or amplification is on environmental ■■ fast vs slow ■■ common objects or ■■ 3–4 digits 3. Syntactic and
noisemakers 2. Notices own vocal sounds or ■■ continuous vs abrupt pictures ■■ 5–6 digits morphologic
2. Responds to music productions noisemakers ■■ high vs low pitch 2. Identifies critical elements in analysis
3. Responds to 3. Monitors status of 2. Searches for ■■ meaningful environmental sounds short phrases 4. Suprasegmental
speech amplification by source of music ■■ intent of utterance based on ■■ picture or object with analysis using
4. Associates loud making noises or 3. Searches for suprasegmental features one critical element auditory feedback
environmental vocalizing source of ■■ mom’s vs dad’s voice ■■ picture or object with 5. Application
sounds or 4. Takes vocal/spoken vocalizations 2. Discriminates vocal utterances – non-true two critical elements of auditory
noisemakers with turns 4. Searches for word productions: ■■ picture or object with information
their source 5. Imitates spoken source of ■■ Vowels three critical elements
5. Associates stimulus discourse ■■ Number of syllables 3. Follows directions
vocalizations with ■■ vowels 5. Localizes to loud 3. Discriminates communicative intent of the ■■ simple one-step
speaker ■■ number of environmental utterance ■■ two-step
6. Associates syllables sounds or 4. Discriminates oral utterances – true word ■■ three-step
discourse with ■■ non-true words noisemakers productions: 4. Identifies critical elements in
speaker ■■ words 6. Localizes to ■■ onomatopoeic sounds short stories
music source ■■ child’s own name ■■ responds to simple
7. Localizes to ■■ familiar commands questions about story
speaker making ■■ number of syllables or words in utterance ■■ responds to complex
vocalizations ■■ familiar words based on vowel differences questions about story
8. Localizes to ■■ familiar words based on consonant
speaker using differences
discourse ■■ familiar words based on syllable differences
Category Category Category Category Category Category Category
Score: 60% Score: 42% Score: 28% Score: 9% Score: 5% Score: 0% Score: .02%
100% Acquired
90%
80%
70% In Process
60%
50% Emerging
40%
30%
20% Not Present
10%
0%
(Shade in appropriate box for each category after determining the percentage for that category)
2/25/2020 4:34:40 AM
Functional Auditory Performance Indicators: An Integrated Approach to Auditory Skill Development
Performance Profile
Name DOB Date Examiner
Auditory Short-term Linguistic
Awareness and Feedback and Localizing Sound Auditory Auditory Auditory Auditory
Meaning of Sounds Integration Source Discrimination Comprehension Memory Processing
1. Responds to loud 1. Changes 1. Searches 1. Discriminates non-linguistic information: 1. Identifies single words 1. Memory 1. Sequencing
environmental vocalizations when for loud ■■ loud vs soft ■■ body parts ■■ 1–2 digits 2. Closure
sounds or amplification is on environmental ■■ fast vs slow ■■ common objects or ■■ 3–4 digits 3. Syntactic and
noisemakers 2. Notices own vocal sounds or ■■ continuous vs abrupt pictures ■■ 5–6 digits morphologic
2. Responds to music productions noisemakers ■■ high vs low pitch 2. Identifies critical elements in analysis
3. Responds to 3. Monitors status of 2. Searches for ■■ meaningful environmental sounds short phrases 4. Suprasegmental
speech amplification by source of music ■■ intent of utterance based on ■■ picture or object with analysis using
4. Associates loud making noises or 3. Searches for suprasegmental features one critical element auditory feedback
environmental vocalizing source of ■■ mom’s vs dad’s voice ■■ picture or object with 5. Application
sounds or 4. Takes vocal/spoken vocalizations 2. Discriminates vocal utterances – non-true two critical elements of auditory
noisemakers with turns 4. Searches for word productions: ■■ picture or object with information
their source 5. Imitates spoken source of ■■ Vowels three critical elements
5. Associates stimulus discourse ■■ Number of syllables 3. Follows directions
vocalizations with ■■ vowels 5. Localizes to loud 3. Discriminates communicative intent of the ■■ simple one-step
speaker ■■ number of environmental utterance ■■ two-step
6. Associates syllables sounds or 4. Discriminates oral utterances – true word ■■ three-step
discourse with ■■ non-true words noisemakers productions: 4. Identifies critical elements in
speaker ■■ words 6. Localizes to ■■ onomatopoeic sounds short stories
music source ■■ child’s own name ■■ responds to simple
7. Localizes to ■■ familiar commands questions about story
speaker making ■■ number of syllables or words in utterance ■■ responds to complex
vocalizations ■■ familiar words based on vowel differences questions about story
8. Localizes to ■■ familiar words based on consonant
speaker using differences
discourse ■■ familiar words based on syllable differences
Category Category Category Category Category Category Category
Score: % Score: % Score: % Score: % Score: % Score: % Score: %
100%
Acquired
90%
80%
70%
In Process
60%
50%
Emerging
40%
30%
20% Not Present
10%
0%
(Shade in appropriate box for each category after determining the percentage for that category)
347
2/25/2020 4:34:40 AM
Chapter 9
348 Chapter 9
Functional Auditory Performance Indicators (FÁPI)

An Integrated Approach to Auditory Skill Development
Name _____________________________________________________________________ DOB ____________________

Type of amplification _______________________________________ Usage:  consistent  inconsistent
Examiner
Categories Scoring
of Auditory N=0–10%, E=11–35%,
Observations &
responds to loud environmental sounds
(vacuum) or noisemakers (drum, bell)
__ with visual cues __ auditory only __ not present = 0
__ close (3’) __ far (10’) __ emerging x 1 = __
__ in quiet __ noise __ in process x 2 = __
__ prompted __ spontaneous __ acquired x 3 = __
Awareness and Meaning of Sounds
Skill Score __
responds to music
__ prompted __spontaneous __ acquired x 3 = __
Skill Score __
responds to speech
Skill Score __
associates loud environmental sounds
(vacuum) or noisemakers (drum, bell) with
their source
Skill Score __
associates vocalizations with speaker
Skill Score __
associates discourse with speaker
Skill Score __
Category Score: ___/144 ____%
Chapter 9
N = not present (0–10%) E = emerging (11–35%) P = in process (36–79%) A = acquired (80–100%)

Categories Scoring
Observations &
changes vocalizations when amplification is
turned on
__ in quiet __ noise __ not present = 0 NOTE: For children who
__ emerging x 1 = __ do not use amplification
__ in process x 2 = __ skip the first and third
__ acquired x 3 = __ items.
Skill Score __
notices own vocal productions
__ in quiet __ noise __ not present = 0
__ prompted __ spontaneous __ emerging x 1 = __
__ in process x 2 = __
Auditory Feedback and Integration
__ acquired x 3 = __
Skill Score __
monitors status of amplification by making
noises or vocalizing
__ emerging x 1 = __
Skill Score __
takes vocal/spoken turns
__ prompted __ spontaneous __ emerging x 1 = __
Skill Score __
Imitates spoken stimulus:
vowels
Skill Score __
number of syllables
Skill Score __
non-true words
Skill Score __
words
Skill Score __
Category Score with Category Score

amplification: ___/132 ____% without amplification:
Chapter 9
___/120 ____%

350 Chapter 9
Categories Scoring
Observations &
searches for loud environmental sounds
(vacuum, telephone) or noisemakers (drum,
bell)
__ close (3’) __ far (10’) __ another room __ not present = 0 NOTE: Some
__ inside __ outside __ emerging x 1 = __ localization skills may
__ in quiet __ noise __ in process x 2 = __ not be applicable
__ prompted __ spontaneous __ acquired x 3 = __ to children who are
Skill Score __ aided monaurally, who
searches for source of music have unilateral hearing
__ close (3’) __ far (10’) __ another room __ not present = 0 loss, or who have
__ inside __ outside __ emerging x 1 = __ monaural cochlear
__ in quiet __ noise __ in process x 2 = __ implants.
Skill Score __
searches for source of vocalizations
(e.g., exaggerated suprasegmentals)
__ close (3’) __ far (10’) __ another room __ not present = 0
__ inside __ outside __ emerging x 1 = __
Localizing Sound Source

Skill Score __
searches for source of discourse
(e.g., connected speech)
Skill Score __
localizes to loud environmental sounds
(vacuum, telephone) or noisemakers
(drum, bell)
__ one level __ multiple levels Skill Score __
localizes to music source

localizes to speaker making vocalizations
(e.g., exaggerated suprasegmentals)
localizes to speaker using discourse
Chapter 9


Categories Scoring
Observations &
Discriminates non-linguistic information:
loud vs soft sounds
__ close (3’) __ far (10’) __ not present = 0
__ in quiet __ noise __ emerging x 1 = __
__ closed set __ open set __ in process x 2 = __
Skill Score __
fast vs slow
Skill Score __
continuous vs abrupt
Skill Score __
Auditory Discrimination
high vs low pitch

Skill Score __
meaningful environmental sounds
Skill Score __
intent of utterance based on supra-segmental
features (e.g. angry voice vs happy voice)
Skill Score __
mom’s vs dad’s voice
Skill Score __
Discriminates oral utterances – non-true
word productions:
vowels:
Skill Score __
number of syllables:
Chapter 9

Skill Score __

Categories Scoring
Observations &
Discriminates communicative intent of
the utterance (e.g. statement, question,
exclamation):
Skill Score __
Discriminates oral utterances – true word
productions:
onomatopoeic sounds (e.g., ding-dong, moo,
choo-choo):
Skill Score __
child’s own name:
Auditory Discrimination

Skill Score __
familiar commands (e.g., stop, come here, wait):
Skill Score __
number of syllables or words in utterance
(one vs two vs three):
Skill Score __
familiar words based on vowel differences
(cat/cut, pat/pet, dig/dog):
Skill Score __
familiar words based on consonant
differences (cat/hat, dad/mad, bye/ my):
Skill Score __
familiar words based on syllable differences
(mommy/mom):
Skill Score __
Chapter 9

Categories Scoring
Observations &
Identifies single words:
points to body parts when named
Skill Score __
points to common objects or pictures when
named
Skill Score __
Identifies critical elements in short phrases:
Auditory Comprehension
Identifies picture or object with one critical

element (e.g., point to the car)
Skill Score __
Identifies picture or object with two critical
elements (e.g., point to the red car)
Skill Score __
Identifies picture or object with three critical
elements (e.g. point to the red car under the
table)
Skill Score __
Follows directions:
Follows simple one-step directions
Skill Score __
Follows two-step directions
Skill Score __
Chapter 9

354 Chapter 9
Categories Scoring
Observations &
Follows three-step directions
Auditory Comprehension
Skill Score
__
Identifies critical elements in short stories:
Responds to simple concrete questions about
story (e.g., who, what, when, where):
Skill Score __
Responds to complex abstract questions
about story (e.g., why, how)
Skill Score __
Category Score: ___/162 ___%
Memory: Recalls digits that are heard as
demonstrated by a response within moments
of the stimulus.
Check mode used:
Short-term Auditory Memory
spoken response
signed response, with or without speech
pointing to picture or object
action demonstrating understanding (writing,
securing object)
1–2 digits
__ with visual clues __ auditory only __ not present = 0
Skill Score __
3–4 digits
Skill Score __
5–6 digits
Skill Score __
Using numerals may not be developmentally
appropriate for very young children. Auditory Category Score: ___/54 _____%
memory may also be assessed by imitating a series of
Chapter 9
syllable patterns (e.g. oo / ah) or animal sounds. (e.g.,

moo / baaa / quack / ruff )

Categories Scoring
Observations &
Linguistic Auditory Processing: Higher level
auditory skills demonstrating the child’s
ability to process linguistic information.
Note: Simultaneous activity refers to processing
auditory information while engaged in another activity,
(e.g., listening while taking notes, listening while
coloring), while single activity refers to processing only
one event (e.g., the auditory information).
Sequencing: Produces correct sequential order of
the auditory linguistic stimuli heard.
Check type of auditory stimuli used and indicate # of
critical elements for each:
digits/word (examples: child repeats, orders
pictures, points) __ 2 __ 3 __ 4 __ 5
Linguistic Auditory Processing
short phrases (example: go to store - buy bread -

walk home – make sandwich) __ 2 __ 3 __ 4 __ 5
sentences (example: It is snowing outside. Get
your coat from the closet. Let’s go outside. Let’s
build a snowman. __ 2 __ 3 __ 4 __ 5
Check mode used:
spoken response
signed response with speech
signed response without speech
pointing to picture, object, digit or word
securing object)
__ familiar vocabulary __ unfamiliar vocabulary __ acquired x 3 = __
__ single activity __ simultaneous activities Skill Score __
Closure: Demonstrates understanding of a whole
word, phrase, or sentence when part is missing.
Check type of auditory stimuli used:
Phrases
examples: Thin sharp ______ (pencil, knife).
Big round _______ (ball, sun).
Sentences
example: I went to buy bread at the _______
(store, market).
Check mode used:
spoken response
pointing to picture, object, or word
securing object)
Chapter 9


356 Chapter 9
Categories Scoring
Observations &
Syntactic and Morphologic Analysis: Integrates
rules of syntax when auditory information is
presented and applies rules of expressive language
correctly.
Auditory stimuli: sentences
Examples:
■■ The boy plays outside. (familiar vocabulary)
■■ The boy played outside.
■■ The boy is playing outside.
■■ He anticipates the school bus coming.
(unfamiliar vocabulary)
■■ He anticipated the school bus coming.
■■ He was anticipating the school bus coming.
Check mode used:

spoken response
pointing to picture or word
securing object)
Suprasegmental Analysis using Auditory

Feedback: Corrects the rhythm, stress, and
intonation patterns of speech using auditory feedback.
Check type of auditory stimuli used:
words
example: tel e phone vs tel e phone
phrases
example: Who are you?
Who are you?
Who are you?
sentences
example I don’t know where it is!
I don’t know where it is!
I don’t know where it is!
Check mode used:
spoken response
pointing to picture or word
securing object)
Chapter 9


Categories Scoring
Observations &
Application of Auditory Information: Child
understands and utilizes auditory information and his/
her general knowledge of language to derive meaning
in a variety of situations.
auditory conversations (e.g., actively participates

in auditory conversation)
Check mode used:
spoken response

securing or manipulating object)
__ familiar vocabulary __ unfamiliar vocabulary __ in process x 2 = __
__ single activity __ simultaneous activities __ acquired x 3 = __
Skill Score __
electronic or recorded sound sources
(e.g., understands messages from tape recorders,
intercoms, message recorders, VCRs, film projectors)
Check mode used:
spoken response
manipulates picture or object
securing object)
Skill Score __
phone conversations (e.g., conducts telephone
conversations)
Check mode used:
spoken response
securing object)
__ familiar vocabulary __ unfamiliar vocabulary __ emerging x 1 = __
__ single activity __ simultaneous activities __ in process x 2 = __
Skill Score __
Chapter 9

358 Chapter 9
Categories Scoring
Observations &
academic content (understands information in
classroom setting)
Check mode used:
spoken response
securing object)
Skill Score __
directions (listens for details utilizing memory and
sequencing skills)
Check mode used:
spoken response
securing object)
Skill Score __
Note. © A. Stredler-Brown & C. D. Johnson (revised July 2010). Available from: www.arlenestredlerbrown.com; pdf fillable form at
Chapter 9
https://www.phonakpro.com/content/dam/phonakpro/gc_hq/en/resources/counseling_tools/documents/child_hearing_assessment
_functional_auditory_performance_indicators_fapi_2017.pdf

Language and communication
American Sign Language (ASL) Listening and spoken language Listening and spoken language Cued speech Simultaneous communication
(Visual) (Auditory-verbal) (Auditory oral) (Combined visual and auditory) (Combined visual and auditory)
Definitions • ASL is a natural, visual/manual language • An approach that emphasizes spoken • An approach that teaches a child to use his/ • An auditory-visual communication • An educational philosophy that uses spoken
totally accessible to children who are deaf, language development through listening. her remaining hearing through approach combining a system of hand cues language and sign language simultaneously.
that has its own grammar and linguistic • Child develops spoken language through amplification and the use of with the natural mouth movements of • Uses an English-based sign language
principles. one-on-one therapy and use of residual speechreading/natural gestures/visual signals speech, specifying each sound (phoneme) of system, which can include speech, speech-
APPENDIX
• The acquisition of English is addressed hearing with optimal amplification. to aid the child’s understanding of language. spoken language clearly. reading, fingerspelling, natural gestures and
through the use of teaching strategies for • Strives to make the most of a child’s • A hand shape (consonant groups) at a the use of residual hearing.
English as a Second Language. ability to learn through listening; location (vowel groups) cues a
therefore, the child does not rely on visual syllable. This integration provides clear
signals. access to all the phonemes (sounds) as
parents coo, babble and talk.
Primary goals • To acquire an age-appropriate internal • To develop spoken language through • To develop spoken language through • To provide clear communication in the • To provide a bridge to the development of
language as a basis for learning a second listening by following the stages and listening and visual signals. spoken language of the home. spoken language in the very young child.
language and opportunities for academic sequence of typical development. • To develop spoken language and • To develop the phonemic language base to • To provide communication between the
9–J
achievement. • To develop the skills necessary for communication skills necessary for school achieve full literacy in conversation, child and his/her family, teachers and peers
• To develop a positive self-image and successful mainstreaming in school and success and integration into the hearing reading and writing. using sign language.
cultural identity providing access to the Deaf integration into the hearing community community. • To support speechreading, speech and • To support integration into both the
community. • To promote a positive self-image through auditory skill development. hearing and the Deaf communities.
• To provide a basis for learning written and, natural family and social interactions using
when possible, spoken English as a spoken language.
second language.
Language The child develops early language • The child develops understanding of spoken The child develops internal language through • The child absorbs language through early, The child develops language through
concepts as well as higher order language through early and consistent early, consistent listening consistent, clear communication using Cued speechreading, listening and exposure to
development cognitive skills by utilizing the visual nature intervention that emphasizes learning experiences and developmentally Speech, speechreading and hearing. a combination of speech and sign-based
(receptive) of ASL. through listening in a developmentally appropriate therapy, which includes speech- • Cueing boosts auditory awareness, systems in English order.
appropriate sequence. reading and the use of hearing technology. discrimination and understanding.
• Optimal listening opportunities require the
use of appropriate hearing
technology.
Expressive • ASL fluency and written English. Spoken and written English Spoken and written English Cued, spoken and written English or other Spoken English using sign language in English
• Ability to code switch from ASL to English languages (60+ cued languages) word order, and written English
language (signed, spoken or written as needed).
Hearing • Encourages individual decision about • Early, consistent and appropriate use of • Early, consistent and appropriate use of • Early, consistent and appropriate use of • Consistent and appropriate use of
amplification. hearing technology (hearing aid(s), hearing technology (hearing aid(s), hearing technology (hearing aid(s), hearing technology (hearing aid(s),
(audition) • Amplification may provide access to cochlear implant(s), bone-conduction cochlear implant(s), bone-conduction cochlear implant(s), bone-conduction cochlear implant(s), bone-conduction
spoken language and allow the child more implant(s), hearing assistive technology implant(s), hearing assistive technology implant(s), hearing assistive technology implant(s), hearing assistive technology
opportunity to become bilingual. system) is important with this approach. system) is important with this approach. system) is important with this approach. system) is strongly encouraged.
• Requires ongoing auditory management. • Requires ongoing auditory management. • Requires ongoing auditory management. • Requires ongoing auditory management.
Family • Parents are committed to learning and • Parents are expected to participate as • Families are expected to provide • Parents are expected to learn to • Families are expected to learn and
using ASL consistently. partners in sessions with therapist(s) to learn appropriate carry-over of goals, strategies speak-and-cue at all times in order for consistently use the chosen
responsibilities • Families emphasize literacy in the home. strategies and techniques that promote the and techniques from the child’s classroom children to absorb the phonemes English-based sign language system.
and guidance • Families provide opportunities for auditory learning of goals. setting and/or individual therapy sessions critical to language and reading • Parents need to work with the child’s
interaction with the Deaf community to help • Families need to carry over the goals into daily routines and play activities. readiness. teacher(s) and/or therapist(s) to learn
ensure a future independent and fulfilled established in therapy into the child’s daily • Parents need to work with the child’s • Families need to provide consistent use of strategies that promote language
Deaf citizen. routines and play activities. teacher(s) and/or therapist(s) to learn cues and speech during daily routines and expansion.
• ASL is learned through classes, media, • Parents learn to create an optimal strategies and techniques for developing play activities.
websites, and interaction with members of “listening” learning environment. listening, speechreading and speaking skills in • The system is taught in less than 20 hours.
the Deaf community. • Parents must provide a language-rich an oral learning environment. Consistent daily use and practice leads to
environment, to make learning through conversational ease within a year.
listening a meaningful part of all experiences.
Copyright © 2016 BEGINNINGS for Parents of Children Who are Deaf or Hard of Hearing, Inc. All rights reserved.
359
Note. Copyright 2016 BEGINNINGS for Parents of Children Who Are Deaf or Hard of Hearing, Inc.
2/25/2020 4:34:43 AM
Chapter 9
APPENDIX 9–K
Early Auditory Skill Development for Special Populations
Stage 1. Sound awareness and early attending; beginning to cooking, water running, voices, animal sounds, repeti-
relate to sound as meaningful event tive songs used in the classroom, door slam, car keys)
■■ Begins to respond to routine words plus gestures (bye-
■■ Overt response to intense sound (startle, diminished ac-
bye, all gone, pat-a-cake)
tivity, vocalization, eye widening or eye blinking)
■■ Overt response to softer sounds (see #1) Note: Child’s cognitive, motor, and visual development is criti-
■■ Overt response to caregiver’s voice cal in this stage, as well as hearing acuity and whether or not the
■■ Eye contact with caregiver or other person making sound child uses amplification. Accurate localization requires good
head control; students who have motor development chal-
Note: Child may habituate if sound stimuli occur frequently
lenges will require firm support to develop this skill. If vision
or if the environment contains competing noise. Reinforce
is severely compromised, multisensory stimulation and rein-
any potential response with touch by the caregiver or other
forcement will be required. Beginning use of co-active gestures
participant, unless child exhibits tactile defensiveness.
should be considered for these students. Knowledge of hearing
status is critical to select appropriate loudness and distance for
Stage 2. Beginning localization; early sound recognition;
auditory signals. Always check for auditory awareness before
beginning deliberate vocalization
working on localization or auditory tracking activities.
■■ Attempts to maintain eye contact with moving caregiver
■■ Begins to search for sound by looking or reaching Stage 4. Increased sound/speech comprehension; improved
■■ Smiling to caregiver’s voice control of vocalizations as communication
■■ Increased vocalizations during dressing, being held, or
■■ Understands familiar phrases, such as no-no, bye-bye,
with diaper change
all gone
■■ Different body responses to varying emotional tone of
■■ Responds to name by turning, smiling, reaching, vocal-
voice (happy, sad, angry)
izing, in different fashion than to any other name
■■ Beginning vocal play (vocalization increases to care-
■■ Initiates and participates in imitative vocal play (at-
giver’s voice)
tempts to change vocalization when stimulated by dif-
■■ Vocalizes to objects
ferent vocal pattern)
■■ Vocalizes to singing or music
■■ Vocalizations are beginning to sound like words or
Note: This stage requires some awareness of cause and ef- meaningful units
fect. Reinforce responses immediately, whenever possible. ■■ More consistent use of appropriate inflectional patterns
(pitch, loudness, and duration) for questions, demands,
Stage 3. Accurate localization and tracking; meaningful comments, confusion, scolding toys, etc.
sound recognition; deliberate vocalization ■■ Uses consistent vocal approximations of names for
caregivers or other meaningful individuals (ma-ma, da-
■■ Manipulates sound maker purposefully to make sound
da, na-na)
■■ Attends to and follows voice for longer periods of time
■■ Purposeful play with more complex sound-making toys
■■ Vocalizes to persuade caregiver to continue play time or
(pushes button, squeezes toys)
pleasurable attention
■■ Shakes head for no
■■ Searching behavior for any change in sound within im-
■■ Increasingly attentive to speakers for longer periods of
mediate environment
time
■■ Different vocalizations to indicate pleasure and
■■ “Dances” to music
displeasure
■■ “Calls” to caregiver to indicate basic needs (wet, hun- Note: Child’s fine and gross motor skills affect responses
gry, desire for physical contact) during this stage. If mobility is compromised, adult should
■■ Unfamiliar sounds are unsettling attempt to substitute an appropriate response, such as push-
■■ Beginning to initiate and maintain repetitive sound ac- ing a button to make a doll dance whenever the music begins.
tivities (clapping, hand-waving, banging toys, primitive Use of switches for students with motor involvement may
Chapter 9
vocal play) assist in assessment and teaching of auditory comprehension

■■ Begins to anticipate daily activities and familiar per- tasks. Oral-motor difficulties can interfere with performance
sons from auditory cues (different response to sounds of of imitative speech tasks, and alternative or augmentative
360

communication systems may need to be considered at this ■■ Lets speaker know when message is not understood
stage. Participation in turn-taking activities should be mas- (primitive requests for clarification)
tered during this stage. ■■ Talks about objects that are not in sight by name
■■ Recognizes names of family members, classmates, and
Stage 5. Early auditory comprehension; meaningful use of a few body parts
listening and spoken language; ability to initiate and main- ■■ Child can attend to primary signals (teacher, peers)
tain conversations when other noise is in the background
■■ Follows simple one-step directions without gestures Note: The child’s progress during this stage will depend on
■■ Expressive vocabulary increases cognitive development and oral-motor function. Beyond this
■■ Uses clusters of speech that sound like sentences, accom- stage, progress in auditory comprehension can be measured
panied by gestures, interspersed with intelligible words using appropriate receptive language scales.
Chapter 9

APPENDIX 9–L
Auditory Response Data Sheet
Student Name: School: Class:

Teacher(s): Observer(s):
Distance/
Observed Conditions Amplification
Behavior Stimulus (quiet versus noise) (yes/no) Date
No response
Cessation of
activity
Quieting
Jerk/startle
(extension)
Jerk/startle
(flexion)
Increased
activity
Vocalization
Cry
Laugh
Smile
Frown
Eye blink
Eye widening
Eye localization
Head turning
Body localization
Reaching
Chapter 9
Note. Copyright © 2000 Singular Thomson Learning.
362

CHAPTER 10
Supporting Wellness
and Social-Emotional
Competence
Chapter 10
With Carrie Spangler
CONTENTS
A Wellness Perspective
Social-Emotional Development ■ Bullying and Victimization
Skills and Strategies for Students to Address Wellness and Social Competence
Self-Determination Skills ■ Self-Advocacy Skills
Counseling Strategies
Reflective Listening ■ Self-Assessment ■ Extending Conversations and Coaching
Self-portrait.
363

364 Chapter 10
Networking for Students

Peer Mentors and Role Models
Referring for Additional Services
Summary
Suggested Reading
Appendices
Chapter 10
10–A Self-Determined Learning Model of Instruction (Text/Online)

10–B Resources for Social-Emotional Development and Social Competence (Text)
10–C Student Accommodations Notification Templates (Text/Online)
10–D Hearing Notification Card (Online)
10–E Audiology Self-Advocacy Checklists (Teacher Forms) and “I Can” Self-Advocacy Checklist (Student
Form) (Text/Online)
10–F Overview of Ida Counseling Tools for Children, Youth, and Young Adults (Text)
10–G Ten Tools for Developing Self-Efficacy With Hearing Loss (Text/Online)
10–H Guide to Setting Up Student Support Groups (Text/Online)
KEY TERMS students can result in greater acceptance and management

of related communication difficulties, as well as an im-
Counseling, identity, mentoring, resiliency, role model, self- proved self-concept, self-determination, and self-advocacy
advocacy, self-confidence, self-determination, self-determined skills, important for long-term outcomes supported by this
learning model of instruction, self-esteem, social compe- investment. Furthermore, the Individuals with Disabilities
tence, social-motional learning, World Health Organization, Education Act (IDEA) includes counseling and guidance of
wellness/well-being pupils within the definition of audiology,1 requiring that we
consider and support student needs and services in this area.
This chapter reviews basic components of wellness
KEY POINTS that are particularly relevant for deaf and hard of hearing
students, discusses skills needed by students for developing
■■ Well-being is paramount to student success in school. social competence, including self-determination and self-
■■ Social competence is primarily learned from experience. advocacy, and counseling strategies that are useful when
■■ Peer and adult role models influence the development assisting students with these skills. Additional information
of identity. on counseling can be found in Chapter 3, Partnering With
■■ Self-determination skills increase the probability of Families, and Chapter 13, Supporting the Educational Team.
greater school success and postschool outcomes. This chapter addresses the following questions:
■■ Effective use of coaching strategies leads to greater self-
■■ What components of wellness are most critical for deaf
determination abilities in students.
and hard of hearing children?
In recent years, a growing emphasis on wellness for ■■ How does a wellness approach impact social-emotional
all students bringing together health, academics, and social- development of deaf and hard of hearing students?
emotional well-being has emerged as part of whole-child ■■ What skills are critical to the development of social
education initiatives. Social-emotional learning programs competence in deaf and hard of hearing students?
have increased attention to social-emotional competence ■■ What roles do self-determination and self-advocacy
of deaf and hard of hearing students and resulted in more play in social competence?
counseling resources to support our work with students and ■■ What is the purpose and role of deaf and hard of hearing
families. Educational audiologists may feel limited by time role models and mentors?
constraints, familiarity with resources, and personal confi-
dence in their efforts to counsel students who are deaf or
hard of hearing. However, the additional time spent with 1
34 C.F.R. §300.34(C)1(v).
364

Supporting Wellness and Social-Emotional Competence 365
■■ What strategies can facilitate effective counseling with

students who are deaf or hard of hearing?
■■ When is a referral for professional counseling appropri- Our challenge as educational audiologists is to bal-
ate and necessary? ance this desire for typicality with providing the
support and accommodations the students need
to be accepted and valued and to fully participate
academically and socially with their peers, in the
A WELLNESS PERSPECTIVE classroom, and in extracurricular activities.
Many, maybe most, deaf and hard of hearing students simply
want to be treated as “normal”; generally, that means, like
their peers. For deaf students attending a school for the deaf,
Chapter 10
their “normal” is a school environment where full and di-
rect communication access with peers and teachers is always nents of wellness that are discussed in this chapter because
present. For deaf and hard of hearing students attending of their significance in the overall development of children
schools in mainstream or inclusive settings, their “normal” who are deaf or hard of hearing.
may be a classroom with hearing peers where access to com- Well-being may be conceptualized differently by each
munication and learning is challenging. Depending on the person. Fattore, Mason, and Watson (2006) found that chil-
setting, they may have some peers who are also deaf or hard dren defined well-being as feeling good about one’s self, the
of hearing, or they have the “solitary” experience of being absence of psychological distress, the presence of positive
the only one in their school. When students feel excluded, affective states (e.g., happiness and contentment), and inte-
low self-esteem, marginalization, and isolation may occur grating sadness with happiness. Another study found that
(Visual Language and Visual Learning Science of Learning children valued relationships with family, friends, and pets
Center, 2016). Hearing status is a difference but not always as an important component of well-being (Sixsmith, Nic
a paramount identity consideration to many students. Gabhainn, Fleming, & O’Higgins (2007).
When the educational audiologist’s desire is to support WHO’s International Classification of Functioning,
students in a normalization perspective, wellness is a key Disability and Health (ICF) (2002) promotes well-being
area that impacts all aspects of a person’s development, re- rather than deficits and differences instead of disabilities
gardless of hearing level. Mental health, as a component (Figure 10–2). The biopsychosocial model illustrated in
of wellness, was defined by the World Health Organization Figure 10–3 integrates medical and social domains in three
(WHO) as, “a state of well-being in which the individual levels of human functioning: the body or body part (Bio),
realizes his or her own potential, can cope with the normal the whole person (Psych), and the whole person in a social
stresses of life, can work productively and fruitfully, and is context (Social). Disability involves a dysfunction in one or
able to make a contribution to her or his community (World more of these levels resulting in impairments, activity limita-
Health Organization, 2018). Figure 10–1 illustrates compo- tions, and/or participation restrictions. The biopsychosocial
FIGURE 10–1 Wellness unpacked.

366 Chapter 10
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FIGURE 10–2 World Health Organization International Classification of Functioning, Disability and Health (ICF, 2002, pp. 10–11).
model represents disability as synthesizing the status of the ■■ balance: ability to balance time spent socially with time
individual’s medical, social, and psychological domains. En- spent alone, balance between work and play, balance
vironmental accommodations are essential for inclusion of between sleep and wakefulness, balance between rest
people with disabilities. and exercise, and even balance between time spent in-
Holmes (2019) identified the following characteristics doors and time spent outdoors;
of positive mental health: ■■ flexibility: ability to experience a range of emotions and
allow themselves to express these feelings, ability to be
■■ ability to enjoy life: living in the present, ability to plan flexible to revise expectations; and
for the future and learn from the past; ■■ self-actualization: ability to recognize our gifts and ac-
■■ resilience: ability to bounce back from adversity; tualize their potential.

Chapter 10
FIGURE 10–3 Biopsychosocial model of functioning. © Violette Hong MD, used with permission.
These characteristics should be explored as part of each The Collaborative for Academic, Social, and Emotional
student’s development and life-experience. ensuring there are Learning (CASEL, https://casel.org) identified Social-
opportunities to discuss and understand their impact on over- Emotional Learning (SEL) competency clusters as shown
all wellness and mental health function. Social-emotional in Figure 10–4. These five clusters, self-awareness, self-
development is a critical underpinning of wellness. management, social awareness, relationship skills, and re-
sponsible decision-making, address the general behaviors of
understanding ourselves, working with others, and making
good decisions. Hearing status and communication access
Social-Emotional Development can significantly impact each of these clusters leading to
Social-emotional development is a broad area that includes children and youth who are more vulnerable to victimiza-
a variety of constructs that affect how a person functions tion due to socially awkward behaviors. For example, rela-
within his or her environment. Lytle and Oliva (2016) iden- tionship skills may be impacted by social communication
tified the following key findings regarding social emotional (e.g., appropriate rules for greetings, exiting conversations,
development in deaf and hard of hearing children: expressing gratitude, getting attention) and social cognitive
■■ Social-emotional development promotes language skills, skills (e.g., perceiving and interpreting situations, deter-
and language skills in turn support social-emotional mining how to initiate conversation and how to respond in
development. conversation, inserting relevant content, and other executive
■■ Direct communication with numerous adults and peers function skills). The following components of social-emotional
is important to learning and social-emotional development. development are discussed due to their specific importance
■■ Deaf and hard of hearing children show gains in self- to the well-being of deaf and hard of hearing children.
esteem and self-confidence when they have friends who
are also deaf or hard of hearing. Identity
■■ After-school, weekend, and summer programs with Within the wellness model, children and youth need to
deaf and hard of hearing peers are excellent means for develop an understanding of their identities and how their
developing friendships and a feeling of belonging. identities intersect with their hearing status. Identity has
■■ Deaf and hard of hearing children are empowered when many layers including culture, race, gender, economic sta-
they are considered part of the overall diversity among tus, sexual orientation, and additional disabilities. Identity
students in a school. evolves from birth and is influenced by how children are

368 Chapter 10
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FIGURE 10–4 Components of social-emotional learning (https://casel.org). (Used with permission.)
nurtured, accepted, and supported in their family structure, hard of hearing peers and adults is a key component as stu-
community, and school environment. As indicated in the Self- dents work through identity development.
Awareness SEL cluster, students should recognize their emo-
tions and values as well as their strengths and challenges.
Understanding hearing level differences between Deaf Self-Esteem and Self-Confidence
(usually meaning culturally deaf), deaf (a functional status Cherry (2019) describes self-esteem as “a sense of self-
that may vary depending on the situation or context), and worth or personal value . . . in other words, how much you
hard of hearing (neither deaf nor hearing) are important dis- appreciate and like yourself.” The American Psychological
cussions as students understand their own hearing status and Association (APA) Dictionary of Psychology defines self-
use of hearing technology, where they feel most comfort- confidence as an individual’s “belief or assurance in one-
able, and how to navigate within and between these groups. self, trusting one’s abilities, judgements, or decisions, either
If there is reluctance, or students are unable to describe the in general or in relation to a specific situation or activity”
features of their identity, they will need assistance and often (https://dictionary.apa.org/self-confidence). These similar
professional counseling to move forward. Access to deaf and constructs build on one another to address overall self-worth
and confidence in one’s abilities and evolve as a result of
positive experiences over time. Those experiences include
feeling love and value, acceptance, inclusion, and positive
Questions to Address for Identity Development reinforcement of actions. These experiences are reinforced
Who am I? through language and communication access. A key find-
Who do I want to be? ing in a Quality of Life study of deaf and hard of hearing
How does my hearing status affect me? children’s perceptions of communication with their parents
found significant correlation between higher perceptions of
their ability to understand their parents’ communication and

TABLE 10–1 Self-Esteem
Signs of Healthy Self-Esteem Signs of Low Self-Esteem

You probably have a good sense of who you are if you exhibit You may need to work on how you perceive yourself if you
the following signs: exhibit any of these signs of poor self-esteem:
■■ Confidence ■■ Negative outlook
■■ Ability to say no ■■ Lack of confidence
■■ Positive outlook ■■ Inability to express your needs
■■ Ability to see overall strengths and weaknesses and accept ■■ Focus on your weaknesses
them ■■ Feelings of shame, depression, or anxiety
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■■ Negative experiences do not impact overall perspective ■■ Belief that others are better than you
■■ Ability to express your needs ■■ Trouble accepting positive feedback
■■ Fear of failure
Note. From Cherry (2019).
perceived quality of life as well as lower reported depressive ■■ Autonomy: Resilient children know who they are, know
symptoms and lower perceived stigma (Kushalnager et al., they can act independently, and feel a sense of control
2011). Signs of healthy and low self-esteem are shown in over their situations/environments.
Table 10–1 (Cherry, 2019). ■■ Sense of Purpose and Future: Resilient children have
the ability to plan and set goals. They are typically op-
Resiliency timistic in the way they view the world.
Resiliency is the process of adaptation when exposed to ad-
verse conditions (Ungar, 2015). Resiliency is influenced by Social Competence
an individual’s ability to cope as well as the school or home’s Social skills and social relationships are key components of
capacity to help students cope in appropriate ways. Within social competence in the development of deaf and hard of
the SEL clusters, resiliency may be a component of rela- hearing children. Antia and Kreimeyer (2015) describe so-
tionships skills that address forming positive relationships, cial skills as “mutually dependent on one another . . . needed
working in teams, and dealing effectively with conflict. in order to develop social relationships and it is within the
In their research with children with speech and lan- context of social relationships that children develop social
guage disorders, Lyons and Roulstone (2018) identified po- skills” (p. 2). Social competence develops over time and
tential risk and protective factors to well-being within the is shaped from parenting and life experience. Social skills
categories of negative and positive feelings. These factors and social relationships are learned “in situ” and cannot be
are summarized in Table 10–2. Bernard (1991) identified the learned solely by breaking them “into components that are
following traits for fostering resilience in children: taught separately and sequentially.” However, educational
audiologists can support social competence by providing
■■ Social Competence: Resilient children respond to others
opportunities for students to reflect on their social interac-
and elicit responses from others easily. They are active,
tions by discussing and analyzing what worked, what did
both physically and socially, show signs of being flex-
not work, and what might work better in their social experi-
ible (even in infancy), and adapt well to change. Quite
ences. Figure 10–5 illustrates the components of communi-
often, resilient children have a great sense of humor and
cation and cognitive skills that impact social relationships.
can laugh at life’s situations and themselves.
Inappropriate conversational behaviors, language use, and
■■ Problem-Solving Skills: Resilient children are able to
communication strategies often cause deaf and hard of hear-
think through challenging situations and follow through
ing children to appear awkward, which can lead to a feel-
on finding a solution.
ing of marginalization, and have a spiraling impact on self-
esteem and confidence. Behaviors of resilience—that is,
hope, agency, and positive relationships—may help them
From a student: “I knew that I have to always climb recover and move forward.
up the stairs to reach the same platform as my Self-determination and the ability to have autonomy
classmates, so I better be stronger and start earlier. with one’s life influences agency2, as well as responsible
My classmates may do things easily, but I can do it
better. ”
2
In this context, agency refers to an action or intervention that produces a
particular effect (Google dictionary).

370 Chapter 10
TABLE 10–2 Risk and Protective Factors in Children With Speech and Language Disorders
Risk Factors for Negative Feelings Protective Factors for Positive Feelings
■■ Communication impairment and disability ■■ Hope
■■ Difficulties with relationships ■■ Agency
■■ Concerns about academic achievement ■■ Positive relationships
Note. From Bernard (1991).

Chapter 10
FIGURE 10–5 Impact of social communication skills and social cognitive skills on social relationships and friendships.
decision making. Self-determination is discussed as a tool ple, cyber-bullying may promote moral disengagement
under skills and strategies. because there is no immediate visual response from the
person being bullied.
Bullying and Victimization Bullying can be preventable, even for our most vulner-
able children and youth, including those who are deaf or
Social cognitive theory, promoted by Bandura (1986), refers
hard of hearing. Bullying and cyberbullying occur in dif-
to how individuals learn through social experiences, particu-
ferent forms—physical, verbal, emotional, or social—and
larly observation of other people and their social interac-
the behavior can be aggressive or subtle. When bullying is
tions, in person as well as through media. Behavior is medi-
directed at a child because of his or her disability, it can re-
ated by what is observed in relation to previous knowledge
sult in a hostile school environment. When bullying of this
and experience. Bauman and Pero (2010) described two
nature occurs, it may be considered “disability harassment”
concepts from social cognitive theory that they associated
under Section 504 of the Rehabilitation Act of 1973 and
with bullying:
Title II of the Americans with Disabilities Act (ADA) of
■■ self-blaming attributions where victims tend to blame 1990 as well as a denial of free and appropriate public edu-
their own deficits (i.e., hearing status) rather than the cation (FAPE) under IDEA. Federal law requires schools
perpetrator, and therefore may feel powerless to stop to address the harassment (https://www.stopbullying.gov).
the behavior; and Warner-Czyz, Loy, Pourchot, White, and Cokely (2018a)
■■ moral disengagement in which individuals can turn off found that children with hearing loss were at an increased risk
their own internal moral controls to justify behavior that of victimization because of being different. They found 50%
would normally conflict with those standards; for exam- of adolescents with hearing loss endured bullying compared

to 28% in the general population, with feelings of exclusion themselves and potentially more equipped to be confident
and coercion being the highest. Factors influencing their vic- in their identity in vulnerable situations.
timization included use of auditory technology (e.g., hearing Several models have been developed to teach self-
aids or cochlear implants), communication difficulties, and determination. One example is the Self-Determined Learn-
immature social skills. Warner-Czyz (2018b) recommended ing Model of Instruction (SDLMI) (Wehmeyer, Palmer,
frequent, open communication between parents and teens to Agran, Mithaug, & Martin, 2000). In this model, teachers
build awareness of the warning signs of bullying and all of (educational audiologists) guide students through three dis-
its manifestations. Hearing health care professionals should tinct phases: (a) goal setting, (b) taking action, and (c) ad-
incorporate routine questioning for bullying in their proto- justing the goal. Promoting self-determination requires the
cols (see suggested dialogue later in this chapter), address educational audiologist to structure opportunities for deaf
peer victimization on Individualized Education Programs and hard of hearing students to take risks and learn from the
Chapter 10
(IEPs) or Section 504 plans, and refer families to appropri- outcomes of those risks. Therefore, the student becomes an
ate counseling when necessary to address family dynamics active participant in the process by selecting goals, actions,
(Warner-Czyz, 2018b). and adjustments that are meaningful to him or her. Even
broad goals, such as making new friends, improving grades,
or going to college, have a component of communication
access that can capably be supported. Each phase of the plan
should be implemented in a manner that provides adequate
SKILLS AND STRATEGIES FOR time for students to thoroughly think through and imple-
STUDENTS TO ADDRESS WELLNESS ment the activities of the goal areas. The educational audi-
AND SOCIAL COMPETENCE ologist provides guidance in evaluating and adjusting the
choices, actions, and opportunities to attain success. An
Educational audiologists have unique and defined roles to example of a self-determined learning plan is illustrated
assist students who are deaf or hard of hearing develop strat- in Table 10–3. The detailed SDLMI is outlined in Appen
egies and skills to be confident in who they are within their dix 10–A. Strategies audiologists can use for promoting self-
world. Figure 10–6 illustrates a developmental perspective determination with parents, children, and youth are sum-
of suggested skills that can form the basis for audiology marized in Table 10–4.
instruction and support. Although there is much focus on
self-advocacy skill development and expectations for stu-
dents to successfully apply those skills, students first need Self-Advocacy Skills
to understand the value of the behaviors they are being asked An active step in overcoming communication barriers faced
to advocate for and be motivated to use them. by deaf and hard of hearing students is the development
of self-advocacy skills. Wrightslaw defines self-advocacy
as “the ability to understand and effectively communicate
Self-Determination Skills one’s needs to other individuals” (https://www.wrightslaw
Self-determination has gained interest as a skill to motivate .com/info/sec504.selfadvo.nancy.james.htm). Martin, Huber-
individuals to improve control and self-regulation of their Marshall, and Maxcon (1993) expanded the definition: “the
behavior and is a prerequisite to self-advocacy. One of the realization of strengths and weaknesses, the ability to formu-
building blocks of successful self-determination is having late personal goals, being assertive and making decisions.”
a trusting relationship with the person the student is work- These skills can be taught from an early age, such as increas-
ing with. Referring to the critical components of the whole ing responsibility for hearing aids through self-advocating
person, there are building blocks that educational audiolo- for communication access and rights in the work and col-
gists can foster in our students. According to the National legial setting. For many deaf and hard of hearing students,
Center on Secondary Education and Transition (n.d.), “self- knowledge and skills need to be taught.
determination is the drive to determine our own thoughts, Awareness of the parameters of communication en-
feelings, behaviors, and choices over life events.” Self- vironments and various communication difficulties is an
determination includes internal motivation and self-awareness important component in the development of self-advocacy
to define personal goals based on own interests, preferences, skills. Instruments such as those in Appendix 10–B, Re-
values, and goals (http://www.ncset.org/topics/sdmhs/de sources for Social-Emotional Development and Social
fault.asp?topic=30). Self-determination theory describes Competence, include sections for the student’s assessment
three basic human needs: autonomy, competence, and re- of his or her own performance in a variety of communica-
latedness/connection (Deci & Ryan, 2008). Simply, self- tion situations. Each of these inventories can help facilitate
determination is knowing and doing what is best for your- a student’s awareness of environmental and communication
self. Children and youth who have these self-determination barriers. Once the student is aware of any communication
skills are more likely to be successful advocates for difficulties related to his or her hearing status, the student

372 Chapter 10
Health/Medical skills Hearing Technology & Use skills Educational Services/Communication Access
Foundation Discovery Exploration Co-Empowerment Personal

/ Support 6-9 yrs 9-12 yrs 14-18 yrs Responsibility
3-6 yrs 18+ yrs
Describes basic treatments and accommodations
Describes basic concepts of
for hearing impairment (e.g., surgery, hearing Provides detailed description of own hearing status (type, level, configuration,
hearing (how we hear/how the
aids, cochlear implants, sign language, hearing cause, implications for communication).
ear and balance systems work).
protection).
Describes some basic causes of hearing impairment (e.g., born with it, acquired Develops, rehearses, and delivers a script for disclosing
from disease or illness, noise exposure). hearing status information and required accommodations
Identifies pertinent medical and health specialists, their credentials, supporting
Describes basic parameters of the audiogram (e.g., frequency, loudness, continuum
roles, and how to locate them (e.g., audiologist, hearing aid dealer, otologist,
Chapter 10
of audibility).
geneticist, mental health/counselor).
Describes basic communication characteristics
Understands and reports when amplification Uses resources (internet, phone book) to identify and access services and find
associated with various hearing levels including
devices are functioning (i.e. ON/OFF). information.
distinguishing deaf and hard of hearing.
Describes own hearing status (e.g., level and
Reports other malfunctions such as static, configuration, cause if known, identifies self as Identifies own medical/health support persons; schedules and keeps
interference, intermittency. person who is deaf, person who is hard of appointments.
hearing, person with hearing impairment).
Identifies the basic parts of
Describes basic communication implications of
personal hearing instruments
his/her hearing status (e.g., what is heard/ not Describes health-related privacy laws and appropriate methods for disclosing and
used (e.g., earmold,
heard, audibility vs intelligibility of speech, sharing of personal information.
microphone, speaker, battery
speechreading).
compartment).
Manages basic daily
maintenance of equipment Demonstrates ability to troubleshoot all personal and hearing assistance
(e.g., checking device function, Describes hearing loss prevention strategies. technology (HAT) and follows pre-determined procedures for getting devices
changing batteries, cleaning serviced.
earmolds, charging.
Uses a calendar to track and
Demonstrates connectivity of personal and assistive devices with other
report daily use and device Describes concepts of privacy and confidentiality.
technologies/equipment (e.g., phone, computer, video).
functioning.
Identifies the basic parts of hearing assistance technology (HAT) used (e.g., Demonstrates how to manipulate technology for various listening situations
transmitter vs receiver, attachment of audio shoes, charging). within school and in the community.
Describes characteristics of other assistive technologies such as phone,

Describes how HAT helps improve communication in different situations.
captioning, alerting devises, text messaging.
Demonstrates use of web and other sources to learn about and locate current
Transports equipment to and from various
and emerging information and resources regarding hearing loss and hearing and
classrooms and school environments.
other assistive technologies.
Understands and is able to notify teacher or Describes cost of purchasing and maintaining hearing aids/cochlear
talker when devices are not working properly. implants/HAT, warranty and service plans, and funding options.
Understands the flexibility of the devices (e.g.,
Asserts self with others (e.g., self-advocates, sets boundaries, voices complaints,
ability to connect to audio devices, computers,
states needs).
video, public address system).
Understands basic functioning of personal and
Consistently employs communication repair strategies (e.g., seeking clarification,
HAT devices (e.g., programming options,
repetition).
limitations of technology).
Utilizes the devices in various environments (e.g.,
lectures, small groups, individual conversations, Explains educational strengths and challenges.
pass around mics),
Actively participates in training of staff on use of
Identifies academic support needs.
devices.
Describes basic characteristics of successful
communication in the classroom (e.g., audibility, Formulates present levels of functioning for individual
visual access, sign language, cued speech, ease of education goals.
communication).
Identifies basic accommodations to address personal communication needs (e.g., Describes achievements and performance levels for
priority seating, sign language interpreter, captioning,). transition planning.
Describes and schedules needed accommodations to instructors, school activities,
Uses accommodations and communication strategies in the classroom. employers, and community events (e.g., personal profile and accommodations
letter).
Describes communication challenges and Negotiates alternative strategies/solutions when desired accommodations are
strategies that work. not provided or available.
Develops a personal profile and accommodations
letter that identifies needed accommodations Describes and differentiates pertinent education and accessibility laws as they
and presents at individual education and access relate to hearing loss and eligibility for services.
planning meetings.
Describes needed accommodations to instructors
Describes resources and services offered by local, state, and national
and tells them when they are not working or
organizations and agencies.
being implemented appropriately.
Recognizes when communication breaks down
Provides evidence of successfully submitted scholarships applications when
and uses communication repair strategies (e.g.,
pursing higher education or employment applications if pursuing employment.
seeks clarification, repetition).
Provides evidence of meeting with office of accessibility/student services to
Understands basic legal rights under education
identify available services for higher education or human resource office for
and disability rights laws.
employment.
FIGURE 10–6 Audiology and related wellness skills development chart. (Adapted from Audiology Self-Advocacy Checklist, C.D.
Johnson and C. Spangler.)

TABLE 10–3 Sample Self-Determined Learning Plan
Phase 1: Set a Goal

What do I want to learn? Being different. I want to know what I do that makes others want to
tease or bully me.
What do I know about it now? Sometimes my hearing aid makes funny sounds. I cannot understand
people talking when it gets noisy or when I can’t see their face.
What must change for me to learn what I don’t know? I need to be able to feel all right telling people about my hearing status.
What can I do to make this happen? I could explain to my classmates about my hearing status and let them
know how it affects how I communicate. I would need to write down
and then practice what to say first.
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Phase 2: Take Action
What can I learn from what I don’t know? Maybe if I talk about my problems first, the students will not tease me.
What could keep me from taking action? I don’t like talking about my hearing problems.
What can I do to remove these barriers? I will pick someone whom I feel comfortable being with and tell them
about my hearing difficulties. This will be the first step in giving me
confidence to tell someone I may not know.
When will I take action? Within the week.
Phase 3: Adjust Goal or Plan
What action have I taken? I explained my hearing problems and technology to a friend who sits
by me on the bus.
What barriers have been removed? My friend now understands why it is hard for me to hear on the bus
and that he needs to look at me. He also knows that he may need to
repeat if I don’t hear and understand what was said.
What has changed about what I don’t know? I learned that my friend has always been curious about my hearing aids
but did not want to ask me. He had some questions for me and now
feels more comfortable talking with me.
Do I know what I want to know? I want to continue to practice sharing my hearing loss so I feel
comfortable in different situations, especially when I might not know
the person well.
TABLE 10–4 Strategies for Audiologists to Promote Self-Determination
For Parents
1. Teach parents about the importance of healthy attachment/bonding and effective communication at home.
2. Support them through the feelings associated with grief.
3. Help them understand the impact hearing impairment has on communication—avoid misunderstanding communication difficulties.
4. Provide opportunities for mentoring—encourage relationships with deaf/hard of hearing adults and peers.
5. Discuss “overprotection.”
6. Encourage parents to involve their children in
setting goals,
evaluating options,
making choices, and
work on achieving goals.
For Children and Youth
General facilitators to self-determination:

■■ Include the child in positive conversations about their hearing loss.
■■ Monitor for “complicated” grief in caregivers.
■■ Support families in developing relationships with other families with children with hearing loss and with deaf/hard of hearing (D/HH)
adults and older children (i.e., Hands and Voices; AG Bell)
(Continues )

374 Chapter 10
For Children and Youth

Ages 3 to 6 Years
1. Model and promote effective communication strategies.
2. Explore the child’s perspective (e.g., “My World” https://idainstitute.com).
3. Talk to families about social and skill development.
4. Foster development of initiatives; provide opportunities for success, caring for equipment, and explaining test results.
5. Monitor child’s grief and develop plan with parent to help child resolve grief.
6. See child alone for some time for informational counseling and emotional reactions to diagnosis.
Chapter 10
7. Empower child to explain new skills/information to parent. (Audiologist coaches and gives feedback.)
8. Child practices stating communication needs, creating good listening/communication environments for themselves across settings.
9. Assess child’s experience with friends/friendships
Who are your good friends?
What makes them “good” friends?
Do you have enough friends?
10. Review accommodations for leisure activities.
11. Tools/Apps:
Rule the school (App)
Hearing aid tic-tac-toe (App)
Ages 6 to 11 Years
1. Assess child’s experience with friends/friendships
Who are your good friends?
What makes them “good” friends?
Do you have enough friends?
2. Review accommodations for sport activities.
3. Review easy access to alerting signals: alarm clock, smoke alarm, fire drill, doorbell, and telephone ringer.
4. Ensure that family information is accessible to all and available to child with hearing loss.
5. Establish a system for privacy in the home.
Ages 11 Years Into Teens

1. Provide informational counseling directly and primarily to teen for all topics (hearing loss, hearing aids, hearing assistance technology
options).
2. Encourage active participation in the Individualized Education Program process.
3. Interact with parent(s) as backup to teen and as the secondary consumer.
Have teenager make appointment, explain degree/impact of hearing loss, call if equipment malfunctions.
Transition planning—identify available support services.
4. Determine whether the student needs to see a new audiologist.
5. Refine teen’s self-determination and self-advocacy skills.
6. Provide information on resources: Vocational Rehabilitation services, support groups for young adults with hearing loss,
postsecondary education programs.
Note. From Montoya and Rall (2004).
can then begin, with the assistance of the educational audi- line]) from the Guide to Access Planning (GAP) (https://
ologist, to identify, develop, and try out different strategies www.phonak.com) program.
to help in these situations. Student-generated self-advocacy Another resource, Self-advocacy and transition skills
videos and letters are important strategies illustrating how for secondary students who are deaf or hard of hearing
students accept personal responsibility for their preferences (Price, 2014), utilizes the COACH concept. In her book,
and accommodations. Sample letters and video templates are COACH stands for concern-observe-access-collaborate-
in Appendix 10–C. A similar strategy is the hearing status make it happen. This resource helps educational audiolo-
notification card (see Figure 10–7 and Appendix 10–D [on- gists set up a framework when working with students. There

Chapter 10
FIGURE 10–7 Sample hearing status notification card; fold card on dotted line and place in wallet.
online interactive tool to assist children, teens, and young

adults and their families to successfully manage life transi-
Nuggets from the Field tions. Another online tool, Living Well for Teens and Tweens,
uses various photo sets (including uploading personal pho-
If a student discloses communication problems tos) as conversation starters to discuss communication strat-
through any of these self-advocacy activities, it egies for difficult situations. For younger children, My World
would be a serious omission for the educational helps audiologists facilitate conversations about reduced
audiologist to disregard those concerns and not hearing. Strategies for using these Ida tools are in Appen
provide counseling to assist the student in resolv- dix 10–F. There is no charge to access these tools (available
ing the issues involved. at https://idainstitute.com/).
The stigma that is often associated with people who
exhibit hearing difficulties is a concern that impacts self-
esteem, confidence, and social relationships (Williams, Cohen,
and Ellertsen (2019) developed 10 manageable suggestions
are several examples of questionnaires and checklists that suitable for teens for developing self-efficacy skills to ad-
help guide self-advocacy development as children age in dress personal communication challenges (Appendix 10–G).
Appendix 10–B. One set of tools, located in Appendix 10–E, This handout is useful for parents as well.
Audiology Self-Advocacy Checklist, has teacher/audiologist
forms for tracking skills across elementary, middle school,
and high school levels as well as the “I Can” Self-Advocacy COUNSELING STRATEGIES
Checklist that is to be completed by the student.
The Ida Institute, an independent, nonprofit organiza- We recognize that educational audiologists may feel limited
tion, develops resources and tools that integrate person- by time constraints and personal comfort when deciding
centered care in hearing rehabilitation to strengthen the how to include counseling support for students. There are
counseling process. Growing Up with Hearing Loss is an multiple demands on an audiologist’s time in the schools,

376 Chapter 10
and service decisions are often based on the availability and The Children’s Peer Relationship Scale (English, 2002),
experiences of multidisciplinary team members. Well-being an eight-item questionnaire for deaf and hard of hearing stu-
and social competence are underlying factors that have im- dents, is a good starting point for supportive listening by edu-
plications for academic performance and student outcomes. cational audiologists. Using simplified language and a three-
Therefore, integrating counseling support into educational choice response format, students rate their feelings about
audiology practice to address acceptance and management school, friends, teasing, hearing aids or cochlear implants,
of related communication difficulties, self-concept, and and peers with hearing loss. Students are asked to choose
greater self-advocacy skills is certainly a worthwhile invest- between three statements, such as, (a) Mostly, other kids like
ment of time. IDEA includes counseling and guidance of me; (b) Sometimes, other kids don’t like me; and (c) Other
pupils under the definition of audiology,3 and the follow- kids don’t really like me. Happy, neutral, and sad faces are in-
ing statement is included under professional competencies cluded above each response box, and each of the eight items
Chapter 10
in the minimum competencies for educational audiologists is followed by a section for comments. This talking tool can
delineated by the Educational Audiology Association (EAA, reveal student concerns about how their hearing status seems
2002): Provide counseling for family/caregivers and students to affect their daily lives. Once a student has indicated a sad
using effective interpersonal communication skills with sen- or negative feeling about a peer relationship situation, this
sitivity to family/caregivers system. opens the door for validation of the student’s feelings.
The ASHA Scope of Practice (2018) defined the role Another technique described by Clark and English
of the audiologist in the counseling process specifically in- (2004) for beginning conversations with children about feel-
cluding interactions related to emotions, thoughts, feelings, ings is called I Start/ You Finish. This activity is modeled after
and behaviors that result from living with hearing, balance, the incomplete sentence technique often used in professional
and other related disorders. Some of the specific activities counseling interviews where clients are asked to finish a par-
outlined in counseling include: tial sentence that can elicit their thoughts, feelings, and con-
cerns. Using more simplified language, partial sentences for
■■ providing support and/or access to peer-to-peer groups
the I Start/ You Finish activity (e.g., I am happy when . . .; I
for individuals and their families;
wish. . . .) are said, and the student is asked to finish each one.
■■ providing individuals and their families with skills that
Once students realize that any answer is acceptable, they may
enable them to become self-advocates; and
feel more comfortable talking about feelings associated with
■■ providing adjustment counseling related to the psycho
their hearing status with the educational audiologist.
social impact on the individual, referring individuals to
other professionals when counseling needs fall outside
those related to auditory, balance, and other related Self-Assessment
disorders.
As mentioned previously, use of self-assessment instruments
Although audiologists have reported feeling inade- can be a strategy to help increase a student’s self-awareness
quately prepared to provide counseling services (Clark, 2001; of environmental and communication barriers. Elkayam and
Clark & English, 2004) there have been an increasing number English (2003) have also explored the use of this strategy as
of opportunities for audiologists to add to their knowledge a framework for the Self-Assessment of Communication—
and upgrade their counseling skills through online courses, Adolescent (SAC-A), and the Significant Other Assessment
print material, workshops, and conference presentations. of Communication—Adolescent (SOAC-A). In their pilot
study with 20 adolescents with hearing loss, Elkayam and
English identified five recurring themes (p. 490):
Reflective Listening
■■ the inherent isolation of hearing loss;
Students often ask for validation of their feelings, and audi-
■■ identity and self-concept;
ologists tend to respond by providing information (English,
■■ cosmetics and other hearing aid issues;
Mendel, Rojeski, & Hornak, 1999). It is important for the
■■ problem-solving; and
educational audiologist to listen carefully to each student’s
■■ self-acceptance.
comments and acknowledge any concerns or feelings that
are present. For example, does the comment, “I don’t want Use of the SAC-A and the SOAC-A allowed the examin-
to wear my hearing aid because it hurts my ear,” mean that ers to explore these recurring themes through dialogue with
the aid is physically uncomfortable, or is it an embarrassing the participating adolescents, and a follow-up questionnaire
reminder that the student is feeling different from his peers? indicated 80% of the participating students felt they derived
Providing a new earmold can seem to be a quick solution, benefit from the resulting counseling session. It can be dif-
but it may not be effective in the long run if the student is ficult for an adolescent to initiate or participate in dialogue
feeling uncomfortable with his hearing loss. about their feelings, and a self-assessment tool can facilitate
3
34 C.F.fn. §300.34(C)1(v).

TABLE 10–5 Coaching Skills to Help Continue Conversations
Strategy Considerations When Implementing

Committed listening Gain clarity about an issue; understand the needs, perceptions, and emotions of the student; gather
feedback; allow the student to refine thinking by being an attentive listener; seek patterns of behavior;
lay a path for building responses and solutions
Nonverbal attending Eye contact; body posture and position; interested facial expression; affirmation by head-nodding;
minimal extraneous movement
Minimal verbal attending Repeat one or two words and pause; “Yes …” “Uh-huh.” “Oh?” “And then …”
Paraphrasing Fully attend; listen with the intent to understand; capture the essence of message and paraphrase the
intent as you understood it; reflect the voice tone and gestures; paraphrase and pause before asking a
Chapter 10
follow-up question
Presume positive intent Frame questions with positive presuppositions that the person has already thought about the
and powerful questions expectation, for example, “What are you looking forward to most this school year?” rather than “Are
you looking forward to anything in school?”
Reflective feedback Clarifies ideas or actions under consideration and offers values, concerns, and suggestions; typically, a
longer paraphrase; use as perception check; use for transition to specific tasks and problem-solving
Note. From Kee, Anderson, Dearing, Harris, and Shuster (2010).
this communication. The Classroom Participation Question- 2. What’s one question I can ask the teacher (student) to
naire (CPQ) (Appendix 5–I) is another tool that facilitates help them reflect on and modify their practice (hearing
a dialogue about access to communication in the classroom. status/self-advocacy/communication barrier)?
The use of a self-assessment approach to elicit conversations 3. What’s one instructional practice (activity/goal) that
about personal adjustment and communication access issues might be useful for this teacher (student) to reflect on
appears to be an effective strategy for initiating counseling and make a change in? How can I help this teacher (stu-
by educational audiologists. dent) reflect on this behavior and make changes?
There are several effective coaching skills that are im-
portant to recognize including committed listening, para-
Extending Conversations and Coaching phrasing, presuming positive intent and powerful questions,
It is crucial for students to perceive that the educational au- and reflective feedback (Kee et al., 2010). Table 10–5 ex-
diologist is truly hearing their concerns and acknowledging pands on some of these coaching strategies.
that these concerns are valid. Statements of reassurance (e.g., It is important to remember that feelings and percep-
“Oh, I’m sure that Susie doesn’t think you are stupid”) do tions about hearing status and its effects may change as stu-
not empower students to work through their perceptions and dents progress through school. Children/youth may be quite
feelings about relationships with peers. Instead, use of the lis- willing to share information about their hearing and hearing
tening strategies listed in Table 10–5 can serve to extend con- assistive devices at younger ages but become reluctant to
versations and assist students in recognizing and addressing talk so freely as they approach adolescence. A student who
their own feelings. Coaching methods provide effective strat- reports being tired of explaining his deafness repeatedly may
egies to build relationships with a variety of people. In other benefit from dialogue about his feelings at this point. Stu-
chapters they are applied to supporting teachers and other dents can be empowered by being asked about their feel-
service providers (Chapter 13) and parents (Chapter 3). Here ings, ideas, and suggestions for ways to solve their com-
we can also apply coaching strategies with students. Typi- munication and social challenges. If a strategy is theirs, they
cally, each coaching model incorporates themes of building are more likely to implement it, and if there is a successful
relationships, effective communication, supporting the goal, outcome, they are more likely to initiate problem-solving
and reflection (Kee, Anderson, Dearing, Harris, & Shuster, independently in the future.
2010; Tschannen-Moran & Tschannen-Moran, 2010). Agui-
lar (2013) identified three questions to consider when prepar-
ing for a coaching conversation with a teacher. We can easily
apply the questions to coaching students who are deaf or
hard of hearing as they are learning advocacy skills. NETWORKING FOR STUDENTS
1. How can I make this conversation meaningful to the Students, especially those in mostly solitaire inclusive set-
teacher (insert student)? tings, often feel isolated and alone. IDEA (2004) requires

378 Chapter 10
that “the IEP team consider opportunities for direct commu- TABLE 10–6 Top Ten Characteristics of a Successful Peer Group
nications with peers . . . in the child’s language and commu- 1. Letting students take ownership of the group
nication mode.”4 These opportunities may include periodic
2. Adaptability and flexibility in planning, scheduling, and
activities such as school visits, field trips, and camps with expectations
other students who are deaf or hard of hearing. States that
3. Silence from adults
have passed Deaf Child Bill of Rights legislation may have
4. Expanding membership by repeatedly inviting new students
further requirements for interactions with peers as well as
5. Encouraging new students to return and bring a friend
deaf and hard of hearing adult role models. One of the items
in the Children’s Peer Relationship (CPR) scale asks if the 6. Availability of food and snacks at meetings
student knows other children with a hearing loss (English, 7. Balance of activities (include both fun and learning)
2002, p. 138). The response to this CPR item can serve as 8. Keeping parents and school personnel informed
Chapter 10
a starting point for exploring a variety of ways to network 9. Selective grouping for specific activities
with other students who are deaf or hard of hearing who 10. Continual evaluations by students
may have similar feelings. Internet resources should be used
Note. From Spangler (2007).
cautiously to ensure they are safe and monitored for privacy.
Appendix 10–B contains a variety of suggested professional
and teaching tools, books, and web-based resources. When Facilitating opportunities to interact with others who
used, they can link students with others who have similar share similar experiences has been a core component for
concerns and questions about their difficulties. Parent list- these chapter authors. In 1999, Spangler started a group
servs such as those identified in Chapter 3, Partnering With called Hit It (Hearing Impaired Teens Interacting Together).
Families, are another avenue to put students with similar con This group has a core theme of promoting the transition
cerns (e.g., fear of surgery for a cochlear implant) in touch to adulthood, leadership, advocacy, and networking. This
with each other. group meets quarterly, targeting topics related to hearing,
An increasing number of deaf and hard of hearing stu- hearing loss, accommodations, communication breakdown
dents have their own website with options for e-mail contact. and repair, and social and emotional learning. A second ex-
Instagram and other social media platforms are popular ways ample of support is through the campUS program, which is
for many children/youth to interact socially, and these visual an overnight camp at the Ohio State University. This pro-
techniques can be very successful communication strategies gram utilizes counselors who themselves are deaf or hard
for children/youth who are deaf or hard of hearing. Safety of hearing to mentor deaf and hard of hearing teen campers
and privacy issues must be clarified with any student using to promote a positive transition from high school to college
the Internet for communication. One example of a publi- (Spangler & Whitelaw, 2019). Appendix 10–H contains a
cation with social media presence can be found at https:// guide for setting up student support groups.
www.hearingourway.com. This magazine for kids and teens Specific activities that can help students who are strug-
with diverse hearing levels inspires young people through its gling with their hearing status include the following:
content, role models, and strategies for self-advocacy skills.
■■ arranging for mentor sessions with adults and/or older
Professional organizations, such as the Alexander
students who are deaf or hard of hearing;
Graham Bell Association for the Deaf and Hard of Hearing
■■ providing written materials (see Appendix 10–B) and
(https://www.agbell.org), and the National Association for
facilitating group discussions about social situations
the Deaf (https://www.nad.org), as well as many manufac-
and barriers resulting from reduced hearing; and
turers of hearing aids and cochlear implants, have programs
■■ maintaining and making available files, links, and web-
to connect students and their families with others in similar
sites of inspiring stories of children and adults with hear
circumstances. One example is Phonak’s HearingLikeMe.
ing loss to students.
com. This news and lifestyle website is for people whose
lives are affected by reduced hearing. Stories are shared to While students often tell us that it is helpful to know
learn to live with the consequences of reduced hearing more that others are experiencing similar challenges when living
successfully and advocate in a more meaningful way. with reduced hearing, Anderson (2005) reminds us, “it is
Facilitating and supporting peer group activities within sometimes more beneficial to build a friendship on shared
larger school systems or multisystem districts is another po- interest rather than a shared disability” (p. 46). Educational
tentially successful strategy for empowering middle and high audiologists can facilitate the empowerment of students
school students. In a program described by Bury (2007), two through information and emotional support, but we need to
educational audiologists identified their top 10 suggestions remember that, in the bigger picture, hearing status is only
for successful peer groups. These are listed in Table 10–6. one part of the student’s identity.
4
34 C.F.R. §300(324)(a)(2)(iv).

(Karcher, 2007). Educational audiologists can utilize this

framework for peer mentorship programs to bring deaf and
Nuggets from the Field hard of hearing elementary, middle, and high school stu-
dents together bridging an important “alone in the main-
stream” feeling for many students.
Understanding students’ need for social connec-
tion with same-self peers, we run an annual event
for students who are deaf or hard of hearing. Dur-
ing the course of the day, we teach a skill set (e.g., REFERRING FOR
communication repair, self-advocacy) and offer a
fun activity (e.g., cartooning, racing) that allows ADDITIONAL SERVICES
Chapter 10
the students to practice his or her newly acquired
As mentioned, counseling is part of the audiologist’s scope
skills. While the skills and activity are reported to
of practice. However, there are times when the individual
be fun and engaging, the magic happens simply by
needs of students are beyond the boundaries of our audiol-
bringing these same-self peers together, allowing
ogy training and expertise. Clark and English (2004) con-
them to see other deaf and hard of hearing stu-
trast psychotherapy and personal-adjustment counseling
dents, like themselves. They compare technology,
on the basis that the former approach considers the patient
swap stories and even contact information. Many
to be ill and in need of treatment, while the latter includes
parents have reported that these days have been
counseling techniques that target support for and facilitate
“the making of their child.”
problem-solving by someone who is fundamentally well.
Although typically short term, counseling for students who
are deaf or hard of hearing should foster the development of
self-determination, attitudes, and skills needed when dealing
with challenges that accompany reduced hearing.
Peer Mentors and Role Models When the educational audiologist is not able to fa-
Many students who are deaf or hard of hearing are the “one cilitate progress toward student goals, or if the student ex-
and only” in their school or school district. In addition, presses difficulties or emotions that appear unrelated to his
IDEA 2004 requires that “the IEP team consider opportuni- or her hearing status and its impact, referral to a professional
ties for direct communications with peers . . . in the child’s counselor is an option to consider. If there is any indica-
language and communication mode.”5 Meeting another per- tion that the student may be suicidal or reports an abusive
son who shares similar experiences is a powerful form of situation, the audiologist must follow the school’s reporting
self-development and is often best facilitated by an educa- protocol. When a student is experiencing difficulties beyond
tional audiologist, teacher of the deaf/hard of hearing, or our professional scope of practice, the educational audiolo-
other person who understands the unique context and who gist should feel comfortable referring to another provider. A
has connections to arrange appropriate opportunities with counselor on the school staff is often an excellent resource,
other students and role models. Garringer and MacRae (2008) and, where available, mental health professionals who are
outlined the benefits and general framework of these types familiar with hearing-related problems are typically the
of programs for both the mentors and mentees. Cross-age preferred referral option. Knowledge of counselors who are
peer mentoring programs bring together older and younger deaf or hard of hearing themselves and ones with expertise
deaf and hard of hearing youth in a structured environment working with individuals who are deaf or hard of hearing
with the purpose of guiding and supporting one another in should be maintained by each educational audiologist for
the areas of academic, social, and emotional development his or her geographic region.
5
34 C.F.R. §300(324)(a)(2)(iv).

380 Chapter 10
SUMMARY are deaf/hard of hearing in Ontario’s schools (https://www

.chs.ca/sites/default/files/CHS003_IFeelGood_EN_FINAL
This chapter described the role of the educational audiologist .pdf ). The following social and interpersonal skills from this
within a counseling framework that is wellness rather than guide (p. 9) summarize student behaviors that promote well-
deficit focused. Each step, from identity and self-esteem to ness and social competence:
self-determination and self-advocacy, promotes development
■■ thinking independently;
of student responsibility and action to manage the student’s
■■ developing self-control;
communication access needs. This approach requires that we
■■ understanding the feelings, needs, and motivations of
accept student-driven goals and actions rather than ones that
oneself and of others;
we might think are more necessary or relevant. This approach
■■ understanding and expressing a range of emotions;
also requires that we balance student needs specific to their
Chapter 10
■■ learning from past experiences in planning for the

hearing status with their desire to be like their peers.
future;
Cognitive coaching strategies that promote effective
■■ responding to challenges and obstacles through effec-
listening, validating student concerns, and problem-solving
tive problem-solving;
discussions are emphasized. It bears repeating that an educa-
■■ recognizing and developing one’s strengths through
tional audiologist should always function as a member of the
self-actualization;
school multidisciplinary team that includes the general edu-
■■ self-advocacy;
cation classroom personnel. As an active team member, the
■■ effectively navigating diverse social situations;
educational audiologist can help identify goals on the IEP in
■■ managing communication breakdowns; and
these counseling areas and communicate the content of their
■■ maintaining healthy relationships with others.
counseling strategies with the other team members. This
communication is critical to assure that the self-advocacy
strategies the student chooses to implement will be rein-
forced in all classrooms, at home, and in social settings.
VOICE for Hearing Impaired Children and the Cana-
SUGGESTED READING
dian Hearing Society developed I feel good: A guide to sup- Antia, S., & Kreimeyer, K. (2015). Social competence of deaf and
port mental health and well-being of children and youth who hard of hearing children. New York, NY: Oxford Press.

APPENDIX 10–A
Self-Determined Learning Model of Instruction
Teacher Objectives and Educational Supports1

Phase 1. Set A Goal
Student problem to solve: What is my goal?
Chapter 10
Student Question Teacher Objectives Educational Supports
1. What do I want to ■■ Enable student to identify specific strengths and instructional ■■ Student self-assessment
learn or improve on? needs. of interests, abilities, and
■■ Enable student to communicate preferences, interests, beliefs, instructional needs
and values. ■■ Awareness training
■■ Teach student to prioritize needs. ■■ Choice-making instruction
■■ Problem-solving instruction
2. What do I know ■■ Enable student to identify current status in relation to the
about it now? instructional need. ■■ Decision-making instruction
■■ Assist student to gather information about opportunities and ■■ Goal-setting instruction
barriers in the environment.
3. What must change ■■ Enable student to decide if action will be focused toward
for me to learn what capacity building, modifying the environment, or both.
I don’t know? ■■ Support student to choose a need to address from prioritized
list.
4. What can I do to make ■■ Teach student to state a goal and identity criteria for achieving
this happen? goal.
Phase 2. Take Action

Student problem to solve: What is my plan?
5. What can I do to learn ■■ Enable student to self-evaluate current status and self-identified ■■ Self-scheduling
what I don’t know? goal status. ■■ Self-instruction
6. What could prevent ■■ Enable student to determine plan of action to bridge gap ■■ Antecedent cue regulation
me from taking action? between self-evaluated current status and self-identified goal ■■ Choice-making instruction
status. ■■ Decision-making instruction
7. What can I do to ■■ Collaborate with student to identify most appropriate ■■ Self-advocacy instruction
remove these barriers? instructional strategies. ■■ Assertiveness training
■■ Teach student needed student-directed learning strategies. ■■ Communication skills training
■■ Support student to implement student-directed learning ■■ Self-monitoring
strategies.
■■ Provide mutually agreed upon teacher-directed instruction.
8. When will I take action? ■■ Enable student to determine a schedule for action plan.
■■ Enable student to implement action plan.
■■ Enable student to self-monitor progress.
1
From Wehmeyer, M. L., Agran, M., Palmer, S. B., & Mithaug, D. E. (1999). A teacher’s guide to implementing the Self-Determined Learning Model
of Instruction: Adolescent Version. Lawrence, KS: Self-Determination Projects, Beach Center on Families and Disability, Schiefelbusch Institute
for Life Span Studies University of Kansas. Exceptional Children.
381

382 Chapter 10
Phase 3. Adjust Goal or Plan

Student problem to solve: What have I learned?
9. What action have ■■ Enable student to self-evaluate progress toward goal ■■ Self-evaluation strategies
I taken? achievement. ■■ Choice-making instruction
10. What barriers have ■■ Collaborate with student to compare progress with desired ■■ Problem-solving instruction
been removed? outcome. ■■ Decision-making instruction
■■ Goal-setting instruction
11. What has changed ■■ Support student to reevaluate goal if progress is insufficient.
about what I don’t ■■ Self-reinforcement strategies
Assist student to decide if goal remains the same or changes.
Chapter 10
■■
know? ■■ Self-monitoring strategies
■■ Collaborate with student to identify if action plan is adequate
or inadequate, given revised or retained goal. ■■ Self-recording strategies
■■ Assist student to change action plan if necessary.
12. Do I know what I ■■ Enable student to decide if progress is adequate or inadequate,
want to know? or if the goal has been achieved.
Tips for Implementing a Self-Determined Learning Model of Instruction Plan
1. Select a deaf or hard of hearing student whom you can work with over an extended period of time. Plan to meet with
the student a minimum of three times, though more frequently might be necessary.
2. Discuss all three phases of the project with the student—Goal Setting, Taking Action, and Adjusting the Goal—so the
student understands the process.
3. Work with the student to select a goal. If the student has several potential goals, you may help to prioritize to choose
just one. Facilitate independence by reminding the student it is his or her goal to select and continue encouraging until
the student is able to choose the goal; you might suggest academic, social, or self-advocacy as areas to consider.
4. Implement the plan. Over the course of the meetings, follow the components of each phase. Encourage the student to
develop activities to address his or her goal, and help the student evaluate and keep records about attainment of the goal.
5. Reflection. At the completion of the goal plan with the student, consider the following questions to evaluate the success
of the plan and potential changes when you conduct the process again.
(a.) Phase 1: Goal setting:
i. What goal did the student select?
ii. How difficult was it for the student to select the goal?
iii. How difficult was it for the student to determine levels of attainment for the goal?
iv. What did you (the instructor) learn from the process of helping the student select a goal?
(b.) Phase 2: Take action:
i. What plans did you and the student make to meet the goals?
ii. How did you support the student to take action?
iii. What kind of evaluation or record keeping did you set up?
iv. In hindsight, how feasible were the action plans?
v. What would you do differently next time?
(c.) Phase 3: Adjust goals
i. What progress did the student make?
ii. What difficulties did the student run into, and how did you deal with the difficulties?
iii. What would you do differently next time?

APPENDIX 10–B
Resources for Social-Emotional Development and Social Competence
PART 1. PROFESSIONAL RESOURCES I’m Determined project, a state-directed project funded by
Chapter 10
the Virginia Department of Education, focuses on provid-
1. A
ssessments, Checklists, and Teaching Tools That ing direct instruction, models, and opportunities to practice
Address Self-Determination and Self-Advocacy skills associated with self-determined behavior. This project
facilitates youth, especially those with disabilities, to under-
Assessments: take a measure of control in their lives, helping to set and
Informal inventory of independence and self-advocacy skills steer the course rather than remaining the silent passenger.
for deaf/hard of hearing students (Clark & Scheele, 2005).
http://www.handsandvoices.org/pdf/SAIInventory.pdf National Deaf Center on Postsecondary Outcomes—online
choice-based game and curriculum to foster development
Self-determination inventory. University of Kansas, Schie
of self-determination skills. https://www.nationaldeafcenter
felbusch Institute for Life Span Studies. Student Report
.org/
and Parent/Teacher Reports. Includes ASL accommodation.
http://www.self-determination.org
Self-advocacy for students who are deaf or hard of hearing
Checklists: (1997), K. English. http://advancingaudcounseling.com/wp
Listening inventory for education—Revised (Anderson, -content/uploads/2019/01/SelfAdvEBook.pdf
Smaldino, & Spangler, 2011). https://www.successforkid
swithhearingloss.com Self-Determined Learning Model of Instruction (See Ap-
pendix 10–A).
Self-advocacy competencies for students who are deaf or
hard of hearing (Luckner & Becker, Odyssey 14, 2013). 2. A
ssessments, Checklists, and Teaching Tools That
Address Social-Emotional Development
Guide to self-advocacy skill development (Anderson, 2012).
https://www.successforkidswithhearingloss.com Assessments:
Social-emotional assessment/evaluation measure (SEAM)
Audiology self-advocacy checklists (Teacher Forms); “I (2014), J. Squires, D. Bricker, M. Waddell, K. Funk, J. Clif-
Can” self-advocacy checklist (Student Form) (Johnson & ford, and R. Hoselton. https://products.brookespublishing
Spangler, 2016) (Appendix 10–E). .com/Social-Emotional-AssessmentEvaluation-Measure
-SEAM-Research-Edition-P717.aspx
Teaching Tools:
Ida Institute (see Appendix 10–F) Social skills improvement system (SSIS) rating scale (2008),
■■ My world S. Elliott and F. Gresham. https://www.pearsonassessments
■■ Living well for teens and tweens .com/store/usassessments/en/Store/Professional-Assess
■■ Growing up with hearing loss ments/Behavior/Social-Skills-Improvement-System-SSIS
-Rating-Scales/p/100000322.htm
Guide to access planning (GAP). https://www.phonakpro
.com/us/en/resources/counseling-tools/pediatric/guide-to Teaching Tools:
-access-planning/guide-to-access-planning.html Social skills improvement system (SSIS) intervention guide
This guide is designed for teens, their parents, and profession- (2008), S. Elliott and F. Gresham. https://www.pearson
als who work with them to promote self-advocacy and foster assessments.com/store/usassessments/en/Store/Professional
responsibility for communication access and hearing assistive -Assessments/Behavior/Interventions/Social-Skill-Improve
technologies. The goal is to guide and prepare students for the ment-System-%28SSIS%29-Intervention-Guide/p/1000
next step in their lives, be it continued education or career. 00355.html
Building effective peer mentoring programs in schools: An
I’m determined: Empowering self-determined behavior. introductory guide (2008), M. Garringer and P. MacRae. The
https://www.imdetermined.org/ Mentoring Resource Center and U.S. Department of Education.
383

384 Chapter 10
https://educationnorthwest.org/sites/default/files/building Matlin, M. (2002). Deaf child crossing. Available from Har-

-effective-peer-mentoring-programs-intro-guide.pdf ris Communications, https://www.harriscomm.com.
Paulitz, J. (2000). Philip and the boy who said, “Huh?”
3. Counseling “Discussion Initiation” Tools Available from Harris Communications, https://www.har
riscomm.com.
Classroom Participation Questionnaire (CPQ) (2006), Piper, D. (1996). Jake’s the name, sixth grade’s the game.
S. Antia, D. Sabers, and M. Stinson https://adevantage.com Available from Harris Communications, https://www
.harriscomm.com.
Children’s home inventory of listening difficulties (2000), Piper, D. (2001). Those sevy blues. Available from Harris
K. Anderson and J. Smaldino. https://successforkidswithhearing Communications, https://www.harriscomm.com.
loss.com/wp-content/uploads/2011/08/CHILD_pgs3-4.pdf Sokol & Fox. (2016). The think confident, be confident
Chapter 10
workbook for teens. Oakland, CA: Instant Help Books,

Children’s peer relationship (CPR) (2002). K. English. An Imprint of New Harbinger Publications Inc. https://
https://successforkidswithhearingloss.com/wp-content/up www.newharbinger.com [This publisher focuses on self-
loads/2011/08/Childrens-Peer- Relationship-Scale.pdf help books for teens on self- esteem, confidence, and
mental health.]
Self-assessment of communication—Adolescent (SAC-A), Stern, V., & Woods, M. (2001). Roadmaps and rampways.
and the Significant other assessment of communication— Washington, DC: Alexander Graham Bell Association.
Adolescent (SOAC-A) (2003), J. Elkayam & K. English. “Stories as told by individuals who are deaf.” In Knowl-
https://successforkidswithhearingloss.com/wp-content/up edge is power. (2002). Mississippi Bend Area Educa-
loads/2017/09/FINAL_SAC-A_2011.pdf https://success tion Agency. Distributed by Educational Audiology
forkidswithhearingloss.com/wp-content/uploads/2017/09 Association.
/FINAL_SOAC-A_2011.pdf
Video Stories/VLOGS:
PART II. STUDENT RESOURCES: STORIES Check websites with various organization and manufacturers
AND NETWORKING ABOUT BEING DEAF OR as well as YouTube.
HARD OF HEARING
Books: Websites:
Augustine, P. (2003). Having hearing aids. https://www https://www.hearingmyway.com Magazine and online com-
.oticon.com munity specializing in publications for children with
Blatchford, C. (2005). What works for me: Young adults with hearing loss through relatable content, role models, and
hearing loss talk to teens. Clarke School Mainstream Cen- advocacy skills.
ter, (413) 584-3450 (V/TDD). http://www.clarkeschools https://www.hearinglikeme.com. A website for people whose
.org/services/educational-products lives are affected by hearing loss. Stories written by
Blatchford, C. (2009). Summer jobs and beyond: A guide people with hearing loss, family members of loved ones
for teens with hearing loss and the adults who work with with hearing loss, and experts are shared on a variety of
them. Clarke Schools for Hearing and Speech, (413) 584- topics.
3450 (V/TDD). http://www.clarkeschools.org/services http://bf4life-hearing.weebly.com/index.html Online com-
/educational-products munity/blog for teens and tweens who are deaf or hard
Cutlet, S., & Del Bottore, J. (2007). Rally caps. Ordering of hearing.
information: www.rallycapsports.org http://www.deafkids.com Website that includes a chatroom
Frigo, V., Stein, K., & Gustus, C. (n.d.). Tips for kids and reserved for Deaf/HH kids 17 years of age and younger.
Tips for friends. The Moog Center, Central Institute for http://www.verywellhealth.com/hearing-loss-and-deafness
the Deaf. http://www.moogcenter.org -4014710 Website that contains links to articles and in-
Heelan, J. (2002). Can you hear a rainbow? The story of formation on hearing loss.
a boy named Chris. Available from Harris Communica- http://www.deaftoday.com Online daily news stories about
tions, https://www.harriscomm.com. and of interest to individuals who are Deaf.
Hodges, C. (1995). When I Grow Up. Available from Harris http://www.kidlfyxkreations.com Website for original ac-
Communications, https://www.harriscomm.com. cessories for hearing aids and HATs.
Kroll, A. (2004). I’m the boss of my hearing loss! Distributed https://www.deaflife.com Site for the online magazine, Deaf
by Educational Audiology Association. http://edaud.org. Life.

http://www.hearingexchange.com Website where students https://otikids.com Website sponsored by Oticon with link
can blog, ask questions, and network. to Kids Corner.
https://www.yumpu.com/en/document/view/19367996/a https://www.saywhatclub.com Networking for older teens
-guide-just-for-you-kids-club-unitron Website for younger and adults who are deaf, hard of hearing, or have a seri-
students sponsored by Unitron Corporation. ous interest in hearing loss.
Chapter 10

APPENDIX 10–C
Student Accommodations Notification Templates
Basic Notification Letter

Chapter 10
Dear __________________________:
My name is _______________________. I have hearing challenges, and it is sometimes difficult for me to understand what goes on in inter-
active classroom environments. This letter lists some suggestions that can help me to do my best work in your class.
Every person who is deaf or hard of hearing has a different hearing situation, and you may have already read some information about mine.
If you do not have this information, please contact:
.
(audiologist’s name, phone number, e-mail)
In your classroom, it will help if I:
 have strategic seating (describe or draw diagram on back)
 can see your face when you talk to the class; it also helps me to see the other students during class discussions.
 can change my seat for different activities when it helps me to see and hear better.
 use hearing assistance technology that includes a microphone for you to wear. This system brings your voice into my ear so I hear
better, especially if the room is even a little bit noisy and when you are not speaking close by me.
It will also help me if you:

 show videos, media, and movies with captions since it is very hard for me to understand when the room is dark. If captions aren’t
included, it would help me to have a written script to study.
 will write homework assignments on the whiteboard or other site (Google classroom), so I won’t miss these requirements.
 would help me choose a “buddy” who can take notes for me and help me find my place if I get lost (it’s really hard to watch you and
take notes at the same time).
The other members of my support team would be happy to meet with you to talk about additional ways we can work together so I can be
successful in your class. They include:
Name
Title
Phone Number/e-mail
I hope we will have a good year together. Please talk to be about my hearing challenges. I am happy to answer your questions. Please let me
know if I am not keeping up with the class or if you have trouble understanding me.
Sincerely,
386

My Personal Profile and Accommodations Letter1
This is a sample from the fillable, downloadable form from Phonak’s Guide to Access Planning program: https://www.phonakpro.com/us/en
/resources/counseling-tools/pediatric/guide-to-access-planning/guide-to-access-planning.html.
Date Insert: date
Chapter 10
Dear Insert: name of your school, employer, etc.
My name is
Insert: your name. I am Insert: age years old.
I enjoy Write down something special or unique about yourself
I am currently Insert: grade in high school, attending college, looking for a job, employed
I have reduced hearing in Insert: my right ear, my left ear, or both ears.
Insert: spoken language, sign language, spoken & sign language to communicate with others. My hearing level is in
I use
the Insert: mild, moderate, severe, profound range of hearing. It is a Insert: sensorineural, conductive, mixed type of loss. I have
had reduced hearing for Insert: number years or since birth. In order to help me hear and communicate better, I use
Insert: a hearing aid, hearing aids, a Baha, a cochlear implant, cochlear implants or combination. or I do not use personal hearing instruments.

Although this technology helps me to hear and communicate better, these devices do not make listening and understanding perfect. There
are certain situations in which it is more difficult to hear. These may include:
■■ Telephone ■■ In poorly lit areas (darkened rooms for presentations, movies)
■■ Cell phone ■■ Fire alarm
■■ One-on-one conversation ■■ Public Address announcements
■■ Group situations ■■ Computer
■■ Small group meetings ■■ Radio/music
■■ Large group meetings ■■ Movies
■■ Restaurant ■■ Large classroom/lecture halls
■■ Automobile ■■ Small classroom/lecture halls
■■ Understanding individuals who have an accent Insert: any other situations
I am aware that I have difficulties hearing in certain situations. To help in these situations, I use the following hearing assistive technologies:
Insert those that you use or any other technology:

■■ A personal FM/DM system
■■ Streaming Device
■■ A special telephone (amplified, captioned phone, videophone
■■ captioning
■■ Visual Alerting Devices (fire alarm, doorbell)
■■ ____________________________
1
Phonak’s Guide to Access Planning CD, 2008. Used with permission.

388 Chapter 10
In addition to the various technologies and services that help me, I benefit from the following accommodations:
Insert those that you use and add any others that you use:
■■ Get my attention before starting to speak.
■■ Face me when you speak and do not cover your mouth.
■■ Try to be within about 6 feet of me when you speak.
■■ Turn off music, TV, or other sources of noise.
■■ Keep the lights on so that I can read lips.
■■ If we are in a group, it is helpful if one person speaks at a time.
■■ If we are in a group, it is helpful if we move to a quiet room/location.

Chapter 10
■■ If we are in a group, it is helpful to be seated at a round table.
■■ I may need repetition or rephrasing when people are talking.
■■ I need a sign language interpreter.
■■ Write important information down; I cannot speechread and take notes at the same time.
■■ _________________________________________________________________________
Thank you for your time. I look forward to learning and working with you. If you have any additional questions about my hearing status, hearing
assistive technology, or accommodations, I would be happy to provide you with more information.
Sincerely,
Insert your name
Insert preferred contact Information (email, phone)

Letter/Video/PowerPoint Accommodations Template
Depending on the age and skill level of the student you are working with, consider helping the student put together a letter, PowerPoint, or
video for their teachers. Below you will find a template that you can use and edit with students’ input. The topic areas can easily be used by
a student to put into a PowerPoint presentation or used as a script for a video.
Insert Picture of Student here
Chapter 10
Date: _______________________
Dear [future] teacher,
My name is ____________________. I will be in your __________class this school year. My favorite subject is _____________. For fun,
I enjoy ___________________________.
I have reduced hearing in one/both ears. I communicate using spoken language/sign language/speechreading/all.
I wear _____________________ (insert technology) to help me hear. Some things you should know about my technology include: _____
______________________________________.
I love my _________________ (insert technology) because:

I also use __________________________ (insert other technologies such as a remote microphone system/captioning) to help me hear
better in the classroom.
Some of my accommodations include:
You can help me communicate better in class by:
I will help myself communication better in class by:
I am looking forward to next year because:
If you have any questions about me or my hearing/communication needs, please let me know!
Sincerely,

Appendix 10–D
HEARING NOTIFICATION CARD
Directions:
1. Fill in your information on the card.
• Indicate your hearing status: “Deaf” or “Hard of Hearing”.
• Fill in boxes that represent your communication preferences.
2. Cut out the card and fold in half.
3. Keep the card in your wallet until needed.
Hello. My name is____________. o I wear a hearing aid/cochlear implant.

I am _______________________.
o I read lips.
Please use these tips to communicate
with me. o I communicate with sign language.
o I communicate in writing.
o Please write down information.
1. Get my attention first and look at me. o Other:
2. Maintain eye contact so I can read your lips.
3. Speak clearly and a little slower.
4. Even if I use a cochlear implant or hearing aid, I
will have trouble understanding you, especially Emergency Contact:____________________
if there is background noise.
Text:________________________________
5. Shining a flashlight in my face will make it
harder for me to understand you. Email:_______________________________
See back of card for more information.
APPENDIX 10–E
Audiology Self-Advocacy Checklists (Teacher Forms) and
“I Can” Self-Advocacy Checklist (Student Form)
Chapter 10
390

Chapter 10

392 Chapter 10
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Chapter 10

394 Chapter 10
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Chapter 10
Note. From Cheryl DeConde Johnson, Ed.D.Carrie Spangler, Au.D.©2013 (Note: for teacher forms just add ©2013 under our
names of each form); Self-Advocacy Checklist ©2016 revised 2019 Cheryl DeConde Johnson cdj1951@gmail.com; Carrie
Spangler CarrieS@cybersummit.org

APPENDIX 10–F
Overview of Ida Counseling Tools for Children,
Youth, and Young Adults
The Ida Institute is an independent, nonprofit organization integrating person-centered care in hearing rehabilitation. Free
resources and tools are developed by Ida in collaboration with hearing care professionals around the world to strengthen the
Chapter 10
counseling process. Visit https://idainstitute.com/ to open a free account and download these tools. This appendix summarizes
three tools available for children, tweens, and teens that are useful for counseling.
My World
This counseling tool uses a set of figures, props, and scenes to help young children describe home, school, and/or community
situations. While describing their experiences, a conversation about communication can develop. With this information, the
educational audiologist, teacher of the deaf/hard of hearing, or speech-language pathologist can discuss communication chal-
lenges and successes as well as accommodations, strategies, and goals for improvement. Technology can also be explored. This
tool is rooted in evidence-based methods including play therapy and narrative counseling. All My World situations including
the props are available to download. Documentation forms are also available. An APP version of My World is being developed.
Living Well for Tweens and Teens
396

Teenagers and young adults are sensitive to how they interact with peers and how they are perceived by peers in their social
context. They will most likely have been in communication situations where another person did not understand why his/her
message may have been misunderstood, or where they felt uncomfortable, awkward, or lonely. Teens and young adults may
also react differently in each of these situations.
Living Well for Teens and Tweens uses various photo sets (including uploading personal photos) as conversation starters to
discuss communication strategies for difficult situations. For each photo set selected, the student rates how important this
situation is in his or her life and then rates how difficult it is to communicate in the situation. Once a tween/teen identifies a
difficulty, the educational audiologist and student can work through problem-solving strategies and self-determination goals
to improve communication. Living Well includes an online option using Ida’s telecare for tweens and teens.
Chapter 10
Growing Up With Hearing Loss
This counseling tool is an interactive platform to help prepare deaf and hard of hearing children and their families and young
adults for transitions at critical times: early childhood years, entering preschool, entering the early school-age years, entering
middle school, entering high school, and for postsecondary education or employment. Each age group considers the “new
environment” that the child or youth will be entering, “inspirational videos” of personal experiences of that situation, the
“Am I ready” (for the new environment) assessment, and “develop new skills” needed to successfully participate in the new
environment. and uses this information as opportunities to learn, grow, and discover. This tool can be utilized in person as
well as a hybrid telehealth model. Resources for professionals are included.
Note. Photos reprinted with permission, Ida Institute.

APPENDIX 10–G
TEN TOOLS FOR DEVELOPING SELF-
EFFICACY WITH HEARING LOSS
What is Self-Efficacy?Ǧ

Chapter 10
Ǥ

ǡ ǡ ǡ
ǡǤ Ǧ
ǡ Ǥ
Ǧ
Ǥ
Tool #1. Own your hearing loss.

Ǥ ǡ Ǥ
Ǥ
ǡ
Ǥ Ǥ
Tool #2ǤIdentify your challenging hearing situations and the triggers that make
them challenging. ǦǦ
Ǥ – ǡ
ǡǡǤ
Tool #3ǤPlan how and when to talk about your hearing loss.
Ǥ ǡ
ǤǤ
Ǥ
Tool #4. Communicate effectively. ǡ ǡ ǡ

ǡ Ǥ
Ǥ ǡ
Ǥ Ǥ
ǡǤ
others’ discomfort about your hearing loss.
Tool #5. Request accommodations. ǡ

Ǥ ǡ
ȋǤǤǡ ǡ
ǡ ȌǤ
ǡ
ǡ Ǥ
ȋȌǡ
auditoryinsight.com
̹ʹͲͳͻȁ Ǥǡ ǡǤǤ
398

Ǥ

Ǥ
Tool #6. Find and observe examples of success to inspire you.
Ǥ
Ǥ ǡ ǡǡǡ
Ǥ
Tool #7. Set realistic and meaningful goals. ǡ ǡ
Ǥ
Chapter 10
Ǥ
Ǥ ǡ Ǥ
Tool #8. Find sources of encouragement. When people express belief in your
capabilities, you are more likely to succeed. Ask for feedback from your family, teachers,
and other people who are Ǥ
Ǥ
Tool #9. Practice, practice, practice.

Ǥ
Ǥǡ
Ǥ
Tool #10. Cultivate well-being. Incorporate the “Big Three” into your life:
ǡ Ǥ ǣǡ
ǡȀ Ǥ
auditoryinsight.com
̹ʹͲͳͻȁ Ǥǡ ǡǤǤ

APPENDIX 10–H
Guide to Setting Up Student Support Groups
Rationale for Implementation and, most importantly, parents and students with hearing
Data suggest that most students who have hearing chal- challenges. Testimonies, in-person presentations, and flyers
lenges are being educated in their neighborhood schools. are instrumental in getting buy-in.
Chapter 10
Professionals who work with deaf and hard of hearing stu-

dents often report that the student they serve is “alone in the Step 2: Training of Key Personnel
mainstream.” In addition, deaf and hard of hearing students Districts or regional areas typically have a few key profes-
need exposure to peers to understand identity and learn self- sionals who work with students who are deaf or hard of
advocacy skills to successfully manage their communication hearing. Depending on the situation, personnel may include
needs, all of which are critical for independent living, work, the teacher of the deaf, educational audiologist, speech-
and college. language pathologist, transition coordinator, guidance coun-
selor, or any other professional who might be working with
deaf and hard of hearing teens. In addition, it is important
Planning: to have at least one deaf or hard of hearing adult as part of
Identify Your Target Group the team because they bring a mentorship perspective to the
Consider ages/grades, distances that might be traveled, and group.
the content, and your anticipated outcomes. The key professionals and deaf or hard of hearing
adult(s) should participate in an overview/training. This
Determine Your Goals and Outcomes training may include the following topics:
Having a focus of why you want to bring deaf and hard
of hearing students together is critical. Think about what ■■ coaching and mentoring,
you expect to achieve. How will the students be impacted ■■ support group benefits,
because of this activity? Following are some examples of ■■ the impact of reduced hearing and the resulting chal-
goals to consider: lenges that students face,
■■ self-advocacy development for targeted age groups,
■■ to meet other students who are deaf or hard of hearing ■■ communication barriers,
(identity development and peer mentorship); ■■ hearing assistance technology and use,
■■ to provide a safe environment for deaf and hard of hear- ■■ educational services and communication access and
ing students to interact with one another; accommodations,
■■ to learn about hearing challenges and their effects on ■■ brainstorming of barriers and successes of support
communication at school, work, and home; groups, and
■■ to gain solutions to be able to advocate for communica- ■■ brainstorming of topics and marketing program to
tion access; students.
■■ to improve social communication skills;
■■ to gain knowledge about the laws that protect individu- Step 3: Development of Content Meeting Materials
als with hearing challenges; Successful implementation of a support group is dependent
■■ to gain communication strategies and accommodations on the stages of planning that occur before, during, and after
to successfully navigate education, employment, and each event. Materials to consider include
independent living; and ■■ letters and PowerPoint to present plan to administrators,
■■ to learn about new communication technologies to pro- ■■ letters for teachers and/or related services professionals,
mote hearing challenge independence. ■■ letters for parents of students,
■■ flyer for first meeting,
step-by-step guide for setting up first meeting, and
Implementation Steps ■■
■■ materials guide for the first face-to-face meeting.

Step 1: Getting Buy-In
Getting buy-in from decision-makers is critical for success- Step 4: Facilities, Location, and Frequency
fully implementing a program. Consider including special Identifying a centrally located meeting space, providing
education directors, speech pathologists, teachers of the dear accessibility as needed (interpreters, assistive technology),
or hard of hearing, regular education teachers, principals, gathering materials (as outlined previously), and providing
400

lunch/snacks/drinks. Transportation is typically one of the not have a lot of students attending, and that is OK. You are
obstacles most often encountered by schools. Some schools making an impact for someone who has hearing challenges
will transport, and some parents will also transport. Decid- and that one opportunity could be a defining positive mo-
ing on how often you want to meet is also a critical factor. ment for that person.
Consider finances, time, and distance when determining fre-
Step 6: Regroup, Evaluate, and Redefine
quency of meetings. You could consider annually, quarterly,
After the first meeting, regroup and reflect. What went well?
or monthly as options.
What could be improved? Having the students do a pre-
Step 5: Jump In and Have the First Meeting and postevaluation also provides insight for future groups.
You never know how things are going to go until you jump The final step is to start planning your next support group
in and have a meeting. Understand that the first meeting may meeting.
Chapter 10

CHAPTER 11
Developing Individual Plans
CONTENTS
The Special Education Process
Chapter 11
Step 1: Identification: Concern About the Child ■ Step 2: Referral to Special Education and Assessment
■ Step 3: Determination of Eligibility ■ Step 4: The Individualized Education Program Meeting
■ Step 5: Review and Revision of the Individualized Education Program ■ Due Process Procedures
■ The Educational Audiologist’s Role in the Special Education Process
The Individualized Education Program

Consideration of Special Factors: Communication Considerations ■ Services, Placement, and Least Restrictive
Environment Considerations ■ Services for Parents ■ Transition Planning ■ Individualized Education Program
Goal Development
Kindergarten student requests for communication access.
403

Section 504 Plan

The Services Plan
The Individual Family Service Plan
Eligibility Criteria ■ Purpose of the Individual Family Service Plan ■ Individual Family Service Plan
Requirements
The Role of Case Law
Summary
Appendices
11–A Individualized Education Program/Section 504 Checklist: Accommodations and Modifications for Students
Who Are Deaf or Hard of Hearing (Text/Online)
11–B Individualized Education Program Team Responsibilities for the Educational Audiologist (Text/Online)
Chapter 11
11–C Communication Considerations Worksheet (Text/Online)

11–D PARC: Placement and Readiness Checklists for Students Who Are Deaf and Hard of Hearing (Online)
■■ General Education Inclusion Readiness Checklist
■■ Interpreted/Transliterated Education Readiness Checklist
■■ Captioning/Transcribing Readiness Checklist
■■ Oral + Manual Instruction Access Checklist
■■ Placement Checklist for Children Who Are Deaf and Hard of Hearing: Preschool/Kindergarten
■■ Placement Checklist for Students Who Are Deaf and Hard of Hearing: Elementary
■■ Placement Checklist for Students Who Are Deaf and Hard of Hearing: Secondary
11–E Checklist for ADA Services (Text/Online)

11–F Sample Section 504 Plan (Text/Online)
11–G Case Law Summary (Text)
KEY TERMS ■■ Accommodations under the Americans with Disabili-

ties Act (ADA) have a higher standard of service than
Rehabilitation Act of 1973, Section 504 plan, Americans those under the Individuals with Disabilities Education
with Disabilities Act (ADA), auditory processing deficit Act (IDEA).
(APD), Deaf Child’s Bill of Rights (DCBR), free and ap- ■■ All services and accommodations must be identified in
propriate public education (FAPE), Individuals with Dis- the Individual Family Service Plan (IFSP), Individual-
abilities Education Act (IDEA), Independent Educational ized Education Program (IEP), Section 504 plan; if not,
Evaluation (IEE), Individualized Education Program (IEP), there is no legal obligation on the part of the school to
Individual Family Service Plan (IFSP), Every Student Suc- provide the services.
ceeds Act (ESSA), IDEA Part B, IDEA Part C, response to ■■ Active participation as a multidisciplinary team mem-
intervention (RtI), Multi-Tiered System of Support (MTSS), ber increases awareness and support for educational
speech-language pathologist (SLP), teacher of the deaf/hard audiology services for students.
of hearing (TODHH), related services, specialized instruc-
The role of the educational audiologist in the develop-
tional support personnel (SISP)
ment of Individual Education Programs (IEPs), Individual
Family Service Plans (IFSPs), and Section 504 plans is es-
KEY POINTS sential to represent the hearing, listening, and communica-
tion needs of deaf and hard of hearing students as well as to
■■ Familiarity with recent case law and U.S. Department be an active participant of the multidisciplinary team. Be-
of Education policy clarifications that impact students cause audiology is a related service in the Individuals with
who are deaf or hard of hearing is necessary in the ad- Disabilities Education Act (IDEA), this demarcation tends
vocacy role of educational audiologists. to blur audiologists’ perceptions of their role in student plan-
404

Developing Individual Plans 405
ning meetings and in the provision of services to students Additionally, case law is discussed as it influences edu
with hearing and listening problems. Teachers are typically cational practices and audiology services. A review of per
seen as the primary service providers for students with dis- tinent legal definitions and terminology for IDEA and Sec-
abilities. In reality, many students who are deaf or hard of tion 504 (see Chapter 1, Legislation and Policy Essentials,
hearing are not eligible for special education and, as a re- and Appendices 1–A, 1–B, and 1–C) may be helpful to re-
sult, receive their accommodations through a Section 504 view prior to reading this chapter.
plan. One might say this is the new caseload for educational
audiologists because they are frequently the only support
provider for these students, whereas IEP students typically THE SPECIAL
have the combined services of a teacher of the deaf/hard of
hearing, a speech-language pathologist, and an educational EDUCATION PROCESS
audiologist. Although each type of planning meeting (IEP, The purpose of IDEA is to “ensure that all children with
IFSP, and Section 504 plan) has a slightly different purpose, disabilities have available to them a free, appropriate educa-
each includes an important role for the audiologist. tion that emphasizes special education and related services
Graduate training programs have also contributed to the designed to meet their unique needs and prepare them for
lack of clarity surrounding the role of audiologists in the further education, employment, and independent living”.1
educational planning process. The (re)habilitative aspects
Chapter 11
Its purpose is also to ensure that the rights of children with
of audiology training programs tend to put more empha- disabilities and their parents are protected. Consequently,
sis on amplification than on any other type of intervention. states are charged with assuring a free and appropriate pub-
Because the parameters of long-term treatment are much lic education (FAPE) for its eligible students. IDEA 2004
more individualized, more complicated, and less well de- further defined FAPE relative to school performance: “Each
fined, this part of (re)habilitation is more complex to learn, state must assure that FAPE is available to any individual
teach, as well as plan for in one’s schedule. Audiologists, child with a disability who needs special education and re-
because of the independent nature of much of our work, are lated services, even though the child has not failed or been
often not trained in collaborative strategies and the nuances retained in a course or grade and is advancing from grade
of working as part of a team to provide services. Bridging to grade.”2
treatment between the family’s supports and the child’s Case law further interprets and defines the regulations,
education program and collaborating with other agencies, especially areas that may seem vague. As discussed in Chap-
service providers, and community resources are elements of ter 1, Board of Education v. Rowley (1982), the U.S. Supreme
the intervention process that are usually more time-intensive Court concluded that FAPE is not the best program and it
than the therapy itself. Yet, the absence of these elements can
impede an optimal treatment program.
Management of students with reduced hearing, audi-
tory processing deficits, and other listening problems ex- FAPE
tends well beyond the auditory disorder. For planning and
services to be effective, audiologists must have knowledge FAPE means special education and related services
of the issues surrounding the hearing condition and of the that—
resources available for support and intervention and, most (a) Are provided at public expense, under public super
important, exhibit sensitivity when addressing them. More vision and direction, and without charge;
on these issues can be found in Chapter 9, Case Manage- (b) Meet the standards of the SEA, including the re
ment and Habilitation. The focus of this chapter is to provide quirements of this part;
an understanding of the special education process, how it (c) Include an appropriate preschool, elementary school,
integrates with general education, and the various individual or secondary school education in the State involved;
planning options that are available. The educational audi- and
ologist’s specific role within each of the following areas is (d) Are provided in conformity with an individualized
discussed: education [34 CFR §300.1(2)] program (IEP)
that meets the requirements of 300.320 through
■■ identification; 300.324. [34 CFR §300.17]
■■ the referral process and Response to Intervention/Multi-
Tiered Systems of Support;
■■ eligibility determination;
■■ the IEP;
■■ the Section 504 plan;
■■ the services plan (private schools); and 1
34 CFR §300.1(2).
■■ the IFSP. 2
34 CFR §300.101(c).

406 Chapter 11
is not a program designed to maximize a child’s potential education process for 3- to 21-year-olds under IDEA, Part B.
for learning. However, it did state that IEPs for children The birth through 3 years process is discussed under the
educated in regular education classrooms should be rea- IFSP section.
sonably calculated to enable the achievement of passing
marks and advancement from grade to grade (U.S. Supreme
Court,1982). This point is important when we consider the
Step 1: Identification:
educational standard for each student with reduced hearing Concern About the Student
is to minimally be one year’s growth in one year’s time. The special education process begins with a concern about
These court rulings continue to play a significant role in the child, which may be identified by the parent, the teacher,
the evolving meaning of FAPE as well as other aspects of school nurse, physician, or other individual or agency. Con-
IDEA. Some cases have raised questions as to whether the cerns may also come from newborn hearing screening
Rowley standard is still applicable. These cases (Deal v. follow-up or other community screening programs (see
Hamilton County Board of Ed, 2006; J.L. v. Mercer Island, Chapter 4, Hearing Screening and Identification, for spe-
2007; and Blake C. v. Hawaii DOE, 2009) have addressed cific information on screening techniques and programs).
individual student potential as the basis for FAPE and seem With reduced hearing, concern typically is followed by a
to be expanding the applicability of adverse effect to include screening or audiological assessment to confirm or rule out
independence, self-sufficiency, and skills to attain a regular hearing acuity. Depending on the individual school district,
Chapter 11
diploma. agency, and state policy, the concern may or may not require
A 2017 Supreme Court case, Endrew F. v Douglas County a formal special education referral prior to audiological as-
School District, reestablished a slightly higher criteria for sessment. However, due to the variety of contributing factors
determining the sufficiency of FAPE, stating that the stan- for hearing and listening problems and the high incidence
dard must be more demanding than “merely more than de of otitis media as a potential cause, most programs screen
minimis”: or perform an initial hearing assessment to determine the
nature of the problem and the appropriateness of a special
■■ “The IEP must be reasonably calculated to enable a
education referral. Children with previously diagnosed re-
child to make progress appropriate in light of the child’s
duced hearing, including those with an IFSP, enter the spe-
circumstances.”
cial education process at Step 2 or Step 3 depending on the
■■ “The student’s educational program must be appropri-
situation.
ately ambitious in light of his circumstances, just as
To begin the IEP process, a building team meeting is
advancement from grade to grade is appropriately am
usually held with the student’s teacher and other school spe-
bitious for most children in a regular classroom. The
cial education providers prior to making the formal special
goals may differ, but every child should have the chance
education referral. Exceptions to this conference may be jus-
to meet challenging objectives.”
tified for students for whom it is obvious that special educa-
This decision raised several additional questions that tion services are necessary (usually children with significant
are addressed in a U.S. Department of Education Q&A sensory disabilities). Generally, the purpose of this meeting
(https://www2.ed.gov/policy/speced/guid/idea/memosdcl is to discuss the student’s presenting problem, associated
trs/qa-endrewcase-12-07-2017.pdf ): implications, and strategies that have been tried to address
What does “reasonably calculated” mean? the issue. Additional strategies and supports that are targeted
What does “progress appropriate in light of the child’s to the child’s diagnosed problem are discussed and may be
circumstances” mean? implemented prior to a referral and multidisciplinary assess-
How can an IEP team determine if annual goals are ap- ment. If the team recommends a special education referral,
propriately ambitious? the meeting may also be used to determine who will obtain
Educational audiologists should join any local school parent permission, the assessments that will be completed,
district discussions on the impact of this case in developing who will conduct them, and when the IEP meeting will be
IEP goals for deaf and hard of hearing students. held. Educational audiologists should have significant in-
The special education process involves multiple steps volvement in any meeting that involves a student with reduced
that lead to an individual program that defines the services, hearing. Because the group of individuals who work with the
where the services are provided, and the providers of those student are present, it is a good opportunity to explain the
services, as well as reviews procedures once the plan is audiological test results and their implications and to discuss
implemented as illustrated in Figure 11–1. With each new recommendations for services and accommodations.
passing of education and special education legislation, the In some cases, the student study team may determine
process and services have become more integrated with gen- that a hearing condition or auditory processing problem is
eral education. This relationship of general education, Sec- not impacting educational performance based on the ab-
tion 504 and IDEA services are illustrated in Figure 11–2. sence of concerns expressed by the teacher or other school
The discussion in this section refers primarily to the special personnel regarding academic, speech/language, or social/

Chapter 11
FIGURE 11–1 IEP process steps. (Colorado Department of Education, IEP Procedural guidance, used with permission. https://www.cde
.state.co.us/cdesped/iep_proceduralguidance)
behavioral status. In these situations, the accommodations decisions regarding children with reduced hearing may not
recommended by the educational audiologist may provide be made without a specialist who has deaf education exper-
adequate intervention and could be the basis for a Section tise as part of the process (usually the audiologist or teacher
504 plan or incorporated within a response to intervention of the deaf). For students who are not eligible after the as-
(RtI)/Multi-Tiered System of Support (MTSS) strategies. sessment has been completed, the development of a Section
In such instances, the student should always be placed on 504 plan can be easily addressed. This process is discussed
a monitor status to be checked at predetermined intervals. in a later section (Section 504 Plan).
The responsibility of the monitor roster may lie with the au-
diologist, speech-language pathologist, itinerant teacher of Response to Intervention/Multi-Tiered System of Support
the deaf/hard-of-hearing, or some other special service pro- Many school districts have expanded their RtI program to
vider, depending on the problem and how responsibility is MTSS, as it is intended to be a broader structure provid-
delineated for these individuals. This practice should be the ing support to all students, advanced as well as struggling
exception, however. Students with educationally significant learners, under a prevention scheme. The framework also
levels of hearing should have the advantage of a comprehen- includes partnerships with families and community. Further-
sive educational assessment to identify any possible gaps more, MTSS emphasizes social, emotional, and behavioral
in communication, language, academic, social, emotional, support as well as academic. Even though RtI included a
or other areas that could impact learning that should be ad- Universal Tier, designed to ensure high-quality instruction
dressed through special education. Often students are not for all students, it was considered primarily an academic
eligible because the assessment lacked sufficient scope and support program. MTSS may be viewed as the umbrella
intensity to identify the problems. Assessment and resulting overarching many different support programs, such as RtI,

408 Chapter 11
Chapter 11
FIGURE 11–2 Relationship of services for students in general education, Section 504, and special education.
Universal Design for Learning (UDL), Positive Behavioral cal or cognitive impairments) should follow the traditional
Interventions and Supports (PBIS). Even though the models special education referral model. However, with the grow-
are slightly different, we use them both as there are schools ing number of students with reduced hearing who are not
who continue with RtI as it is focused on students requiring eligible for special education, the RtI/MTSS model provides
various levels of learning supports. a framework to support access and learning needs outside
The traditional special education process changed of special education. The increased emphases on research-
under IDEA 2004 with the implementation of the RtI model based interventions that benefit students within the multiple
under general education. RtI is a problem-solving method of tiers of the model also benefit children with hearing and lis-
providing successively more intense interventions to address tening problems.
student learning and behavioral issues. Student responses to Figure 14–3 illustrates a tiered framework of services
these interventions must be considered before a referral is for deaf and hard of hearing students as an adaptation of
made to special education. Students with reduced hearing the RtI model. Table 14–4 details specific types of services
(as well as students with other sensory impairments, physi- and supports that accompany each tier. Tier 1 describes sup-
ports and services for students performing at or above grade
level emphasizing the same prevention proactive approach
as Tier 1 for RtI. The goal for these students is to provide
For students with reduced hearing, the RtI process supports that will sustain their performance. Tier 2 targets
of interventions may constitute a denial of FAPE students who are performing within 1 to 2 years of their
as these children have sensory-based impairments grade level, and Tier 3 targets students who are more than
that impact learning more often than learning prob 2 years delayed. Within this model, interventions such as ap
lems that are a result of inadequate instruction. propriate classroom acoustics and use of classroom sound
Therefore, students with reduced hearing should distribution systems can be implemented at the Tier 1 core
first be assessed for eligibility under IDEA when con instruction level. Tier 2 interventions might include special
cern is raised flexible seating or use of personal remote microphone (RM)
systems. This integration of general education and special ed-
ucation services within one model blurs the roles of the audi-

ologist. Ideally, to support students with hearing and listening sion to have their child assessed. If this occurs, the local edu-
problems, audiologists should be involved with school mul- cational team must decide if the concerns that exist are sig-
tidisciplinary teams at each of these tiers to ensure that ap- nificant enough to pursue the referral through legal means.
propriate interventions and accommodations are instituted. The purpose of the assessment is to obtain informa-
Each state decides how specialized instructional support tion regarding how the student is functioning in order to
personnel (i.e., related services personnel) are involved in determine eligibility for special education. IDEA requires “a
the RtI. IDEA does not prevent this involvement. variety of assessment tools and strategies to gather relevant
As the use of RtI/MTSS increases, more will be learned functional, developmental, and academic information about
about how general education and special education supports the child, including information provided by the parent”3
are integrated throughout the tiers of intervention to support and also states no “single measure or assessment [can be
students with reduced hearing in special education as well as used] as the sole criterion for determining whether a child
those who may be on 504 plans. An important distinction of is a child with a disability and for determining an appropri-
RtI/MTSS is its focus on prevention as compared to failure ate educational program for the child.”4 Assessments must
for special education services. Therefore, RtI/MTSS opens also be “provided and administered in the child’s native lan-
the door for educational audiologists to support the class- guage or other mode of communication,”5 be “administered
room listening needs of all students who might benefit from by trained and knowledgeable personnel,”6 be “selected and
audiology services, not just those who have IEPs. administered so as best to ensure that if an assessment is
Chapter 11
administered to a child with impaired sensory, manual, or
speaking skills, the assessment results accurately reflect
the child’s aptitude or achievement level or whatever other
Students with auditory processing deficits (APDs) generally factors the test purports to measure, rather than reflecting
fall under the learning disabilities or speech-language eligi- the child’s impaired sensory, manual, or speaking skills
bility categories for special education. If the APD problems (unless those skills are the factors that the test purports to
are considered learning problems, the student would likely measure),”7 and “assess in all areas related to the suspected
proceed through the RtI/MTSS process in the school be- disability.”8 Any existing evaluation data must also be re-
fore making a referral to special education. Considerations viewed including that which is “provided by the parents,”
include data that are already collected on RtI/MTSS and current “classroom-based, local or State assessments and
whether the parent has requested an evaluation. If a parent classroom-based observations, and observations by teach-
requests an evaluation, the school either needs to proceed ers and related service providers.”9
with the evaluation or decline the request by issuing the
prior written notice process that provides the parents with
The Independent Educational Evaluation
a response and a reasonable period of time to address their
concern. Generally, APD assessment would occur as part IDEA describes the parent’s right to an Independent Educa-
of the special education referral process rather than the RtI/ tional Evaluation (IEE).10 At the request of the parent, the
MTSS process. Because educational audiologists are typi- school or public agency must provide information about
cally not routine members of the building-level team, it is where such an evaluation can be obtained as well as the stip
helpful for them to provide the team information regarding ulations associated with the IEE. These stipulations include
common behaviors associated with APD, possible manage- the following:
ment strategies that could be implemented under RtI/MTSS, ■■ The IEE is conducted by a qualified examiner who is
as well as referral criteria. More discussion on APD and RtI/ not employed by the public agency responsible for the
MTSS is presented in Chapter 6, Auditory Processing De student;
ficits, including a multitiered model of APD interventions ■■ The IEE is conducted at public expense (no cost to par-
in Appendix 6–J. ents) if the parent disagrees with an evaluation obtained
by the school.
Step 2: Referral to Special To respond to the parent’s request the school must ei-
ther file a due process complaint to request a hearing that
Education and Assessment
A referral for initial evaluation may occur as a result of a 3
34 CFR §300.304(b)(1).
student study team recommendation, transition from an 4
34 CFR §300.304(b)(2).
IFSP, parent request, or a request from another agency. The 5
34 CFR §300.304(c)(1)(ii).
assessment requires parent consent, including notification 6
34 CFR §300.304(c)(1)(iv).
of parent rights. The notice to parents must describe the 7
34 CFR §300.304(c)(3).
proposed evaluation procedures. Assessment must be com- 8
34 CFR §300.304(c)(4).
pleted and determination of eligibility made within 60 days 9
34 CFR §300.305 (a)(1).
of receiving parent consent. Rarely, parents refuse permis- 10
34 CFR §300.502.

410 Chapter 11
shows their evaluation was appropriate or ensure the IEE is tional assessment is critical for children with reduced hear-
provided appropriately and at public expense. A parent is en- ing and, in listening skill development, may be more indica-
titled to only one IEE at public expense each time the school tive of the challenges experienced than the audiogram itself
or agency conducts an evaluation. If the hearing officer, as (see Appendix 5–G for a description of Common Functional
a result of the school’s due process complaint, determines Outcome Measures for Listening Performance). Assessment
that the school’s evaluation is appropriate, the parent may procedures and options that should be included in the educa-
still obtain an IEE but not at public expense. tional audiology evaluation are discussed fully in Chapter 5,
Parent-initiated evaluations that are shared with the Assessment. In addition, Appendix 5–L contains Michigan’s
school or agency, whether provided at public expense or Low Incidence Outreach Educational Impact Matrix for Stu-
not, must be considered in any decision regarding FAPE for dents Who Are Deaf or Hard of Hearing (DHH), which en-
the child so long as they meet agency requirements (e.g., compasses broad areas of skills for deaf and hard of hearing
conducted by a qualified examiner). If you are providing an students. This type of information provides an additional
audiological assessment as an IEE for a school district, you perspective to standardized tests and should be completed
will need to write up your evaluation, attend the IEP meet- with input from teachers of the deaf, classroom teachers,
ing, explain the evaluation results and how reduced hear- other related services professionals, parents, and the stu-
ing affects the student’s ability to communicate and learn dents themselves.
including classroom listening data, why the student needs A well-written, concise report that includes background
Chapter 11
certain services, and what will happen if the student does information, test results, implications of hearing loss within
not receive the services. the educational environment, and recommendations should
accompany all initial evaluations. Care should be taken so
The Educational Audiology Assessment that the information is understandable to those for whom it
Appropriate assessment must always be the foundation of is written, including parents, teachers, and other educational
disability and eligibility determination. To be identified personnel.
with a hearing disability, a formal hearing evaluation must
be completed by an audiologist. Measures should include Step 3: Determination of Eligibility
routine diagnostic audiological procedures as well as func-
Special education means specially designed instruction. It
tional measures of auditory performance with an emphasis
is provided at no cost to the parents and is designed to meet
on classroom listening skills as noted in the Ninth Circuit
the unique needs of a child with a disability.11 Disability and
Court of Appeals, S.P. v. Whittier City School District. Func-
eligibility for special education can be confusing terms. The
presence of a disability is determined from the assessments
that are completed and the resulting needs of the student.
Once a disability is diagnosed, eligibility for special educa-
tion and related services is considered by ascertaining if the
In S.P. v. Whittier City School District, the Ninth Cir-
disability adversely affects educational performance (i.e.,
cuit Court of Appeals ruled on two issues. First,
that S.P. did not have a sufficient evaluation of the
hearing impairment for the IEP team to reason-
ably develop a plan designed to provide reasonable Specially Designed Instruction
education benefit. The citation addressed specifi-
cally that IDEA requires assessment in all areas of Specially designed instruction means adapting, as ap
suspected disability. Although an audiogram was propriate to the needs of an eligible child under this part,
provided by the mother (completed privately), the the content, methodology, or delivery of instruction—
school district’s assessment consisted only of an (i) To address the unique needs of the child that result
auditory skills assessment obtained through obser- from the child’s disability; and
vation and review of records. The Court of Ap- (ii) To ensure access of the child to the general cur
peals ruled that “such a limited review was insuf- riculum, so that the child can meet the educa
ficient to satisfy the District’s evaluation obligation.” tional standards within the jurisdiction of the
Furthermore, the court stated that the special fac- public agency that apply to all children. [34 CFR
tors considerations for children identified as deaf §300.39(b)(3)]
or hard of hearing were not applied because the
school had identified her as a student with speech-
language disabilities which resulted in addressing
only speech and language delays
11
34 CFR §300.39(a)(1).

Child With a Disability

(a) General. (1) Child with a disability means a child evalu (b) Children aged three through nine experiencing develop
ated in accordance with 300.304 through 300.311 as mental delays. Child with a disability for children aged three
having mental retardation, a hearing impairment (including through nine (or any subset of that age range, including ages
deafness), a speech or language impairment, a visual im three through five), may, subject to the conditions described
pairment (including blindness), a serious emotional distur in 300.111(b), include a child— (1) Who is experiencing
bance (referred to in this part as “emotional disturbance”), developmental delays, as defined by the State and as mea
an orthopedic impairment, autism, traumatic brain injury, sured by appropriate diagnostic instruments and procedures,
another health impairment, a specific learning disability, in one or more of the following areas: Physical development,
deafblindness, or multiple disabilities, and who, by reason cognitive development, communication development, social
thereof, needs special education and related services. or emotional development, or adaptive development; and
(2) Who, by reason thereof, needs special education and
related services. [34 CFR §300.8]
Chapter 11
the student’s ability to obtain reasonable benefit from regu- Reduced Hearing and Eligibility
lar education alone). States and local education agencies For children with hearing differences, the question of what
have the option of holding the eligibility meeting separate level constitutes a disability cannot be determined by audio-
from the meeting to develop the IEP. metrics alone. Many factors affect the relationship of hear-
To determine if the student is eligible to receive special ing impairment and the ability to compensate for it. Age of
education and related services, the IEP team, including the onset, age of intervention, intellectual capacity, neurologic
parents, reviews the information provided from the various function, central auditory processing ability, environment,
assessments and ensures that all information is documented other health factors, and the effects of otitis media are all
and carefully considered. IDEA 2004 added a special rule variables that impact the disabling effects of reduced hear-
for eligibility determination that states a child cannot be eli- ing. For some children, reduced hearing in the minimal or
gible if the delay is due to lack of appropriate instruction mild range can have significant implications, whereas for
in reading, including the essential components of reading others, the same level may present no consequences. How-
instruction, or lack of appropriate instruction in math.12 ever, it is important that children with reduced hearing have
These stipulations are in addition to limited English profi- the correct eligibility label so that accurate statistics can be
ciency. Once eligibility determination is made, an IEP must reported, and the children can be assured of appropriate ser-
be developed. vices (see S.P. v. Whittier City School District). Therefore,
If a child has a disability according to the IDEA cate unless there is clear evidence that supports another label, the
gories but only needs a related service and not specialized
instruction (i.e., the specific requirement that indicates spe-
cial education), the child is not eligible as identified13 unless
the related service is determined to be special education ac-
cording to the state’s standards (e.g., some states consider a Nuggets from the Field
language impairment as special education rather than a re-
lated service even when the primary provider is the speech- Did you know? Students who are deaf or hard
language pathologist). To be entitled to a related service, the of hearing only have access to “special consider-
child must meet the following requirements: ations” in the IEP if they have this specific disability
■■ The child must have a disability that requires special category label. State regulations vary, and some
education under IDEA. have a work-around. Check your state’s IDEA reg
■■ The service must be necessary to aid a child with a dis- ulations as this will impact how you determine eli-
ability to benefit from special education. gibility for special education.
■■ The service must be performed by a nonphysician.
12
34 CFR §300.306(b)(1).
13
34 CFR §300.8(a)(2)(i).

412 Chapter 11
eligibility category should be deaf or hard of hearing or deaf ity to learn is difficult, and often impossible, to delineate.
blind when a dual sensory impairment is present. Each factor affects the other so that determination of the
Criteria for a hearing disability vary by state. Some primary disability, or cause of the child’s problems, may
states use the federal definitions for deafness, hearing im- not be clear. Before adding a disability, or changing the pri-
pairment, and deaf-blindness (see Appendix 1–C and 1–D mary disability, a thorough evaluation must be conducted to
[online] for IDEA definitions), while others stipulate specific determine how the hearing status either contributes or does
decibel hearing levels. For example, Colorado (Colorado De- not contribute to the behaviors of the child. The team should
partment of Education, 2013) uses the following criteria: be able to document why a different primary disability label
is justified. According to IDEA, children identified under the
■■ Three frequency, pure tone average hearing loss in the
category of learning disabilities need the eligibility team to
speech range (500–4000 hertz (Hz) of at least 20 deci-
affirm that the learning disability is not primarily the result
bels Hearing Level (dB HL) in the better ear which is
of “(i) A visual, hearing, or motor disability.”14
not reversible.
A label of deafness or hearing impairment, while used
■■ A high-frequency, pure tone average hearing loss of at
to meet disability and eligibility requirements, does not mean
least 35 dB HL in the better ear for two or more of the
the student necessarily has to be served solely by a provider
following frequencies: 2000, 3000, 4000, or 6000 Hz.
who is a specialist in deafness. Speech-language patholo-
■■ A three-frequency, pure tone average unilateral hear-
gists frequently serve children with hearing differences due
Chapter 11
ing loss in the speech range (500–4000 Hz) of at least

to their language needs. For students who exhibit behavior
35 dB HL which is not reversible.
and social problems, a behavioral specialist in collaboration
■■ A transient hearing loss, meeting one of the criteria in
with the teacher of the deaf might be the most appropri-
(a)(i)–(a)(iii) above, that is exhibited for three (3) months
ate and effective service provider arrangement. The focus
cumulatively during a calendar year (i.e., any three
should be on designing a program to meet the child’s needs
months during the calendar year) and that typically is
and assuring appropriate services. Several states provide for
caused by non-permanent medical conditions such as
primary, secondary, and tertiary labels on the IEP.
otitis media or other ear problems.
Within the continuum of hearing differences, minimal Options for Children Who Are Not
levels that are unilateral, in the high-frequency range, or bi- Eligible for Special Education
lateral with pure-tone averages (PTAs) in the 15 to 25 dB Section 504 and the Americans With Disabilities Act
range may have questionable impact on communication and Schools must ensure that students who are deaf or hard of
learning unless a comprehensive evaluation is performed. hearing receive accommodations, modifications, auxiliary
For eligibility under IDEA, the hearing status must aids, and services so that they can access all educational pro
adversely affect educational performance. Adverse effects grams and activities of the school. Children who are not eli
should be considered across functional, developmental, and gible for special education and related services under IDEA
academic areas. The amount of delay that constitutes ad- are generally qualified under ADA and therefore eligible
verse effect is up to school district guidelines and the IEP for a 504 plan to address services and accommodations in
team. For deaf and hard of hearing children, areas to con- the schools. Chapter 1 provides more information on ADA
sider may include: and 504 regulations. Figure 11–3 illustrates a process for
■■ communication difficulties resulting from auditory skill considering eligibility and services between IDEA and 504.
deficits including difficulty listening in noise, or sign
language deficits;
■■ language delays including pragmatic language problems;
■■ articulation, voice, or fluency problems; Section 504
■■ reading and/or math deficits;
■■ poor academic achievement; No otherwise qualified individual with a disability in
■■ attention problems; the United States, as defined in Sec. 705(20) of this
■■ social problems; title, shall, solely by reason of her or his disability, be
■■ behavior issues; excluded from the participation in, be denied the ben
■■ independence, self-advocacy, and/or self-sufficiency; and efits of, or be subjected to discrimination under any
■■ emotional problems. program or activity receiving federal financial assis
tance . . . [29 U.S.C. §794(2)]
Reduced Hearing and Other Disabilities
The relationship between hearing, especially when it is at a
mild level, and speech/language disorders, learning disabili-
ties, emotional or behavioral problems, and a limited capac- 14
34 CFR §300.309 (a)(3)(i).

of the U.S. Department of Education. Of note, OCR

Section 504 Regulations also enforces Title II of the ADA that prohibits discrimi-
Regarding IDEA nation by state and local governments. Complaints of
discrimination are made to the OCR that then requires
A free appropriate public education is the provision school districts or agencies to conduct impartial hear-
of regular education or special education and re ings for resolution. In contrast to special education, the
lated services that . . . are designed to meet individual procedures and requirements of these hearings are not
educational needs of persons with disabilities as ad specified. If there is not voluntary compliance with the
equately as the needs of persons without disabilities resolution, OCR will initiate enforcement action by be-
are met. [34 CFR §104.33(b)(1)] ginning proceedings to terminate financial assistance or
refer the case to the Department of Justice for judicial
proceedings. (U.S. Department of Education)
4. Section 504 does not include any designated funding.
The purpose of Section 504 is to protect individuals
Appendix 1–A compares pertinent components of
with disabilities from discrimination for reasons related to
IDEA, Section 504, and ADA. More about Section 504 is pre
their disabilities (Wright & Wright, 2009); the purpose of
sented in a later section in this chapter (Section 504 Plan).
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IDEA is to ensure that all children with disabilities have a
FAPE. Inherent in FAPE is protection from discrimination.
Eligibility for Section 504 and ADA is based on the student Individuals With Disabilities Education Act and Ameri
having a physical or mental impairment that substantially cans With Disabilities Act Eligibility Students with IEPs
limits at least one major life activity. If a child has such an are generally automatically eligible for ADA by virtue of
impairment (e.g., reduced hearing) that substantially lim- their disability. This dual eligibility presents some interesting
its one or more major life activities (e.g., communication consequences because the ADA service standard of “equal
access) but does not require specially designed instruction to” that of nondisabled persons is often higher that FAPE
or related services, the child is eligible to receive Section under IDEA. As described in Chapter 1, the U.S. Department
504 services. Amendments to Section 504 because of the of Justice and U.S. Department of Education together
Americans with Disabilities Act Amendments Act of 2008 published a policy guidance, Frequently asked questions on
broadened the interpretation of disability though it did not effective communication for students with hearing, vision,
affect the provision of Section 504 under the U.S. Depart- or speech disabilities in public elementary and secondary
ment of Education. It also stated that mitigating factors such schools (2014), to address obligations of schools to provide
as hearing aids, other assistive technology, or extra tutoring these services (https://www2.ed.gov/about/offices/list/ocr
could not be used in the determination of eligibility. /docs/dcl-faqs-effective-communication-201411.pdf). This
IDEA and Section 504 may be differentiated in several guidance describes eligibility and accommodations under
ways: Title II of the ADA and the IDEA as well as important dif
ferences between the laws. See Chapter 1 for more informa
1. Section 504 is a general education program. The eli- tion on meeting the “effective communication” components
gibility team may include an administrator from the of ADA as well as the ADA Checklist in Appendix 11–E.
school, the student’s teacher(s), the parents, and a spe- ADA rights for deaf and hard of hearing students who are
cialist who understands the impact of the disability. If not eligible for IDEA are met through the 504 plan.
the student meets the disability criteria, then Section
504 needs are identified, and a plan is developed (see
Section 504 plan section of this chapter). Section 504 Other Considerations If there are no limitations determined,
services are based on access to the education program the child is not eligible for Section 504 services. Another
rather than a specially designed program to meet the option for students with hearing and listening problems is to
unique needs of the student. For a student who is deaf explore strategies to improve learning through the RtI/MTSS
or hard of hearing, common access supports include an process. The audiologist, or another designated professional
interpreter, a RM system, a notetaker, and captioning. such as the speech-language pathologist, teacher of the deaf/
These access services are considered reasonable accom hard of hearing, school nurse, or health aide, should have
modations under Section 504. responsibility for monitoring the performance of students with
2. Section 504 does not contain the procedural safeguards hearing differences who are not receiving any special education
of IDEA; it does not require a written plan (though a or Section 504 services. Using RtI/MTSS, access to learning
plan is recommended), and it does not require a meeting trajectories through progress monitoring programs provide
prior to making changes in the plan. evidence when special education or Section 504 services may
3. Section 504 is implemented and enforced under the ju- need to be reconsidered. More strategies for monitoring are
risdiction of the Office of Civil Rights (OCR), an entity presented in Chapter 9, Case Management and Habilitation.

414 Chapter 11
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FIGURE 11–3 IDEA and Section 504 considerations for services.
Step 4: The Individualized 30 days of eligibility determination and include rights and
Education Program Meeting due process procedures. Each plan is actually a contract be
Individual plans and programs are written documents that tween the school and/or other agencies and the child’s pa
define the content and parameters of appropriate educational rents. Fulfillment rights of the plan or program pertain to
services for each child. These plans must be developed within parameters of the document such as how often, by whom,

TABLE 11–1 Sample Individualized Education Program (IEP) ■■ consideration of special factors;
Meeting Agenda ■■ participation of the general education teacher; and
1. Introduce IEP team participants. ■■ an agreement for how changes and amendments will be
2. State the purpose of the meeting. made to the IEP after the annual meeting.
3. Ask parents if they have questions regarding their
Procedural Safeguards, Rights, and Responsibilities. Individualized Education Program Team Participants
4. Describe present levels of academic achievement and IEP team members are mandated by IDEA (see text box
functional performance.
on p. 416). Attendance at IEP meetings can be waived with
5. Determine special factors (e.g., communication written permission from the parents for team members two
considerations for students who are deaf and hard of
through five if that member’s area of the curriculum or re-
hearing).
lated services is not being discussed or modified or if the
6. Determine post-school goals and transition needs (required
member submits in writing to the parent and IEP team, input
if 16 years or older).
into the development of the IEP prior to the meeting.
7. Develop annual goals.
8. Determine accommodations and modifications including
Adaptations, Accommodations, and Modifications
those necessary for state and district assessments.
Although these terms are often used interchangeably, it is
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9. Determine serviced delivery.
important to understand their distinctive meanings, because
10. Determine placement in the least restrictive environment.
they are used so frequently with reference to deaf and hard
Note. Adapted from Colorado Department of Education (2008). IEP manual, of hearing students as well as all students in special edu-
and Colorado Department of Education. (2017). IEP procedural guidance: cation. Adaptations are changes made to the environment,
Exceptional student services unit technical assistance. curriculum, instruction, and/or assessment practices for a
student to be a successful learner. Adaptations include ac-
commodations and modifications defined as follows.
or the amount of time services are scheduled rather than the
Accommodations are provisions in how a student ac-
amount of progress made by the child. IDEA 2004 added a
cesses information and demonstrates learning and do not
new provision for failure to meet transition objectives that
substantially change the instructional level, content, and/or
pertains only to participating agencies, and requires the pub-
performance criteria. The changes are made to provide a stu-
lic school to “reconvene the IEP team to identify alternative
dent equal access to learning and equal opportunity to dem-
strategies to meet the transition objectives for the child.”15
onstrate what is known. Support for teachers to adjust their
To address requirements of the No Child Left Behind
attitudes regarding providing accommodations may also be
(NCLB) act and increased accountability for performance,
necessary. Accommodations work only as well as how they
IDEA 2004 also contained regulations increasing the federal
are implemented. Accommodations include changes in and/
and state monitoring procedures with specific emphasis on
or provision of the following:
improving educational results and functional outcomes for
student with disabilities.16 Each state must have a State Per- ■■ presentation and/or response format and procedures;
formance Plan to address 20 performance indicators with ■■ instructional strategies;
targets that are approved by Office of Special Education Pro- ■■ time and scheduling;
grams (OSEP). An Annual Performance Report (APR) must ■■ architectural features;
be submitted indicating current performance based on data ■■ environmental features; and
collected from school districts and agencies. ■■ equipment.
Development of the IEP requires consideration of the
Modifications are substantial changes in what a student
following components17 (a sample IEP meeting agenda that
is expected to learn and demonstrate. These changes are made
would include these components is described in Table 11–1):
to provide a student the opportunity to participate meaning-
■■ the strengths of the child; fully and productively in learning experiences and environ-
■■ the concerns of the parents for enhancing the education ments. Modifications include changes in the following:
of their child;
■■ instructional level;
■■ the results of the initial or most recent evaluation of the
■■ content; and
child (i.e., present levels of academic achievement and
■■ performance criteria.
functional performance [PLAAFP]);
■■ the academic, developmental, and functional needs of Adaptations are critical for students as they participate
the child; in high-stakes assessments at local or state levels. Most
15
34 CFR §300.324(c)(1).
16
34 CFR §330.600(b)(1).
17
34 CFR §300.324(a).

416 Chapter 11
The Public Agency Must Ensure That the IEP Team for Each Child with a
Disability Includes
1. The parents of the child; 5. At the discretion of the parents, other individuals who
2. At least one regular education teacher (if the child have knowledge or special expertise regarding the
is, or may be participating in the general education child;
environment; 6. Whenever appropriate, the child;
3. A representative of the school or public agency who 7. For transition services:
is qualified to provide or supervise specially designed 16 years and older: the child is required to attend
instruction to meet the child’s needs, and, when appropriate and with consent of the
is knowledgeable about the general education cur child, a representative of any participating agency
riculum, and that is likely to be responsible for providing or pay
is knowledgeable about the availability of resources ing for transition services.
of the school or public agency; Part C to Part B; an invitation to a Part C service rep
4. An individual who can interpret the instructional implica resentative at the request of the parent. [34 CFR
Chapter 11
tions of evaluation results; §300.321(a)]
assessments allow the use of certain accommodations if they needs of the student, attendance may be optional. However,
are also included on the student’s IEP. Modifications often if the audiologist provides direct intervention services, at-
are used for students who participate in state alternative as- tendance is required as a service provider. Generally, edu-
sessments. A checklist for identifying necessary accommo- cational audiologists should use their professional judgment
dations and modifications for students who are deaf or hard of the situation when deciding the need to attend the annual
of hearing is in Appendix 11–A. review. If unable to attend, a current written report or “up-
date” should be provided to the parents and the IEP team.
Reevaluations require parent permission, including the
Step 5: Review and Revision of the comprehensive audiological evaluation. Attendance at the
Individualized Education Program IEP meeting is also necessary unless the parents and school
The IEP should be reviewed periodically but no less than have determined the evaluation is not necessary or that a writ-
annually18 to determine if the goals are being, or have been, ten report will suffice. Functional, as well as standard, audio-
achieved. Revision of the goals should occur to address lack logical assessments should be completed, including a written
of expected progress on the annual goals, the results of any “update” report for the student’s file. Information should also
new evaluations, information about the child provided to, contain a summary of the student’s performance in the class-
or by, the parents, the child’s anticipated needs, or other room relative to hearing. The IEP review meeting functions
matters. Providers should be mindful of the Endrew case, in the same way as the initial placement meeting except that
ensuring that the goals enable a child to make progress that parent permission to continue services is not required.
is appropriate in light of the child’s circumstances. Special
factors should also be addressed at each IEP review. A re- Due Process Procedures
evaluation and determination of eligibility should occur (a)
Each school district or public agency is required to maintain
every 3 years from the date of the last eligibility determina-
procedural safeguards.19 As part of this process, a proce-
tion, (b) prior to a change in eligibility, (c) if the child’s
dural safeguards notice must be provided at least annually
parent or teacher requests a special education evaluation,
to parents of children with disabilities in an understand-
or (d) if there is any change in circumstances. The parents
able format and include a full explanation of the following
and school district/public agency may agree that no further
components20:
evaluation data are needed to continue eligibility.
The educational audiologist’s role in annual review ■■ independent educational evaluations;
meetings is to provide any new or updated information ob- ■■ prior written notice;
tained from the student’s annual hearing evaluation. Often ■■ parental consent;
audiologists’ caseloads are high and prohibit attendance at ■■ access to educational records;
every annual review. If there are no changes in the status or ■■ the due process and state complaint procedures;
19
34 CFR §300.500.
18 20
34 CFR §300.324 (b). 34 CFR §300.504.

■■ the availability of mediation; ■■ civil actions; and

■■ the child’s placement during the time a complaint is ■■ attorney’s fees.
pending;
When parents are not in agreement with procedures or
■■ procedures for students who are subject to interim alter-
services as part of assessment and IEP development and im-
native educational settings;
plementation, they may exercise their due process rights. Op-
■■ unilateral placement by parents;
tions include mediation, due process complaint, or an impar-
■■ hearings on due process complaints;
tial due process hearing. These are described in Table 11–2.
■■ state-level appeals;
All options require the parents to provide notice in writing.
TABLE 11–2 Due Process Options for Parents
Type Description
Mediation [34 CFR ■■ To resolve disagreements involving any matter under Part B of IDEA.
§300.506] ■■ Voluntary process for both parties.
■■ Procedure can be used whether or not a due process complaint has been filed and cannot deny or
Chapter 11
delay the right to a due process complaint.
■■ Must be conducted by a qualified and impartial mediator who is selected by the state.
■■ Cost is born by the state.
■■ Resolution requires a legally binding agreement.
■■ All discussions from the process are confidential and cannot be used as evidence in any subsequent
due process hearing or civil proceeding.
Due Process Complaint ■■ In regard to identification, evaluation, or educational placement of a child with a disability, or
[34 CFR §300.508] provision of FAPE.
■■ Have occurred no more than 2 years from date of making complaint.
■■ Requires the due process complaint be filed with the school or public agency and the state
education agency (contents of complaint remain confidential).
■■ Content of complaint must include the name, address, and school of the child, the nature of the
complaint, and a proposed resolution.
■■ Meet procedural requirements for complaints.
■■ School or public agency must respond to parents within 10 days stating (a) why they proposed or
refused to take the action raised in the complaint; (b) a description of other options considered
by the IEP team and reasons why those options were rejected; (c) a description of each evaluation
procedure, assessment, record, or report the school or agency used as the basis for the proposed
or refused action; (d) a description of other factors that are relevant to the school or agency’s
proposed or refused action.
■■ Within 15 days, the school district or agency must schedule meeting with parents to discuss the
complaint and the facts that form the basis for the complaint (meeting can be waived if both
parties agree or decide to use the mediation process).
■■ If resolution reached, a legally binding agreement is written.
■■ If complaint not resolved within 30 days to parent’s satisfaction, the due process hearing may
proceed.
■■ Total complaint time is 60 days, which can be extended (30-day resolution period plus 30-day due
process hearing period).
Impartial Due Process ■■ Only a parent or school district/public agency can file.
Hearing [34 CFR §300.511] ■■ Depending on state regulations, due process hearing conducted by either state education agency
or school district/agency responsible for educating the child.
■■ Utilizes an impartial hearing officer who must have the knowledge and ability to render and write
decisions in accordance with appropriate, standard legal practice.
■■ Both parties typically utilize legal counsel.
■■ Process involves presentation of evidence, confrontation, and cross-examination of witnesses.
■■ All evidence must be disclosed at least 5 business days prior to the hearing.
■■ Decisions are made based on whether a child was denied FAPE on (a) substantive grounds or
(b) due to procedural violations.

418 Chapter 11
TABLE 11–3 Examples of the Educational Audiologist’s Role in the Special Education Process
1. Refer student for consideration ■■ Any student with reduced hearing or APD that is potentially educationally significant (i.e.,
of special education and related the hearing status or APD could interfere with the student’s ability to obtain reasonable
services. benefit from regular education).
2. Participate in child study ■■ If audiological assessment has been completed,

meeting. explain the parameters of the auditory disorder, including whether the hearing
condition meets established criteria to qualify as a hearing disability;
explain the communication, learning, and social implications of the auditory disorder;
provide recommendations for educational management and amplification;
provide recommendations for medical intervention, if appropriate;
provide additional follow-up support, when indicated; and
support RtI/MTSS process if student with APD.
■■ If audiological assessment has not occurred,
address the concerning behaviors, existing data, and provide clarifying information
regarding the potential implications of hearing status.
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3. Conduct comprehensive ■■ Integrate information regarding the student’s hearing and auditory skill development and
educational audiology functional listening abilities into the discussion of communication considerations and needs.
assessment. ■■ Evaluate candidacy for personal and hearing assistive technology.
■■ Verify and validate current use of hearing technology.
■■ Assess classroom listening (observation, communication access, acoustics, accommodations).
4. Prepare a written report. ■■ Detail background information, audiological findings, implications of hearing status or
APD, auditory and communication needs, recommendations for audiologic follow-up,
and classroom management (see Chapter 5, Assessment) for information on specific
components of the written report.
■■ Provide copies to parents, teachers, nurse, special education personnel, the student’s
physician, dispensing or private audiologist, and others, as appropriate.
5. Participate in meeting for ■■ Discuss the team’s assessment results considering the other findings.
disability and eligibility. ■■ Integrate audiological findings and recommendations into the discussion of the student’s
needs.
■■ Determine disability and eligibility.
■■ Address the student’s communication considerations under special factors.
6. Participate in development of ■■ Promote high standards and expectations.

individual plan. ■■ Advocate for appropriate services including required accommodations and modifications
and a supportive placement.
■■ Develop relevant goals for communication and auditory skill development, social-
emotional wellness, self-determination, self-advocacy, and competency with personal and
hearing assistance technology.
Appeals and impartial reviews are conducted according tion, to the state education agency or school district/public
to IDEA procedural requirements.21 If there is no right to ap- agency against the parent.23
peal, a civil action with respect to the due process complaint
may be brought in any state court or jurisdiction or in a
The Educational Audiologist’s Role
U.S. District Court.22 Attorneys’ fees may be awarded to the
prevailing party (e.g., the parent) or, if the parent’s request in the Special Education Process
was deemed frivolous, unreasonable, or without foundation The educational audiologist has specific roles in the special
or represented improper cause, such as to harass or to cause education assessment, eligibility, and IEP meeting process
unnecessary delay or needlessly increase the cost of litiga- for students with auditory disorders. Table 11–3 describes
21
34 CFR §300.514.
22 23
34 CFR §300.516. 34 CFR §300.517.

some of these activities. Appendix 11–B contains a checklist ■■ The IEP is a compliance/monitoring document that
of team responsibilities for the educational audiologist. may be used by authorized monitoring personnel from
each governmental level to determine whether a child
with a disability is actually receiving the FAPE agreed
to by the parents and the school.
THE INDIVIDUALIZED ■■ The IEP serves as an evaluation device for use in deter-
EDUCATION PROGRAM mining the extent of the child’s progress toward meet-
ing the projected outcomes.
The IEP is a written statement that is developed, reviewed,
To complete the IEP, certain decisions must be made
and revised in accordance with IDEA requirements. In ac-
and included as statements in the document. The educational
cordance with these requirements:
audiologist has a direct role in some of these discussions and
■■ The IEP document sets forth in writing a commitment of decisions and a more peripheral role in others. Care must be
resources necessary to enable a child with a disability taken to present information in a sensitive way that invites or
to receive needed special education and related services. includes parent input, as well as input from the teachers and
■■ The IEP is a management tool that is used to ensure that other professionals who work with the student; IEP devel-
each child with a disability is provided special educa- opment is a team process. Information used in the develop-
Chapter 11
tion and related services appropriate to the child’s spe- ment of the IEP and the audiologist’s role in providing that
cial learning needs. information are presented in Table 11–4.
Definition of Individualized Education Program

The IEP must include- child to advance appropriately toward attaining the an
1. A statement of the child’s present levels of academic nual goals; to be involved in and make progress in the
achievement and functional performance [including general education curriculum . . . and to participate in
how the disability affects the child’s involvement and extracurricular and other nonacademic activities, and
progress in the general education curriculum and to be educated and participate with other children with
those that are a result of special factor considerations]; disabilities and nondisabled children;
2. A statement of measurable annual goals, including 7. An explanation of the extent, if any, to which the child
academic and functional goals designed to will not participate with nondisabled children in the
(i) Meet the child’s needs that result from the child’s regular class and . . . activities;
disability to enable the child to be involved in, and 8. A statement of any individual appropriate accommo
make progress in, the general education curricu- dations that are necessary to measure the academic
lum; and achievement and functional performance of the child
(ii) Meet the child’s other educational needs that re on State and districtwide assessments . . . and if the
sult from the child’s disability; IEP team determines that the child must take an
3. For children with disabilities who take alternate as alternate assessment, a statement of why the child
sessments aligned to alternate achievement standards, cannot participate in the regular assessment and why
a description of benchmarks or short-term objectives; the particular alternate assessment selected is appro
4. A description of priate for the child;
(i) How the child’s progress toward meeting the an 9. Transition services. Beginning not later than the first
nual goals will be measured; and IEP to be in effect when the child turns 16, or younger
(ii) When periodic reports on the progress the child if appropriate, and updated annually thereafter, the
is making toward meeting the annual goals (e.g., IEP must include
quarterly reports concurrent with the issuance (i) appropriate measurable post-secondary goals
of report cards) will be provided; based upon age-appropriate transition assess
5. A statement of the special education and related ser ments related to training, education, employment
vices and supplementary aids and services, based on and, where appropriate, independent living skills;
peer-reviewed research to the extent practical, to be and
provided to the child, or on behalf of the child; (ii) The transition services (including courses of study)
6. A statement of the program modifications or supports needed to assist the child in reaching those goals.
for school personnel that will be provided to enable the [34 CFR §300.320]

420 Chapter 11
TABLE 11–4 The Educational Audiologist’s Contribution to Required IEP Development.
Part 1. Development, review, and revision of the IEP [34 CFR §300.324]
Required Information Audiologist’s Contribution

The strengths of the child. Describe positive information about the student’s communication skills
and related areas including ability to accommodate the hearing condition,
self-advocacy skills, etc.
The concerns of the parents for enhancing the education of Contribute concerns that parents have shared through the assessment
their child. process.
Results of the initial or most recent evaluation. Describe audiological and functional assessment data regarding the hearing
condition, listening performance, use of hearing and/or other technology,
and classroom acoustics analysis.
The academic, developmental, and functional needs Describe the impact of the hearing condition or APD on academic
of the child. performance, communication skills, and social and emotional wellness
as they relate to the student’s acceptance of the hearing condition and
Chapter 11
the need to self-advocate in areas including managing personal and

assistive amplification, knowledge of hearing condition/APD, and use of
accommodations. Describe the services and accommodations needed to
address these needs.
Consideration of special factors: Consider Address the student’s language and communication needs relative to
(a) the child’s language and communication needs, communication and learning abilities in various classroom situations, and
(b) opportunities for direct communications with peers the need for accommodations and services specifically addressing assistive
and professional personnel in the child’s language and technology devices and the accompanying services to use them.
communication mode, academic level, and full range of
needs,
(c) including opportunities for direct instruction in the child’s
language and communication mode
(d) whether the child needs assistive technology devices and
services.
Part 2. Components of the IEP [34 CFR §300.320]
A statement of the child’s present levels of academic Present audiological and functional assessment data regarding the hearing
achievement and functional performance. condition, listening performance, use of hearing and/or other technology,
and classroom acoustics analysis.
A statement of measurable annual goals, including academic Write annual goals for the development of auditory and listening skills, use
and functional goals. and independence with hearing aids and hearing assistance technology,
self-advocacy for determination of appropriate accommodations,
and other areas as appropriate for the student’s age and hearing,
communication, or processing needs.
Include measurement strategies for each goal as well as benchmarks.
A description of how the child’s progress towards meeting the Describe how progress will be reported to parents and provided at the
annual goals will be measured including when the reports same time as regular progress reports and report cards; these progress
will be provided. notes can be combined with other special education reporting from the
team.
A statement of the special education and related services Present the necessary audiology services, including annual hearing
and supplementary aides and services, to be provided to the evaluations (more frequent if necessary), classroom acoustic modifications,
child or on behalf of the child. use of hearing assistance technology such as RM system, assistive
technology services such as orientation and training with the RM system,
monitoring the functioning of the hearing aids and RM system, specific
auditory and listening skill development, and self-advocacy development.
(Continues)


A statement of program modifications or supports for school Report recommendations for accommodations based on assessment
personnel that will be provided to enable the child to advance results and classroom listening needs. Describe support and training
toward attaining the annual goals, to be involved in and that will be provided to teachers and staff to ensure that the specified
make progress in the general education curriculum, and to be accommodations and services are implemented as intended.
educated and participate with other children with disabilities
and nondisabled children.
A statement of individual accommodations necessary Report the accommodations that are necessary to participate in assessments
to measure the academic achievement and functional as a result of the student’s hearing condition (e.g., communication
performance on state and districtwide assessments. accommodations, use of assistive technology).
The projected date for the beginning of the services and Report required service delivery data. Consider short- and long-term
modifications and the anticipated frequency, location, and services based on the student’s needs.
duration of those services and modifications.
For transition students (16 years and older), appropriate Report relevant information to assist the student in developing goals
Chapter 11
measurable postsecondary goals related to training, education, that are based on access needs, knowledge of rights, and services
employment, and where appropriate, independent living skills through ADA, and other agencies. Provide community linkages necessary
and the transition services needed to assist the child in reaching to continue hearing or processing-related services once the student
those goals. graduates. These may include establishing a relationship with a community
audiologist for hearing and hearing aid services, working with vocational
rehabilitation for support services, and connecting with the Center on
Deafness or other community programs for individuals who are deaf or
hard of hearing or who have learning disabilities.
Goals on the IEP that promote auditory development, Consideration of Special Factors:
independence with amplification, self-determination, and
Communication Considerations
self-advocacy to accommodate hearing status should al-
ways be included. Depending on the specialists in hearing The communication considerations portion of the IDEA24
and their individual roles, these goals might be the respon- is perhaps the most critical component of the IEP for stu-
sibility of the speech-language specialist, the audiologist, or dents who are deaf or hard of hearing. Each point that fol-
the teacher of the deaf/hard-of-hearing or a combination of lows must be discussed at each IEP meeting (initial, reeval-
these. See Appendix 2–A for Supporting Students who are uation). This discussion should be a thorough exploration
Deaf and Hard of Hearing: Shared and Suggested Roles of and description of the child’s language and communication
Educational Audiologists, Teachers of the Deaf and Hard of skills and needs. It should occur early in the IEP meeting
Hearing, and Speech-Language Pathologists (EAA, 2018) (after eligibility is determined) so that communication needs
for guidance determining team member responsibilities. The can drive the remaining discussion about strengths, goals,
educational audiologist should always promote academic services, and placement. Communication considerations
goals that reflect minimally 1 year’s growth in 1 year. as that must be discussed are:
supported by the U.S. Supreme Court statement: “the IEP, ■■ the child’s language and communication needs;
and therefore the personalized instruction, should be formu- ■■ opportunities for direct communication with peer and
lated in accordance with the requirements of the Act, and if professional personnel in the child’s language and com-
the child is being educated in the regular classrooms of the munication mode;
public education system, should be reasonable calculated to ■■ the child’s academic level and full range of needs;
enable the child to achieve passing marks and advance from ■■ opportunities for direct instruction in the child’s lan-
grade to grade” (Hendrick Hudson School District Board of guage and communication mode; and
Education v. Rowley, 1982). Alternatively, goals should be ■■ assistive technology needs.
“reasonably calculated to enable a child to make progress
appropriate in light of the child’s circumstances.” (Endrew v.
Douglas County School District, 2017). See Chapter 14 for
more information about the educational growth model. 24
34 CFR §300.324(2)(iv).

422 Chapter 11
Educational audiologists should consider auditory com- still means general education classrooms, limited supports,
munication access needs as part of this discussion. Areas and isolation from peers with reduced hearing. As a result,
to discuss include classroom acoustics, lighting, speech-to- deaf educators have renamed the acronym LRE to “Lan-
noise advantage for the teacher and students, and seating ar- guage Rich Environment” (read more about these issues in
rangements. The audiologist should also advocate for hear- Chapter 14).
ing and other assistive technology support as needed by the Special education and the IEP are about services, not
student. Appendix 11–C provides a sample worksheet devel- necessarily placement. However, we must address where
oped by the Wisconsin Department of Instruction that can be the services are to be provided. As educational audiologists,
used to guide the communication considerations discussion. along with deaf educators, our role is to prepare students with
Other states (e.g., Colorado, Minnesota, Ohio) have similar hearing differences and listening problems to be successful.
guides emphasizing the importance of the discussion that Therefore, placement decisions should be based on two pa-
occurs when addressing communication for deaf and hard rameters: (a) what is the student’s “readiness” for the place-
of hearing students. As indicated earlier, state interpretation ment under consideration and (b) how well is that “placement”
varies as to whether communication considerations apply equipped to meet the needs of the student. Appendix 11–D
to all IEP students with reduced hearing regardless of their (online) contains a series of documents, the Placement and
eligibility category (e.g., a child with Down syndrome who Readiness Checklists (PARC). The three placement check-
also has hearing loss). Some states have also passed Deaf lists vary slightly to address the needs of the students at pre-
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Child’s Bill of Rights (DCBR) legislation. The requirements school/kindergarten, elementary, and secondary levels. The
of DCBR are similar but generally expand the requirements four readiness checklists cover general education inclusion,
of communication considerations under IDEA. So long as interpreted/transliterated education, captioning and transcrib-
the DCBR addresses the areas required under IDEA, it may ing, and instruction communication access. Social-emotional
be used to meet the requirements of the communication con- wellness should also be part of these discussions.
siderations. DCBR is discussed in Chapter 1, Legislative and Each IEP team should utilize documents such as these
Policy Essentials, and Chapter 14, Educational Consider- to facilitate a discussion of where services are delivered and
ations for Students who are Deaf or Hard of Hearing, includ- the student’s readiness to benefit from these services. When
ing a Communication Plan in Appendix 14–A. students are not ready, or the environment is not prepared,
students may be set up to fail. These checklists can be the
catalyst for making alternative plans. These include IEP
Services, Placement, and Least Restrictive goals to better prepare and support students to become pre-
Environment Considerations pared for the recommended setting as well as recommenda-
IDEA requires that placement is determined at least annu- tions for adapting and improving the setting under consider-
ally, that it is based on the child’s IEP, and that it is as close ation or making a different setting recommendation. And we
as possible to the child’s home.25 Further, unless the IEP should always be reminded that the word “individualized” is
requires some other arrangement, the child is educated at the operational part of the IEP.
the school he or she would attend if nondisabled. Participa- Services on the IEP are determined by the IEP team.
tion in nonacademic and extracurricular activities has the Educational audiologists should consider both direct services
same requirement. Least restrictive environment (LRE) is- provided to the student as well as indirect services such as
sues have been controversial when applied to the education consultation or training that is directed to the teachers, school
of children with hearing differences. Although historically personnel, and parents. Services must be related to specific
these students were most often educated in separate class- IEP goals and include the type of service (e.g., audiology),
rooms and facilities, the trend for mainstreaming in the the person or type of person providing the service (e.g., au
1970s resulted in more frequent participation in regular edu diologist), the frequency and duration (e.g., one time per
cation classrooms. The inclusion movement in the 1980s month for 90 minutes), and the start and end dates. Consid-
furthered this initiative, advocating for full participation and erations for specific services are discussed under IEP goals.
challenging our philosophical biases regarding the extent to
which participation in regular education could really provide
an appropriate education for children who were deaf or hard Services for Parents
of hearing. Recent research, however, has shown that the Parent counseling and training is a related service under
performance expectations have increased through general IDEA, recognizing the important role that parents play in
education participation and that the average mainstream their children’s development and education. The purpose is
student was performing within one standard deviation of to assist parents in acquiring skills to support the implemen-
his or her hearing peers (Antia, Jones, Reed, & Kreimeyer, tation of their child’s IEP. Parent counseling and training
2009). For some deaf and hard of hearing students, inclusion can take many forms, such as providing written information,
25
34 CFR §300.116.

providing connections to parent support groups and work-

shops, providing written and recorded materials, making Parent Counseling and Training
home visits, or any format that meets the family’s and child’s
needs. It is often a challenge to schools to determine who (i) Assisting parents in understanding the special needs
will provide the support and how. Nonetheless, it generally is of their child;
worth the effort and is a win-win for all involved. Figure 11–4 (ii) Providing parents with information about child de
contains a decision chart to assist in the determination of velopment; and
parent counseling and training services. These questions (ii) Helping parents to acquire the necessary skills
may assist IFSP/IEP teams, as they work with parents at that will allow them to support the implementa
eligibility or triennial meetings, to make decisions regard- tion of their child’s IEP or IFSP. [34 CFR 300.34(8)]
ing related services. The Family Needs Interview (Appen-
dix 3–B), as well as developmental rating scales and other
checklists, provide useful information in answering these
questions. Other factors such as the recent onset or progres-
sion of reduced hearing or other health problems, acute or Transition Planning
chronic nature of the child’s needs, and resources already The emphasis on transition planning in IDEA has increased
possessed by parents should also be considered. relevance for audiologists in assisting students to independence
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FIGURE 11–4 Parent counseling and training decision chart. (Adapted from Parent counseling and training: Guidelines for Colorado parents
and educators [2002]. Colorado Department of Education, Special Education Services Unit. Used with permission.)

424 Chapter 11
after graduation. Under the goals of self-advocacy and per- ized and functional assessments to determine those
sonal responsibility, the audiologist plays a critical role in accommodations as well as any discussed in the IEP meet
developing competencies regarding communication access ing. Be sure to include data on the classroom environ-
and use of technology. Table 11–5 contains the IDEA and ment. Our purpose is to set students up to be successful
Section 504 definitions pertaining to transition from high by ensuring the learning environment and instruction is
school and supports beyond. In addition, schools are now fully accessible.
required to include a “Summary of Performance” for the 2. Identify the access skills needed to benefit from the
student at the time they exit special education at graduation educational program. Access skills to be considered
that describes their academic achievement and functional include the following:
performance. In addition, the Summary of Performance ■■ Use of technology (hearing and other assistive tech-
should provide a historical review of assessments and ser- nology). Training and other services are required
vices received in the kindergarten through 12th-grade setting under Assistive Technology services in IDEA [34
and describe a student’s functional limitations along with the C.F.R. 300.6]. Use of technology is also part of our
accommodations and supports that may be useful in postsec- role in orientation and training as described in the
ondary education and employment. AAA HAT Guidelines (American Academy of Audi-
Phonak’s Guide to Access Planning (GAP) (Phonak ology, 2008). Use the SETT (Student, Environments,
US, https://www.phonakpro.com/us/en/resources/counseling Tasks, and Tools) framework to identify and analyze
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-tools/pediatric/guide-to-access-planning/guide-to-access assistive technology needs and services (see Chap

-planning.html) is an interactive online program that provides ter 7 for more information on this framework).
information for teens and young adults (MyGAP) as well as ■■ Knowledge and understanding of the student’s hear-
professionals who serve them and their parents. This pro- ing levels, communication implications, and appro-
gram includes self-assessments regarding knowledge about priate use of communication access accommodations.
rights, communication access, hearing status, use of technol- Without enough knowledge in this area, the student’s
ogy, and self-advocacy competencies. Topics for information ability to access instruction is lessened, and he or
and support include (a) rights, the legal system, and fund- she must be dependent on others to address these
ing; (b) developing self-advocacy and personal responsibil- accommodations. This content may be repeated
ity skills and a personal profile and accommodations letter; several times (e.g., at different ages) to increase the
(c) amplification and other technologies; and (d) inspirational complexity level of the information.
profiles, tips, and problem-solving activities for situations ■■ Acceptance of hearing status. Just knowing about
of communication challenges. Appendix 10–E contains a one’s hearing condition does not lead to acceptance.
checklist for the development of self-advocacy skills from Some students may need individual and group coun-
elementary age through adulthood. MyGAP can be used as seling to work toward their own adjustment to being
a curriculum, and as such, IEP goals, for audiologists and deaf or hard of hearing (see Chapter 10 for more
others who support teens and young adults who are deaf and information on this topic).
hard of hearing for the development of these important skills. ■■ Self-advocacy skills. Goals for increasing student
independence start at preschool; the skills should
be no different than what would be expected from
Individualized Education a student with typical hearing. Consider some of
Program Goal Development the precursors to successful self-advocacy (identity,
self-esteem/confidence, self-determination) when
Annual IEP goals must be aligned with state academic
developing goals. Some students will need training
grade-level content standards. Since audiologists typically
and support to achieve self-advocacy competence.
are not responsible for academic content, we can gener-
These training goals should be on the IEP until no
ally leave that to the teachers and put our focus on accom-
longer needed. These areas are discussed in Chap-
modations, access skills, social-emotional wellness, self-
ter 10, Supporting Wellness and Social-Emotional
determination, and self-advocacy. Remember that the IEP
Competence.
is like a contract; as such it is important to make sure all es-
■■ Auditory skill development and listening skills. De-
sential services are included. Some schools may take certain
velopment of these skills could be the responsibil-
services for granted, such as annual hearing evaluations, but
ity of the SLP, TODHH, or educational audiologist.
if the student were to move to another school district or state,
Goals must be based on thorough assessment (see
that service may not be provided unless it was in the IEP.
Chapter 5 for more on assessment). Auditory skill
Here are some steps that may be useful when determining
development is one of the areas of the expanded core
and writing IEP goals:
curriculum for deaf and hard of hearing students;
1. Identify the accommodations needed to access the gen- therefore, every student who utilizes audition should
eral education curriculum. Use data from both standard- have goals in this area until the specialists and IEP

TABLE 11–5 Regulations Regarding Transition Planning
Law/Regulation Main Themes

IDEA, Individuals with Transition Services
Disabilities Education Act Definition of Transition Services—34 CFR §300.43
(2004) https://idea.ed.gov. (a) Transition services means a coordinated set of activities for a child with a disability that—
Regulatory Authority: (1) Is designed to be within a results oriented process, that is focused on improving the academic
The Office of Special Education and functional achievement of the child with a disability to facilitate the child’s movement
Programs, Office of Special from school to post-school activities, including postsecondary education, vocational education,
Education and Rehabilitative integrated employment (including supported employment), continuing and adult education, adult
Services, U.S. Department of services, independent living, or community participation;
Education
(2) Is based on the individual child’s needs, taking into account the child’s strengths, preferences, and
interests; and includes—
(i) Instruction;
(ii) Related services;
(iii) Community experiences;
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(iv) The development of employment and other post-school adult living objectives; and
(v) If appropriate, acquisition of daily living skills and provision of a functional vocational
evaluation.
(b) Transition services for children with disabilities may be special education, if provided as specially
designed instruction, or a related service, if required to assist a child with a disability to benefit from
special education.
[Authority: 20 U.S.C. 1401(34)]
Definition of Individual Education Program, Transition Services—34 CFR §300.320
(b) Transition services. Beginning not later than the first IEP to be in effect when the child turns 16, or
younger if determined appropriate by the IEP Team, and updated annually, thereafter, the IEP must
include—
(1) Appropriate measurable postsecondary goals based upon age appropriate transition
assessments related to training, education, employment, and, where appropriate, independent
living skills; and
(2) The transition services (including courses of study) needed to assist the child in reaching those
goals.
[Authority: 20 U.S.C. 1414(d)(1)(A) and (d)(6)]
504 (Section 504 of the Definition of Transition Services. . . . a coordinated set of activities for a student designed with
Rehabilitation Act of 1973) an outcome-oriented process that promotes movement from school to post-school activities including
http://www.ed.gov/about/offices postsecondary education, vocational training, integrated employment, continuing and adult education,
/list/ocr/docs/edlite-FAPE504. adult services, independent living, or community participation. The coordinated set of activities shall be
html based upon the individual student’s needs, taking into account the student’s preferences and interests,
Subpart A: General Provisions and shall include instruction, community experiences, the development of employment and other post
school adult living objectives, and, when appropriate, acquisition of daily living skills and functional
Subpart B: Employment Practices
vocational evaluation. [29 U.S.C. 705 Definitions (37)]
Subpart C: Program Accessibility
Subpart D: Preschool, Elementary, Other populations: all employers, schools and educational programs, nursing homes, mental health
and Secondary Education centers, and human service programs that receive or benefit from federal financial assistance. Under
Section 504, any qualified individual with a disability has the right to a reasonable accommodation, such
Subpart E: Postsecondary Setting
as services or aids, to help that individual participate in the programs or jobs offered by the federally
Subpart F: Health, Welfare, and funded employer, school, or other organization.
Social Services
Subpart G: Procedures Postsecondary:
Regulatory Authority ■■ Appropriate academic adjustments as necessary to ensure that it does not discriminate on the
Office for Civil Rights (OCR), U.S. basis of disability. If the postsecondary school provides housing to nondisabled students, it must
Department of Education provide comparable, convenient, and accessible housing to students with disabilities at the same
cost.
■■ Programs do not have to make modifications that would fundamentally alter the nature of a
service, program, or activity or would result in undue financial or administrative burdens.

426 Chapter 11
team have determined that the student has mastered

the necessary skills. Smart Goals
■■ Knowledge of rights and adult services (including
medical and audiological) to obtain technology and Specific: state the precise skill that is expected to
other communication access accommodations. This be learned during the current IEP year; if it is too
area is important in transition planning for deaf and broad, it cannot be measured or attained within
hard of hearing students. Goals should be constructed 1 year.
with the student so that he or she understands the rel- Measurable: indicate how it will be measured.
evance of this information and has opportunities to Attainable: can it reasonably be attained in the
practice the knowledge that has been acquired. time frame determined?
3. Write goals that meet SMART criteria. Goals like “Jack Results-driven: does the goal lead to an outcome
will improve his listening skills” do not provide suf- that is appropriate for the student?
ficient information for accountability. Instead the goal Time-bound: indicate the time frame under which
should be written: “Jack will increase auditory compre- you expect the student to gain this skill; the time
hension under noise conditions by correctly answering should never be longer than 1 year.
simple questions with 80% accuracy as measured by an
informal 20-question assessment by December 15.” Be
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prepared with benchmarks and objectives that reflect

what the student will do to meet each of the goals.
4. Maintain records that document progress on the stu- sponsibility to be an advocate during IEP development to
dent’s IEP goals. Students must demonstrate meaning- ensure that these skills are addressed and included in an ap-
ful educational progress. If they do not, it is possible the propriate way.
goal was not written appropriately or that the student is
unable to make the intended progress. Maintain a log of
data that can be analyzed and used to make adjustments SECTION 504 PLAN
to the student’s IEP.
According to Section 504 regulations, Section 504 disabilities
Goal-setting strategies and examples of goals and ob- and accommodations must be discussed but not necessarily
jectives are included within each of the chapters that address documented in writing. However, given the myriad of infor-
content areas. Table 11–6 provides some recommendations mation we are all required to remember, it behooves all parties
of where to include some of the common services provided to have a written plan. The determination of necessary ser-
by audiologists. Most importantly, it is the audiologist’s re- vices and accommodations must be made by a group of per-
TABLE 11–6 Common Educational Audiology Services and Suggestions for the Individualized Education Program (IEP)
Service Where to Include in the IEP

Training students regarding use of their hearing aids, cochlear ■■ IEP goals and objectives—assistive technology services,
implants, and hearing assistance technology counseling
Counseling and training for students regarding self-determination ■■ IEP goals and objectives—counseling
and self-advocacy skills
Participating in peer group activities to build social relationships, ■■ Special Factors/Communication Plan, IEP goals and objectives—
develop identity and understanding of what it means to be deaf or counseling
hard of hearing
Recommending modifications based on classroom acoustic ■■ Accommodations

evaluations that structure or modify the learning environment
Educating and training teachers, other school personnel, students, ■■ Related services—audiology, counseling
and parents about the student’s hearing status, communication ■■ Related services—parent counseling and training
access needs, amplification, and classroom and instructional ■■ Assistive technology services
accommodations and modifications
Monitoring the functioning of hearing aids, cochlear implants, ■■ Related services

and hearing assistance technology (by whom, how often, where, ■■ Monitoring Plan Addendum
procedures used to monitor and what will occur when a problem
is identified)

sons knowledgeable about the student, including the parents 1. Provide evidence to support disability and eligibility
and the student whenever possible. This group must review for 504.
the nature of the disability and how it affects the student’s 2. Recommend necessary accommodations and services
accessibility to education as well as ADA requirements for ef- based on hearing status and its implications. These may
fective communication (see ADA Checklist, Appendix 11–E). include:
Eligibility determination must be made without consideration ■■ hearing assistance technology;
of the benefit provided by mitigating factors such as hearing ■■ a notetaker or captioning;
aids, assistive technology, or tutoring provided by the parents ■■ an interpreter;
outside of school. The decisions about Section 504 services ■■ classroom acoustics, lighting, and other environmen-
should be documented in the student’s file and reviewed pe- tal modifications;
riodically. A formal 504 plan is often used to document this ■■ instructional accommodations; and
information. A sample form is located in Appendix 11–F. ■■ assistive technology (video or text phone, flashing
Most children with hearing differences (at least those alarm/smoke detector, captioned announcements,
who meet the recommended audiometric criteria discussed captioned media).
earlier) should meet Section 504 disability requirements; See Appendix 11–A for a complete list of accommodations.
that is, they have a physiological impairment (e.g., hearing) 3. Conduct annual hearing evaluations and update hearing
that impacts education by “substantially limiting major life and listening accommodations as needed.
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functioning in the areas of hearing, speaking, communicat- 4. Monitor function of personal hearing instruments and
ing and learning.” Although Section 504 is a general edu- hearing assistance technology including teacher train-
cation service, the audiologist is the individual most likely ing and support.
to present the evidence and make the Section 504 recom- 5. Monitor academic performance.
mendation. The blurring of roles between special education
and regular education are evident in this process. Because
Section 504 eligibility determinations occur independently THE SERVICES PLAN
of special education, Section 504 consideration and deter-
mination may occur at the IEP meeting if enough regular Students in parentally placed private (and parochial) schools
education personnel are present. The parent, the teacher, do not have an individual right to receive the same special
and an administrative representative such as the principal education and related services they would receive if they
are typical members of the team that makes the eligibility were enrolled in a public school. However, they may receive
determination and develops the Section 504 plan. support for their special education and related services needs
Parents who disagree with the determination made by through a services plan. The services plan is the responsibil-
the school have a right to a hearing with an impartial hear- ity of the school district where the private school is located.
ing officer. The Family Educational Rights and Privacy Act School districts must develop, review, and revise the ser-
(FERPA) also specifies rights related to educational records. vices plan through meetings they initiate for each student.
Under FERPA, the parent or guardian has the right to: The services plan is often similar to the IEP. Many plans
include:
■■ inspect and review the child’s educational records; ■■ the present level of academic achievement and func-
■■ make copies of these records; tional performance;
■■ receive a list of all individuals having access to those ■■ measurable annual goals;
records; ■■ a statement of the services that will be provided;
■■ ask for an explanation of any item in the records;
■■ ask for an amendment to any report on the grounds
that it is inaccurate, misleading, or violates the child’s Services in Accordance With a
rights; and
■■ request a hearing on the issue if the school refuses to
Services Plan
make the amendment.
(1) Each parentally-placed private school child with
a disability who has been designated to receive ser
Although Section 504 is a civil rights act that governs vices under 300.132 must have a services plan that
all education programs, the audiologist is often the consult- describes the specific special education and related
ing specialist when reduced hearing is involved. However, services that the LEA will provide to the child in light
since 504 plans and services are determined by individual of the services that the LEA has determined, it will
school districts, this practice varies. RtI/MTSS practices fur- make available to parentally-placed private school chil
ther open up possibilities for audiologists to be involved in dren with disabilities. [34 CFR §300.138(b)]
prevention supports. The audiologist’s role in Section 504
may include the following:

428 Chapter 11
under Part C of IDEA.26 Appendix 1–B compares pertinent

sections of Part B and Part C regulations. The most signifi-
Nuggets from the Field cant difference between IEPs and IFSPs is that the IEP is
child centered and school directed, while the IFSP is family
focused and parent driven. The family-centered philosophy
Be sure to check with your school district adminis-
was promoted in response to recognition of the importance
tration policies prior to offering services to private
of the family’s role in (a) supporting the development of
school students.
their child, (b) determining the services needed by their
child and their family, and (c) determining how their child’s
needs might best be met relative to their specific family con-
text. The designation of the family as the central agent for
■■ a statement of needed accommodations and modifications;
the development and coordination of services has resulted in
■■ an explanation of the extent, if any, to which the stu-
the need for audiologists and other professionals to rethink
dent will not participate with nondisabled children in
their role with families. Rather than a directive approach of
the general education environment;
telling parents what to do, the challenge is to provide fami-
■■ the projected date for beginning the services and the
lies with information and options that enable them to make
amount, anticipated frequency, location, and duration
their own decisions for their child. In theory, this concept is
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of services; and
laudable; in reality, the coordination of services requires a
■■ a statement of how the student’s progress toward the an-
significant amount of time and effort when considering the
nual goals will be measured and when periodic reports on
multiple agencies that are often involved. Despite these ef-
progress toward meeting the annual goals will be provided.
forts to empower parents, many families still require a great
Funding for special education services is provided by deal of professional support to coordinate services for their
the local school district via a formula that is based on a pro- child. The components that must be included in each state’s
portionate amount of federal funds that the school district system for early intervention services based on the statute
spends on special education. Since there is no individual are located at 20 U.S.C.§1435.
entitlement to services, an agreement is developed between
the school district and the private school through a consulta-
tion process. The agreement includes provisions for how the Eligibility Criteria
consultation process works, how special education and re- Infants and toddlers from birth through age 2 years are eli-
lated services are provided, and the equitability of services. gible for early intervention services. Infants and toddlers
who are deaf or hard of hearing qualify under either Part (1)
or (2) of the definition. Unlike Part B of IDEA (ages 3 to
THE INDIVIDUAL FAMILY 21 years), infants and toddlers may qualify for services
SERVICE PLAN based solely on the presence of reduced hearing.
Audiologists are often the professionals who begin the
The IFSP defines services for infants and toddlers (birth IFSP process because they make the diagnosis. The referral to
through age 2 years). Services to this age group are specified their local Part C point of entry must be made within 2 days of
An Infant or Toddler With a Disability

(a) Means an individual under three years of age who (b) may also include, at a State’s discretion –
needs early intervention services because the individual- (1) At-risk infants and toddlers; and
(1) Is experiencing delays, as measured by appropriate (2) Children with disabilities who are eligible for services
diagnostic instruments and procedures, in one or more under Section 1419 and who previously received
of the areas of cognitive development, physical devel services under this part until such children enter, or
opment. Communication development, social or emo are eligible under State law to enter, kindergarten or
tional development, and adaptive development; or elementary school. . . . [34 CFR §300.25]
(2) Has a diagnosed physical or mental condition that
has a high probability of resulting in developmen
tal delay; and
26
34 CFR §303.

the diagnosis. Following the referral, a 45-day process begins established for their child and themselves. The IFSP process
that leads to the initial IFSP meeting. With the increase in should:
newborn hearing screening programs, audiologists are identi-
■■ be flexible, family focused, and nonintrusive for families;
fying more hearing conditions shortly after birth, before par-
■■ reflect a variety of services and supports that provide
ents have suspicions about auditory development. As a result,
options for the delivery of services for families; and
audiologists who work with pediatric populations have a re-
■■ support, enable, and empower families to coordinate
sponsibility to know, and be connected with, early childhood
and utilize local community resources.
Part C regulations and services in their communities.
Individual Family Service

Purpose of the Individual Plan Requirements
Family Service Plan Following assessment, the IFSP should be developed within
The IFSP should be a working, fluid document that identifies a reasonable period and be reviewed at least every 6 months
and organizes the formal and informal community resources with an annual meeting to evaluate progress. With parents’ con-
that are available to help families achieve the goals they have sent, services may begin before the assessment is completed.
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TABLE 11–7 Required Information for the Individual Family Service Plan and the Educational Audiologist’s Role in Contributing to
That Information
Required Information Audiologist’s Role
A statement of present levels of physical, cognitive, communication, Present results of audiological assessments, including information
social or emotional, and adaptive development based on objective regarding the child’s auditory development and functional use of
criteria hearing; describe the impact of the hearing condition or deafness
on communication, language, learning, and social and emotional
wellness.
A statement of the family’s resources, priorities, and concerns related to Provide additional information or clarification to support parents
enhancing the development of the child and supplement the group discussion; provide resources for
lease or purchase of hearing instruments and hearing assistance
technology.
A statement of the measurable results or outcomes expected to be Assist the family in the development of the outcomes and
achieved for the child and the family, including preliteracy and language evaluation components, especially those relevant to the child’s
skills, and the criteria, procedures, and timelines used to determine the hearing or deafness status.
degree to which progress toward achieving the results or outcomes is
being made, and whether modifications or revisions of the outcomes or
services are necessary
A statement of specific early intervention services based on peer- Provide specific recommendations and goals for intervention and
reviewed research, to the extent practicable, necessary to meet the treatment of the child related to the hearing condition or deafness
unique needs of the infant or toddler and the family including the and the supports needed and desired by the family. Include all
frequency, intensity, and method of delivering services service and program options discussed with the family.
A statement of natural environments where services will be provided Contribute to the discussion of accessible communication
environments and use of accommodations; discuss the concept
of “Language Rich Environment” and the importance of
communication-like peers.
The projected dates for initiation of the services and the anticipated Assist the family in determining reasonable dates and timelines.
length, duration, and frequency of the services
The identification of the service coordinator from the profession most Assist the family in determining whom the most appropriate
immediately relevant to the infant, toddler, or family’s needs, who is individual will be.
responsible for implementation of the plan and coordination with other
agencies and persons, including transition services
The steps to be taken to support the child’s transition to preschool or Help bridge the family between pediatric/clinical and school-based
other appropriate services audiology services; schedule a meeting with both audiologists and
parents present to determine roles and responsibilities related to
the child’s audiology services and needs.

430 Chapter 11
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FIGURE 11–5 Transition status of children served through Part C at time of exit (U.S. Department of Education, 2017).
The components of the IFSP are like the IEP. These include 7. The identification of the service coordinator from the pro-
the following27: fession most immediately relevant to the infant’s or tod-
dler’s or family’s needs . . . who will be responsible for the
1. A statement of present levels of physical development, cog- implementation of the plan and coordination with other
nitive development, communication development, so agencies and persons, including transition services; and
cial or emotional development, adaptive development, 8. The steps to be taken to support the transition of the tod-
based on objective criteria; dler…to preschool or other appropriate services.
2. A statement of the family’s resources, priorities, and
concerns relating to enhancing the development of the The specific content requirements of the IFSP and the
family’s infant or toddler with a disability; audiologist’s role in providing content are described in Ta
3. A statement of measurable results or outcomes expected ble 11–7. Transition plans must begin no less than 90 days,
to be achieved for the infant or toddler and the family, and no more than 9 months, before the child is eligible for
including pre-literacy and language skills . . . and the preschool services. The plan should state the activities to
criteria, procedures, and timelines used to determine the be completed and the individual responsible during the tran-
degree with which progress toward achieving the results sition period. Examples of activities include meeting school
or outcomes is being made . . . special education personnel and visiting potential preschool
4. A statement of specific early intervention services based or other service programs.
on peer-reviewed research, to the extent practicable, Part C services are funded through a patchwork of com-
necessary to meet the unique needs . . . including the munity services, private and public insurance, Medicaid,
frequency, intensity, and method of delivering services; and other state programs. Part C funds cannot be used to
5. A statement of the natural environments in which early meet the financial obligation of any public or private source.
intervention services will appropriately be provided, in- Agency agreements within each state define this often-
cluding a justification of the extent, if any, to which the complex funding system. Audiology services are generally
services will not be provided in a natural environment; paid by individual insurance (private or public) or Medicaid.
6. The projected dates for initiation of services ant the an- If not, Part C, as the payer of last resort, would be required
ticipated length, duration, and frequency of the services; to pay for any uncovered services.28
27 28
34 C.F.R. §303.344 20 U.S.C. §1440.

For children who are not eligible for Part C, a conference gions, or circuit courts. Federal judges are bound by deci-
should be convened with the lead agency, family, and pro- sions made by their Circuit Court of Appeals; both Circuit
viders to discuss appropriate services. Procedural safeguards Court and state court decisions are regarded in the region or
are like Part B, except that parents have a right to accept or state that the particular court represents. However, their de-
decline any early intervention service without jeopardizing cisions may serve as the basis for rulings made by the other
their right to other early intervention services. Figure 11–5 circuit or state courts. U.S. Supreme Court rulings determine
illustrates the transition status of children served through the law of the land. The Office of Civil Rights (OCR) rules
Part C during 2014–2015 (U.S. Department of Education, on cases that are filed through their office. These rulings also
2017). Because Part C data are not disaggregated by dis- have national implications. The U.S. Department of Educa-
ability, we do not have exit data for children who are deaf tion, Office of Special Education Programs (OSEP), may
or hard of hearing. However, audiologists are encouraged to periodically provide interpretation of its regulations through
seek this data locally to track the exit status. letters of policy clarification written in response to specific
inquiries made by state education officials, parents, or other
pertinent parties. Clarification is also provided in the com-
THE ROLE OF CASE LAW ments section of the federal regulations where responses to
public comment from the proposed regulations are written.
Case law has become the “interpretive” arm for IDEA regu- Selected comments pertaining to hearing aids and cochlear
Chapter 11
lations. Case law begins with due process hearings, and then implants are included in Chapter 8, Hearing Instruments
appeals move into state or federal court. These are two dif- and Remote Microphone Technology. Pertinent court cases
ferent judicial systems, but both ultimately can appeal to the that have impacted and defined services for deaf and hard of
Supreme Court. Federal courts are arranged within 10 re hearing students are presented in Appendix 11–G.

Individual planning serves a variety of purposes for children AND RESOURCES
with disabilities. For nearly five decades, federal legislation National Association of State Directors of Special Education.
has served these children well, providing them access to the (2018). Optimizing outcomes for students who are deaf or hard
quality education, services, and supports that are deserved of hearing: Educational service guidelines (3rd ed.). Alexan-
by each one. Educational audiologists have a critical role dria, VA: Author.
in planning, providing, and advocating for these services, https://www.wrightslaw.com. Resources for IDEA, IEPs, Sec
because it is the individual plan, whether the IFSP, the IEP, tion 504 plans, and so on.
or Section 504 plan, that is the defining legal document that http://www.handsandvoices.org. Resources for IDEA, IEPs, Sec-
determines the services and supports for these children. Au- tion 504 plans, and so on.
diologists must use this avenue to advocate for the needs
and services required by children with hearing differences.

APPENDIX 11–A
Individualized Education Program/Section 504 Checklist: Accommodations
and Modifications for Students Who Are Deaf or Hard of Hearing
Name: Date:
Note: Accommodations provide access to communication and instruction and are appropriate for 504 or IEP services; modifi-
cations alter the content, the expectations, and the evaluation of academic performance and are generally provided through an
IEP as part of specialized instruction. This checklist contains many supports and services that should be reviewed to comply
with IDEA Special Factors (34CFR300.324(2)(i-v).
Personal and Assistive Hearing  Buddy system for notes, extra explanations/directions
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Technology Accommodations  Check for understanding of information

 Down time/break from listening/watching
 Personal hearing instrument (hearing aid, cochlear  Extra time to complete assignments
implant, bone anchored, tactile device)  Step-by-step directions
 Personal hearing assistance technology (HAT) (hear-  Interpreting (ASL, signed English, cued speech, oral)
ing aid + HAT)  Speech to text software (speech recognition)
 HAT only (without personal hearing instrument)  Tutoring
 Classroom sound distribution system (CADS)  Notetaker
Assistive Technology Accommodations  Direct instruction (indicate classes): _______________
 Videophone or Text Phone Physical Environment Accommodations
 Alerting devices  Noise/reverberation reduction (carpet & other sound
 Other absorption materials) reANSI.s12.60
Communication Accommodations  Special lighting
 Room design modifications:
 Priority seating arrangement:
 Flashing fire alarms/smoke detectors
 Ensure student’s attention prior to speaking
 Reduce auditory distractions (background noise) Curricular Modifications
 Reduce visual distractions  Modified reading assignments (shorten length, adapt
 Allow student time/assistance to locate speaker in phonics-based instruction)
small or large group setting  Modified written assignments (shorten length, adjust
 Enhance speechreading conditions (avoid hands in front evaluation criteria)
of face,, mustaches well-trimmed, no gum chewing)  Extra practice
 Present information in simple, structured, sequential  Pre-teach, teach, post-teach vocabulary, concepts
manner  Strategies to adapt oral/aural curriculum/instruction to
 Enunciate speech clearly accommodate reduced auditory access
 Allow extra time for processing information  Supplemental materials to reinforce concepts of curriculum
 Repeat or rephrase information when necessary  Alternative curriculum
 Frequently check for understanding  Expanded core curriculum:
 Use speech to text software (speech recognition) ■■ advocacy/ ■■ communication/
 Provide interpreting (e.g., ASL, signed English, cued self-determination pragmatic language
speech, oral) ■■ audiology (under- ■■ Deaf studies
Instructional Accommodations & standing hearing ■■ disability rights
loss and resulting ■■ functional skills

Modifications communication ■■ family education
 Visual supplements (overheads, charts, vocabulary accommodations, ■■ listening skill
lists, lecture outlines) technology options development
 Interactive whiteboard (e.g., Smart Board, Mimio) (HAT, connectivity) ■■ ASL/sign language
 Classroom captioning (CART, CPrint, TypeWell) ■■ assistive technology ■■ social-emotional skills
 Captioning and/or scripts for television, videos, movies ■■ transition planning
432

Evaluation Accommodations &  Deaf/Hard of Hearing peers*

Modifications  Deaf/Hard of Hearing role models
 Recreational/Social opportunities
 Reduce quantity of tests  Transition Services:
 Alternate tests or methods  disability rights
 Reading assistance with tests for clarification of direc-  financial assistance
tions, language of test questions (non-reading items)  linkages to higher education, job training
 Extra time  Vocational Rehabilitation services
 Special setting  Other
 Other
Other Needs/Special Considerations

 Counseling
 Family supports and training
 Sign language instruction for family members
Chapter 11
Note. Copyright © C. D. Johnson, Revised 2014. Available from http://www.ADEvantage.com

APPENDIX 11–B
Individualized Education Program Team Responsibilities
for the Educational Audiologist
Preparation for the Individualized  Share information regarding the student’s functional
auditory skills, use of personal and assistive hearing
Education Program Meeting technology, knowledge of hearing and hearing status,
 Review the current Individualized Education Program social-emotional wellness, and self-advocacy includ-
(IEP) to determine the extent of mastery of annual ing progress toward IEP goals.
goals (particularly those related to hearing, listening,  Recommend supplementary aids and services the stu-
amplification, self-advocacy) or, if this is a meeting dent may need to be successful in the general educa-
to determine eligibility, compile all assessment re- tion classroom environment and elsewhere, including
Chapter 11
cords (including auditory processing deficit [APD]), hearing assistance and other technology, parent coun-
anecdotal information including use of amplification seling and training, expanded core curricula (listening
(if prescribed) and classroom communication and skill development, transition, self-advocacy, counsel-
participation, information about student’s functional ing), and access to peers and adult role models.
listening abilities, classroom acoustics, and other data  Make recommendations regarding annual goals.
relevant to determine the student’s potential for learn-  Make recommendations for accommodations and
ing, rate of learning, and need for specialized instruc- modifications that will allow the student to be edu-
tion and/or accommodations. cated in the least restrictive environment.
 Review current achievement levels and progress to-  Suggest individual modifications and accommoda-
ward achieving state standards and IEP goals. tions to be considered for the administration of any
 Identify student’s talents, hobbies, and other interests. assessments (classroom, district-wide, and statewide).
 Review student’s educational needs in relationship to
the general education curriculum.
 Review social-emotional wellness. Implementation of the IEP
 Consider special factors, for example, language and  Review the IEP and understand responsibilities for
communication, communication access, access to implementation.
peers and adult role models, that may impede a stu-  Assess, review, and document the student’s progress
dent’s learning. toward goals related to hearing status and communi-
 Review data on student’s attendance and class cation access, proper functioning of personal hearing
participation. instruments, and use of hearing assistive technology.
 Review data on levels of English language profi-  Prepare progress reports with supporting data when
ciency for students from a non-English language/ASL needed.
background.  Communicate with other service providers, including
 Review data on native language proficiency for stu- general education teachers, regularly.
dents who are English language learners (ELLs) who  Implement the IEP—provide instruction, services,
are receiving bilingual services. and consultation in accordance with the IEP.
 Confer with general educators, other special educa-  Document service delivery as appropriate.
tion providers, and parents as needed.  Establish and maintain effective and positive commu-
 Develop brief written summary reports or notes. nication with parents.
 Inform case manager if the need for an IEP amend-
ment or review is identified.
During the IEP Meeting  Collect evidence of progress toward benchmarks and
 Discuss student’s communication access needs rela- goals.
tive to special factors.
Note. Adapted from Colorado Department of Education, Special Education Services Unit. Used with permission.
434

APPENDIX 11–C
Communication Considerations Worksheet
Consideration of Special Factors (IDEA 2004) When a Student
Is Deaf or Hard of Hearing1
The purpose of this document is to assist IEP teams in having a comprehensive discussion and documentation of the
Special Factors that support the educational needs of a student who is deaf or hard of hearing as outlined in IDEA.
Since some of the terms are “disability specific,” a short glossary has been included at the end.
A. Does the student’s behavior impede his/her learning or that of others?  Yes  No
If so, what are the behaviors?
Chapter 11
NOTE: A student who is deaf or hard of hearing will often demonstrate behaviors that indicate when learning is impeded
due to poor acoustics, poor or insufficient visual information, or language expectations beyond the student’s abilities. These
behaviors may include (but are not limited to) poor attention span due to fatigue, restlessness, inattentiveness, “tuning out,”
class clown, anxiety, complaining of not knowing or not understanding, etc.
If yes, include positive behavioral interventions, strategies, and supports to address that behavior.
B. Is the student an English language learner*?  Yes  No

There are some students who are deaf or hard of hearing who may also be English language learners. This may be the situa-
tion for students whose primary language is American Sign Language or another spoken language. If the IEP team believes
that the student may be an English language learner, it is important to assess their English language proficiency (in Wisconsin
the ACCESS-ELL is used) to determine the level of proficiency and assist the IEP team in drafting IEP goals that address
strategies of English as a second language learning as well as considerations for the WSAS. The following questions are
designed to assist in the IEP team discussion.
■■ What is the student’s English language proficiency level?
■■ How was it determined?
■■ Is the student’s communication and language proficiency adequate to enable him/her to succeed in acquiring grade-level
skills and concepts within the general curriculum?
■■ What are the implications for instructional strategies and educational services?
What supports are needed?
What will be done to increase English proficiency?
C. If visually impaired, does the student need instruction in Braille or the use of Braille?  Yes  No
If the student who is deaf or hard of hearing also has a loss in vision (corrected or not), the combined effects may affect the
student’s abilities to learn. Even if the student does not meet the criteria for a visual impairment, or is a student in need of
Braille, it is important for the IEP team to consider the possible implications and modifications needed in order to benefit
from his/her education. If the student has met criteria for both hearing impairment and visual impairment, this student may
be identified as deafblind with access to several state and national resources.
D. In developing each student’s IEP, the IEP team shall . . . identify the communication needs of the child who is deaf
or hard of hearing, including a) the student’s language, b) opportunities for direct communication* with peers and profes-
sional personnel in the child’s language and communication mode, and c) academic level and full range of needs, including
opportunities for direct instruction in the student’s language and communicative mode. The following chart is one way an
IEP team may address and document the child’s communication.
1
Wisconsin Department of Public Instruction, 2007. Available from https://dpi.wi.gov/sped/program/deaf-hard-of-hearing/special-factors. Used
with permission.
435

436 Chapter 11
a) The Student’s Language and Communication Needs:

1. What is the child’s primary communication/language use in various settings? Note for all environments.
*American *English- *Sign- Receptive language—
Sign based Supported Auditory/ sign/Expressive
Language sign Speech Oral language—spoken Other, please describe
Home/
Community
School
With adults
With peers
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* See the glossary at the end of this document for definitions.
b) Opportunities for direct communication with peers and professional personnel in the child’s language and com
munication mode. (“Direct communication” means person-to-person communication and not through an interpreter.)
1. What are the opportunities for the child to have direct communication with grade-level peers?
2. What are the opportunities for direct communication with professional personnel (i.e., teachers, related services staff, etc.)?
c) Academic level and full range of needs, including opportunities for direct instruction in the student’s language and
communicative mode.
1. What is the student’s academic level in relation to the student’s same-age peers? What accommodations or modifications
are recommended so this student can achieve along with their peers? (If appropriate, include the student’s WKCE results.)
2. What are the “full range of needs” for this student? (Check areas below that apply. Add other areas of need that may need
to be further addressed in the IEP.)
 Opportunity to interact with deaf or hard of hearing adult role models
 Instruction along the expanded core curriculum (see glossary)
 Staff is able to meet the linguistic needs of the student utilizing the student’s primary means of communication
 Access to technology that supports communication
 Acoustic accessibility for students using auditory/oral communication including those with cochlear implants
 Visual accessibility for students using sign communication including those with cochlear implants
 Social interaction
 Transition information that is supportive of people who are deaf or hard of hearing
 Parent support in building strong communication skills in order to support their child’s education at home
 Other:
Discussion on the least restrictive educational environment for students who are deaf or hard of hearing needs to consider the
opportunities for the student to have direct communication with peers and staff. This is in addition to the student’s participa-
tion in the general education curriculum with supports and services as needed.
What factors were considered when discussing the educational environment that is least restrictive for this student?
 Student communication
 Ability of the student to directly interact with peers
 Ability of the student to directly interact with staff
 Access to school information available to all students
 Student’s ability to participate in the general curriculum
 Supports and services needed for academic success
 Continuum of placements that can provide the educational environment needed to meet the academic and social-
emotional needs of the student including:

 the school the student would attend if he/she did not have a disability
 schools within the district
 schools within neighboring districts
 schools within the CESA
 schools within the state
E. Does the student need assistive technology services or devices? (see the list below as a reference only)  Yes  No
■■ If yes, specify particular device(s) and/or service(s).
For example:

Audiology services: ¨ Communication software:
 Monitoring personal hearing aids ¨ Telecommunication software
 FM system ¨ Personal pager
 Other Assistive Listening Device ¨ Video Relay Service (VRS) module
 Services supporting use of a cochlear implant ¨ Other:
 Access to school environment
Chapter 11
 Visual alarm/alerting system
 Captioning of films and other sound media
GLOSSARY:
American Sign Language is the language of sign used by the people in the Deaf community in the United States and most
of Canada with over 200 years of evolution. This language is a sophisticated visual language with its own grammatical fea-
tures that support communication and learning with the mind that does not hear spoken languages.
English-Based Sign has a few different forms that have evolved since the 1970s. These sign modalities have been created
by people with the intent to mimic English on the hands. It is not a language and is not generally used by the community of
Deaf or hard of hearing adults.
Sign-Supported Speech is a process of “interpreting” that includes a mix of oral interpreting and signing of key and new
concepts or vocabulary. It is most often used when the student is able to hear spoken messages, but not with full comprehen-
sion, and does not need all language interpreted. These students usually speak for themselves.
Expanded Core Curriculum includes the knowledge and skills needed by a student who is deaf or hard of hearing that
support their independence in life. It includes knowledge of the technology and resources available in the community, state,
and country that provide resources and services that allow for full participation in work, postsecondary, personal, and com-
munity activities. For a list of components that are within the Expanded Core Curriculum, see the DPI Eligibility Guidelines
for Students who are Deaf or Hard of Hearing, pp. 25–27. https://dpi.wi.gov/sites/default/files/imce/sped/pdf/hi-ecc.pdf

Appendix 11–D
PARC: Placement And Readiness Checklists
for Students who are Deaf and Hard of Hearing
Part 1 Readiness Checklists
PARC is a set of placement and readiness checklists designed to assist IEP teams, including students, teachers,
specialists, parents and school administrators, when making decisions about programming and placement for students who
are deaf and hard of hearing (DHH). Most DHH students are considered for placement in the general education classroom
for at least part of their school day. Ultimately, inclusion in the general education classroom for these students should
mean that when provided the necessary accommodations, modifications, and supports, they have the ability to actively and
meaningfully participate in the communication, instruction, and social activities of their class using their identified
communication mode(s). There are two components that should be considered when evaluating placement and service
delivery; first, the skills of the student and, second, the learning environment . Specifically, students should be matched
for the learning environment by 1) demonstrating a set of prerequisite skills that are based on their identified individual
goals and 2) documenting that the instructional environment is designed to support the student to achieve those goals.
These checklists may be used as tools to assist the IEP team in examining the many factors that influence how well a
student is able to function and perform in various classroom settings. Thorough assessment in academic, communication
and social areas to identify strengths and challenge areas as well as frequent monitoring of performance is always
necessary to ensure that student skills, services and placement are aligned. In some cases, students may be “ready” for
some classes or situations while not “ready” for others.
Part 1, the Readiness Checklists, focus on essential skills that students require in order to actively and meaningfully
participate in their education programs with the intended communication approach. There are four checklists: General
Education Inclusion Readiness , Interpreted/Transliterated Education Readiness , Captioning/Transcribing Readiness , and
Instructional Communication Access. These checklists can be used in combination or independently, depending on the
student and the purpose of the review. The General Education Inclusion Readiness Checklist may be used to evaluate
overall readiness for inclusion in the general education classroom and is appropriate for most students. The
Interpreted/Transliterated Education and the Captioning/Transcribing Readiness Checklists identify skills that students
need in order to fully benefit from these services in the general education classroom. The Instructional Communication
Access Checklist contains indicators that analyzes how a student accesses instruction using listening and spoken language,
sign or cues, or both, and how proficient the student is with that approach. This checklist may help determine what
communication approach and supports a student may need for their instructional environment whether it is in the general
education classroom, a resource room, or a special classroom. These checklists are intended to emphasize skills that may
be needed for DHH students to have successful learning experiences. The Readiness Checklists can also be used to
identify IEP goals that will assist a student with acquisition of the necessary skills as well as a tool to monitor the
acquisition of the desired skills.
Part 2, the Placement Checklist, assists the IEP team in evaluating the accessibility and appropriateness of the general
education setting to support students who are DHH. The appropriate age level checklist is selected (2A-
Preschool/Kindergarten, 2B-Elementary, or 2C-Secondary) and then completed through observation, interview and
discussion among team members. The Checklist considers the physical environment, the general learning environment, the
instructional style of the teacher, the school culture, and how well the learning environment is matched to the student’s
communication, language, and social needs. The Placement Checklist is intended to be used as often as the classroom
environment changes or other needs suggest monitoring.
Acknowledgements: These checklists were compiled and adapted from existing materials. I would like to recognize
the original authors of the respective “readiness” checklists (Mary Ellen Nevins & Pat Chute, Brenda Schick, and the
team at Children’s Hospital of Boston) and the contributors and reviewers for the development of the placement
checklists: Dinah Beams, the Colorado Home Intervention Program; Arlene Stedler Brown, formerly with the Colorado
Home Intervention Program; Mandy Darr, deaf education consultant, Denver CO; Susan Elliott, teacher of the
deaf/hard of hearing, Douglas County School District, Highlands Ranch, CO; Heather Abraham, previously Director of
Outreach, Washington School for the Deaf, and Debbie Pfeiffer, Virginia Department of Education. Please contact Cheryl
DeConde Johnson, Ed.D. at cdj1951@gmail.com with comments or for further information.
PARC: Placement and Readiness Checklists, C.D. Johnson, Revised 2011. Reproduction is permitted. 1
PARC: General Education Inclusion Readiness Checklist1
Each year during the Individual Education Program (IEP) process, discussion of whether a student is benefitting
from, or ready to benefit from, placement in the general education classroom should be based on analysis of
pertinent skills as well as the student’s academic performance. The items in this scale include ones suggested by
Nevins and Chute in the Mainstream Checklist they designed for children with hearing impairments. The scale
represents some of the basic critical skills and behaviors that are thought to contribute to successful
participation and inclusion.
Directions: Rate each item using the rubric scale of 1 to 5 that best describes the student’s performance.
Interpretation: Students with higher ratings (mostly 4s and 5s) will likely be able to participate more successfully
in the general education classroom. Ratings in the 2-3 range indicate that the skill is emerging but still requires
significant support to benefit from the general education setting. Students with lower ratings (mostly 1 and 2) will
likely require specialized instruction from a teacher of the deaf with focus on language, communication, concept,
and academic skill development. Participation should be determined on a class by class basis.
General Education Inclusion Readiness Checklist

Name:__________________________________________ Date:__________________
Completed by:________________________________________________________________
1 2 3 4 5
1. Knowledge of classroom routines and ability to handle transitions:
 Appears unaware  Makes  Makes transitions  Makes  Aware of
of routine/does not transitions with by observing others transitions with routines/makes
make transitions adult assistance verbal/sign transitions
prompting independently
2. Following Directions:
 Does not follow  Follows  Follows directions  Follows  Follows directions
directions directions with by observing others directions independently
adult assistance verbal/sign prompt
3. Attention to classroom instruction (as compared to classmates):
 Student is  Attends less  Attends 50%  Attends 75%  Attends 100% of
disengaged that 25% of the of the time of the time the time
time
4. Comprehension of classroom instruction:
Example:
 Does not  Appears to  Appears to  Appears to  Appears to have
comprehend understand understand understand most complete
information that information that is information understanding of all
is familiar/highly familiar/highly presented information
structured structured and some
information that is
new or less
structured
5. Typical behavior when content is not understood:
 Drops  Facial cues  Looks to another  Asks for  Indicates
out/engages in indicate lack of student for assistance from specific content not
irrelevant activity understanding assistance teacher understood
1
Adapted with permission from M.E. Nevins and P. Chute (1996). Mainstream Checklist: Checklist for observing
classroom participation of hearing impaired student. In Children with Cochlear Implants in Educational Settings,
(Appendix J). Singular Publishing Group, Inc.
PARC Part 1 Readiness Checklists: General Education Inclusion Readiness Checklist, C.D. Johnson, 2014 . 2
1 2 3 4 5
6. Typical response behavior:
 Student is  Does not  Answers when  Answers when  Volunteers
disengaged respond when called on but called on with response/comment
called on response is not response on topic and is on topic
related to topic
7. Student’s response and comments in lecture/teacher directed activities:
Example:
 None made  Not related to  Incorrect but  Correct and  Enriching to the
the topic related to the topic related to the topic discussion
8. Student’s participation in group discussion and cooperative learning:
Describe context:
 Student is  Attentive  Attentive;  Attentive;  Participates
disengaged. initially; gives up participation not comments constructively
productive appropriately some
of the time
9. Attends and processes chain of communication:
 Does not  Aware of  Follows chain of  Follows chain of  Follows chain of
acknowledge multiple speakers communication communication communication
speaker in chain of understanding 50% understanding 75% understanding 90%
communication of information or of information or of information or
less more more
10. Independently initiates communication interaction within the classroom or self-initiates a comment:
 Does not initiate  Initiates  Initiates  Initiates  Initiates
inappropriately appropriately 50- appropriately 70- appropriately 90%
70% of the time 90% of the time of the time or more
11. Academic Performance (reading, writing, math):
More than 3 years 2-3 years below 1-2 years below Within 1 year of At or above grade
below grade level: grade level: grade level: grade level: level:
 reading  reading  reading  reading  reading
 writing  writing  writing  writing  writing
 math  math  math  math  math
12. Language Skills:
more than 3 years 2-3 years below 1-2 years below age Within 1 year of age At or above age
below age level: age level: level: level: level:
 receptive  receptive  receptive  receptive  receptive
 expressive  expressive  expressive  expressive  expressive
13. Self-Advocacy Skills:
 does not know  does not usually  does not usually  most of the time  consistently
when information is know when know when recognizes when recognizes when
misunderstood, information is information is information is information is
does not know how misunderstood; misunderstood, but misunderstood, how misunderstood, how
to ask for knows how to ask knows how to ask for to ask for to ask for
assistance for assistance but assistance assistance, and when assistance, and
manner is not appropriately when it is appropriate to when it is
appropriate needed ask for repetition appropriate to ask
for repetition
Notes:
PARC Part 1 Readiness Checklists: General Education Inclusion Readiness Checklist, C.D. Johnson, 2014 . 3
PARC: Interpreted/Transliterated Education Readiness Checklist1
For students who utilize educational interpreting/transliterating services (oral, sign language, cued speech), access to
instruction in the general education classroom is dependent on the ability of the interpreter/transliterator and
classroom teacher to work together to support the student, the accuracy with which the information is
interpreted/transliterated, and the skills of the student to utilize the interpreter/transliterator. This checklist
contains skills that have been found to be important for a student to be a successful consumer of educational
interpreting/transliterating services.
Each year during the Individual Education Program (IEP), discussion of a student’s ability to fully benefit from
placement in the general education classroom should be based on analysis of several skills as well as the student’s
academic performance.
Directions: Rate each of the following skills according to the scale of always (>90%), frequently (70-90%), sometimes
(40-69%), rarely (10-39%) or never (<10%).
Interpretation: Students with mostly ratings of “always” and “frequently” are most likely to benefit from an
interpreted/transliterated education program. Areas with ratings of “sometimes” indicate the skill is emerging but
still may need significant support. Students with many ratings of “rarely” or “never” will require a program that
utilizes more direct instruction from a teacher for students who are Deaf/HH. This checklist can also be used to
identify student goals to develop interpreter/transliterator readiness skills as well as to monitor developing student
competence with the skills.
1
Adapted with permission. Schick, B., (2004). Interpreter Use Inventory. In Colorado Department of Education
Educational Interpreter Handbook, 2nd Edition.
PARC Part 1 Readiness Checklists: Interpreted Education Readiness Checklist, C.D. Johnson, 2010. 4
Interpreted/Transliterated Education Readiness Checklist
Name:__________________________________________ Date:__________________
Completed by:________________________________________________________________
NEVER RARELY SOME FREQ ALWAYS
<10% 10-39% 40-69% 70-90% >90%
1. Does the student demonstrate the ability to:
a. learn abstract and/or decontextualized material with
minimal expansion?     
b. learn new vocabulary from typical classroom exposure?     
c. comprehend class content and instructions?     
d. understand what to do without the
interpreter/transliterator directing?     
e. make age-appropriate progress without excessive
assistance?     
f. complete class material and tests without interpreter
assistance?     
g. store, retrieve, and organize information received
through an interpreter/transliterator?     
2. Does the student demonstrate understanding of the role of

the interpreter/transliterator by:
a. having appropriate expectations (based on the student’s
age) for the interpreter/transliterator?     
b. maintaining appropriate boundaries with the
interpreter/transliterator?     
c. allowing the interpreter/transliterator to mostly
interpret/transliterate?     
3. Does the student demonstrate how to use the

interpreter/transliterator by:
a. recruiting interpreting assistance when needed?     
b. understanding when an interpreter is needed?     
c. advocating for communication needs?     
d. speaking up about missing information?     
e. requesting clarification from the interpreter?     
f. participating in class discussion?     
g. participating in small group discussion?     
4. Does the student demonstrate appropriate social

development by:
a. interacting with peers about class materials?     
b. interacting with peers about social issues?     
c. appreciating a variety of traits and personalities?     
d. experiencing authentic peer relationships?     
e. arguing, playing, preferring, negotiating, or persuading
peers?
    
f. participating appropriately in class?
    
5. Attentional Factors – Does the student…

a. attend to the interpreter/transliterator and the teacher?     
b. manage the multiple visual and/or auditory demands of
complex visual and auditory environments?     
PARC Part 1 Readiness Checklists: Interpreted Education Readiness Checklist, C.D. Johnson, 2010. 5
PARC: Captioning/Transcribing Readiness Checklist1
Captioning and transcribing are real time speech to text services that provide critical access to instruction for many
students with hearing loss as well as English Language Learners (ELL) and other students with listening, attention, or
learning disabilities. Before implementing these services, careful consideration must be made regarding the student’s
literacy skills and ability to use written information as well as social skills. An individual’s reading rate is likely to be
affected by the level of difficulty of the material2 and also on the purpose for reading as well as other factors 3.
Depending upon the student’s language and reading skills, a choice between a verbatim and a meaning-for-meaning
service must be determined.
Captioning is a verbatim, word for word, transcription service while the meaning–for-meaning system adapts and
condenses the vocabulary and modifies the language so that it is understandable to the user. CART (Computerized
Access in Real-time) is an example of a formal captioning system with highly trained captioners delivering material.
Meaning–for-meaning transcription systems utilize special equipment and/or software that assist with inputting the
text with an on-site notetaker adapting the vocabulary and language. TypeWell (www.typewell.com) and C-Print
(www.ntid.rit.edu/cprint) are examples of these types of systems. The delivery of captioning and transcribing
requires specific training. The services can be provided with the captioner or transcriber in the classroom or
remotely. Some systems may also have an option of using speech recognition software in place of a transcriber or
captioner although at this time the accuracy of speech recognition software is highly variable. All systems utilize a
laptop computer or hand-held device for the user; remote systems require internet access and some may also require
a phone line. In addition to these formal programs, captioning may also be provided informally in the classroom as long
as the captioners/transcribers are trained to appropriately provide the service.
In addition to a formal training in captioning and transcribing, an individual providing these services to a student
should have a good understanding of the student’s language, reading, and communication levels. Transcripts are useful
tools for reviewing material discussed in class: for parents to review with their children to assist with homework; for
teachers to reinforce concepts taught in class, and to help students who are not deaf or hard of hearing, but who
may have missed class. Schools using these services should develop policy regarding who has access to the transcript.
For additional information on captioning and transcription services, see Providing Real-time Captioning, C-Print®,
Speech to Print Transcription and Assistive Listening Devices - Questions and Answers: A handbook that answers
questions related to real-time captioning, C-Print and assistive listening devices. Produced by MCPO. 2000.
Item #: 109. Available from: http://pdc.pepnet.org/content/PDFforms/PEPNetCatalog3.pdf.
Directions: Rate each of the following skills according to the scale of always (>90%), frequently (70-90%), sometimes
(40-69%), rarely (10-39%) or never (<10%).
Interpretation: Students with mostly ratings of “always” and “frequently” are most likely to benefit from the use of
captioning/transcribing services with consideration given to the type of service that is most appropriate. Areas with
ratings of “sometimes” indicate the skill is emerging, but still may need significant support. Students with many
ratings of “rarely” or “never” should not utilize these services and will require other accommodations. This checklist
can also be used to identify student goals to prepare students to use captioning/transcribing services in the future.
1
Adapted from Interpreter Use Inventory (B. Schick, 2004) by C.D. Johnson, D. Pfeiffer, and B.Parrish-Nowicki.
2
Carver (1974) as cited in Shroyer & Birch, 1980
3
Shroyer & Birch, 1980
PARC Part 1 Readiness Checklists: Captioning/Transcribing Readiness Checklist, C.D. Johnson, 2011. 6
Captioning/Transcribing Readiness Checklist
Name:_______________________________________________ Date:______________________
Completed by:____________________________________________________________________
NEVER RARELY SOME FREQ ALWAYS
<10% 10-39% 40-69% 70-90% >90%
1. Does the student demonstrate the ability to:
a. read English at the instructional language level used by the
teacher?     
b. learn abstract and/or decontextualized material with
minimal expansion?     
c. learn new vocabulary from typical classroom exposure?     
d. comprehend written class content and instructions?     
e. understand what to do without continuous prompting from a
teacher or other adult?     
f. make age-appropriate progress without excessive     
assistance?
g. complete class material and tests without frequent teacher     
assistance?
h. store, retrieve, and organize transcription information     
received through captioning or transcribing?
2. Communication strengths/preferences. Does the student:

a. prefer reception of academic information in print?     
b. require captioning/transcribing of classroom speech to
support residual hearing or other support services?     
c. display motivation to read captions/transcripts of class
content? (Note: studies show this to be an important factor
in successful use of captioning/transcription services.)     
d. understand classmates’ questions/inputs from
captioning/transcribing services?     
e. communicate his/her own questions/comments in class?     
TRANSCRIPTION is recommended if a student is unable
to communicate his/her own questions/comments in class
as captioning does not allow for the captioner to
communicate for the student.
f. need technology that would allow two-way communication
with the transcriber?     
TRANSCRIPTION is recommended in this situation
(TypeWell and C-print provide this service).
g. read at a speed or linguistic level that would require or
benefit from condensing strategies?     
TRANSCRIPTION is recommended if the student has
reduced language and reading levels.
h. read at a speed and linguistic level that would enable the
student to receive the teacher’s speech verbatim, using full
text captioning.     
CAPTIONING is recommended in this situation.
3. Does the student demonstrate how to use

captioning/transcribing services by:
a. asking for assistance when needed?     
b. understanding when additional support is needed (e.g., an
interpreter, or teacher of the deaf)?     
c. advocating for communication needs?     
d. speaking up about missing information?     
e. requesting clarification from the teacher?     
f. participating in class discussion?     
g. participating in small group discussion?     
h. utilizing captions/transcripts as notes for study after
class?     
i. utilizing highlighting/notetaking tools included in newer
transcription software during class, if available?     
j. using messaging technology to communicate
questions/comments to captioner during class (if available in
transcription software)?     
4. Does the student demonstrate adequate social development to:

a. interact with peers about class materials without support?     
b. interact with peers about social issues without support?     
c. participate appropriately in class?     
d. take the responsibility to doublecheck spelling of new
vocabulary in notes after class?     
e. benefit from remote captioning/transcribing?     
5. Attentional Factors – Does the student…

a. attend to the captioning/transcribing and the teacher?     
b. manage the multiple visual and/or auditory demands of
complex visual and auditory environments (reading
captions/transcript; looking at teacher; looking at
classmates to get the mood of the class; review graphics
from board/book, etc)?     
Notes:
PARC: Instructional Communication Access Checklist1
The Instructional Communication Access Checklist contains indicators that are thought to represent skills necessary for students to access and fully participate
in their learning environment. The checklist is designed to analyze the communication approaches used by a student to access instruction and how proficient the
student is using that approach whether it is listening and spoken language (LSL), sign/cue, or both. The General Skills section considers competencies that lead
to learner independence and may assist with Individual Education Program (IEP) team decisions regarding the level of instructional support needed. Responses to
the remaining questions should be based on the student’s present learning environment or the one being considered for the student. Examples of typical learning
environments are: a special class with direct instruction from a teacher of the deaf or other special educator, a general education classroom with most
instruction delivered by the classroom teacher that may also include an interpreter/transliterator, or a setting where class size is smaller and instruction,
though provided by the classroom teacher, is more individualized for each student.
The growing number of students who have gained effective use of their listening and spoken language skills with cochlear implants and advanced hearing
instrument technology has increased the emphasis on placements in typical learning environments. One aim of this checklist is to help the IEP team determine a
student’s readiness for instruction through a LSL approach as well as to monitor progress in these critical skill areas through the transition processes from
sign/cue.
Due to changing student, instruction, and environmental conditions, consideration of whether a student is ready to benefit from placement and services in the
general education classroom, or other setting, as well as the communication competencies of the student that are necessary to sustain meaningful participation
in the desired learning environment, should be reconsidered each year through the IEP review process.
Directions: Using the column that represents the communication approach used by the student, rate each of the following skills according to the scale of always
(>90%), frequently (70-90%), sometimes (40-69%), rarely (10-39%) or never (<10%). Some students may only use one approach and other students may use a
combination. Then determine how proficiently the student is functioning by identifying the communication approach used and selecting a rating using a scale of 1
to 6 (1= not at all proficient; 6= completely proficient). Multiple colors or symbols can be used to rate proficiency with each approach if desired.
Interpretation: Compare the proficiency level of the student to the approach used to determine if that approach is appropriate or if adjustments may be
needed to increase student access to instruction. Students with mostly ratings of “always” or “frequently” are most likely to be successful in the identified
communication approach if their proficiency level is high. Areas with ratings of “sometimes” indicate the skill is emerging but still may need significant support.
Students with several ratings of “rarely” or “never” in the LSL column will likely require a program that utilizes more sign-supported or cue-supported speech or
other direct instruction support for clarification of information. Students with several ratings of “rarely” or “never” in the sign/cue column may require
additional direct instruction support for clarification of information. Students with general skills at these rating levels (“rarely” or “never”) likely have
insufficient skills to be able to function in general education classes without significant support. This checklist can also be used to identify student goals to
develop specific skills in the desired approach as well as to monitor developing competence with these skills.
1
Adapted with permission. Competencies for Transition from Manual to Oral Instruction, the Child with a Cochlear Implant. Boston Center for Deaf and Hard of
Hearing Children, Children’s Hospital of Boston, 2003.
PARC Part 1 Readiness Checklists: Instructional Communication Access Checklist, C.D. Johnson, Revised 2011. 9
Instructional Communication Access Checklist
LISTENING & SPOKEN  SIGN/CUE ONLY HOW

LANGUAGE (LSL)  LSL WITH SIGN/CUE PROFICIENT?
Name:______________________________________________ APPROACH:
Frequently 70-0%
Frequently 70-0%
 LSL
Rarely 10-39%
Rarely 10-39%
Some 40-69%
Some 40-69%
Always >90%
Always >90%
Date:___________________ Grade:______________________
Never<10%
Never<10%
 SIGN/CUE
Completed by:________________________________________  LSL WITH
SIGN/CUE
Title:______________________________________________ Not at all-Completely
1 2 3 4 5 6
1. General Skills
Does the student demonstrate the ability to…
a. learn abstract and/or decontextualized material with minimal           1 2 3 4 5 6
expansion?           1 2 3 4 5 6
b. store, retrieve, and organize information received?           1 2 3 4 5 6
c. learn new vocabulary from typical classroom exposure?          
1 2 3 4 5 6
d. understand what to do without on-on-one direction?          
e. make age-appropriate progress without excessive assistance?           1 2 3 4 5 6
f. complete class material and tests independently?           1 2 3 4 5 6
g. self-advocate for communication and learning needs?
2. Receptive Language
Does the student…
a. understand connected discourse used by adults in the proposed
education setting?           1 2 3 4 5 6
b. comprehend and follow directions related to the curriculum?           1 2 3 4 5 6
c. understand the language of instructional activities and posses a
language base strong enough to learn topics in depth?           1 2 3 4 5 6
d. attend to group conversations?           1 2 3 4 5 6
e. demonstrate incidental learning?           1 2 3 4 5 6
f. exhibit relative speed in processing of new information comparable
to classroom peers?           1 2 3 4 5 6
g. demonstrate the above receptive skills for language in the
following settings:
 one-on-one?           1 2 3 4 5 6
 small group?           1 2 3 4 5 6
 large group?           1 2 3 4 5 6
LISTENING & SPOKEN  SIGN/CUE ONLY HOW
LANGUAGE (LSL)  LSL WITH SIGN/CUE PROFICIENT?
Name:______________________________________________ APPROACH:
Frequently 70-0%
Frequently 70-0%
 LSL
Rarely 10-39%
Rarely 10-39%
Some 40-69%
Some 40-69%
Always >90%
Always >90%
Date:___________________ Grade:______________________
Never<10%
Never<10%
 SIGN/CUE
Completed by:________________________________________  LSL WITH
SIGN/CUE
Title:______________________________________________ Not at all-Completely
1 2 3 4 5 6
3. Expressive Language
Does the student…
a. express him/herself in a manner that is easily understood by
 familiar adults?           1 2 3 4 5 6
 less familiar adults?           1 2 3 4 5 6
 peers in academic and social conversations?           1 2 3 4 5 6
b. use no more that 2 to 3 repairs/rephrases per conversation with
an adult?           1 2 3 4 5 6
c. carry on a conversation with one peer
 independently?           1 2 3 4 5 6
 with assistance?           1 2 3 4 5 6
d. participate in group conversation (NOTE: group number should be
comparable to the typical size in the proposed educational setting)
 independently?           1 2 3 4 5 6
 with facilitation by an adult?           1 2 3 4 5 6
e. express ideas and convey a meaningful message using connected
language?           1 2 3 4 5 6
f. adjust expressive style (pragmatics) to match environmental
conditions?           1 2 3 4 5 6
4. Written Language Skills (reading and writing)

Does the student…
a. demonstrate reading skills comparable to potential
classmates/peers?           1 2 3 4 5 6
b. demonstrate written skills comparable to potential
classmates/peers?           1 2 3 4 5 6
Notes:
for Students who are Deaf and Hard of Hearing
Part 2 Placement Checklists
PARC is a set of placement and readiness checklists designed to assist IEP teams, including students, teachers,
specialists, parents and school administrators, when making decisions about programming and placement for students who
are deaf and hard of hearing (DHH). Most DHH students are considered for placement in the general education classroom
for at least part of their school day. Ultimately, inclusion in the general education classroom for these students should
mean that when provided the necessary accommodations, modifications, and supports, they have the ability to actively and
meaningfully participate in the communication, instruction, and social activities of their class using their identified
communication mode(s). There are two components that should be considered when evaluating placement and service
delivery; first, the skills of the student and, second, the learning environment. Specifically, students should be matched
for the learning environment by 1) demonstrating a set of prerequisite skills that are based on their identified individual
goals and 2) documenting that the instructional environment is designed to support the student to achieve those goals.
These checklists may be used as tools to assist the IEP team in examining the many factors that influence how well a
student is able to function and perform in various classroom settings. Thorough assessment in academic, communication
and social areas to identify strengths and challenge areas as well as frequent monitoring of performance is always
necessary to ensure that student skills, services and placement are aligned. In some cases, students may be “ready” for
some classes or situations while not “ready” for others.
Part 1, the Readiness Checklists, focus on essential skills that students require in order to actively and meaningfully
participate in their education programs with the intended communication approach. There are four checklists: General
Education Inclusion Readiness, Interpreted/Transliterated Education Readiness, Captioning/Transcribing Readiness, and
Instructional Communication Access. These checklists can be used in combination or independently, depending on the
student and the purpose of the review. The General Education Inclusion Readiness Checklist may be used to evaluate
overall readiness for inclusion in the general education classroom and is appropriate for most students. The
Interpreted/Transliterated Education and the Captioning/Transcribing Readiness Checklists identify skills that students
need in order to fully benefit from these services in the general education classroom. The Instructional Communication
Access Checklist contains indicators that analyzes how a student accesses instruction using listening and spoken language,
sign or cues, or both, and how proficient the student is with that approach. This checklist may help determine what
communication approach and supports a student may need for their instructional environment whether it is in the general
education classroom, a resource room, or a special classroom. These checklists are intended to emphasize skills that may
be needed for DHH students to have successful learning experiences. The Readiness Checklists can also be used to
identify IEP goals that will assist a student with acquisition of the necessary skills as well as a tool to monitor the
acquisition of the desired skills.
Part 2, the Placement Checklist, assists the IEP team in evaluating the accessibility and appropriateness of the general
education setting to support students who are DHH. The appropriate age level checklist is selected (2A-
Preschool/Kindergarten, 2B-Elementary, or 2C-Secondary) and then completed through observation, interview and
discussion among team members. The Checklist considers the physical environment, the general learning environment, the
instructional style of the teacher, the school culture, and how well the learning environment is matched to the student’s
communication, language, and social needs. The Placement Checklist is intended to be used as often as the classroom
environment changes or other needs suggest monitoring.
Acknowledgements: These checklists were compiled and adapted from existing materials. I would like to recognize
the original authors of the respective “readiness” checklists (Mary Ellen Nevins & Pat Chute, Brenda Schick, and the
team at Children’s Hospital of Boston) and the contributors and reviewers for the development of the placement
checklists: Dinah Beams, the Colorado Home Intervention Program; Arlene Stedler Brown, formerly with the Colorado
Home Intervention Program; Mandy Darr, deaf education consultant, Denver CO; Susan Elliott, teacher of the
deaf/hard of hearing, Douglas County School District, Highlands Ranch, CO; Heather Abraham, previously Director of
Outreach, Washington School for the Deaf, and Debbie Pfeiffer, Virginia Department of Education. Please contact
Cheryl DeConde Johnson, Ed.D. at cheryl@colorado.edu or cdj1951@gmail.com with comments or for further
information.
PARC: Placement and Readiness Checklists, C.D. Johnson, Revised 2011. Reproduction is permitted. 1
Part 2A: Placement Checklist for Children who are Deaf and Hard of Hearing
PRESCHOOL/KINDERGARTEN
Before the Individual Education Program (IEP) team makes a decision regarding services and placement for a child
who is deaf or hard of hearing, two areas should be considered. First, is the child ready for the placement under
consideration and, second, is the classroom environment under consideration sufficiently prepared to support the
child? This checklist is the Placement component of this two part instrument. Its purpose is to guide considerations
and decisions related to placement and service options for children who are deaf or hard of hearing for preschool
and kindergarten. Ratings may also guide the IEP team in providing for supports when needed. The companion set of
checklists consider the readiness of the child for the various learning environments and situations under
consideration.
The information to complete this placement checklist should be obtained through observation and discussion with
the current early intervention provider, the prospective teacher(s), the parents and other members of the IEP team.
Placement decisions should consider the child’s communication, language, pre-academic, and social needs in the
context of the proposed learning environment. Note: Each area or item may not be applicable to every child.
Child’s Name: ____________________________________________ Date: _________________________
Person completing this form: _________________________________ Title: _________________________
Name of School: __________________________________________ Level:  PS  K
Type of Classroom:  Special education class  General education class  At-risk class
 Deaf education class  Co-taught class  Other__________
Primary Instructor:  Deaf education teacher  Preschool or Kindergarten teacher
 Special education teacher  Other____________________________________
If not a deaf education teacher/specialist, describe previous experience with children who
are deaf or hard of hearing:_______________________________________________
IEP Deaf education services:  Consult/Itinerant  Direct- in classroom  Direct- out of classroom  other__
Days/week program offered: ______________________ Hours per day: ___________________________
Child’s communication mode(s): _____________________ Mode(s) observed in classroom: _______________
Total number of children in classroom: ___ Number of children with hearing loss: ___ Child: adult ratio: ___
Age span of children: ___ to ___ yrs Number of children who are typical language models: ___
Personal Hearing Instrument:  Hearing Aid(s)  Cochlear Implant(s)  Bone anchored device  none/other___
Hearing Assistance Technology used:  None  Personal FM System  Classroom Audio Distribution System
 Other
IEP Related and Support Services: Training
Area with D/HH? If provided, is service…
Speech-language therapy □ Yes □ No □ Yes □ No In class: □ Out of class □
English Language Learner (ELL) □ Yes □ No □ Yes □ No In class: □ Out of class □
Educational audiology □ Yes □ No □ Yes □ No
Occupational therapy/physical therapy □ Yes □ No □ Yes □ No
Psychology/mental health □ Yes □ No □ Yes □ No
Counseling (by psychologist or social worker) □ Yes □ No □ Yes □ No
Behavior/Positive Behavior Intervention/Support Plan □ Yes □ No □ Yes □ No
Other support services:  Deaf/Hard of Hearing Role Models

 Parent counseling and training  Parent Support Groups/Activities
 Transportation  After school programs
© PARC: 2A-PS/Kindergarten Placement Checklist. C. D. Johnson, D. Beams, A. Stredler-Brown, 2003. Revised 2011. 1
NOTE: If an item is not relevant for a child, please write “NA” in the “NO” column.
I. Classroom- Physical Environment YES NO

1. Is the room size conducive to learning? (A large room/high ceiling can distort sound; a
small room may be noisier.) ____ ____
2. Is the room adequately lit? (Lighting and shadows may affect speechreading and signing
abilities.) ____ ____
3. Is the ambient noise level for the classroom within recommended standards (noise
≤35dbA and reverberation ≤.6 msec, ANSI S12.60-2009/10)? ____ ____
4. Is the room treated to reduce noise (carpet on floor, acoustical ceiling tiles, window
coverings, cork or other wall coverings)? ____ ____
5. Are noise sources in the classroom minimized (e.g., fish tanks, ventilation/heater fans,
computers)? ____ ____
6. Does noise from adjacent spaces (hallways, outside the building) spill over into
classroom? ____ ____
Comments____________________________________________________________________________
___________________________________________________________________________________
II. General Learning Environment YES NO

7. Does teacher(s)/adult(s) use a variety of techniques to elicit positive behavior from
children? ____ ____
8. Are there a variety of centers (fine motor, art, manipulatives, science, music, dramatic
play, sensory, literacy)? ____ ____
9. Is there a visual schedule identifying daily routines and child expectations? ____ ____
10. Is there a visual behavior management system that provides clear structure for the
class and consistent rules? ____ ____
11. Is the curriculum standards-based, including a variety of themes, topics, and children’s
literature? ____ ____
12. Does the teacher use lesson plans to guide daily activities? ____ ____
13. Are activities modified to meet a variety of children’s needs? ____ ____
14. Are special services children receive
a. usually in the general education classroom? ____ ____
b. Supportive of the general education content? ____ ____
Comments____________________________________________________________________________
___________________________________________________________________________________
III. Instructional Style YES NO

14. Classroom Discourse and Language
a. Are the teacher(s) and other adults good language models for the children? ____ ____
b. Is language consistently accessible to the child? ____ ____
(If sign/cuing is used, do all adults in the classroom consistently sign/cue, including
their communications with other adults?)
c. Are peer responses repeated? ____ ____
d. Is vocabulary and language expanded by an adult? ____ ____
15. Teacher’s Speaking Skills
a. Is enunciation clear? ____ ____
b. Is rate appropriate? ____ ____
c. Is loudness appropriate? ____ ____
d. Is facial expression used to clarify the message? ____ ____
e. Are gestures used appropriately? ____ ____
f. Are teacher’s (or other speaker’s) lips available for speechreading? ____ ____
g. Is teacher’s style animated? ____ ____
h. Is a buddy system available to provide additional assistance or clarification? ____ ____
16. Use of Visual Information
a. Are props or other visual materials used for stories and activities? ____ ____
b. Are appropriate attention-getting strategies utilized? ____ ____
c. Are fingerplays, action songs, and dramatic play used in circle time, story time,
centers, etc. ____ ____
17. Small Group/Circle Time
a. Are all children encouraged to share and participate? ____ ____
b. Does the teacher face children when speaking? ____ ____
c. Do the children face one another when speaking? ____ ____
d. Does the teacher lead group activities in an organized, but child-friendly manner? ____ ____
e. Is appropriate wait time utilized to encourage children to think and participate? ____ ____
f. Are children seated within the teacher’s “arc of arms”? ____ ____
g. Does teacher obtain eye contact prior to and while speaking? ____ ____
h. Is the FM microphone passed around to all speakers? ____ ____
18. Use of Sign (note: Direct instruction is preferable to use of an interpreter/  Not
transliterator for preschool children. The IEP team may find the Interpreted/ Applicable
Transliterated Education Readiness Checklist a useful tool for assessing readiness levels
of young children and suggesting supports that may be needed).
a. Is sign consistently used by all adults in the class? ____ ____
b. Is sign consistently used by all children in the class? ____ ____
c. Does the type of sign used in the classroom match the signs used by this child? ____ ____
d. Is fingerspelling used? ____ ____
e. Does the interpreter/transliterator adjust the language in order to make it more
accessible to the child? ____ ____
f. Does the interpreter/transiliterator make changes to content vocabulary for
the child? ____ ____
g. Does the interpreter/transliterator expand on concepts presented in class? ____ ____
h. Are gestures used appropriately? ____ ____
i. Are there opportunities for parents and peers to learn to sign? ____ ____
19. Opportunities for Hands-on Experience
a. Are a variety of materials available? ____ ____
Check those used:  books  visual props  audio tapes  video tapes
 objects for dramatic play  manipulatives
b. Are stories experienced in a variety of ways? ____ ____
c. Are there field trips? ____ ____
d. Are cooking experiences available? ____ ____
e. Are art and sensory activities conducted? ____ ____
20. Amplification/Technology  Not
a. Are personal hearing instruments (hearing aids/cochlear implants) and hearing Applicable
assistance devices (FM, infrared) checked at school each day? ____ ____
b. Is amplification used consistently in all learning environments? ____ ____
c. Are current instructional technologies used (Smart boards, computers, internet)? ____ ____
Comments____________________________________________________________________________
___________________________________________________________________________________
IV. School Culture YES NO

21. Is there evidence that the school administration supports children with
disabilities? ____ ____
22. Is the school welcoming of parents and does it encourage parent involvement? ____ ____
23. Is the school/district administrator knowledgeable about hearing loss or willing to
learn about hearing loss? ____ ____
24. Is the school committed to making the necessary accommodations for
children with hearing loss? ____ ____
25. Is the teacher open to consultation with other professionals or specialists? ____ ____
26. Does the teacher provide opportunities for individualized attention? ____ ____
27. Is the teacher welcoming of children with special needs? ____ ____
28. Is the teacher willing to use and troubleshoot hearing assistance technology (FMs)
and other technologies (captioning, transcription)? ____ ____
Comments____________________________________________________________________________
___________________________________________________________________________________
Reflection
V. Individual Child Considerations YES NO
29. Communication and Language ____ ____
Think about how the child communicates thoughts, ideas, and needs. Think about how
the child interacts with other children. Are there sufficient opportunities for direct
communication with peers and professionals in the child’s language and communication
mode and at the child’s academic level? Is there direct instruction in the child’s
language and communication mode? Will the child’s communication needs be nurtured in
this classroom environment? Does the child have sufficient language abilities to benefit
from instruction in the classroom? Will this child develop English language competency
in this environment?
30. Social Interactions and Self-Concept ____ ____
Think about how the child plays alone and in groups. Think about how the child interacts
with other children. Will the child’s self-concept and social needs be nurtured in this
classroom environment? Will this child be encouraged to develop self-advocacy skills?
31. Listening Skills
Does the child attend well? Is the child able to listen and process information in noise? ____ ____
Think about what the child does when he/she cannot hear? Does the child take  Not
responsibility for his/her personal hearing instruments? Will the child’s listening needs Applicable
be supported in this classroom environment? In the lunchroom and other school
environments? Is the staff qualified and able to support the child’s listening needs?
Comments____________________________________________________________________________
___________________________________________________________________________________
Part 2B: Placement Checklist for Students who are Deaf and Hard of Hearing:
ELEMENTARY
Before the Individual Education Program (IEP) team makes a decision regarding services and placement for a
student who is deaf or hard of hearing, two areas should be considered. First, is the student ready for the placement
under consideration and, second, is the classroom environment under consideration sufficiently prepared to support
the student? This checklist is the Placement component of this two part instrument. Its purpose is to guide
considerations and decisions related to placement and service options for students who are deaf or hard of hearing in
elementary school. Ratings may also guide the IEP team in providing for supports when needed. The companion set of
checklists consider the readiness of the student for the various learning environments and situations under
consideration.
the current teacher, the prospective teacher(s), the parents and other members of the IEP team. Placement
decisions should consider the student’s communication, language, pre-academic, and social needs in the context of the
proposed learning environment. Note: Each area or item may not be applicable to every student.
Student: ____________________________________________ Date: _________________________
Person completing this form: ______________________________ Title: _________________________
Name of School: _______________________________________ Grade: ________________________
 Deaf education class  Co-taught class  Other__________
If primary instructor is not a deaf education teacher/specialist, describe any previous experience with students who
are deaf or hard of hearing:_______________________________________________________________
IEP Deaf education services:  Consultation/Itinerant  Direct- in classroom  Direct- out of classroom
 Special School  other____________________________________
Observers:  Deaf education teacher: check type:  classroom  itinerant  consultative  co-teacher
 General education teacher  Special education teacher  Parent Other________________
Total number of students in classroom: ___ Number of students with hearing loss: ___ Student: adult ratio: ___
Student’s communication mode(s): _________________ Mode(s) observed in classroom: _________________
Receptive language level:  above grade level  at grade level  below grade level  >2 yrs below grade level
Expressive language level:  above grade level  at grade level  below grade level  >2 yrs below grade level
Personal Hearing Instrument:  Hearing Aid(s)  Cochlear Implant(s)  Bone anchored device  None/other___
Hearing Assistance Technology used:  Personal FM System  Classroom Audio Distribution System  None
 Other
Educational Interpreter assigned?  Yes  No Meets state’s minimum standard?  Yes  No
IEP Related and Support Services: Has had training

Area with D/HH? If provided, is service…
©PARC: 2B-Elementary Placement Checklist. C. D. Johnson, M. Darr, S. Elliott. Revised 2011. 1

≤35dbA and reverberation ≤.6 sec, ANSI S12.60-2009/10)? ____ ____
5. Are noise and movement sources in the classroom minimized (e.g., computers,
ventilation/heater fans, fish tanks, small group activities)? ____ ____
Comments____________________________________________________________________________

7. Do teacher(s)/adult(s) use a variety of techniques to elicit positive behavior from
students? ____ ____
8. Are there a variety of centers (fine motor, art, manipulatives, science, music, dramatic
play, sensory, literacy) or opportunities for demonstrating learning? ____ ____
9. Is there a visual schedule identifying daily routines and student expectations? ____ ____
11. Is the curriculum standards-based including a variety of themes, topics, and children’s
literature? ____ ____
13. Are activities modified to meet a variety of students’ needs? ____ ____
Comments____________________________________________________________________________

a. Are the teacher(s), students, and other adults good language models for the
student? ____ ____
b. Is language consistently accessible to this student? If sign/cueing is used, does the
interpreter/transliterator, or all adults in the classroom if no interpreter,
consistently sign/cue, including communications with other adults? ____ ____
c. Are peer responses repeated or signed/cued? ____ ____
d. Is vocabulary and language expanded by the teacher? ____ ____
c. Are overhead projectors, VCRs, LCDs, Smart Boards and other equipment to provide
visual supplements utilized? ____ ____
d. Is computer assisted notetaking, or a comparable procedure, utilized to support

access to course content, instruction, and discourse amongst the class? ____ ____
e. Is visual information accessible to the student (e.g., within view, written in
appropriate language)? ____ ____
17. Oral Discussion/Small Groups
a. Are all students encouraged to share and participate? ____ ____
b. Does the teacher face the students when speaking? ____ ____
c. Do the students face one another when speaking? ____ ____
d. Does the teacher lead group activities in an organized and student-friendly manner? ____ ____
e. Is appropriate wait time utilized to encourage students to think and participate? ____ ____
f. Are students seated within the teacher’s “arc of arms”? ____ ____
g. Does the teacher obtain eye contact prior to and while speaking? ____ ____
h. If used, is the FM microphone passed around to all speakers? ____ ____
18. Use of Sign/Cued Speech  Not
a. If an educational interpreter/transliterator is assigned to the student, does the Applicable
interpreter/transliterator promote student self-advocacy yet assure full access to
all communication in the classroom? ____ ____
b. Is the interpreter/transliterator familiar with the student’s IEP, and does s/he
know his/her role in its implementation? ____ ____
c. Does the interpreter/transliterator adjust the language in order to make it more
accessible to the student? ____ ____
d. Does the interpreter/transiliterator make changes to content vocabulary for the
student? ____ ____
e. Does the interpreter/transliterator expand on concepts presented in class? ____ ____
f. Is sign/cued speech consistently used by all adults in the class? ____ ____
g. Are teachers and paras proficient in the sign/cued mode of the student? ____ ____
h. Is sign/cuing consistently used by all students in the class? ____ ____
i. Does the type of sign/cuing used in the classroom match the signs/cues used by this
student? ____ ____
j. Is fingerspelling used? ____ ____
k. Are there opportunities for parents and peers to learn to sign/cued speech? ____ ____
l. Do they take advantage of them? ____ ____
19. Opportunities for Hands-on Experience
Check those used:  books  visual props  audio/video CDs/DVDs
 objects for dramatic play  manipulatives
d. Are art and sensory activities conducted? ____ ____
20. Amplification/Technology  Not
a. Are personal hearing instruments (hearing aids/cochlear implants) and hearing Applicable
Comments____________________________________________________________________________

21. Is there evidence that the school administration supports students with
22. Is the school welcoming of parents and does it encourage parent involvement? ____ ____
23. Is the school/district administrator knowledgeable about hearing loss or willing to
learn? ____ ____
24. Is the school committed to making the necessary accommodations for
students with hearing loss? ____ ____
27. Is the teacher welcoming of students with special needs? ____ ____
28. Is the teacher willing to use and troubleshoot hearing assistance technology (e.g.,
FMs) and other technologies (e.g., captioning, transcription)? ____ ____
29. Are the extra-curricular (sports, drama, clubs) staff and settings prepared to
assure communication access for this student? ____ ____
Comments____________________________________________________________________________
V. Reflection: Individual Student Considerations YES NO

Think about how this student communicates thoughts, ideas, and needs. Think about how
this student interacts with other students. Will his/her communication be nurtured in
this classroom environment? Are there opportunities for direct communication with
peers and professionals in the student’s language and communication mode and at the
student’s academic level? Is there direct instruction in the student’s language and
communication mode? Does this student have sufficient language abilities to benefit
from instruction in the classroom (generally within 2 years of most students in the
class)? Will this student develop English language competency in this environment?
31. Social Interactions, Self-Concept, Self-Efficacy, and Self-Advocacy ____ ____
Think about how this student plays and behaves alone and in groups. Think about how
this student interacts with other students. Will this student’s social skills and self-
concept be nurtured in this classroom environment? Will this student be supported to
develop self-efficacy and self-advocacy skills?
32. Listening Skills ____ ____
Does this student attend well? Is this student able to listen and process information in  Not
noise? Think about what this student does when he/she cannot hear? Does this student Applicable
take responsibility for his/her personal hearing instruments? Will this student’s
listening needs be supported in this classroom, lunchroom and all other school
environments? Is the staff qualified and able to support the student’s listening needs?
Comments____________________________________________________________________________
___________________________________________________________________________________

Part 2C: Placement Checklist for Students who are Deaf and Hard of Hearing:
SECONDARY
Before the Individual Education Program (IEP) team makes a decision regarding services and placement for a
student who is deaf or hard of hearing, two areas should be considered. First, is the student ready for the placement
under consideration and, second, is the classroom environment under consideration sufficiently prepared to support
the student? This checklist is the Placement component of this two part instrument. Its purpose is to guide
considerations and decisions related to placement and service options for students who are deaf or hard of hearing in
middle school and high school. Ratings may also guide the IEP team in providing supports when needed. The companion
set of checklists consider the readiness of the student for the various learning environments and situations under
consideration.
the current teacher, the prospective teacher(s), the parents and other members of the IEP team. Placement
decisions should consider the student’s communication, language, academic, and social needs in the context of the
proposed learning environment. Note: Each area or item may not be applicable to every student.
Student: ____________________________________________ Date: _________________________
Person completing this form: ______________________________ Title: _________________________
Name of School: _______________________________________ Grade: ________________________
 Deaf education class  Co-taught class  Other_________________
If primary instructor is not a deaf education teacher/specialist, describe any previous experience with students who
are deaf or hard of hearing:_______________________________________________________________
IEP Deaf education services:  Consultation/Itinerant  Direct- in classroom  Direct- out of classroom
 Special School  other____________________________________
Range of class size of student’s in classrooms: ___to___ Number of students with hearing loss in school: ______
Student’s communication mode(s): _________________ Mode(s) observed in classroom: __________________
Receptive language level:  above grade level  at grade level  1-2 yrs below grade level  >2 yrs below grade level
Expressive language level:  above grade level  at grade level  1-2 yrs below grade level  >2 yrs below grade level
Personal Hearing Instrument:  Hearing Aid(s)  Cochlear Implant(s)  Bone anchored device  None/other___
Hearing Assistance Technology used:  Personal FM system  Classroom Audio Distribution System  None
 Other____________________________________________________
Educational Interpreter assigned?  Yes  No Meets state’s minimum standard?  Yes  No
IEP Related and Support Services:

Has had training If provided, is service…
Area with D/HH?
©PARC: 2C-Secondary Placement Checklist. C.D. Johnson, M. Darr, S. Elliott. Revised 2011. 1
≤35dbA and reverberation ≤.6 sec, ANSI S12.60-2009/10)? ____ ____
5. Are noise and movement sources in the classroom minimized (e.g., computers,
ventilation/heater fans, fish tanks, small group activities)? ____ ____
Comments____________________________________________________________________________
___________________________________________________________________________________

7. Do teacher(s)/adult(s) use a variety of techniques to elicit positive behavior from
students? ____ ____
8. Is there a visual schedule identifying daily routines and student expectations? ____ ____
10. Is the curriculum standards-based including a variety of themes, topics, and age level
appropriate literature? ____ ____
12. Are activities modified to meet a variety of students’ needs? ____ ____
Comments____________________________________________________________________________
___________________________________________________________________________________

a. Are the teacher(s), students, and other adults good language models for the student? ____ ____
b. Is language consistently accessible to this student? If sign/cuing is used, does the
interpreter/transliterator, or all adults in the classroom if no interpreter/
transliterator, consistently sign/cue, including communications with other adults? ____ ____
c. Are peer responses repeated or signed/cued? ____ ____
d. Is vocabulary and language expanded by the teacher? ____ ____
c. Are overhead projectors, VCRs, LCDs, Smart boards and other equipment to provide
visual supplements utilized? ____ ____
d. Is computer assisted notetaking, or a comparable procedure, utilized to support
access to course content, instruction, and discourse amongst the class? ____ ____
e. Is visual information accessible to the student (e.g., within view)? ____ ____
16. Oral Discussion/Small Groups
a. Are all students encouraged to share and participate? ____ ____
b. Does the teacher face the students when speaking? ____ ____
c. Do the students face one another when speaking? ____ ____
d. Does the teacher lead group activities in an organized and student-friendly manner? ____ ____
e. Is appropriate wait time utilized to encourage students to think and participate? ____ ____
f. Are students seated within the teacher’s “arc of arms”? ____ ____
g. Does the teacher obtain eye contact prior to and while speaking? ____ ____
h. If used, is the FM microphone passed around to all speakers? ____ ____
17. Use of Sign/Cued Speech  Not Applicable
a. If an educational interpreter/transliterator is assigned to the student, does the
interpreter/transliterator promote student self-advocacy yet assure full access to
all communication in the classroom? ____ ____
b. Is the interpreter/transliterator familiar with the student’s IEP, and does s/he
know his/her role in its implementation? ____ ____
c. Does the interpreter/transliterator adjust the language in order to make it more
accessible to the student? ____ ____
d. Does the interpreter/transiliterator make changes to content vocabulary for the
student? ____ ____
e. Does the interpreter/transliterator expand on concepts presented in class? ____ ____
f. Is sign/cued speech consistently used by all adults in the class? ____ ____
g. Are teachers and paras proficient in the sign/cue mode of the student? ____ ____
h. Is sign/cuing consistently used by all students in the class? ____ ____
i. Does the type of sign/cue used in the classroom match the signs/cued speech used
by this student? ____ ____
j. Is fingerspelling used? ____ ____
k. Are there opportunities for parents and peers to learn to sign/cued speech? ____ ____
l. Do they take advantage of them? ____ ____
18. Opportunities for Experiential Learning
Check those used:  books  visual props  audio/video Cds/DVDs
d. Are art and sensory activities conducted? ____ ____
19. Amplification/Technology  Not Applicable
a. Are personal hearing instruments (hearing aids/cochlear implants) and hearing
20. Transition
a. Is personal responsibility/self-advocacy development supported for independent
thinking and decision-making? ____ ____
b. Is there an emphasis on career exploration and development of career goals? ____ ____
c. Does the student’s education program support his/her post-school goals? ____ ____
d. Are there opportunities for job shadowing within the community? ____ ____
e. When appropriate, are linkages made with adult services (e.g., Voc Rehab)? ____ ____
Comments____________________________________________________________________________
___________________________________________________________________________________

21. Is there evidence that the school administration supports students with
22. Is the school/district administrator knowledgeable about hearing loss or willing to ____ ____
learn?
23. Is the school committed to making the necessary accommodations for students ____ ____
with hearing loss? ____ ____
26. Is the teacher welcoming of students with special needs?
27. Is the teacher willing to use and troubleshoot hearing assistance technology (FMs) ____ ____
and other technologies (captioning, transcription)?
28. Are the extra-curricular (sports, drama, clubs) staff and settings going to assure ____ ____
communication access for this student?
Comments____________________________________________________________________________
___________________________________________________________________________________
V. Reflection: Individual Student Considerations YES NO

Think about how this student communicates thoughts, ideas, and needs. Think about how
this student interacts with other students. Will his/her communication be nurtured in
this classroom environment? Are there opportunities for direct communication with
peers and professionals in the student’s language and communication mode and at the
student’s academic level? Is there direct instruction in the student’s language and
communication mode? Does this student have sufficient language abilities to benefit
from instruction in the classroom (generally within 2 years of most students in the
class)? Will this student develop English language competency in this environment?
30. Social Interactions, Self-Concept, Self-Efficacy, and Self-Advocacy ____ ____
Think about how this student behaves alone and in groups. Think about how this student
interacts with other students. Will this student’s social skills and self-concept be
nurtured in this classroom environment? Will this student be supported to develop self-
efficacy and self-advocacy skills?
31. Listening Skills ____ ____
Does this student attend well? Is this student able to listen and process information in  Not Applicable
noise? Think about what this student does when he/she cannot hear? Does this student
take responsibility for his/her personal hearing instruments? Will this student’s
listening needs be supported in this classroom, lunchroom and all other school
environments? Is the staff qualified and able to support the student’s listening needs?
Comments____________________________________________________________________________
___________________________________________________________________________________
APPENDIX 11–E
Chapter 11
Note. From Hands and Voices (2015), http://www.handsandvoices.org. Used with permission.
438

APPENDIX 11–F
Sample Section 504 Plan1
Student: _________________________________________________ D.O.B:________ Grade: ____
School: _________________________________________________ Meeting Date:_____________
Qualifying Disability: ______________________________________ Start Date:________________
Case Manager: ___________________________________________ Review Date:______________
Documentation of Disability:
Chapter 11
The disability impacts the student’s education. [ ] YES [ ] NO
Is the student disabled under Section 504? [ ] YES [ ] NO
Team Members Present
Name Title
_______________________________________________ ________________________________
_______________________________________________ ________________________________
_______________________________________________ ________________________________
_______________________________________________ ________________________________
_______________________________________________ ________________________________
Discussion Notes
1
There is no standard Section 504 plan document.
439

440 Chapter 11
Accommodations/Services Plan
Area of
Difficulty Accommodation or Service Person(s) Responsible Frequency
Chapter 11
Date Approved: ____________________________________________________
Student Signature: __________________________________________________
I give permission for my son/daughter to receive the above-mentioned services.
____________________________________________________________________________________________
Parent Date

APPENDIX 11–G
Case Law Summary
School did not complete a sufficient evaluation of the

LEGAL INTERPRETATIONS hearing impairment for the IEP team to reasonably develop
RELATING TO AUDIOLOGY AND a plan designed to provide reasonable education benefit.
DEAF EDUCATION SERVICES1 Although an audiogram was provided by the mother (com-
pleted privately), the school district’s assessment only con-
Case law is determined through the rulings of the court. Cir sisted of an auditory skills assessment obtained through ob-
cuit court and state court decisions are regarded in the region servation and review of records. The Court of Appeals ruled
or state that the court represents. However, their decisions may that “such a limited review was insufficient to satisfy the Dis-
serve as the basis for rulings made by the other circuit or state trict’s evaluation obligation.” (Also see Eligibility below).
Chapter 11
courts. U.S. Supreme Court rulings determine the law of the Detroit City School District – Michigan State Education
land. The Office of Civil Rights (OCR) rules on cases that are Agency 15-00085 (2015)
filed through their office. These rulings also have national Failure to document daily use of FM system as stipu-
implications. The U.S. Department of Education provides lated in student’s IEP was a violation of IDEA regulations.
further legal interpretation through the Office of Special Lack of recording keeping violated 34 CFR 76.731 which
Education Programs (OSEP). Clarification and interpretation requires districts maintain records to show compliance with
of federal regulations are made through letters of policy clari IDEA.
fication written in response to specific inquiries made by state
education officials, parents, or other pertinent parties. Auditory Processing Disorders
E.M. v. Pajaro Valley Unified School District (2014), Ninth
Circuit Court of Appeals
LANDMARK AND IMPORTANT Determined that auditory processing disorder consti-
tuted an “other health impaired” condition under IDEA;
CASE LAW RULINGS established that the diagnosis must be made by a licensed
audiologist as a result of an examination; defined APD ac-
Audiology Services cording to ASHA’s definition: “a deficiency in neurological
Stratham School District v. Beth and David P., 103 LRP processing that adversely affects an individual’s ability to
4317 (02-135-JD, 2003 DNH 022) identify and distinguish similar sounds and understand oral
On appeal, courts affirmed an administrative law judge communication.” The U.S. Department of Education pro-
decision ordering the school district to pay for cochlear im- vided the interpretation of IDEA regulations pertaining to
plant mapping services, and associated transportation ex- this case.
penses, because a proper functioning cochlear implant was
necessary for the child to receive FAPE and that service was Ambient Noise Levels
included under definition of audiology as a related service
Pa. Commw. Ct. 1982. Silvio v. Commonwealth, Depart. Of
of IDEA.
Educ., 553:577.
Avon Local School District 38 IDELR 254 (SEA 2003) Ohio)
District did not have to establish exact ambient noise
Impartial Hearing Officer decision orders same.
levels for classroom for hearing impaired students because
Meagan C. v. ECI Life path Systems (ECI Docket No. 001-
there was sufficient evidence to show that the ambient noise
ECI-0803) (Texas)
levels were appropriate.
Cochlear Implant mapping, related audiological testing
and associated travel expenses ordered to be paid under Part C
and that the IFSP be amended to provide these services (Im- Use of FM System
partial Hearing Officer) NOTE: Review IDEA 2004 OSEP OSEP 1992. Letter to Anonymous, 18 IDELR
regulations comments for more clarification in this area. Parent may request IEP meeting to consider use of FM
S.P. v. East Whittier City School District, (2018), Ninth Cir- system if student has current IEP but IEP does not discuss use
cuit Court of Appeals. of such a system. If student does not have current IEP, parent
1
Summarized from the Individuals with Disabilities Education Law Report; compiled and updated by C.D. Johnson 8/2019. The document is
intended to provide information; it does not constitute legal advice.
441

442 Chapter 11
may request an evaluation to determine if a disability is pres- NOTE: Review IDEA 2004 OSEP regulations comments
ent, and to discuss use of FM system at time of IEP meeting. for more clarification in this area.
OCR 1994. Robertson (TN) County School District, 22
IDELR 255.
District not in violation of Section 504 or Title II of
Hearing Loss Corrected by a Hearing Aid
ADA for failing to properly repair FM listening device since SEA PA 1995. City of Erie School District, 22 IDELR 394.
problem was due to static and not faulty repair. A student whose hearing loss was corrected by hearing
SEA AZ 1997. Glendale Union High School District, 26 D aids, no longer qualified for special education as hearing
IDELR 243 impaired. The case found that her hearing loss, because cor-
District not required to provide FM trainer to student rected, did not interfere with her performance on an IQ test,
with speech impairment and normal hearing. and the district did not fail to make necessary accommo-
OCR 2003 Ceres, CA Unified School District, 39 IDELR 221 dations for her hearing loss during the assessment process;
Parent of an HI student contended that the child’s class- therefore, the district’s results indicating that she was not
room teacher did not use an FM device as required by the gifted were valid.
student’s IEP, which called for the teacher to wear the device
90% of the instructional time as a means of communicating
with the student. OCR determined the teacher had experi-
Public Agency’s Role for Providing
Chapter 11
enced intermittent problems maintaining and using the unit. Assistive Technology
However, evidence confirmed that the school’s principal OCR. 1991. Humboldt (AZ) Unified School District, 18
took steps to identify and correct the problem. The princi- IDELR 28 (Insufficient hearing loss)
pal, along with a resource specialist instructor, met with the Lack of evidence to show student’s alleged hearing
teacher to ensure she understood how to use the device and impairment was substantial enough to qualify as a “handi-
was aware of the requirements of the child’s IEP. capped person” under 504.
OSEP 1993. Anonymous letter to, 21 IDELR 1126
Inquiry: What obligations does a state have under
School’s Role for Providing Hearing Aids Part H to provide early intervention services in the form
OSEP 1993. Letter to Seiler, 20 IDELR 1216 of audiology services and assistive technology (devices and
Declares that a hearing aid is considered a covered de- services)?
vice under the definition of “assistive technology device”; Finding: Part H requires audiology services/assistive
therefore, if the hearing aid is required by the student with a technology if necessary, to meet developmental needs of
disability to receive FAPE, and the hearing aid is specified child/family.
within the student’s IEP as a need, then the district is respon- OSEP 1994. Letter to Gay, 22 IDELR 373.
sible for providing the hearing aid at no cost to the child or When the IEP indicates the requirement of an assis-
his/her family as per 34 CFR 300.308. tive technology device, such as a hearing aid, as part of the
OSEP 1994. Letter to Galloway, 22 IDELR 37 student’s special education program, then the responsible
Inquiry: Which public agency is responsible for the public agency must provide the device at no cost to the stu-
purchase of a hearing aid if a child’s IEP indicates that the dent or his/her family. If a state’s regulations indicate that
device is necessary—the home school district or a state- personal items are to be provided by a student’s parents, an
supported school for the deaf? additional statement must be included which explains that
Should a state’s regulation, which provides that parents personal items specified on the student’s IEP as necessary
will assume the costs for personal items such as hearing aids, for FAPE, would be provided at no cost to parents. When the
be amended to include the statement “unless otherwise spec- child attends a state-supported school for the deaf, the state’s
ified in the IEP for educational purposes”? law, regulation, or policy defines whether the student’s home
Finding: State determines which public agency must school or the school for the deaf pays for the device. The re-
pay for assistive device; state’s regulation regarding finan- sponsible public agency may seek funds from other sources
cial responsibility for personal items required amendment. provided they ensure FAPE and there is no cost to the stu-
OSEP 1995. Letter to Bachus, 22 IDELR 629 dent or his/her family.
LEA must provide eyeglass if they are necessary for OSEP 1994, Anonymous letter to, 21 IDELR 1057
FAPE and included in IEP. Inquiry: Is s school district responsible for an assistive
SEA IA 1999. technology device, purchased by the parents, if that device
ALJ determined that FM trainer provided appropriate is utilized by the student in completion of his/her IEP goals
assistive technology for HI student and that hearing aids and therefore his/her academic work?
were not required to receive FAPE. Parent’s request for re- Finding: Although not mandatory, assuming liability
imbursement for hearing aids was denied. for family-owned assistive technology devices is reasonable.

OSEP 1994. Robertson TN County School District, 22 ting from additional supports she did not receive. Issue: the
IDELR 255 “label” is meaningless . . . you are looking for services to
Problem with listening device was static interference, meet the student’s needs.
not faulty repair by district.
OSEP 1994. Letter to Anonymous, 21 IDELR 745 (Provision
of Phonic Ear device)
Communication Method
Regarding parent request for use of Phonic Ear hearing Age v. Bullit County Public Schools, 6th Circuit Court
device by student with hearing loss placed by parents at pa- (1982)
rochial school, OSEP indicated that LEA must ensure genu- Placement of profoundly deaf children in a segregated
ine opportunity for equitable participation in one of public classroom while being instructed in total communication
school’s special education programs. However equitable was an appropriate education.
participation does not require district to provide Phonic Ear Silvio v. Commonwealth of Pennsylvania (1982)
device as part of its special education and related services. Transfer of child with hearing impairment from private
Comment: The audiologist along with the IEP team oral school to school using total communication would not
should determine which type of assistive listening device, if impede the child’s speaking ability and the association with
any, is most appropriate to meet the educational needs of the nonhandicapped children would actually improve her com-
individual student. Parents can provide input into the decision munication with others.
Chapter 11
but cannot demand a specific brand or type of equipment. Unified School District No. 512, KS (1995)
OSEP 1995. Letter to Naon, 22 IDELR 856 The District’s plan to serve a student who was hear-
Need for assistive technology devices/services must be ing impaired in a self-contained classroom using total com-
based upon individual. munication was determined appropriate even though the
OSEP 1996. Letter to Anonymous, 24 IDELR 388 parents wanted placement in an oral program offered at a
Public agency may be responsible for assistive technol- private school for deaf students.
ogy devices/services depending upon how addressed in IEP.
OSEP 1997. Letter to Culbreath, 25 IDELR 1212
State law governs financial liability for damage or theft
Disability and Eligibility Identification as a
of assistive technology devices. Child with Hearing Impairment (FAPE)
OCR 1998. Detroit Public Schools, 29 IDELR 619 Phyllene W v. Huntsville City Board of Education (2015),
Assistive technology at home not required under IEP. Eleventh Circuit Court of Appeals
OSEP 1998. Letter to Hutcheson, 30 IDELR 708 Child with chronic otitis media, seven surgeries, and
Both local and state educational agencies have obliga- fluctuating, progressing to permanent, hearing loss was
tion relating to provision of assistive technology devices and identified as student with specific learning disabilities
services. throughout school (grades 2–10), consistently performed
E.D. PA 1999. East Pennsylvania School District v. Scott B., below grade level in reading and math; mother informed
29 IDELR 1058 school at each IEP meeting about hearing issues; “prefer-
Assistive technology device was inadequate. ential seating” provided in 6th grade, fitted with hearing aid
SEA IA 1999. Ankeny Community School District, 30 IDELR in 10th grade. Mother enrolled daughter in private school
451 for 10th grade and filed due process. Independent evalua-
Only assistive technology student required was FM tion by SLP revealed “profoundly impaired language skills,”
trainer. audiologist revealed long-standing fluctuating hearing levels
and severe difficulty understanding speech in background
noise. District Court found on behalf of School District be-
Open Classroom/Minimal Hearing Loss cause sufficient evidence of school denying FAPE was not
OCR 1994. Brockton (MA) Public Schools, 21 IDELR 1076. provided. Court of Appeals ruled that the district violated
Found placement of a student with disabilities, includ- IDEA and FAPE by not assessing areas of “suspected” dis-
ing minimal hearing loss, in an open space resource room ability (i.e., hearing) despite growing deficiencies without
was adequate to meet the student’s needs. Placement rec- considering the effect they may have on academic progress
ommendations were made by a team that included initial and that proper evaluation and services may have prevented
acceptance by the student’s guardian. academic delays.
Wachlaorwicz v. School Bd of Indept SD No 832, MN. 42 S.P. v. East Whittier City School District (2018), Ninth Cir-
IDELR 7, (2004) cuit Court of Appeals
Student with high frequency hearing loss and speech School district did not appropriate evaluate child to
apraxia did not qualify for “hearing disability” according provide sufficient information for proper disability category.
to the state criteria; parents sued the district for not benefit- Therefore, the special factors considerations for children

444 Chapter 11
identified as deaf or hard of hearing were not applied be- “Educational benefit” described as not just that the child
cause the school had identified S.P. as a student with speech- must receive “any” benefit: the benefit must be “received”
language disabilities which resulted in addressing only within the context of the child’s unique needs, not the needs
speech and language delays. (Also see Audiology.) of the agency.
Deal v. Hamilton County Board of Ed, 6th Circuit TN (2006),
46 IDELR
ADA/IDEA (FAPE) Zachary Deal, a high-functioning preschooler with au-
K.M. v. Tustin Unified School District, Ninth Circuit Court tism would not receive FAPE and may digress in the school’s
of Appeals predetermined setting with a predetermined methodology;
D.H. v. Poway Unified School District, Ninth Circuit Court Court stated that “meaningful educational benefit must be
of Appeals gauged by the child’s potential”; “there is a point at which
Both are landmark cases in that they establish that stu- the difference in outcomes between two methods can be so
dents served by IDEA were also eligible under ADA. Deci- great that the provision of the lesser program could amount
sion include U.S. Departments of Education and Justice and to a denial of FAPE.” Will this lead to a new standard of
provide the 2014 policy guidance, Frequently Asked Ques- FAPE as maximizing potential?
tions on Effective Communication for Students with Hear- Forest Grove SD v. T.A., 9th Cir. (2008)
ing, Vision, or Speech Disabilities in Public Elementary and Parent provided intensive home support for their child
Chapter 11
Secondary Schools describing eligibility and accommoda- who did not appear to meet IEP eligibility. During 504 meet-
tions. Of most significance is the different standards of the ing, parents expressed concerns for his LD/ADHD, concerns
two laws, i.e., ADA requires communication must be “as ef- noted but not followed up on my schools. Parents placed him
fective as communication for others,” while IDEA requires into private school, then sought reimbursement. Question:
schools “to meet each student’s individual needs to provide a Can parents sue the school if it never had a chance to provide
“reasonable education program.” Therefore, ADA is a higher FAPE? Regarding RtI: If the school goes through RtI before
standard that can be used to justify services. eligibility can be established, can parents remove their child
and seek private placement because there is no IEP? Is the
school liable? District denied payment, 9th Circuit ruled in
Adequate Services and favor of parents, Supreme Court ruled in favor of parents
Maximum Potential (FAPE) October 2009.
Hendrick Hudson School District v. Rowley (1982) Endrew F. v. Douglas County School District (CO) (2017).
The first and perhaps most far-reaching ruling regard- U.S. Supreme Court
ing the definition of “appropriate” services. The Supreme Revisited the definition of FAPE stating that the IEP
Court defined “appropriate” as sufficient for educational goals must be more demanding than “merely more than de
benefit but not for maximization of the student’s potential. minimis”:
The court further stated that the IEP, and therefore the per- ■■ “The IEP must be reasonably calculated to enable a
sonalized instruction, should be formulated in accordance child to make progress appropriate in light of the child’s
with the requirements of the Act, and if the child is being circumstances.”
educated in the regular classrooms of the public education ■■ “The student’s educational program must be appropri-
system, should be reasonably calculated to enable the child ately ambitious in light of his circumstances, just as
to achieve passing marks and advance from grade to grade. advancement from grade to grade is appropriately am
In addition, this decision established the school district’s bitious for most children in a regular classroom. The
right to determine appropriate methodology. goals may differ, but every child should have the chance
Bonadonna v. Cooperman, 619 F. Supp. 975, 1985–1986 to meet challenging objectives.”
EHLR DEC. 557:178, 183 (D. NJ 1985)
NJ District Court judge reversed decisions of two ad-
ministrative law judges in case of child with hearing impair- Placement/LRE
ment; found that the school district’s evaluations of Alisa fell Letter to Siegel OSEP (1990)
“woefully short” because they relied solely on “subjective LRE must include placements options that for students
teacher observations” not objective or scientific test data. with hearing impairment must include staff members who
Issue turned on fact that only one assessment method was can interact with the child in his or her mode of communi
used, e.g., observation, stating that “such procedures lacked cation. The EHA-B (Education for the Handicapped Act–
scientific validity, in that they were not systematic, were lim- Part B) contains regulations to ensure that children are as-
ited to a narrow range of behavior, and were not confirmed sessed in their native language or appropriate mode of commu-
by recent test data”, thus discriminatory evaluation, i.e., nication and that individuals providing special education and
evaluation that is biased, in this case, against deaf children. related services are adequately trained and qualified. OSEP
Honig v. Doe, 484 U.S. 305, 308 (1988) clarified that the placement of a deaf or hearing-impaired

child should facilitate interaction with language-appropriate to pay for the private school placement and reimburse the
peers and staff members who are skilled in the child’s mode parents for past services provided at that center.
of communication. C.M. v. Miami-Dade County School Board (2003)
Cobb County Board of Education, GA (1990) Parent of a 4-year-old child with a cochlear implant
Placement at a school for the deaf was ordered because sought reimbursement for verbotonal therapy while attend-
the school district’s recommended program failed to address ing a private school. The Administrative Law Judge ruled in
the child’s need for a total communication environment. favor of the district finding that the school had sufficiently
The School District of Philadelphia, PA—OCR (1990) trained staff to address the child’s verbotonal therapy needs
The district did not have to provide speech therapy for a and that the IEP was reasonable calculated to provide the
hearing impaired child by a certified speech therapist since student with meaningful educational benefit given her needs.
the teacher of the hearing impaired, by virtue of her course- J.C. v. California School for the Deaf, 46 IDELR 184 (CA,
work in teaching speech to the deaf and district observations 2006)
of her teaching skill, was sufficiently competent to meet the A deaf student with additional disabilities was discrimi-
requirements of Reg. 104.33. nated against by CSDB by intentionally excluding her from
Traverse City Area Public School, MI (1993) classroom lessons and other activities due to her autism
Because student who was deaf had an adequate IEP, and cognitive impairments. The court rejected the district’s
continuation of the student’s program in total communi- claim that the student lacked the ability to benefit from an
Chapter 11
cation at a regular school was determined least restrictive education at CSDB.
rather than the parent’s request for placement at the state Cave v. East Meadow Union Free SD, IDELR 92 (2nd Cir,
school for the deaf. 2008)
Dreher ex rel. Dreher v. Amphitheater Unified School Dis- 504/ADA case in which a deaf student tried to bring
trict, 9th Circuit Court (1994) his service dog to school, but 2nd Circuit said no, this is
Parents requested reimbursement for speech therapy not on his IEP (schools claimed student allergy prohibition).
services at a private school for their profoundly deaf child. Parents sued, but courts said parents should have tried to
The district’s program of oral methods and sign language get this on the IEP, since they did not, they did not “exhaust
was found to constitute FAPE, even though the parents did their administrative remedies.” Issue: Is the dog required for
not choose that option. FAPE?
Anonymous letter to, 21 IDELR 67 (1994) M.M. v. NYC Dept of Ed, 51 IDELR 128 (S.D.N.Y. 2008)
Inquiry—What efforts have been made to ensure that Can 3-year-old “stay put” in IFSP if her parents do not
the needs of children who are deaf are appropriate identified like the IEP? No. The school district did not have to pay for
and met, and that placement decisions meet the standards of the private early intervention program the parents elected to
the IDEA and its regulations? continue during a dispute over her initial IEP. Circuit Courts
Finding: Placement for students who are deaf must have varied on “stay put” with IFSP, but in this case, the
offer FAPE to meet LRE requirement ruling upheld OSEP’s official comments that districts have
Shapiro v. Paradise Valley School District, 35IDELR 187 no obligation to fund Part C services when a parent disputes
(D. Ariz. 2001) Part B plan. In this situation, the child was not considered
Confirming an earlier finding, US District Court ruled to have a “current educational placement”; therefore, “stay
that an out of state private school specializing in the educa- put” did not apply.
tion of children who are deaf and hard of hearing was an
appropriate place for the student who had a cochlear im-
plant. The court upheld an administrative award requiring Related Services
the school to reimburse the parents for their placement costs. Anthony Wayne Local School District, Ohio (1990)
This case recognizes that there are different education and Even though the child (actually two twin sisters) placed
social needs of students with sensory impairments that must by parents at private, out-of-district school, the school dis-
be considered when determining the instruction and services trict the child resided within remained responsible for pro-
necessary to provide FAPE within LRE. viding related services at the private school. The district
D.D. v. Foothill SELPA 38 IDELR 29 (CA 2002) was also ordered to reimburse the parents for tuition to the
Ruled that the program developed by the staff of the private school since the district failed to provide the related
early childhood program could not meet the needs of a child service (individual and small group instruction) as required
with a cochlear implant because the staff did not have suf- by her IEP, thereby denying the child FAPE.
ficient training to work with this situation. Even though the Letter to Dagley, OSEP (1991)
district claimed that the private school provider could not Sign language instruction must be provided to parents
meet all of the needs on the child’s IEP and that the private (under “parent counseling and training”) if IEP team determines
school setting violated natural environment requirements of instruction for parents is necessary for the child to receive
Part C, the Administrative Law Judge ordered the SELPA benefit from his education program.

446 Chapter 11
Benicia, CA Unified School District, OCR 30 IDELR 900 placed him, because unlike other special education services,
(1998) the purpose of the sign language interpreter was to provide
Plan resolved district’s obligation to provide audiologist the student with assistance most of the time, a service that
and sign language interpreter. could be provided outside of the private school classroom.
NOTE: Review IDEA 2004 OSEP comments for more Fowler by Fowler v. Unified School District No. 259 KA (1995)
clarification in this area. The district was ordered to provide an interpreter at a
private, nonsectarian school for the deaf student because
there was agreement he needed the service and the district
504 would have had to provide the service if he attended the
OCR 1988. Cleveland (OH) Public School District, 353:307. public school. Because the district had provided services
School district violated 504 when it failed to provide outside of its cluster site to other students, it failed to prove
FM systems, individualized speech therapy, and sufficient that doing so for this student at a private school would pose
interpreters in a timely manner. an unreasonable burden.
J.W. v. Fresno Unified SD, 50 IDELR 42, (E.D., CA 2008) Park City School District, UT (1995)
A California district court agreed with the school dis- The district was found to have no obligation to provide
missing the case regarding a student with a hearing disability a cued speech transliterator for a deaf student in a parochial
on a 504 plan because he could not seek the legal remedies school since it could provide FAPE within the public school.
Chapter 11
of the IDEA when he alleged that he had not been provided The ruling indicated that neither IDEA nor EDGAR entitled
with a FAPE. Section 504 does not focus on the needs of the a private school student to services that were essential to
student based on his or her disabilities, but on the access to maintaining him in the private school placement
educational services.
Other
Interpreter Services OSEP 1991. Letter to anonymous, 18 IDELF 627
Zobrest v. Catalina Foothills School District, 9th Circuit State Board may not change IEP team’s determination.
Court, (1992), U.S. Supreme Court, (1993) B.F. v. Fulton County SD, 51 IDELR 76 (GA 2008)
The 9th Circuit Court in 1992 determined that the provi- Can the parent dictate to the school which teacher or
sion of an interpreter at public expense at a parochial school staffer can work with their child? No, not even when the stu-
would violate the Establishment Clause of the U.S. Consti- dent suffers PTSD resulting from encounters with his case
tution (dealing with separation of church and state) because manager and para. Unfortunately, the parents did not docu-
the interpreter would be required throughout the school day, ment their concerns with the teacher/staff until they wrote
for both education and religious instruction. The U.S. Su- a letter requesting homebound services (substantiated by a
preme Court in 1993, however, ruled that the provision of private psychologist’s opinion). Courts could not determine
interpreter services to students with disabilities at parochial if the parent concerns were expressed simply as justification
schools is not barred by the U.S. Constitution as a matter of for their claim for homebound instruction.
separation of church and state. This case only considered
whether the Establishment Clause could bar the school dis-
trict from providing a publicly paid sign language interpreter Medical Services in a School Setting
on the grounds that it was a religious school. Zobrest did
Bright-line test of medical services provided by a school com-
not address the issue of whether private school students are
pared to a physician; Courts distinguished medical services
entitled to such services under IDEA.
from related services by defining medical service as those
Tugg v. Towey, FL (1994)
provided by a physician and that any service by a nonphysi-
The use of interpreters for counseling services for deaf
cian could be considered an educationally related service.
and hearing-impaired individuals, including students, was
found to be unequal to those provided to the general pub- ■■ Irving Independent School District v. Tatro, 648U.S.
lic. The Florida Department of Health and Rehabilitation 883 (1984)School ordered to provide in-school cath-
Services was ordered to provide mental health services to eterization services.
individuals who were deaf by counselors with sign language ■■ Supreme Court in Cedar Rapids Community School
skills and an understanding of the mental health needs of the District v. Garrett F., 526 U,S. 66 (1999). School was
deaf community. ordered to provide full-time nursing care in school to
Cefalu ex re. Cefalu V. East Baton Rouge Parish School ventilator-dependent student; services not considered
Board, LA (1995) medical because it did not require a physician and could
The court ruled that IDEA regulations specifically re- be done in school by a trained health provider.
quired the board of education to provide a sign language in- NOTE: Review IDEA 2004 OSEP regulations and com-
terpreter to a student in the parochial school his parents had ments for more clarification in this area.

CHAPTER 12
Prevention of
Noise-Induced Hearing
Loss and Tinnitus in Youth
With Deanna K. Meinke
CONTENTS
Epidemiology Estimates of Noise-Induced Hearing Loss in Youth

Epidemiology of Noise-Induced Tinnitus in Youth
Chapter 12
Rationale for Hearing Loss Prevention Targeting Youth
Public Health Role for Audiologists
447

Raising Public Awareness in the School Setting

Noise Awareness and Prevention Programs
Education to Prevent Noise-Induced Hearing Loss
Dangerous Decibels
Hearing Screenings for At-Risk Individuals
Advocating for Public Policies
Challenges and Future Directions
KEY TERMS ■■ How do awareness campaigns and intervention pro-

grams differ?
Noise-induced hearing loss, tinnitus, hearing health promo- ■■ How should hearing screening and hearing loss preven-
tion, health communication, epidemiology of noise-induced tion education interface?
hearing loss, youth, adolescents ■■ What are the challenges and suggested solutions to
overcoming them?
Chapter 12
KEY POINTS EPIDEMIOLOGY ESTIMATES

■■ An estimated 5.9 million youths between the ages of 9 OF NOISE-INDUCED
and 19 years of age have elevated hearing thresholds in HEARING LOSS IN YOUTH
the 3 to 6 kHz range suggestive of noise-induced hear-
ing loss. National representative data on the hearing status of youth
■■ Tinnitus is an early indicator of noise-induced hearing in the United States have been obtained by the U.S. National
loss. Center for Health Statistics since 1960 using a standardized
■■ Gradual-onset noise-induced hearing loss is insidi- measurement approach (CDC NHANES, 2009). The data
ous and develops into more severe hearing losses with collection included measuring hearing thresholds for both
long-term consequences without intervention to prevent ears at frequencies of 0.5, 1, 2, 3, 4, 6, and 8 kHz in youth
progression. aged 12 to 17 or 19 years combined with demographic/sur-
■■ Audiologists have a role in public health efforts to pre- vey questions (Hoffman et al., 2019). These data sets are
vent noise-induced hearing loss in youth and adults. periodically released and publicly available for researchers
■■ Health communication science has contributed to the to further investigate hearing status and trends over time in
development of behavior change theories that have been U.S. civilian, noninstitutionalized youth.
incorporated into hearing health promotion programs. Early evidence of a NIHL has been identified as the
■■ Evidence-based strategies to change knowledge, atti- presence of a notched audiometric configuration in air-
tudes, and intended behaviors have been developed and conducted pure-tone audiograms (Niskar et al., 2001). The
can be implemented in the classroom. presence of a “notch” requires that the audiogram meets the
following three criteria: (1) threshold at 0.5 and 1 kHz are
Educational audiologists have a unique opportunity
both 15 dB HL or less; (2) the maximum threshold at 3, 4,
and professional obligation to advocate and support public
or 6 kHz is 15 dB higher than the highest (poorest) thresh-
health efforts to prevent noise-induced hearing loss (NIHL)
old at 0.5 and 1 kHz; and (3) the threshold at 8 kHz is 10 or
and tinnitus in both youth and adults. The need for such pre-
more dB lower (better) than the maximal threshold at 3, 5, or
vention efforts is great despite recent epidemiological data
6 kHz. Niskar et al. (2001) reported 15.5% (95% confidence
suggesting that “kids [adolescents] hear better nowadays
interval [CI]: 13.3% to 17.6%) of children aged 12 to 19 years
than we did” (Hoffman et al., 2019). Questions addressed in
with a noise-induced threshold shift (NITS) in one or both
this chapter include the following:
ears based on the National Health and Nutrition Examina-
■■ What are current trends in the prevalence of NIHL? tion Surveys (NHANES) III data collected between 1988
■■ How prevalent is tinnitus in youth? and 1994. Henderson, Testa, and Hartnick (2011) used the
448

Prevention of Noise-Induced Hearing Loss and Tinnitus in Youth 449
ducted a 10-year (2003 to 2013) retrospective review of

Call to Action electronic health records and follow-up telephone survey
methods to describe the clinical features and natural his-
Extrapolating the 12.8% prevalence to the 2018 tory of tinnitus in a pediatric otolaryngology clinic setting
U.S. youth census numbers suggests that at least (Chan, Jensen, & Gao, 2018). One-hundred-eighty pediatric
5.9 million youth aged 9 to 19 years have audio- patients (≤18 years of age; m = 11.5 years) were identified
metric test results suggestive of early NIHL (U.S. who presented with a primary complaint of tinnitus and who
Census, 2019). This estimate does not include the also had pure-tone audiometry results. The majority (77.8%)
number of youths that demonstrate a HFHL that of the subjects with tinnitus had normal hearing (unspecified
may have progressed beyond a notched audiomet- criteria), and 9.4% had sensorineural hearing loss. The re-
ric configuration due to continued exposure to maining had conductive or mixed hearing conditions. Noise
hazardous noise. Regardless of the count estimates, exposure was identified as the underlying etiological fac-
millions of U.S. youth would benefit from efforts to tor in 7.2%, head trauma in another 7.2%, and remained
prevent the onset and progression of NIHL. unknown in 47.2%. These authors specifically noted that
opportunities for preventing pediatric tinnitus include ad-
dressing the risk of hazardous noise exposure and head in-
jury in youth.
Tinnitus is a well-recognized indicator of hazardous
same NITS criteria as Niskar et al. (2001) and also included sound overexposure (Griest & Bishop, 1998) and occurs in
both low-frequency (0.5, 1, and 2 kHz) and high-frequency adolescents after high-level sound exposure (Chung, Des
(3, 4, and 6 kHz) prevalence rates to investigate trends in the Roches, Meunier, & Eavey, 2005; Gilles, Van Hal, De Rid-
NHANES III data from 1988 to 1994 and NHANES 2004 to der, Wouters, & Van de Heyning, 2013; Jokitulppo, Bjork,
2006. Hearing loss was defined as average thresholds greater
Chapter 12
& kaan-Penttila, 1997; Mercier & Hahmann, 2002; Zocoli,
than 15 dB HL in one ear. Henderson et al (2011) found no Morata, Marques, & Corteletti, 2009). Estimates range be-
statistically significant increases in the rates of NITS, high- tween 45% and 77% of adolescents reporting temporary
frequency hearing loss (HFHL) or low-frequency hearing tinnitus and hearing loss after loud music exposure. Gilles
loss (LFHL) between 1988 to 1994 and 2005 to 2006 co- et al. (2013) surveyed 3,892 high school students regard-
horts. Their analysis reported 15.9% (95% CI: 13.55% to ing the prevalence of temporary and permanent tinnitus and
18.2%) 12- to 19-year-old subjects had NITS in the 1988 to administered the Youth Attitudes to Noise Scale (Widen &
1994 data set (comparable to Niskar et al., 2001) and 16.8% Erlandsson, 2004) and the Beliefs About Hearing Protec-
(95% CI: 13.9% to 19.7%) had NITS in the 2005 to 2006 tion and Hearing Loss (Stephenson & Stephenson, 2011)
data set. There was evidence of a significantly ( p = 0.0001) questionnaires. The prevalence of temporary tinnitus was
higher prevalence of NITS among female youths in the 74.9% and permanent tinnitus was 18.3% in this high school
earlier data set (11.6% [95% CI: 9.0% to 14.1%]) when population. The prevalence of temporary tinnitus increased
compared to the later data set (16.7%: [95% CI: 13.25% to with age. The majority of students had a “neutral attitude”
20.3%]). More recently, Su and Chan (2017) retrospectively toward loud music. Only 4.7% reported using hearing pro-
analyzed the audiometric data from youth 12 to 19 years ob- tection, and in general, their knowledge about the risks of
tained in the NHANES III (1988 to 1994), NHANES 2005 loud music was reported to be extremely low. Gilles et al.
to 2006, NHANES 2007 to 2008, and NHANES 2009 to (2013) stressed the importance implementing prevention
2010. Trends in the prevalence of NITS reveal an increas- efforts that focus on tinnitus as a warning signal for noise-
ing prevalence from 15.8% in NHANES III to 17.5% in induced auditory damage and highlighted the connection
NHANES 2007 to 2008, and then decreasing to 12.8% by between temporary and permanent noise-induced tinnitus
NHANES 2009 to 2010. (Table 4–3 summarizes these data.) for these students.
EPIDEMIOLOGY OF NOISE-INDUCED
TINNITUS IN YOUTH RATIONALE FOR HEARING LOSS
PREVENTION TARGETING YOUTH
A systematic review of tinnitus prevalence estimates was
published by Rosing, Schmidt, Wedderkopp, and Baguley While preventing NIHL and tinnitus in youth provides a
(2016). Across studies, the prevalence of tinnitus among clear rationale for prevention efforts, the importance is fur
children in the general pediatric population with normal ther underscored by considering the long-range implica-
hearing varied from 5.4% to 46%. The prevalence increased tions for youth when incurred at a young age. Educational
to 23.5% to 62.2% among children with hearing loss. Re- audiologists are well acquainted with the academic rami-
searchers from the Children’s Hospital of Colorado con- fications of even a slight or minimal hearing loss (Bess,

450 Chapter 12
Dodd-Murphy, & Parker, 1998; Gustafson, Key, Hornsby, (2013) found that 19.6% of new-recruit audiograms were
& Bess, 2018), but perhaps less well known are the long- eligible for medical disqualification unless a medical waiver
term implications in terms of future job opportunities, qual- was granted. Many workplaces (military, firefighting, coast
ity of life, and long-term costs of living with NIHL. Sixteen guard, law enforcement and aviation) require effective com-
percent of 2,526 young workers aged 17 to 25 years had munication skills as a crucial requirement to ensure safe and
HFHL when beginning employment between 1984 and 2004 effective operations (Giguére et al., 2008). Adolescents with
(Rabinowitz, Slade, Galusha, Dixon-Ernst, & Cullen, 2006). NIHL may unknowingly experience limitations with regard
Hearing loss was defined as hearing threshold >15 dB HL to their career options upon graduation.
at 3, 4, or 6 kHz in either ear. Audiometric notches consis NIHL in youth is insidious and cumulative over time
tent with noise exposure were found in approximately 20% without intervention (Folmer, Griest, & Martin, 2002; Lass,
of the subjects and remained essentially constant over the Woodford, Lundeen, Lundeen, & Everly-Myers, 1986). Fol-
20-year period of study. Although stable, the fact that one- mer et al. (2002) noted that a mild HFHL in a 16-year-old
fifth of young adults start work with NIHL suggests a need high school student may deteriorate into a debilitating level
for greater public health efforts. Young military recruits may later in life. The economic cost of hearing loss in the United
be medically disqualified based on medical conditions that States has been estimated by Neitzel et al. (2017) using un-
may “reasonably be expected to prevent or interfere with deremployment and wage differentials as a function of hear-
the proper wearing or use of military equipment (including ing status based on the work by Jung and Bhattacharyya
hearing protection)” and includes the following conditions (2012). They estimated that those with hearing loss were
(U.S. DoD Instruction 6130.03, 2018): 2.5 times more likely to earn less (25% less) than individuals
with typical hearing. A range of $58 billion to $152 billion
■■ atresia of the external ear or severe microtia;
(core estimate of $123 billion) could be saved annually if
■■ congenital or acquired stenosis;
hearing losses attributed to hazardous noise exposures were
chronic otitis externa;
Chapter 12
■■
prevented (Neitzel et al., 2017). These costs do not include
■■ severe external ear deformity;
health care, special education costs, lost quality of life, tin-
■■ history of Ménière’s syndrome or other chronic diseases
nitus, and caregiver contributions, and they did not consider
of the vestibular system;
the potentially positive impact of hearing aids or cochlear
■■ history of any surgically implanted hearing device;
implants.
■■ history of cholesteatoma;
Recent research into cochlear synaptopathy also called
■■ history of any inner or middle ear surgery;
“hidden hearing loss,” suggests that hazardous noise expo-
■■ current perforation of the tympanic membrane or his-
sure at young ages in mammals has long-lasting implica-
tory of surgery to correct perforation during the preced-
tions for auditory system dysfunction later in life (Kujawa
ing 180 days; or
& Liberman, 2015). Audiologists are also at a disadvantage
■■ chronic eustachian tube dysfunction with the last 3 years
since audiometry and otoacoustic emissions are insufficient
as evidenced by retracted tympanic membrane, or recur-
for the early detection of cochlear synaptopathy in humans.
rent otitis media, or the need for pressure-equalization
Kujawa and Liberman (2015) expressed concern that the
tube.
risk of hidden hearing loss from both recreational and oc-
Recruits may also be medically disqualified if hearing cupational sources is not fully appreciated and may be more
thresholds exceed the values in Table 12–1 or if a hearing detrimental than initially thought. They also noted that fed-
aid is worn. Gubata, Packnett, Feng, Cowan, and Niebuhr eral regulations for daily allowable workplace noise expo-
TABLE 12–1 U.S. Department of Defense Medically Disqualifying Audiometric Criteria (DoD Instruction 6130.03, 2018)
Average Thresholds (both ears) Maximum Threshold (either ear)

Frequency (Hz) (dB HL) (dB HL)
500 >25 >30
1000 >25 >30
2000 >25 >30
3000 No standard >35
4000 No standard >45
6000 No standard No standard

sures are flawed, since they all rely on the assumption that for 2030 will be forthcoming and are expected to also in-
complete hearing threshold recovery indicates full cochlear clude hearing health goals for schools and youth.
recovery. They further stated that noise is a much more dan- Themann (2016) summarized 1,811 survey responses
gerous environmental hazard than originally thought. from audiology members of the ASHA in 2014. Audiolo-
Beyond the obvious health benefit, the prevention of gists recognize their role in public health in several contexts:
NIHL in youth encompasses long-term improvements in (a) raising public awareness regarding the importance of
academic achievement, improved quality of life, enhanced good hearing to overall health, (b) educating others about
career opportunities, and economic savings. hearing and balance risk factors and strategies to prevent
hearing loss and falls, (c) providing hearing screenings for
at-risk or underserved populations, and (d) advocating for
PUBLIC HEALTH ROLE public policies that support hearing loss prevention efforts
and access to intervention.
FOR AUDIOLOGISTS
The American Public Health Association states that “Public
health promotes and protects the health of people and the
communities where they live, learn, work and play” (APHA,
RAISING PUBLIC AWARENESS
2019). The APHA notes that public health “saves money, IN THE SCHOOL SETTING
improves our quality of life, helps children thrive and re-
duces human suffering.” Certainly, educational audiologists Raising awareness will not necessarily change health be-
recognize the importance of the school environment as a haviors, but it is a starting point for encouraging individuals
gateway to reaching students and their parents as well as an to consider their hearing health, identify potential risks, and
opportunity to help students thrive and learn lifelong lessons realize the need for behavior change. It is well understood
Chapter 12
to encourage hearing health. that individuals must recognize their own vulnerability and
In the United States, hearing loss prevention is inte- susceptibility to a health condition before steps are taken to
grated into audiology scope of practice (SOP) documents. change behavior. Simple efforts that can be undertaken in
Professional audiology associations develop SOP documents this regard include school announcements prior to sporting
to establish boundaries for which audiologists are consid- or music events at the school reminding students to protect
ered competent, based on their education, training, and ex- their ears, posters/infographics regarding NIHL, and strate-
perience. Hearing loss prevention or hearing conservation gies for prevention.
is acknowledged in the SOPs published by the American
Academy of Audiology (AAA, 2004), the American Speech-
Language-Hearing Association (ASHA, 2018), and the Edu- Noise Awareness and Prevention Programs
cational Audiology Association (EAA, 2019) (see Appen The U.S. Department of Health and Human Services pro-
dix 2–C). EAA specifically note that educational audiologists motes a public campaign entitled “It’s a Noisy Planet” de-
are responsible for signed to increase awareness among parents of children 8
to 12 years of age about the causes and prevention of NIHL
■■ educating students and school personnel about the pre-
(https://www.noisyplanet.nidcd.nih.gov/). A review of the
vention of hearing loss; and
program is provided by Figg (2018).
■■ managing school programs for hearing loss prevention
Adopt-A-Band is an awareness program targeting young
education.
musicians provided by Etymotic Research Inc. (https://www
The audiologist’s role in public health is also stated in .etymotic.com/hearforalifetime/adopt-a-band). Auchter and
federal laws. The Individuals with Disabilities Education Act Le Prell (2014) demonstrated that the campaign increased
(IDEA) (https://sites.ed.gov/idea/statuteregulations/#statute) the use of flat-attenuation earplugs in members of two high
identifies creation and administration of programs for preschool marching bands. However, the authors noted that self-
vention of hearing loss within the definition for audiology.1 reported behavioral change was low at the end of the school
Healthy People 2020 (https://www.healthypeople.gov/2020 band season.
/topics-objectives) also stipulates national goals related to Dangerous Decibels has found great success with the
prevention of NIHL in adolescents—reducing the propor- Jolene educational mannequin (http://dangerousdecibels
tion of adolescents with NIHL, increasing the use of ear- .org/jolene/) (Martin & Martin, 2008). A Jolene (shown in
plugs/earmuffs in adolescents, and integrating hearing loss Figure 12–1) is a system for approximating the sound level
prevention topics into school-based education. New goals of personal audio devices (e.g., smartphones). Jolene has a
1
34 CFR §303.13(b)(2)(iv) and §300.34(c)(1)(iv).

452 Chapter 12
Chapter 12
FIGURE 12–1 Jolene being used at a community event to educate youth and adults about safe listening levels.
modified sound level meter wired to a silicone ear. Listeners EDUCATION TO PREVENT
can set their preferred listening level when listening to their
own music and then remove their headphones/earphones and NOISE-INDUCED HEARING LOSS
place them on Jolene. The sound level meter attached to the
Knowledge is easy to change, especially in the short term.
Jolene will then provide an estimated listening level that can
Long-term behavioral change is much more challenging to
be used by the Jolene handler to determine the safe listening
accomplish. Behavior change theories inform health pro-
duration. The listeners can also learn at what volume control
motion and intervention (National Cancer Institute, n.d.),
listening becomes unsafe/safe depending on their chosen
and these theories have been incorporated into evidence-
level. Older students have great fun building Jolenes using
based hearing health intervention programs targeting youth
the Jolene cookbook and teaching younger youth. Jolenes
have been used in peer-reviewed scientific research (Levey,
Levey, & Fligor, 2011; Park, Guercio, Ledon, & Le Prell,
2017), science fairs, and has recently been incorporated
in a permanent exhibit at the Musical Instrument Museum Hearing loss prevention programs targeting youth
(https://www.bizjournals.com/phoenix/news/2018/01/25 should be oriented toward the target audience, use
/mim-debuts-its-new-stem-gallery-showing-connection.html). interactive (not passive) instruction, incorpo rate
Jolenes can also show up at school events and help inform skills-based learning, and use appropriate scientific
parents, teachers, and students. It is important to note that content. Educational audiologists are encouraged
the Jolene measurement system is a tool to increase aware- to review the literature for programs founded on
ness and is not an exact measure of ear canal sound pressure theory with evidence-based outcomes that result
levels (Berger, Megerson, & Stergar, 2009). More precise in intended or self-reported behavioral change
clinical methods are available to audiologists to measure (Meinke, Martin, Griest, Howarth, Sobel, & Scar-
the real ear sound levels using microphone-in-real-ear tech- lotta, 2008).
niques when evaluating and counseling patients (Portnuff,
Fligor, & Arehart, 2013).

(Meinke & Martin, 2017; Sobel & Meikle, 2008). Educa-

tional audiologists are encouraged to review the literature for
programs founded on theory with evidence-based outcomes Nuggets from the Field
that result in intended or self-reported behavioral change.
Neufeld et al. (2011) reported that the Sound Sense from
When teaching about hearing loss prevention, my
the Hearing Foundation of Canada (http://soundsense.ca/)
trusty favorite is the Dangerous Decibels online
significantly improved earplug use practices in 775 sixth-
tool.
grade elementary school students. The authors did not re-
port the theoretical basis of the intervention that consisted
of a 45-minute session in which trained personnel covered
“aspects of the hearing mechanism, anatomy of the ear, eti-
ology, signs, and consequences of NIHL, and hearing con- Griest, Folmer, and Martin (2007) demonstrated the
servation practices.” The program incorporates discussion, effectiveness of the Dangerous Decibels program in 1028
sound level meter measurements of their audio players, and fourth- and seventh-grade students (both intervention and
a 10-minute video of an animated character inside the hear- control groups). The fourth-grade cohort demonstrated im-
ing organ. Students are left with earplugs and stickers at the provements in knowledge and attitudes immediately after pro-
end of the presentation. Neufeld et al. (2011) did not report gram delivery and 3 months later. The seventh-grade students
changes in knowledge, attitudes, and behaviors other than also exhibited immediate improvements in knowledge and
self-reported earplugs use. Although the improvement in attitudes; however, the improvement in attitudes regressed
earplug use was statistically significant, the actual percent- to baseline 3 months postpresentation. Subsequent research
ages of youth reporting the use of earplugs as “always or used a randomized control trial design to compare four inter-
sometimes” at music-related events (dances, rock concerts, vention approaches: (a) the Dangerous Decibels classroom
program taught by school nurses, (b) the Dangerous Decibels
Chapter 12
percussion instrument, and electric guitar) were maximally
7.9% and 7.5% for “other noises” for the treatment group. classroom program taught by older peer educators (high
The majority of youth were not wearing earplugs, and school students), (c) self-guided exploration of the Dangerous
Neufeld et al. (2011) stated that the rates of improvement in Decibels museum exhibit at the Oregon Museum of Science
earplug use were “1–6% at 2 weeks post intervention, and and Industry, and (d) self-guided exploration of the online Dan-
1–3% at 6 months post-intervention.” (p. 180) gerous Decibels virtual exhibit (http://dangerousdecibels.org
/exhibit/virtual-exhibit/) (Martin, Griest, Sobel, & Howarth,
2013). Outcomes from 53 fourth-grade classrooms (1,120
Dangerous Decibels students) found that all interventions produced significant
The core of the resources from Dangerous Decibels is the improvements, but the number of improvements decreased
classroom program (Martin, 2008). Several health communi- over time (baseline, to postpresentation to 3 months post). The
cation theories guided the development and evaluation of the classroom programs were more effective than the Internet-
program (Sobel & Meikle, 2008). These theories include the based virtual exhibit and the museum exhibit. Using high
Transtheoretical Model (also called the Stages of Change), school students to deliver the program to younger students
the Theory of Reasoned Action, the Theory of Planned Be- also contributes to changes in knowledge, attitudes, and in-
havior, the Health Belief Model, and the Social Cognitive tended behaviors in this hard-to-reach adolescent population
Theory. More recently, the program has been evaluated in (Martin et al, 2013; Welch, Reddy, Hand, & Devine, 2016).
the context of the Socio-Ecological Model (McLeroy, Bi- Regardless of the initial outcomes, ongoing booster interven-
beau, Steckler, & Glanz, 1988; Reddy, Welch, Ameratunga, tions are needed to support the long-term outcomes. The ro-
& Thorne, 2017). The 45- to 50-minute program can be bustness of the Dangerous Decibels program when adapted
adapted for K–12 students, adults, and special populations and translated for global audiences has resulted in similar
(musicians, military, recreational firearm users). The pro- outcomes in youth from New Zealand, Brazil, Singapore, and
gram consists of nine interactive modules that guide the stu- China (e.g., Knobel & Lima, 2014). Currently, the program is
dents through the exploration of (a) the sources of hazardous being integrated into “serious gaming” with the goal of inte-
sound exposure, (b) the consequences of hazardous noise grating technology, STEM (science, technology, engineering,
exposure, and (c) strategies to prevent NIHL and tinnitus. and mathematics) learning, and hearing health promotion.
The program is designed for anyone with an interest in hear-
ing health promotion to be trained as a classroom educator.
The training of educators is delivered in 2-day workshops HEARING SCREENINGS FOR
that train, prepare, and equip individuals to be able to deliver AT-RISK INDIVIDUALS
the program immediately after successfully completing the
training. Workshop information can be obtained by visiting Hearing screening provides an opportunity to identify stu-
the Dangerous Decibels website. dents with hearing differences and is addressed in Chapter 4.

454 Chapter 12
It is difficult for hearing screening programs to detect NIHL Schools offer an ideal setting to implement strategies to
in the early stages when intervention is most critical. Meinke target all of these influencing levels. For instance, parent-
and Dice (2007) found that the majority of school-based teacher associations might communicate hearing health
hearing screening protocols used in the United States would messages to parents, raise money for educator training and/
identify only 22% of students with a high-frequency notched or provide earplugs; clubs within the school may work to
audiometric configuration suggestive of NIHL. Children eliminate or reduce noise exposures at the school; school
participating in noise hazardous activities will need hear- newspapers and social media can be used to communicate
ing threshold testing to detect NIHL and monitor their hear- hearing health messages throughout the year; and school
ing status. Extended high-frequency audiometry and oto- policies could be developed to promote safe environments
acoustic emissions are also useful for these same purposes. (e.g., music levels at dances). Curriculum changes at the dis-
Meinke, Meade, Johnson, and Jensema (2008) described the trict and state levels could be reviewed, and hearing health
feasibility and practicality of using an occupational model promotion could become an expected classroom topic. Small
of automated audiometry for identifying and monitoring efforts at each level will gradually shift the culture, and the
youth with NIHL. Advanced technology and boothless school will become a place where hearing is valued, and
audiometry offer new options for educational audiologists individuals are able to easily implement the strategies that
(Meinke et al., 2016). Teachers, coaches, and maintenance will promote healthy hearing.
and food service staff employed in the school setting may
also be noise exposed. The school district may be respon-
sible for providing regulatory required hearing conservation
programs according to the Occupational Safety and Health CHALLENGES AND
Administration (OSHA, 1983) or best-practice hearing loss
prevention programs based on the National Institute of Oc- FUTURE DIRECTIONS
Chapter 12
cupational Safety and Health (NIOSH, 1998) recommenda-

Researchers and U.S. government agencies have been dem-
tions. School hearing screenings will not adequately moni-
onstrating the need for hearing conservation education di-
tor these workers, and the educational audiologist may be
rected toward youth since the early 1940s. Unfortunately,
asked to support these hearing conservation needs (Johnson
the need is still ever present, and millions of youth are at
& Meinke, 2008).
risk of NIHL. There are many challenges to overcome for
Hearing screenings may also provide a unique oppor-
hearing loss prevention to become an integral part of the
tunity to reinforce the benefits of healthy hearing. Most
educational audiologist’s job duties. Perhaps we should start
students pass the school hearing screening, and educational
by considering the reasons for this situation highlighted by
audiologists are encouraged to leverage this outcome to
Folmer et al. (2002):
reinforce the value of good hearing and strategies to keep
it that way. Perhaps screening results can contain positive ■■ First, there is a lack of public awareness about how
hearing health messages for the families. Students can be en- excessive noise damages the ear and the consequences
couraged to design healthy hearing posters to be on display of hearing loss. If school administrators, teachers, and
during the hearing screenings. Proper earplug use can be parents are not aware of the risk and strategies to ame-
demonstrated and taught at the time of the screenings while liorate the risk, then it is unlikely that resources will be
students are waiting their turns. This is also an opportune committed to hearing conservation efforts.
time to implement Jolene. ■■ Second, lack of effective dissemination of existing hear-
ing loss prevention programs in the schools. There is no
systematic way to integrate hearing health promotion
into all classrooms. Dissemination of existing evidence-
ADVOCATING FOR based programs relies on a key individual(s) to cham-
PUBLIC POLICIES pion the effort and develop a grassroots effort in their
own communities. Teachers and audiologists frequently
The socioecological theory of health promotion recognizes do not have the resources to purchase materials or at-
the importance of interventions targeting not only the indi- tend training sessions.
vidual at risk but also the circles of influence around the in- ■■ Third, hearing health promotion efforts are not sus-
dividual. Educational audiologists can advocate for policies tained if the key individual retires, moves, or becomes
that support hearing loss prevention efforts and access to unavailable. Department of Education and Health De-
intervention. These include interpersonal relationships (fam- partment agencies should be approached to help de-
ily, friends, social networks), institutional or organizational velop the strategies that would support effective and
influencers (schools, workplaces, health care facilities, faith- ongoing dissemination of evidence-based programs.
based groups), community influencers (local media, lead- Classroom time is in high demand for both academic
ers), and public policy (national, state and local laws, rules). purposes and health education, but health education

topics tend to be a lower priority. Fortunately, hearing 5. Work with parent organizations and administrators to
health messages contain many STEM-related concepts, control hazardous noise sources and reduce exposures
and this may help motivate administrators and teachers at school.
to dedicate class time to the topic. 6. Partner with local industry to underwrite the cost of pro-
gram personnel and supplies; many of them have experts
What can be done to overcome these barriers? in hearing safety and may be willing to support efforts to
have a future workforce with undamaged hearing.
1. Begin by raising public awareness about high-level
7. Last, seek a mandate from local school boards or state
sound exposure risks, how hearing can be damaged, the
or federal legislators to support the implementation of
consequences of NIHL and tinnitus, and the success of
hearing health promotion in K–12 classrooms.
prevention programs.
2. Run a pilot project to identify the number of students Ultimately, educational audiologists have an ethical
with early indicators of NIHL and compare with na- obligation to promote hearing health and care for at-risk
tional prevalence rates. This may help justify the need students. We have a long road ahead to change the environ-
for hearing health promotion at the local level. ment and our culture regarding hazardous sound exposure.
3. Ask for your job duties to include hearing loss pre- Yet, working together to communicate the need and address
vention activities. If administrators do not hear the re- these challenges is the best way forward. Perhaps you will
quests, the need will not be addressed now or in the think creatively and become the hearing champion in your
future. school and help open the ears of others to the importance of
4. Write a local grant or coordinate a training workshop hearing health promotion. It is time we change the course
for audiologists, teachers, high school students, or vol- of the past 75 years and fully address the need for hearing
unteers to become trained and equipped to provide an health education targeting youth and ultimately reduce the
evidence-based intervention program in your schools. risk of NIHL in children and adults.
Chapter 12

SECTION II
COLLABORATIVE PRACTICES
AND PROGRAM EFFECTIVENESS
457

CHAPTER 13
Supporting the
Educational Team
With Carrie Spangler
CONTENTS
Formal Inservice
Preparation ■ Presentation ■ Follow-Up ■ Continuing Contact With Participants
Coaching and Mentoring
Educational Coaching ■ Coaching for Educational Audiologists ■ Mentoring
Chapter 13
“Check your volume when listening to music.”
459

460 Chapter 13
Summary
Appendices
13–A Inservice Outlines (Text)
13–B Inservice and Hearing Simulation Resources (Text)
13–C Sample Index Card Handouts (Text/Online)
13–D Inservice Evaluation Form (Text/Online)
13–E Sample Coaching Concept Organizer (Text)
KEY TERMS or experience with the challenges that hearing and listening
difficulties present for our students. While the role of edu-
Inservice, coaching, mentoring, audience effects, teaming cational audiologists in supporting student learning has not
changed, our responsibilities and strategies of support for
educational team members in a variety of educational set-
KEY POINTS tings may require a combination of approaches for improv-
ing student outcomes.
■■ Inservice typically targets job-specific information or Creating a culture of adult learning is necessary for
skills related to needs in the present job situation. teachers to understand and implement what we want them to
■■ Inservice often focuses on information not adequately know and apply. Adult learners who are actively engaged in
addressed in earlier adult and preservice education the learning process where new knowledge is connected to
programs. meaningful situations learn more. Regular systematic feed-
Chapter 13
■■ Inservice sessions in educational audiology typically back regarding the learning helps the adult learner adjust
are time-bound formal presentations that can benefit to ensure he or she is gaining the knowledge wanted and
adult learners by increasing awareness of listening and needed to meet individual goals (McDonough, 2013).
communication difficulties in education, prevention This chapter describes traditional inservice develop-
strategies, referral procedures, and classroom acoustics. ment for presenting information to educational team mem-
■■ Coaching incorporates building relationships, effective bers followed by materials related to a coaching philoso-
communication, supporting goals, and reflection. phy and mentoring approach applied to ongoing support
■■ Mentoring in education involves a relationship between for classroom teachers. Finally, a combination of these
two people in the same or similar professions, where
the mentor plays a supportive and advisory role for the
individuals being mentored (i.e., mentees), in their cur-
rent job settings.
■■ Combining coaching models with educational audiol- The 40th Annual Report to Congress on Imple
ogy inservice presentations creates a culture of adult mentation of the Individuals with Disabilities Edu
learning in which new and advanced knowledge is cation Act (IDEA, 2018) reported 61.3% of deaf
learned, information is connected to meaningful learn- and hard of hearing students on Individualized Educa
ing situations, and teacher and staff become engaged tion Programs (IEPs) spent 80% or more of their
and begin to develop appropriate instructional and sup- time in the general education classroom, another
port strategies on their own. 15.5% spent 40% to 79% of their time in the gen
■■ A variety of models including inservice, coaching, and eral education classroom, resulting in 76.8% of
mentoring can be used to accomplish voluntary or re- DHH students receiving most of their education
quired professional development in education and other in the general education classroom. This number
professional fields. does not account for students served on Sec
tion 504 plans, all of whom receive all of their edu
An increasing number of deaf and hard of hearing stu- cation program in the general education classroom.
dents are spending the majority of their time in general edu-
cation classrooms where many teachers have no background
460

Supporting the Educational Team 461
approaches is discussed and recommended for facilitating

educational support for deaf and hard of hearing students.
This chapter addresses the following questions: Inservice in education is problem-centered, learner-
oriented, and time-bound with activities and infor
■■ What activities should be completed when planning and mation intended to develop a sense of purpose,
preparing for an inservice? broaden perception of students and their needs,
■■ What techniques make inservice presentations inter- and increase capacity to gain knowledge and facili
esting and effective for the target audience of adult tate mastery of techniques.
learners?
■■ What strategies are helpful in maximizing carryover of
information and implementing strategies that have been
presented?
■■ What is coaching, and how can it be used as a tool to
audiologists whose responsibilities include providing inser-
maximize adult learning to support deaf and hard of
vice for school staff. Three major phases are essential in the
hearing students?
development and delivery of inservice sessions: preparation,
■■ What characteristics facilitate successful coaching and
presentation, and follow-up.
mentoring in education?
■■ How can teachers, as well as students, benefit from
relationship-based support systems?
Preparation
Educational audiologists have a wealth of information to
share with their colleagues. Preparation is critical to deter-
FORMAL INSERVICE mine what, when, and how much information to share within
a given inservice session. These decisions should be based
The word inservice typically is used within the field of on knowledge of service schedules, target audiences and
American education to refer to training or education sessions their existing level of knowledge, and current student needs.
provided to school personnel after they have accepted or are Organization of materials, equipment to be demonstrated, as
already working in a specific job. Inservice content usually well as preparation of technology and the facility can help to
targets job-specific information or skills related to needs in make more efficient use of inservice time during the actual
Chapter 13
the present job situation that were not addressed in detail in session. Specific strategies to facilitate planning for educa-
the employee’s preservice education, that is, education that tional audiologists are described in the following sections.
took place before the individual was hired. Although inser-
vice was initially used as an adjective in conjunction with
the word training, common usage has been shortened to the Scheduling
single word inservice as it is used throughout this section. The educational audiologist should find out if the school
Inservice sessions are typically one approach provided for building or district has a formal inservice schedule. If so,
voluntary or employer-required professional development/ identify the individual who oversees this schedule and ask
continuing education for their employees. him or her what procedure is required to be added to the
Professional development such as formal inservice ses schedule. Preplanning days are often used for inservice,
sions and coaching activities should be provided for all edu- but teachers may not have much time or interest in formal
cational staff working with one or more students who are presentations during this period. Individual or small group
deaf or hard of hearing. In addition, all school personnel inservice meetings can be more effective if short time peri-
can benefit from information provided via inservice to in- ods are available. An alternative approach would be to re-
crease their awareness of pediatric hearing and listening quest 15 minutes with the entire school faculty and staff.
difficulties, prevention strategies, referral procedures, and Within this limited amount of time, a brief description of
classroom acoustics. The importance of auditory function educational audiology services and the educational audiolo-
in traditional and dynamic learning environments, as well gist’s role, the importance of hearing for classroom learning,
as social interaction and development, is often overlooked. student characteristics that suggest a need for referral, and
Inservice sessions can be a relevant reminder of these fac- current referral procedures with contact information and re-
tors even if there are no identified deaf or hard of hearing ferral forms as handouts may be all you can cover. If deaf
students within a specific school building or district. and hard of hearing students have already been identified, in-
Frequent conferences and numerous publications are clude an overview of the impact of varying degrees of hear-
available to assist individuals in developing and improving ing and listening challenges in the classroom, a brief review
the skills necessary to present information in workshop or and handout covering possible classroom and instructional
inservice formats (see Suggested Readings and Resources). accommodations (e.g., “Tips for the Classroom” from Gal-
This section gives suggestions specifically for educational laudet University, 2015. See Appendix 13–C), and end with

462 Chapter 13
TIP: When presenting to entire faculty, manipulate the volume or on–

off switch for the microphone and have a slide in the background that
shows differing levels of visual clarity as a visual reinforcer of what stu
dents with hearing challenges might miss.
a short question and answer time for those who have had group audiences typically will require planning for only a
students with hearing and listening challenges in the past to short period of time, so have critical information summa-
share strategies that worked for them. rized and supported with visual and auditory experiences
that grab attention and will be remembered.
Targeting the Audience Adults have varied learning styles, so have several dif-
Familiarize yourself with the audience and their reasons for ferent strategies in mind for critical points you wish to have
attending. If the audience consists of teachers who are re- the audience take away. Some individuals respond and retain
quired to be there for professional development credit, the visual information more readily than auditory information,
educational audiologist will need to plan techniques to in- some the reverse, and some individuals benefit from a com-
volve them or pique their interest in the topic before present- bination. As already noted, actively involving the audience
ing key information. Have these staff members heard infor- typically enhances learning and retention, and personalizing
mation on hearing previously, and have most of them been information makes it more likely to be retained.
involved with deaf and hard of hearing students in the past? Key principles for effective adult learning were identi-
Chapter 13
If so, the information provided should be different than that fied at the University of Washington School of Public Health
given to an audience receiving materials for the first time. If (2014) and are described in Table 13–1.
the educational audiologist is new to the school system or Additional information on techniques and strategies
if there has been a significant change in school personnel, to maximize adult learning can be found in Cockrell, Cap
a brief needs assessment of the target audience can help to low, and Donaldson, (2000); McCarthy (2000); Peterson
describe prior knowledge of and experience with the topic(s) (2019); University of Washington, Northwest Center for
being considered. Public Health Practice (2014); U.S. Department of Education
What is the group size? A group of 12 to 15 people is (2011).
excellent for audience participation, and smaller groups can
have relevant discussions and brainstorm while completing Selecting Content
hands-on activities. Audience questions and comments in Knowledge of the target audience, together with current
larger groups can cause presenters to lose focus and make it student needs, can help in selecting content that should be
more difficult for each attendee to feel closely involved in practical and personalized as much as possible. The educa-
the topic. Larger group problem-solving requires a method tional audiologist should prioritize information and deter-
of quickly recording suggestions (e.g., Smart Board, chart mine what is critical to present orally and what information
paper) and a recorder with legible writing who can syn- can be given in writing for later review and follow-up. For
thesize information on the spot. As noted previously, large example, if a remote microphone (RM) system will be used
for the first time immediately after the inservice, it would
TIP: Give the unfair hearing test (https://successfor

kidswithhearingloss.com/for-professionals/dem I hear and I forget. I see and I remember. I do and I
onstrations-simulated-listening-with-hearing-loss understand.”
-devices/) instead of describing difficulties with ac
cessing classroom instruction. Confucius (551bc– 479bc)

be critical that all school staff see and listen to this sys-
tem to recognize it and to understand its purpose, benefits,
and limitations. Only teachers using the system would need TIP: Adults will stay more involved when you vary
to have information on current operation, monitoring, and methods used to present material and include in
maintenance. Table 13–2 lists a variety of suggested inser- teraction and physical or mental activity every 15
vice topics for educational audiologists that can be useful to 20 minutes.
with differing audiences and time schedules.
TABLE 13–1 Key Factors for Effective Adult Learning

Organizing Inservice Sessions
■■ Learning environment feels safe and comfortable for learners
to participate Develop an Outline After the topic has been selected,
■■ Material is immediately recognized as useful to learners the audience is known, and the time has been defined, the
educational audiologist should identify the objectives and
■■ Learning objectives are based on learners’ needs, interests,
and skill levels develop an outline for this session. The time allotted for each
subtopic or activity should be estimated; this is especially
■■ Presentation engages and actively involves learners
crucial if time is of the essence, as it always seems to be in
■■ Presenter is respectful and recognizes the unique histories
a school system. The longer the inservice session, the more
and characteristics of learners
need for a variety of presentation methods. A general rule
■■ Presenter encourages learners to share experiences
of thumb to consider when planning is that there should
■■ Coaches work collaboratively with learners to select
be interaction and physical or mental activity every 15 to
methods, materials, and resources for instruction
30 minutes for maximum involvement in adult learning.
Note. From U.S. Department of Education, TEAL Center Staff (2011) and Univer Collaboration in which attendees work together as a team
sity of Washington School of Public Health (2014). in a problem-based learning format has been demonstrated
to enhance adult learning and retention (NaeveVelguth, Har-
iprasad, & Lehman, 2003), but ensuring that all members of
TABLE 13–2 Suggested Inservice Topics each team are actively involved can be challenging. Breaking
Chapter 13
■■ Introduction to hearing loss into small groups where participants have to change their
seats may use up precious time in a short inservice session,
■■ Overview of the district’s audiology and deaf and hard of
hearing program so include a quick strategy for designating team members
(e.g., counting off, use of table talk where participants at the
■■ Effects of hearing status on learning
same table form the group) in your plan. Use of polling with
■■ Strategies to support deaf and hard of hearing students
participants using their phones or clickers to vote is a quick
■■ Social-emotional impact of atypical hearing
and easy way to get participants to answer targeted ques-
■■ Integrating auditory skill development into the classroom tions and stimulate discussion. Because many participants in
■■ Students with hearing challenges in general education inservice sessions like to have an outline of the presentation
■■ Management/maintenance of personal hearing instruments with space to take notes, consider a handout. Sample outlines
and/or cochlear implants for various inservice topics can be found in Appendix 13–A.
■■ Use of remote microphone technology in the classroom
(RM) Select Materials Collect more materials than you plan to
■■ Hearing assistance technology (HAT; DM/FM) use and then divide them into those that are essential for
■■ Communication modes and methods the topic and those that can be put aside to refer to if there
■■ Deaf culture is extra time. Materials, portable test equipment, personal
■■ Working with classroom support personnel (e.g., tutor, hearing instruments, FM/DM receivers, RM HAT systems,
interpreter, notetaker) and supplementary videos can also be shown or links can
■■ New technologies in hearing assessment be made available for individual perusal at a later time. In
■■ Prevention of hearing loss our experience, extra materials are rarely looked through
■■ Early hearing detection and intervention (EHDI) after the inservice session has concluded, and one teacher’s
■■ Unilateral and minimal hearing challenges recent blog reported that a folder of handout materials typ
ically is filed away and never used. Generally, it is better to
■■ Classroom strategies for auditory processing difficulties
have a few specific resources than overwhelming the audi
■■ Hearing screening
ence with too many.
■■ Classroom acoustics
Review videos in advance and have them set to
■■ Collaborative services; roles of the ED Aud, SLP, and TOD
begin exactly where needed to illustrate a point. If using

464 Chapter 13
PowerPoint, or similar platform, embed videos into the ing assistance technology (RM HAT) equipment in use or
slides for more seamless viewing. Keep video segments proposed for use within the participating school system(s).
brief and provide the audience with oral or written instruc- Commercial materials and older equipment should only be
tions concerning what they should look for during each seg- used to introduce topics or illustrate specific points. Often
ment. A number of videos and PowerPoint presentations are videos can be found online that support your presentation
available online that can be accessed free or at minimal cost focus.
(see Suggested Readings and Resources at the end of this
chapter; Chapter 7, Classroom Acoustics and Other Learn-
ing Environment Considerations; and Chapter 8, Hearing Preparing Technology and Facilities
Instruments and Remote Microphone Technology). It is dif- Technology Immediately preceding the inservice session,
ficult to keep visuals updated with current technology, but make sure any audiovisual technology and demonstration
often manufacturers will provide new graphics that could equipment is working and positioned for easy access with
be easily inserted to update an earlier presentation when appropriate space and lighting for interpreters, if used. A vari
necessary. ety of media can help maintain attention during an inservice,
Visuals should be easy to read and have minimal infor- but multiple pieces of equipment can lead to awkward body
mation contained on each one. If the information on a slide positions and occasional stumbles over extension cords if the
is crucial, consider providing it in a handout as well. The equipment is not wireless. Use of a room public address (PA)
same teacher’s blog mentioned previously stated, “Do system, if installed, or a portable classroom audio distribution
NOT read PowerPoint slides to us!” Avoid using slides as system (CADS) with a pass-around microphone, should
speaker’s notes; blacken or use a blank slide, an interest- be used for all inservice sessions. This demonstration not
ing photograph, or related image for discussion time. Use only ensures communication access for all participants
images other than text on your slides to make a point (e.g., but also illustrates the use of the pass-around microphone.
photos, charts, videos, graphics). Remember that you and When personal hear ing instruments or hearing assistive
your information are the focus, not the visuals. Standard technology (RM HAT) is to be demonstrated, equipment
guidelines for designing PowerPoint slides are summarized should be checked immediately before the session, and
in Table 13–3. A list of currently available commercial ma- plans for troubleshooting should also be available just in
terials useful for inservice presentations is included in Ap- case. Spare devices should be available for an inservice if
pendix 13–B. Commercial vendors are typically very eager audience members have not experienced their use before.
Chapter 13
to share research and materials that support their equipment, (Equipment malfunction can be a great reinforcement for
and they often will provide demonstration equipment on teachers whose RM systems always seem to break down just
loan. However, it should be reemphasized that inservice for before the educational audiologist is scheduled to arrive.) A
school personnel should be personalized as much as possible wireless mouse for use with PowerPoint or other computer-
to the relevant educational environment, as illustrated by the assisted visuals allows the presenter to move about the room
students presently enrolled and the remote microphone hear- while talking or asking questions, but if this device has not
been used before, the presenting educational audiologist
should check its range and position for use. A Bluetooth
portable speaker is another valuable tool to bring as some
TABLE 13–3 Suggested Guidelines for PowerPoint Slides
laptops and CADS may not be compatible with any audio/
■■ Use no more than eight lines of text. visual clips that you plan to show. Finally, have a backup
■■ Use a common font that is easy to read. plan in case of equipment malfunction during the session.
■■ Use 20- to 28-point font for text. Valuable time can be lost while waiting for tech support,
■■ Use 28- to 44-point font for title text. so use this time for activities such as informal discussion,
■■ Use a maximum of two fonts on a slide. brainstorming or group problem-solving, a review of audi
■■ Use high color contrast for readability. ence questions, or even a rescheduled break.
■■ Be aware of color combinations that cause eye fatigue or
those that can be affected by color blindness (e.g., avoid
using red and green together). The Room Structure the room so that participants can
■■ Design colors and contrast with the worst lighting situation both see and hear; a U shape is preferred if numbers and
in mind. space allow. Poor seating arrangements can dramatically
■■ Avoid using more than two text slides in a row. illustrate difficulties faced by students who are deaf or hard
■■ Include graphics as well as text.
of hearing, and time should be available for participants to
change their seating arrangement(s) if that is the point being
■■ Graphics should relate to the topic.
emphasized. Any time the audience is required to move
■■ Avoid distracting visual effects (e.g., rapid appearance or
around, a period of 10 to 15 minutes is required before they
disappearance of text).
can come back together as a group.

Teachers always appreciate a table for taking notes

and spreading out, especially after a full day in the class-
room. If there are extra materials to peruse, arrange them TIP: Always have extra blank cards placed on tables
on a separate table for easy access. Check the temperature or chairs around the room for questions that may
and the lighting and know where the controls are so each arise during the inservice sessions. Some people
can be modified, if necessary, during the inservice. Many feel more comfortable writing down their ques
conference rooms and classrooms now have built-in media tions than asking them before the group.
systems, and these can be very helpful if the presenter is
familiar with the placement and use of controls for any avail-
able instructional technology.
Another familiarizing technique is to have participants
take the first 2 or 3 minutes to write one question they have
Presentation about the topic, on index cards that are provided when they
Dealing With Audience Effects arrive. Collect and review these cards during the first break
to see if the information being presented is on target for this
Being sensitive and responsive to emotional states and prac-
audience. Another strategy is to have participants answer
tical needs of audience members can add to the enjoyment
relevant questions as a group during the wrap-up of the ses-
and effectiveness of an inservice session. Below are key
sion, especially to emphasize key points addressed.
strategies that can help to facilitate an environment condu-
cive to adult learning.
Be Flexible Allow time for questions throughout the pre
sentation. Questions are invaluable for identifying issues
Personalize Information Introduce yourself with a de
of concern and the focus of audience members. Questions
scription that helps participants to identify with you and your
can let the presenter know if the information presented has
experience (e.g., you have been a classroom teacher; your
been understood and when the information has already been
child has had ear infections; you are deaf or hard of hearing).
personalized to individual participants’ teaching situations.
Audience members listen and attend to presenters with whom
If the answer is not known (or inaccessible during the stress
they feel a personal connection. Reinforce the participants’
of a formal presentation), arrange to follow up quickly with
current knowledge and make information presented as spe
the participant at school. This, again, not only personalizes
Chapter 13
cific to their situation as possible. The prevalence of reduced
the information but is also a good marketing tool for the
hearing is such that almost all participants will know some
educational audiology program.
one (a child or an adult) who has a hearing problem. If it is
Postpone questions if they will be more relevant during
possible to trigger thoughts of that person, any information
a later portion of the presentation, but remember to answer
provided immediately becomes more personalized and more
them and identify the person who asked, whenever possible.
likely to be remembered.
One technique that can be helpful for remembering ques-
If participants number fewer than 15 and their back-
tions is use of a chart or section of whiteboard for record-
ground is unfamiliar to the educational audiologist, ask each
ing or “parking” deferred questions in full view of both the
participant to make a comment that reflects on their interac
presenter and audience. Providing small pads of sticky notes
tion with someone they have known or worked with in
to participants can facilitate this strategy; this is especially
the past with hearing or listening challenges. Record this
useful in preventing a discussion from going off on a tangent
information on chart paper to incorporate in later discus-
while still reinforcing that all questions are important to you.
sion on incidence, demographics, challenges, and so on.
This technique can be especially useful when participants
Be Alert to Physical and Mental Limits Respect the par
do not know each other well, because they can immediately
ticipants’ time and energy. No one likes to sit and listen for
identify those with whom they share a common background.
lengthy periods of time after a full school day. Let audience
members specify or choose time for break(s); this strategy
empowers attendees to allocate their attention in the way
they believe is most productive. Encourage participants to
move for better viewing or listening or just to change position
TIP: At the end of an hour-long inservice, have par
ticipants write down two or three ideas on an in
dex card that they would like to implement in the
next week. Ask them to star one idea they could TIP: Change the pace. Listening with retention only
use within 24 hours. lasts about 20 minutes at a time.

466 Chapter 13
when needed. This can be a meaningful demonstration of a

recommendation for flexible seating often given for deaf and
hard of hearing students. Consider placing bowls of candy Nuggets from the Field
or other food energizers on each table as well as sensory
toys such as soft squishy balls that can also help the urge to
Provide earplugs for teachers to wear during lunch
fidget while listening.
and ask them to jot down their impressions.
Use Ice Breakers and Humor If the inservice is scheduled

for a half or full day, consider taking time for a warm-up
activity. One that has been used frequently is to break up
into pairs or small groups and have each person introduce (DM) receiver on separate stethoscopes can be a dramatic
another participant, giving name plus one piece of personal demonstration of the difference in the auditory signal avail-
information—hobby, children’s ages, pets, or travel fantasy. able to the student. Some educational audiologists have
If your audience is large with participants sitting at tables, the reported successfully using earplugs during this activity to
introductions may be just among each table’s group. Small demonstrate the possible effects of a mild hearing loss in one
groups can be used to generate discussion, specific questions, or both ears. Recorded simulations are another technique
or other concerns about hearing brought to the session. to illustrate the potential impact of various hearing levels
Familiarity among participants typically increases the and configurations in a variety of communication situations,
comfort level of the audience, and knowledge of participant and a number of these recordings can be incorporated into a
interest and motivations can be invaluable for the presenter. presenter’s computer network. A list of sources for hearing
Humor can have many benefits during inservice, as loss simulations is provided in Appendix 13–B.
well as life. Humor can reduce stress, facilitate learning, To illustrate the benefit of visual supports in the class-
enhance creativity, diffuse anger and feelings of frustra- room, use captioned videos whenever possible. If not spe-
tion, and improve communication. Strategic use of cartoons cifically included in the formal presentation time, have a
can illustrate key points, as well as serve as a break from captioned video available for viewing during a break or dem-
processing auditory and written information. Daily comic onstrate how to find captioned videos on YouTube. Partici-
strips often deal with pertinent points (e.g. competing noise, pants typically are eager to have their own hearing screened
multiple word meanings, idioms), and these can be lami- using audiometry, tympanometry, or otoacoustic emissions
Chapter 13
nated and passed around during a presentation. Visual im- if they have not done so previously, and these activities are
ages are abundant online, but remember that including any easily completed during break times. Demonstrations for
copyrighted work on a handout requires permission from different apps for tablets, computers, and phones could be
the author or publisher. Cartoons and jokes should be used loaded and ready for presentation. One example would be
judiciously, however, because they can become a distrac- ClearCaptions (https://clearcaptions.com), an app that tran-
tion when there are too many or if they are not relevant to scribes voice phone calls to print. Another classroom app
the topic. that could be demonstrated is Too Noisy Pro (apps.apple
.com), a classroom noise level app that can help students
Audiology or Amplification Equipment Demonstration and teachers regulate classroom noise levels. Again, as with
lecture information, take every opportunity to incorporate
If equipment is demonstrated, make sure all participants
practical applications into equipment demonstrations.
have hands-on experience before they leave the inservice.
For example, the easiest way to demonstrate a classroom
Use of Handouts
audio distribution system (CADS) is to use it when present-
ing. This technique is especially effective at the end of a Handouts can be used as outlines to follow during a presen-
school day, when everyone appreciates improved signal-to- tation, for notetaking, or as follow-up information. Either
noise conditions. Passing around a personal hearing instru- use requires at least a mention and may need some direc-
ment and a frequency modulated (FM)/digitally modulated tion during an inservice—for example, under what circum-
stances the handout might be useful or highlights for specific
information on a reference list. Handouts should be easy to
read and use (double or triple spaced, bulleted, highlighted
by different fonts). If the inservice covers several different
TIP: Personalized information is more easily re areas (e.g., RM HAT use and maintenance, teaching strate-
tained, and flexible seating for attendees reinforces gies, referral procedures), consider color coding handouts
recommendations often given for students with for easy future reference for participants. Appendix 13–C
hearing or listening issues. includes sample tips for teachers and equipment available
for check-out that could be posted on index cards to leave
with teachers after an inservice or follow-up coaching visit.

Gallaudet University’s InfoToGo program has developed a

series of bookmarks with brief information about strategies
for teachers to incorporate in their classrooms (see Suggested TIP: Demonstrate benefit from technology by us
Resources at the end of this chapter). ing a classroom audio distribution system (CADS),
Always provide a single handout restating the critical including pass-around mic, to improve the signal-
points to be taken away from the inservice and include your to-noise ratio for your inservice participants.
contact information (e.g., name, office address, phone/text
number, e-mail, and hours you can typically be reached). If
office hours are not an option, make sure you provide the
best way you can be reached. Information on slides should
be considered as handouts. A preferred “greener” strategy realistic? Which activities were successful, and which ones
for providing copies of a PowerPoint presentation is to send did not go well? Why? What should be changed for future
it on request via e-mail. Permission should be obtained presentations?
for copyrighted material before dissemination and sources Reevaluate all handouts before disseminating them
should be credited on each relevant page. again. Were they read? Were they useful to and used by the
Commercial brochures and other written materials may participants after the inservice? Is the content still current?
contain useful information, but they are frequently not per- The reevaluation can take the form of a brief follow-up ques-
sonalized and too general for immediate use. Although they tionnaire for inservice participants or can be as informal as a
typically have an eye-catching design, they are more likely glance around the teachers’ rooms the next day to see what
to be placed on a shelf or in a file without being read. happened to the materials that were distributed. In addition
to observing which handouts seem to be used most often
by inservice participants, educational audiologists should
Follow-Up request selected teacher critiques of handouts before using
Follow-up activities make up a critical part of any inservice them in the future. Log any follow-up contacts from partic
program designed and delivered by the educational audiolo- ipants requesting additional information, materials, or edu-
gist. Evaluation of materials and formal presentations helps cational audiology services. If handouts contain necessary
to ensure that future inservice programs are informative and information for attendees but were not read or used, try to
current. Participants should have the opportunity to evaluate rephrase or illustrate the point in a more meaningful manner
Chapter 13
the inservice at its conclusion either on a brief form or with for the next inservice.
a follow-up e-mail linked to a brief electronic survey. Most
individuals do not return a form later if they take it with
them. If a specific form is not already required for use in Continuing Contact With Participants
the school district, the educational audiologist should design Follow-up contact with educational team members (see
one that will elicit the maximum information in a format that coaching section later in this chapter) helps to ensure that
is quickly completed. If the educational audiology session information is retained and implemented for the benefit of
was a part of a larger course or inservice program, provide the student(s) being served. Provide a sign-up list for par-
evaluation questions that relate to the audiology portion of ticipants during the initial inservice presentation. Sending a
the course evaluation. A sample inservice evaluation form is follow-up message or letter through the school’s communi-
included in Appendix 13–D. cation network identifying activities that can be requested is
Review and reflect on the outline and objectives de- another way to elicit opportunities to interact individually
veloped during the preparation phase. Were the objectives with inservice participants after a formal presentation. In-
appropriate for this audience? Were the anticipated times clude a request form and referral sheet with these messages.
If specialized equipment such as video phones, captioning,
or a classroom audio distribution system is available for loan,
provide a sign-up sheet for such equipment and other mate-
rials identified during the inservice. Even if directions for
installation and use are not required, another opportunity for
Nuggets from the Field face-to-face interaction can occur if the educational audiolo-
gist delivers the requested equipment or material in person.
Have teachers write down their e-mails before It is critical to provide follow-up information on spe-
they leave. Follow up within a few days after the cific students in small group or individual conferences to
inservice with a quick summary of the presenta ensure that relevant information has been understood and
tion.This gives teachers a direct way to reply when that recommendations are being implemented appropriately.
they have questions. Use of small group sessions as a follow-up to an educa-
tional audiology inservice is an efficient way to help school

468 Chapter 13
exhibiting hearing or listening problems not yet formally

identified or, more likely, regarding assistance for a student
TEAMING IS: already identified and receiving support on an IEP or 504
Guiding, not directing plan. Requests should be followed up quickly to reinforce
Collaborating, not competing individual interactions with teachers that can facilitate con-
Guidelines, not rules tinued consultation in the future as well as promote ap-
Activities, not lectures propriate intervention for the student. If the concerns are
Diversity, not sameness regarding a new student, the observation can introduce and
Openness, not secrecy guide interventions through the school’s response to inter-
Active not passive vention (RtI) or Multi-Tiered Systems of Support (MTSS)
Involved, not isolated process or result in a potential referral for special education
services.
Adapted by K.Yuskow from Use of Teams in Classes
Special Activities on Request Additional requests subse
quent to an educational audiology inservice may include
measurement of classroom noise levels, lecture or classroom
teaching covering anatomy of the ear or the hearing process,
personnel implement information on troubleshooting of per- information for a spouse or other relative concerning hearing
sonal hearing instruments and RM HAT. The EARS program assessment and amplification, or student/staff information
in Arkansas has developed a series of very short YouTube on ear protection. Although some of these activities may
videos demonstrating several amplification systems, main- not be listed as a priority in the educational audiologist’s job
tenance, and troubleshooting tips (https://www.youtube.com description, each affords an opportunity to build credibility
/playlist?list=PLStceB-WlntRlSi7FXtKloLGlVUDtieKW). and improve communication with local school staff members.
If a student has a similar device, these could be shown in For this reason, whenever a request follows an inservice, it
a small group or individual follow-up session as a support should be addressed by the educational audiologist as quickly
for written and/or more formal inservice information. Col- as possible.
laborative follow-up for the student’s educational team
might include the regular classroom teachers, specialized
Chapter 13
instructional support personnel, tutors, interpreters, speech-

language pathologists, building administrators, other adults COACHING AND MENTORING
involved in extracurricular activities, and the students them- Coaching is a trainer/trainee strategy being utilized in many
selves. Staff and student responsibilities could be assigned aspects of business, educational, and professional communi-
during this session, and a workable form for daily recording ties. Coaching is defined broadly as a form of development
for equipment function could be developed or modified at in which a person called a coach supports a learner or client
this time. Whenever possible, allow students to identify and in achieving a specific personal or professional goal by pro-
assume their own responsibilities for troubleshooting their viding training and guidance. There are many different types
personal hearing instruments and HATs. (See Chapters 9 of coaches depending on a person’s needs (e.g., life coaches,
and 10 for more information on self-determination and self- fitness coaches, leadership coaches, career coaches), as well
advocacy for deaf and hard of hearing students.) as numerous models of coaching in both business and edu-
cation. Regardless of the enterprise, each coaching model
Classroom Observations and Individual Consultations incorporates building relationships, using effective commu-
Chapter 2, Roles and Responsibilities of Educational Audi nication, supporting personal and professional goals, and
ologists, and Chapter 9, Case Management and Habilita- incorporating reflection.
tion, discuss the roles of educational audiologists in case Mentoring, like coaching, is also a relationship-based
management and consultation. This information serves to professional support model where a more knowledgeable
illustrate the importance of proficiency and flexibility when and experienced individual advises and supports an individ-
delivering information for maximum benefit of individual ual with less knowledge and experience in the same or simi-
students with hearing or listening difficulties. It is impera- lar profession. The overall goal for mentoring, like coaching,
tive that teacher requests for consultation for students with is to promote and support the independent decision-making
reduced hearing be addressed by the educational audiolo- and practice of the individual being mentored or coached.
gist as quickly as possible, even if the information requested
has been given previously in writing or during an earlier
face-to-face contact. Educational Coaching
Teachers may request a classroom observation as a Education has implemented a focus on coaching practices
follow-up to an inservice. The request may be for a student to improve student and school outcomes. Districts are utiliz-

ing educational coaches to assist administrators and teachers TABLE 13–4 Open-Ended Questions and Comments for
to incorporate effective practices that will help them attain Coaching Conversations
their goals. This process differs from traditional evaluations ■■ Tell me about a time that you worked with a student who
as schools increasingly are looking to coaching and other has hearing loss.
relationship-based professional development strategies to ■■ What changes do you think your student would really
improve the skill and performance of teachers and school appreciate?
leaders. Such interventions lead to improved school climates ■■ What possibilities do you see for yourself in the next few
and teachers who are productively engaged in the work of weeks/months?
student learning (Tschannen-Moran, 2011). ■■ What would it take to succeed with __________________?
■■ How would you rate your confidence in implementing
Coaching for Educational Audiologists ___________?
■■ What do you think are the best possible outcomes of our
Educational audiologists are charged with providing teams
work together?
of educators with training and guidance as defined by our
■■ How can you expand this experience for even better results
role. IDEA 20041 requires the training or technical assis-
next time?
tance for professionals (including individuals providing edu-
cation or rehabilitation services), employers, or other indi-
viduals who provide services to, employ, or are otherwise
substantially involved in the major life functions of children
with disabilities. In addition, the Educational Audiology Applying coaching models to educational audiology
Association’s (EAA) recommended professional practices services can motivate teachers and other support staff to
for educational audiologists include provision of inservice implement strategies for deaf and hard of hearing students
training and consultation to school personnel, parents, and in a more consistent and successful pattern. Questions such
students regarding impact of hearing loss as well as training as those listed in Table 13–4 can foster relationship-based
for HAT (EAA, 2009). A common theme that has emerged conversations with educational team members.
from the coaching literature incorporates adult learning and It is important that we build trust with the teachers and
action. Elena Aguilar (2013) identifies three questions to think staff in our schools. This is a process that takes time, but the
about when preparing for a coaching conversation: student outcomes are generally positive. Many audiologists
report that they are covering large territories and do not have
Chapter 13
1. How can I make this conversation meaningful to the time to build relationships. This is where thinking outside of
teacher? the box for coaching is important. Can you send a weekly
2. What’s one question I can ask the teacher to help them email? Can you do a teleconference to check in? Can you
reflect on their practice? do a monthly check in?
3. What’s one instructional practice that might be useful A second main theme that has surfaced from the coach-
for this teacher to reflect on and make a change in? How ing model practice is listening. Many times our inservice
can I help this teacher reflect on this behavior and make sessions attempt to provide all the information we want
changes? teachers to know related to hearing and communication ac-
cess in 30 minutes. Then we leave them with a handout, and

“There are times when I think my message has Nuggets from the Field
been loud and clear about the needs of a student
with hearing loss in the classroom. A follow-up “I have learned that chocolate goes a long way! I
visit tells me something different when the teacher often carry some with me to support teachers’
lets me know that they have not been wearing good microphone use, placement, etc. While most
the transmitter because the student seems to be times it works like a charm, there was that instance
hearing fine without it.” when a teacher on a diet was offended . . . oops!!”
1
34CFR303.13(b)(1)(i)(f).

470 Chapter 13
as a relationship between adults and youth, and for more

information on this perspective for educational audiologists
Good coaches respect teacher awareness, choice, and deaf and hard of hearing students, see Chapter 10, Sup-
and responsibility.They understand teacher experi porting Wellness and Social-Emotional Competence. If you
ences and show empathy and appreciation. They are a new educational audiologist working for the schools,
recognize vitality and build on teacher strengths. consider reaching out to an experienced educational audi-
ologist to be a mentor. If you have one in your district, ask
Tschannen-Moran (2011). to schedule monthly meetings to connect and ask questions.
If you do not have another audiologist in your district, reach
out to your state department of education or the EAA for po-
tential educational audiology mentors. Mentoring does not
off we go to conduct the next scheduled inservice. What if have to take place in person and could be arranged through
we started the session with a question for the team that gave video teleconferencing if distance is an issue.
us the opportunity to listen to their concerns? “What are you For educational audiologists working with new edu-
most looking forward to learning about having a deaf or hard cational audiology staff and/or related team members, the
of hearing student in your classroom or school?” “What is one knowledge, advice, and resources shared as a mentor depend
thing that you are wondering about?” Then, carefully listen on the format and goals of the specific mentoring relation-
to what each person has to say, ask clarifying questions, and ship. In these situations, information to be shared between
provide relevant information and reflective feedback to gener- mentor and mentee may include personal career path details,
ate meaningful discussion targeting student needs. as well as guidance, motivation, emotional support, and role
A third theme that surfaces from coaching practice is modeling. Support and assistance may also be provided for
supporting the right work. At the end of the inservice, what exploring professional development, setting goals, devel-
if we asked the team, “what is one practice that you want oping contacts, networking, and identifying resources. In
to focus on in the next week?” Our next step is then to help these relationships, characteristics of mentoring are similar
each teacher set up a specific goal for himself or herself. to those of coaching and include:
Finally, it is our job to follow up and follow through. The
coaching model can be utilized in each of our follow-up con ■■ valuing the mentee as a person;
versations whether on the phone, through e-mail, teleconfer- ■■ developing mutual trust and respect;
Chapter 13
ence, or in person. (See Appendix 13–E for an example of com- ■■ maintaining confidentiality;
bining a coaching approach with a formal inservice session.) ■■ listening to how things are said as well as what is being
said;
■■ helping mentees to solve their own problems, rather
Mentoring than giving direction; and
Mentoring is similar in concept to coaching, and some even ■■ focusing on the mentee’s individual development and
consider these terms to be synonymous. Historically, the resisting the urge to produce a clone (University of
U.S. Department of Education (1993) described mentoring Washington, 2019).
SUMMARY peer group meetings and mentoring relationships, as well as

through professional newsletters and conferences. Thought-
Inservice for district staff and ongoing team member con- ful planning and rapid follow-up can help to improve skills
sultation need to be integral parts of an educational audiol- and expand opportunities for inservice, coaching, and men-
ogy program. Too often, students with hearing challenges toring for educational audiologists.
remain unidentified or underserved because school person-
nel are not given information in an interesting and relatable
format, and too often we feel that time for developing sup-
portive coaching relationships is not available. Successful SUGGESTED READINGS
adult learning requires active engagement and regular sys-
tematic feedback. Educational audiologists should develop AND RESOURCES
ongoing lists of successful techniques used in both group Gallaudet University, Laurent Clerc National Deaf Education Cen-
and one-on-one meetings and adapt these whenever possible ter. (2015). Tips to Go, Accommodating deaf and hard of hear-
for use in a school-based inservice. Information on success- ing students in schools. Retrieved from https://www3.gallaudet
ful techniques and relevant materials can be shared during .edu/clerc-center/tips-to-go.html

Kee, K. A. (2010). Powerful communication skills: The new essen- Severance, G., & Klein, B. (2012). What you need to know about
tials in results coaching: The new essential for school leaders. student’s hearing technology for classroom listening. Power-
London, UK: Sage Books. Point and handout. Retrieved from https://successforkidswith
Naeve-Velguth, S., Hariprasad, D., & Lehman, J. (2003). A com- hearingloss.com/
parison of lecture and problem-based instructional formats for Success for Children with Hearing Loss. (2019). Inservicing the
FM inservice. Journal of Educational Audiology, 11, 5–14. classroom teacher. Retrieved from https://successforkidswith
Peterson, D. (2019). The basics of adult learning. ThoughtCo., hearingloss.com/inservicing-the-classroom-teacher
March 6. Retrieved from https://www.thoughtco.com/what-is Tschannen-Moran, B. A. (2010). Evocative coaching: Transforming
-adult-learning-31425 schools one conversation at a time. San Francisco, CA: Jossey-Bass.
Pike, B., & Solem, L. (2013). 50 Creative Training Openers and University of Washington, Northwest Center for Public Health
Energizers: Innovative ways to start your training with a Bang! Practice. (2014). Effective adult learning: A toolkit for teach-
Hoboken, NJ: Wiley. ing adults. Retrieved from http://www.nwcphp.org
Pike, R. (2002). Creative training techniques handbook (3rd ed.). What is coaching? Retrieved from https://www.skillsyouneed.com
Amherst, MA: HRD Press. e-book (2003). /learn/coaching.html
Chapter 13

APPENDIX 13–A
Inservice Outlines
TIPS FOR USING OUTLINES:

■■ Copy on 5 × 8 index cards.
■■ Start a new index card for each segment.
■■ Write down stopping points for each video or audio segment. Set at next beginning point immediately after playing
segment.
■■ Color code supplementary materials (handouts, slides video, equipment) and insert in sequence of use.
■■ Write out important points to emphasize for each segment.
TITLE: GETTING STARTED (30 MINUTES)

TARGET AUDIENCE: TEACHERS AND SCHOOL PERSONNEL WHO HAVE A STUDENT
WITH IDENTIFIED HEARING OR LISTENING NEEDS
Rationale: Teachers and school personnel have many requirements and trainings at the start of the school year. In order to
ensure that a deaf or hard of hearing student has a good start to the school year, it is important that teachers have foundational
information regarding the impact of hearing challenges in the classroom. Below is a starting outline of components that you
may want to include. If you are running out of time during the scheduled inservice session, think about what three KEY points
you want EVERY teacher to remember. The educational audiologist should plan a follow-up visit with the core teacher and/
or primary contact staff member within 2 weeks if at all possible.
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OBJECTIVES:
■■ Participants will gain an overview of hearing and different hearing levels
■■ Participants will gain an overview of a particular student and his/her needs
■■ Participants will demonstrate competency in the student’s personal equipment as well as remote microphone technology
■■ Participants will identify individual accommodations outlined in the student’s IEP/504 plan and be able to explain why
they are needed.

■■ Participants will identify who to contact when he/she has questions or concerns.
Initial Activity: 3 minutes

■■ Participants will sign in with their name, room number, and e-mail address (or best way to be contacted)
■■ Participants will introduce themselves and explain how they will be serving the student
■■ Participants will briefly share prior experience with hearing loss (could be yes/no, student/family member/other, cause,
treatment, etc.]
■■ Participants will share (verbally or by writing down on index card) one thing they are most looking forward to learning
about regarding hearing and listening challenges.

Overview of Hearing and Student’s Hearing Loss: 7 Minutes
■■ Briefly discuss how critical hearing is for classroom learning. Discuss briefly that hearing levels are measured on a
continuum and can range from mild to profound, unilateral or bilateral, fluctuating and/or permanent. Any degree of
compromised hearing can have a negative impact on how a child communicates, learns, and his/her access to informa-
tion. Some related factors (not exhaustive) may include motivation, history of hearing loss, type of hearing loss, language
level, use of technology, and environment.
■■ Have participants take the unfair spelling test (can use the mild hearing loss word list in order to save time). This is avail-
able on YouTube and other hearing loss websites (e.g., https://successforkidswithhearingloss.com ) Mention the issue of
fatigue when a student has to work so hard to understand information in the classroom.
■■ Share specific information about the specific student’s hearing.
■■ Ask participants what they might expect from info they have been given about hearing loss. Then repeat info that each
student is an individual and might be totally different than they expect. Emphasize that the accommodations that have
been recommended are individualized to help each student have the same access to information as his/her classmates.
472

Demonstration of Personal Hearing Technology and Hearing Assistive Technology: 10 Minutes

Participants will learn about the student’s specific technology that is being used. If loaner equipment or the student’s tech-
nology is available, participants can listen to the devices. If not available, use an audio recording or YouTube video of what
hearing aid, cochlear implant, and RM HAT sounds like (see online resources).
Supplementary Materials: ■■ Student’s technology for demonstration and troubleshooting
■■ Teacher sheets for use and troubleshooting of student’s equipment (see Chapter 8
for examples)
■■ Calendar or Ling Six-Sound Chart (Appendix 8–I) for daily monitoring
■■ Troubleshooting kit (battery tester, air blower, dry aid kit, extra batteries)
Classroom Accommodations for Student: 5 minutes
Review typical barriers to listening in the classroom (noise, distance, reverberation, external and internal noise sources).
Reflect back on the unfair spelling test and how difficult and tiring it was to hear and understand the given words. Technology
can help, but it is not a cure. Ask participants to quickly brainstorm potential accommodations. Then, as a team, review the
student’s current Individualized Education Program (IEP)/504 accommodations and expand on why these accommodations
benefit the student.
Supplementary Materials: ■■ Summary sheet specific for the student listing technology and accommodations
■■ Student created “All about Me” handout. This could be a self-advocacy/learning
activity that is done each school year and shared by the student with his/her team.
Summary: 5 minutes
■■ Quickly summarize the above components. What are your three KEY points that you want the team to implement right
away?
■■ Schedule a classroom visit ASAP to review technology and accommodations and answer any questions that will surface.
■■ Leave your business card with best ways to contact you.
Chapter 13

474 Chapter 13
TITLE: CLASSROOM AMPLIFICATION (45 MINUTES)

TARGET AUDIENCE: ADMINISTRATORS
OBJECTIVES:
■■ Participants will gain knowledge about classroom amplification.
■■ Participants will experience classroom amplification.
■■ Participants will receive information concerning benefits of using classroom amplification in educational settings.
Initial activity (3–5 minutes): Participants and instructor introduce themselves while a tape of classroom noise is being
played; show slide and turn off noise. Reactions?
Materials needed: Audio recording made in local classroom
Slide photo of classroom with students
I. System Overview (15 minutes): Turn on classroom FM system and identify microphone and speakers being used; explain
equipment, advantages, and other system options (alternate microphone styles and speaker arrangements) following ICA
transparencies
Materials needed: Working classroom FM system
YouTube videos from Jane Madell, EARS project, or similar (see resources)
II. Benefits (15 minutes): Summarize research demonstrating benefit from sound-field amplification (MARRS study); iden-
tify at-risk populations with local statistics for each category.
Materials needed: ICA slide IV-8, “Summary of FM Soundfield Benefits Based on Research Findings”
Handout—annotated research studies on classroom amplification
Handout with local info for each category
III. Summary (10 minutes): Present classroom info for initial audio demo using classroom grid from ICA manual); proposal
for trial period in local classrooms; questions and answers
Materials needed: Classroom audio demo
Chapter 13
Transparency/slide of classroom noise measurements

Commercial packets
Activity: Replay classroom audio while using classroom FM system and explaining grid
Activity: Pass out commercial package on equipment proposed for trial that includes estimated costs if purchased;
schedule follow-up appointments to select classrooms and develop plan for training and data collection

TITLE: HEARING AID MONITORING (1 HOUR)

TARGET AUDIENCE: SUPPORT PERSONNEL
OBJECTIVES:
■■ Participants will accurately identify parts of behind-the-ear (BTE) and in-the-ear (ITE) hearing aids.
■■ Participants will demonstrate competency in routine visual and listening checks for BTE and ITE hearing aids.
■■ Participants will demonstrate knowledge of solutions for typical hearing aid malfunctions.
Initial activity: Pre-test (5 minutes): Fill in the blank illustration of BTE and ITE hearing aids
I. Review parts of aids, using loaner BTE and ITE hearing aids (10 minutes): battery, on–off switch, volume control,
microphone, tone/output controls, amplifier, tone hook, tubing, earmold. Identify make, model, and serial number for each
aid used. Distribute battery warning and demonstrate childproof battery compartment. Group asked to ID parts on slide or
handout.
Materials needed: BTE and ITE hearing aids—no less than one for every two participants
Handout/PowerPoint slide of Pre-test
II. Visual inspection and possible problems (20 minutes): Case, battery compartment, OTM switch, tone control, tubing,
earmold; basic cleaning instructions; moisture problems and solutions
Materials needed: Handout listing visual inspection components.
Hearing aids with hole in tubing, scratched/dirty case, cerumen in earmold, loose/broken tone
hook, missing battery door/tone control cover
Cleaning “supplies,” air blower
Dri-aid kit and instructions
III. Listen check and possible problems (20 minutes): feedback; Ling sound check using stethoscope.
Materials needed: Handout listing problems and troubleshooting techniques
Hearing aid stethoscopes
Battery testers
Hearing aids with battery upside down/dead; dead aid; aids with internal feedback, distortion,
Chapter 13
static
Brief video clip to summarize (ck. Mfg. resources)
IV. Summary (5 minutes): Procedure for reporting problems that cannot be solved during daily check; post-test (connect
problems and troubleshooting technique); questions and answers.
Note: Schedule follow-up classroom visit ASAP for any support personnel who are responsible for daily monitoring of
hearing aids.

APPENDIX 13–B
Inservice and Hearing Simulation Resources*
A.G. Bell Association for the Deaf, Inc. Supporting Success for Children with Hearing Loss https://suc
3417 Volta Place, NW cessforkidswithhearingloss.com/product/teacher-inservice
Washington, DC 20007-2778 -combo/ Includes five checklists and 12 handouts helpful
https://www.agbell.org for inservicing.
Free downloadable handouts for mainstream teachers
KIP-Knowledge Is Power
Additional Web Resources and Hearing Loss
Audiological and Education Simulation Sites
Distributed by Educational Audiology Association
3030 W. 81st Street Tina Childress’ site
Westminster, CO 80031-4111 https://www.youtube.com/watch?v=RBrnvGKLF_Q Short
800-460-7322 (5-min) video created by pediatric audiologist, Jane Madell,
http://edaud.org that demonstrates difference between classroom listening
Program designed to help students learn about their hearing with and without FM support.
losses
https://successforkidswithhearingloss.com/for-professionals
The Mainstream Center /demonstrations-simulated-listening-with-hearing-loss-de
Clarke Schools for Hearing and vices/ (2016). Website with collection of a number of simu
Speech lations of differing conditions for hearing (e.g., quiet, noisy,
Round Hill Road various levels and etiologies of hearing conditions). Refer-
Northampton, MA 01060-2199 ences and sources are identified for many of the simulations.
Chapter 13
413-582-1121 (V/TDD)
http://www.clarkeschools.org/services https://www.bced.gov.bc.ca/specialed/hearimpair/toc.htm
mainstream@clarkeschools.org Hard of hearing and deaf students: A downloadable resource
Link to mainstream services including downloadable infor- guide to support classroom teachers. (2007). British Colum-
mation and videos for teachers, educational products and bia Ministry of Education.
conferences, and subscription information for The Main-
stream News, periodical for school personnel published five http://www.deafed.net Online information and resources for
times per year. Videos, DVDs, and print materials on oral teachers of students who are deaf/hard of hearing.
transliterating. Brings up page with links to Hands and Voices materials for
deaf/hard of hearing students, families, and providers.
Phonak, Inc.
4520 Weaver Parkway http://www.handsandvoices.org/ Website developed and
Warrenville, IL 60555 maintained by nonprofit, parent-driven organization dedi-
800-777-7316 cated to supporting families of children who are deaf or hard
Information and multiple links to resources for pediatric of hearing. Articles and useful links to information and re-
hearing loss and APD; information and demonstrations on sources for families and professionals on communication
noise, FM, and classroom amplification options, deaf education, legislations, and other topics of
interest.
National Information Center on Deafness,
Gallaudet University https://www.utdallas.edu/hhlab/resources-and-publications
NICD, Dept. P-94 /tutorials-on-wireless-technology/ PDF and PowerPoint tu-
800 Florida Avenue NE torials developed by Linda Thibidoux, PhD, at UTDallas
Washington, DC 20002 Hearing Health Lab that illustrate FM technology, coping
(202) 651-5000 (V/TDD) strategies for teens, and transition from high school.
https://www3.gallaudet.edu/clerc-center/info-to-go.html
Manages Educational Resource Centers on Deafness; cata- http://www.oticonus.com/css/Ecaps/Pediatrics%20Counsel
log includes current mainstream modules, videos, publications ing.zip Large (130 MB) download included in the Pediatric
476

Counseling Program developed by Oticon Corp. Can also ■■ Simulations (http://www.healthsciences.uci.edu/). Acous
be requested on a free CD from http://www.oticonus.com tic simulations of cochlear implants and auditory
neuropathy
https://www.phonak.com/au/en/hearing-loss/signs-of-hear ■■ YouTube demos using Fred Flintstone character (http://
ing-loss-and-what-to-do/hearing-loss-simulation.html Sim- www.youtube.com/watch?v=1EJ4g3J6cJM&feature
ulations developed by Phonak of different levels of hear- =related)
ing loss listening to singing, conversations, environmental
sounds, recorded pop music, etc. *Readers’ note: URLs and websites change frequently, so
we apologize for any of these sites that are no longer avail-
able. Please share this information with your colleagues and
Additional sites with hearing loss help us to keep our online section as up to date as possible.
simulations: Thank you.
■■ YouTube: Name that sound—What does hearing loss
sound like? (http://www.hearingcenteronline.com/sound
.shtml)
Chapter 13

APPENDIX 13–C
Sample Index Card Handouts
Tips for the Classroom

■■ Maintain the same high expectations for deaf and hard of hearing students as you have for their hearing peers.
■■ Take time to learn about each student’s family and background.
■■ Learn what works in communicating effectively with each student (e.g., being close to the student, speaking clearly,
showing your face to the student when speaking, lighting, amplification).
■■ Create visual supports such as graphics, charts, hands-on demonstrations, and PowerPoint presentations.
■■ Allow time to view pictures and/or read information.
■■ Repeat and paraphrase information to ensure clarity.
■■ Identify who is speaking during class discussions.
■■ Create accessible materials as appropriate for students’ skill levels as indicated on their Individualized Education
Programs.
Source: Gallaudet University, Laurent Clerc National Deaf Education Center (2015).
EQUIPMENT AVAILABLE FOR STUDENTS AND TEACHERS

IN DISTRICT
Chapter 13
The following equipment is available for short- or long-term loan for use in district classrooms:
■■ Classroom amplification system (CADS)
■■ Personal RM/FM units
■■ TV caption adaptor
■■ Amplified telephone training unit
■■ Sound level meter
■■ 3-D model of the ear
■■ Sample earplugs
Contact, Educational Audiologist,
at for details.
478

APPENDIX 13–D
Inservice Evaluation Form
INSERVICE TITLE:
DATE:
Please mark 1 to 5, with 1 = Strongly Agree to 5 = Strongly Disagree
1. Inservice content was appropriate for my needs 1 2 3 4 5
2. Inservice information was targeted for my level of knowledge 1 2 3 4 5
3. Presentations were interesting 1 2 3 4 5
4. Presentations were informative 1 2 3 4 5
5. Presenter was knowledgeable about topic 1 2 3 4 5
6. I acquired relevant information during this inservice 1 2 3 4 5
7. I obtained materials/resources that I can apply in my
Chapter 13
work situation 1 2 3 4 5
8. I would recommend that my colleagues attend this

inservice if it were presented again 1 2 3 4 5
9. What I liked best about this inservice:
10. What I liked least about this inservice:
11. Suggestions for improving this inservice in the future:
12. Name and contact information (optional):
479

APPENDIX 13–E
Sample Coaching Concept Organizer
Serving a deaf or hard of hearing student extends past ■■ Initiate coaching engagement with listening
the initial teacher/staff inservice. Applying coaching models What are you most looking forward to learning about
to educational audiology services can motivate teachers _____________ (hearing loss, student)?
and other support staff to implement strategies for deaf What is one thing that you are wondering about?
and hard of hearing students in a more consistent and ■■ Validate engagement responses
successful pattern. It is important that we build trust with Offer reflection
the teachers and staff in our schools. Following is a sample Celebrate progress
outline on how to continue to support and coach a mem ■■ Inquire and expand on what the teacher would like to
ber of the student’s team after the inservice. learn or problem-solve
Personalize learning goals
Hands-on opportunities
Handouts to reference
Logistical Preparation Summarize with two or three key points
■■ Identify a key teacher/professional after the inservice ■■ Conclude coaching with action items
■■ Identify a time together that works for both of you for What is one thing you learned today?
follow-up meeting What is one practice that you want to focus on?
■■ Together designate a specific amount of time to meet How can I help you?
(30 min) What suggestions do you have for me?
■■ Have a variety of ways to meet (in person, through tele- ■■ Follow-up to build trust and communication
Chapter 13
conference, on phone); identify teacher/professional’s Schedule a follow-up visit

preferences Send e-mails to check in
Use teleconferencing to check in
Personalize the follow-up by asking “How is
Coaching Mindset Questions ________(the teacher identified action) working in
These questions will help you frame your mind before meet- the classroom?”
ing with the teacher to ensure that this is beneficial for the
teacher.
Educational Audiology Reflection on Coaching
1. How can I make this conversation meaningful to the ■■ Reflect on the coaching session
teacher? What are two or three things that went well?
2. What is one question I can ask the teacher to help them How did you feel afterward?
reflect on their practice? What are two or three things that did not go well?
3. What’s one instructional practice that might be use- What could you do differently next time?
ful for this teacher to reflect on and make a change in? When will you follow up to continue developing
How can I help this teacher reflect on this behavior and trust and communication with this team?
make changes?
Coaching Meeting
■■ Establish Rapport: Ask how things are going? Ask
about something that is personal to this teacher (Pet?
Kids? Upcoming trip). What’s the best thing that’s hap-
pened to you this week?
480

CHAPTER 14
Educational Considerations
for Students Who Are
Deaf or Hard of Hearing
CONTENTS
Critical Issues in Deaf Education

Accountability and Oversight ■ Communication and Communication Access ■ Quality Instruction
Evidenced-Based Practices ■ Students Not Eligible for Special Education ■ Maintaining Teacher of the Deaf and
Related Service Provider Positions ■ Parent and Family Engagement ■ Early Hearing Detection and Intervention
and Early Childhood Education ■ Technology ■ Deaf Versus Hard of Hearing
Chapter 14
Captioned transcript of student describing communication challenges.
481

National Association of State Directors of Special Education: Ten Essential Principles for Effective Education of
Deaf and Hard of Hearing Students
What Is Research Saying?
Legislative Initiatives in Deaf Education
Language Acquisition and Literacy Accountability ■ Deaf Child’s Bill of Rights ■ Hearing Aid Insurance
Educational Assessment
Transition Planning
Best Practice Considerations for Educating Children and Youth Who Are Deaf or Hard of Hearing
Know Your Students ■ Program Standards ■ Program Review ■ Evidence-Based and Consensus-Based Practices
Progress Monitoring ■ Expanded Core Curricula ■ Deaf and Hard of Hearing Peers and Role Models ■ Engage
Parents and Caregivers
Summary
Suggested Reading
Appendices
14–A Colorado Individualized Education Program Communication Plan (Text/Online)
14–B Assessment Terminology (Text)
14–C Summary of Psychoeducational, Language, and Communication Assessments (Text)
14–D National Association of State Directors of Special Education (NASDSE) Implementation: Deaf and Hard
of Hearing Program and Service Review Checklist (Text/Online)
KEY TERMS The education of students who are deaf or hard of hear-
ing is multifaceted and often poorly understood by educators
Evidenced-based practices, progress monitoring, expanded and administrators. While the issues are complex, solutions
core curriculum, transition, educational assessment, Univer- exist, and there is evidence that the trends are reversing for
Chapter 14
sal Design for Learning, legislation, NASDSE many students. To do so, however, requires commitment
to the goal that all deaf and hard of hearing students will
achieve the same outcomes as their hearing counterparts and
KEY POINTS that our work is not done until that goal has been attained.
Educational audiologists play an integral role in support-
■■ While early identification and intervention have im- ing the education of students with reduced hearing levels,
proved language outcomes for many young children, as well as those who have normal hearing accompanied by
all remain at-risk for later learning problems and must listening and/or auditory processing difficulties. Though a
be closely monitored. primary role of educational audiologists is maximizing audi-
■■ Many critical issues in the education of deaf and hard tion and ensuring communication access to facilitate learn-
of hearing students continue to be barriers to successful ing in school and for social participation, we have a role
outcomes. with students’ overall educational programs as members
■■ A variety of instructional strategies are needed to address of the educational team. To be an effective team member,
individual language and communication approaches. we must be knowledgeable about the issues and practices
■■ Research is providing more evidenced-based strategies associated with assessing and educating deaf and hard of
for improving outcomes. hearing students and be prepared to advocate for the services
■■ Professional guidance, such as provided in the Na- they need.
tional Association of State Directors of Special Educa- This chapter pertains primarily to students who are deaf
tion (NASDSE) Guidelines, can help school districts or hard of hearing. Students with auditory processing defi-
evaluate their deaf education services and plan program cits were addressed in previous chapters. Questions that will
improvements. be addressed include the following:
482

Educational Considerations for Students Who Are Deaf or Hard of Hearing 483
■■ What are critical issues regarding the education of deaf for a child was first acknowledged in “Deaf Students Ed-
and hard of hearing students? ucation Services: Policy Guidance” 57 Fed. Reg. 49274
■■ What is current research saying about outcomes for (1992). This report stated that “The (U.S. Department
deaf and hard of hearing students? of Education) Secretary believes that communication
■■ What is the status of state and national initiatives sup- and related service needs of many children who are deaf
porting deaf and hard of hearing children and youth? have not been adequately considered in the development
■■ What are common assessment practices? of the IEP.” Moreover, it points out that the child’s com-
■■ What are best practices in the education of deaf and munication needs, linguistics needs, and social and emo-
hard of hearing students? tional needs must be primary factors in considering the
least restrictive environment for each child.
The general classroom does not adequately serve all
CRITICAL ISSUES IN DHH students because it frequently denies full commu-
nication access. As long as communication is perceived
DEAF EDUCATION as secondary to the Individuals with Disabilities Edu-
cation Act’s (IDEA) core concept of LRE, the specific
In 1975 the Individuals with Disabilities Education Act and systematic problems that are unique to educating
(IDEA) mandated that children with disabilities were DHH children will continue. The intent of IDEA, is to
entitled to be educated in the least restrictive environ- decrease, not increase, a child’s isolation.
ment (LRE), i.e.., the environment where their typical (Colorado Department of Education, 2002, pp. 8–9).
peers were educated. With the goal that children with
disabilities were not to be isolated, inclusion has been Simply understanding the implications of fragmented
the conceptual basis of an educational system designed hearing or not hearing, and particularly the resulting impact
to provide equal opportunity for all students, with or on communication, is one of the biggest challenges in deaf
without disabilities. Over time, it has become clear education. It becomes even more important when you con-
that while inclusion has served many children with dis- sider the fact that most children with reduced hearing now
abilities very well, that is not always the case for many receive the majority of their education in general education
children who are deaf or hard of hearing (DHH). classrooms as illustrated in the comparison between 2007
Communicating “differently” or without direct and 2016 in Table 14–1. Accountability, as the hallmark of
conversation with teachers and peers can create the the No Child Left Behind (NCLB) Act, created the most
most restrictive environment for many DHH students significant force for instructional change in schools in many
in a classroom of hearing peers. Legally, “LRE” has years. NCLB’s commitment to all students also provided an
been interpreted and implemented without sensitivity opportunity to focus on the access and performance of stu-
to, or acknowledgement for, the special communication dents who are deaf or hard of hearing and address some of the
needs presented by deaf children that often go unmet in long-standing challenges. The Every Student Succeeds Act
Chapter 14
the “least restrictive environment.” The outcome has (ESSA), the current version of the Elementary and Second-
been isolation and academic underachievement. Until ary Education Act, signed into law on December 10, 2015,
the conceptual basis of education (and all supporting reduced many of the federal requirements of NCLB giving
mandates) is understood to be communication-driven more discretion to states to determine academic standards and
for DHH students, the system will continue to discrimi- assessments, while continuing the focus on accountability.
nate against this population. In fact, it is the inequity of
our present educational system that has resulted in the
further disabling of DHH children. Accountability and Oversight
At the federal level, the importance of communication The NCLB and ESSA focus on accountability has yielded
as a starting point for identifying appropriate services systemic analysis of the performance of students who are
TABLE 14–1 Trends in Placement for Deaf or Hard of Hearing (DHH) Students 2007 Versus 2016.
Office of Special Education Programs (OSEP) Annual Data Collection Fall 2007 Fall 2016
DHH students in general educational class >80% 51.88% 61.30%
DHH students in general education class 40% to 79%: 17.64% 15.50%
DHH students in general education class <40%: 16.83% 11.30%
DHH students in separate schools, residential, etc. 13.66% 11.90%

484 Chapter 14
deaf and hard of hearing. Although states can disaggregate to be effective. Supervision is most often conducted by
student test scores in order to analyze performance of their program coordinators or school administrators who are
deaf and hard of hearing students and track improvement, not familiar with common practice standards for students
there are few states that have done so. Such an analysis in who are deaf or hard of hearing or for the roles and re-
Colorado found that even though the majority of deaf and sponsibilities of educational audiologists and educational
hard of hearing students were performing in the lowest of interpreters. Teachers and support staff are often evalu-
four performance categories, a more in-depth analysis of ated on behaviors that do not directly affect the prog-
the data showed that 81% of all deaf and hard of hearing ress that students are making (e.g., quality of instruction,
students were making 1 year’s growth or more in reading, fidelity of instruction, effective access services, or accu-
92% were making a year’s growth or more in math, and 92% racy of sign language interpretation). Furthermore, gen-
were making 1 year’s growth or more in writing (Johnson, eral education and special education inservice opportuni-
2006). These data reinforce the benefits of a growth model ties are not always relevant for teachers of deaf and hard
analysis and promote the premise that students should mini- of hearing students or related services personnel.
mally be expected to make 1 year’s growth in 1 year’s time ■■ Monitoring at the state level is limited. State-level spe-
regardless of the grade level or state test performance level cial education improvement and monitoring programs
at which they are functioning. Obviously, to catch up to rarely focus on issues and practices that are unique to
hearing peers, greater growth is needed. However, justifica- low-incidence populations such as students who are
tion for less progress should be required. Further evidence to deaf or hard of hearing. This problem is confounded
support the expectation of 1 year’s growth in 1 year can be by the fact that few state education agency departments
found in the decision penned by the U.S. Supreme Court in have content experts within their special education units
Board of Education v. Rowley (1982). The court concluded to conduct this level of oversight.
that Individualized Education Programs (IEPs) for children
educated in regular classrooms should be reasonably calcu-
lated to enable the achievement of passing marks and ad- Communication and Communication Access
vancement from grade to grade (see Chapters 1 and 11 for Communication is one of the most fundamental require-
more discussion of Rowley). ments of human development. Without access to commu-
Several issues continue to challenge the delivery of ap- nication, language and cognition cannot develop normally
propriate programming and services and ultimately raise out (Marschark, 2001; Sacks, 1989). Accessible communication
comes for students who are deaf or hard of hearing. Three results in equal participation and shared meaning between
that are most common include the following: the communication partners. The impact of the loss of com-
munication cannot be easily overcome. Full communication
■■ Difficulty providing services that are based on individ- access, whether through an auditory, visual, or combined
ual student needs. Most school districts are not large method, must begin at birth if children are to have a chance
enough to offer a continuum of program options that in- to overcome the potential negative impact of the hearing
Chapter 14
clude neighborhood school and center-based placement condition. Schools are particularly challenged to ensure
and service options. Therefore, students are most often fully accessible learning experiences, especially in inclusive
served in the general educational classroom with con- educational programs.
sultative or itinerant teacher support services. While ac- Communication occurs on a dynamic continuum that
ademic needs may be addressed, communication access varies depending on the environmental conditions and the
as well as social opportunities with peers are challeng- communication situation as well as the message being con-
ing. Intermediate school districts or service agencies, veyed. Communication approaches include American Sign
such as BOCES (Board of Cooperative Educational Language, Bilingual-Bimodal, Cued Speech, Listening and
Services), area education agencies, co-ops, or regional Spoken Language, Pidgin Signed English, Sign Supported
districts offer programs for low-incidence disabilities Speech, and Simultaneous Communication. Parents have
and related services for a number of smaller districts. the primary decision-making role in the selection of ap-
These programs often provide opportunities for single proaches. In addition, deaf and hard of hearing students uti-
deaf and hard of hearing students from multiple schools lize a variety of devices and technologies, including ampli-
to join for group learning and social activities, which fication systems, communication devices, assistive devices,
results in larger numbers of students (i.e.., critical mass) and computers for notetaking. Educational interpreters (sign
as well as additional options and services. The alterna- language, cued and oral) are necessary for some students.
tive is often fitting students into existing programming, Considering the variety of communication options and tech-
e.g., available services, rather than a program that was nologies available and/or required, it is often impossible for
designed based on individual needs. each school district or education agency to provide all of
■■ Administrative support and instructional leadership in them. Yet because IDEA requires that services must be de-
schools often lack the necessary knowledge and expertise livered according to individual student needs, schools often

inadvertently compromise quality (e.g., use of unqualified survey results indicating only 36% of states had developed
interpreters) to provide the range of services and the neces- specific plans and guidelines for implementing “Special
sary supports. Students who are hard of hearing are often Considerations.” A complete discussion of this requirement
lost between two cultures—hearing and deaf. They are not is contained in Chapter 11, Developing Individual Plans.
deaf; they have partial hearing and are able to use their audi- Ongoing grassroots efforts continue to increase the
tory skills to participate in daily communication. The per- numbers of states that have passed a Deaf Child’s Bill of
ception, therefore, is that they are hearing, and, as such, they Rights (DCBR). The DCBR often contains more require-
are expected to behave like their classmates who are hearing. ments than stipulated in IDEA and, because it is state legis-
Typically, there is confusion about the extent of their needs, lation, it is more likely to have greater compliance monitor-
and often these students are not provided the accommoda- ing for implementation. As an example, Colorado’s DCBR
tions necessary to access communication fully. Because they legislation requires a Communication Plan (see Appen
must work harder to listen and process what they hear, they dix 14–A) for every student with reduced hearing regard-
may begin a spiral beginning with fatigue, which impacts less of primary disability that addresses (a) each student’s
cognitive processing and then academic performance (Horn- primary language and communication mode, (b) supports
sby, Werfel, Camarata, & Bess, 2014). Hard of hearing stu- needed by parents and family members to increase their pro-
dents are the least understood and the most disadvan- ficiency for communicating with their child, (c) the need for
taged among all those with reduced hearing (Ross, 2001). adult role models and peer groups in the student’s primary
The acoustical characteristics of a classroom also play language and communication mode, (d) the proficiency of
a major role in a student’s ability to access communication. school staff to deliver the communication plan, and (e) the
The invisible barriers created by noisy air exchange, heating, communication-accessible instruction and services that will
and refrigeration systems, along with reverberating sound be received by the student. Regardless of the plan used, the
from walls and ceilings that distorts speech, are exacerbated process should focus on the discussion and documentation
by the busy noise of the classroom. Standards exist (ANSI/ of the student’s language and communication rather than
ASA, 2010) that need to be implemented to ensure that a checklist that simply indicates each part was considered.
classroom acoustics do not interfere with a deaf or hard of For some students, the lack of direct communication
hearing student’s ability to learn. This topic is discussed in may also be a consideration in communication access. Deaf
detail in Chapter 7. adults have reported that an interpreted education is a poor
IDEA recognizes the importance of communication substitute for direct contact with teachers and peers. In these
access in special considerations Development, Review, and situations, every time the student wants to communicate
Revision of IEP, Consideration of special factors1: with anyone in the classroom, he or she must do so through
an adult interpreter. This process interferes with the educa-
The IEP team must: tional dynamic—the give and take that stimulates learning.
(iv) Consider the communication needs of the child, And, when students do not communicate directly with one
and in the case of a child who is deaf or hard of hear- another, their social experience suffers as well.
Chapter 14
ing, consider the child’s language and communication In addition to communication access, children must de-
needs, opportunities for direct communications with velop communication proficiency. Because communication
peers and professional personnel in the child’s lan- impacts all aspects of human functioning, from academic
guage and communication mode, academic level, and to social, from work to pleasure, from social-emotional to
full range of needs, including opportunities for direct intellectual, the ability to understand and produce language
instruction in the child’s language and communication defines us as humans and provides us with the means to
mode; become literate adults. The unique nature and consequence
(iv) whether the child needs assistive technology de- of deafness or reduced hearing is that it can separate deaf or
vices and services. hard of hearing children from communication with others,
and subsequently starve the student from active and passive
Because of this requirement, every IEP team must ad- learning of both academic and social skills. Communication
dress each deaf or hard of hearing student’s language and access and competence must be a priority in our educational
communication needs including opportunities for direct system.
communication with peers and adults and the need for direct
instruction. Many states continue to struggle to understand
and fully implement this requirement of IDEA. These regu- Quality Instruction
lations provide an action plan for how the various compo- It is becoming difficult to assess the performance of deaf and
nents of communication access are defined and implemented hard of hearing students as more students move to 504 plans
through the IEP. Luft and Amiruzzaman (2015) reported their (see Table 1–3). As a result, the IEP student data pool reflects
1
[34 CFR §300.324 (2)].

486 Chapter 14
FIGURE 14–1 Reading performance changes of deaf and hard of hearing students who transitioned from an IEP to no special education
services, from an IEP to a 504 plan, and who remained in special education. (From Anna Paulson, Minnesota Commission of the Deaf,
DeafBlind, and Hard of Hearing. Personal Communication June 24, 2019. Used with permission.)
students who meet eligibility by requiring specialized in- cation classrooms. Therefore, it is important that teachers
struction because they are behind in one or more areas. The of deaf and hard of hearing students are trained to support
focus minimally should be on maintaining performance and adult learners to effectively support students in an itinerant
optimally improving or closing the achievement gaps. or consultative delivery system. At the same time, teach-
Through the Minnesota Deaf Education Collabora- ers must be able to support students who may require in-
tive under the direction of the Minnesota Commission of struction in American Sign Language, who utilize spoken-
the Deaf, Deafblind, and Hard of Hearing, data were col- language communication strategies, or who have additional
lected and analyzed on a cohort of students across 4 years disabilities. Providing a full range of educational options for
to evaluate trends in their performance on the Minnesota a small number of children represents a financial hardship
Comprehensive Assessment (MCA) based on the services for even the best endowed districts.
they received (i.e., IEP and 504) (A. Paulson, personal Another variable in the instructional quality formula
Chapter 14
communication, June 24, 2019). All students were initially is the training and status of educational interpreters. With
served by IEPs in 2013; in 2017 at the time of analysis, IDEA 2004, the educational interpreter was officially identi-
1,661 of the 2,489 with IEPs were still in the Department of fied as a member of the related services team. Approximately
Education’s database. Of these, 77% remained on IEPs with 30 states require the Educational Interpreter Performance
Deaf/Hard of Hearing as the primary disability category, and Assessment (EIPA) (qualifying scores vary by state), Na-
an additional 12% had IEPs with a dual diagnosis; 9% had tional Interpreter Certification, the Cued Language Translit-
exited special education with no other services, and 2% had erator Assessment, or some other assessment. A bachelor’s
moved to 504 plans. An analysis of the reading scores is degree is also recommended. The National Association of
presented in Figure 14–1 illustrating the patterns of perfor- Interpreters in Education (NAIE), the professional organiza-
mance changes for each of the three groups between 2013 tion for educational interpreters, has published Professional
and 2017. Students who remained on IEPs were most likely guidelines for interpreting in education settings (http://www
to make improvements (34%), and those who moved to 504 .naiedu.org/guidelines).
plans had the greatest percentage whose performance de- An analysis of approximately 800 EIPA written tests and
clined (18%). A similar pattern occurred with math scores. more than 18,000 performance assessments found that only
This type of data analysis is useful to inform state and local educational interpreters who have achieved an EIPA score
practices to ensure that decisions about placements and ser- of 4.0 or greater had skills that met the free and appropriate
vices are made judiciously and that students who are at risk public education (FAPE) mandate and therefore were quali-
are monitored when they exit special support services. fied to interpret for students who are deaf or hard of hearing.
As more students are educated in general education While EIPA scores have improved over the years, only 40%
classrooms, the delivery of specialized instruction has of the almost 9,000 educational interpreters completing the
changed due to fewer resource and self-contained deaf edu- EIPA in 2009 to 2014 achieved a score of 3.5 or greater,

and only 23% achieved a score of 4.0 or greater (Johnson, holes in the knowledge base . . . . Most articles that com-
Taylor, Schick, Brown, & Bolster, 2018). Therefore, when pared groups did not match them carefully. Most articles
interpreters perform 4.0 on the EIPA, it is unlikely that they that compared groups looked at existing skills based on
are conveying all the information occurring in the classroom some kind of test or rating. Few engaged in experimental
or conveying it accurately. In addition to interpreting tasks, design, so although we can make assumptions about what
interpreters often are expected to tutor DHH students. Inter- is working in literacy instruction based on existing skills
preters who take on this added responsibility should be both of a sample, we cannot point to many programs, materi-
trained in tutoring approaches and directed and supervised als, strategies, or interventions and declare there is experi-
by the classroom teacher and/or the teacher of the deaf/hard mental proof of their effectiveness. In addition many of the
of hearing. As the number of students receiving their educa- practices that are considered sacred cows in deaf education
tion in the general education classroom increases, the need have little or no evidence to support their efficacy. (p. 31)
for interpreters who can provide students with a competent
interpretation of the classroom content also increases. Without clear direction to guide deaf and hard of hear-
ing teachers, whether in preservice or inservice training
programs, it is difficult for school programs to develop sys-
Evidence-Based Practices tematic, multilevel instructional programs to support literacy
Many of the educational practices used with deaf and hard of development. The Center on Literacy and Deafness was cre-
hearing students are lacking research or evidence-based prac- ated by a grant from the National Center for Special Educa-
tices. ESSA and IDEA both require use of scientifically based tion Research, Institute of Educational Sciences (http://clad.
research to guide instruction. The U.S. Department of Educa- education.gsu.edu). CLAD’s research team of collaborators
tion (2003, p. v.) provided the following guidance when deter- from Georgia State University, the University of Arizona, the
mining if an intervention is supported by rigorous evidence: University of Colorado at Boulder, the Rochester Institute of
Step 1. Is the intervention backed by “strong” evidence of effectiveness?

Quality of studies to establish Quantity of evidence needed:
“strong” evidence: ■■ Trials showing effectiveness in two
+ =
■■ Randomized controlled trials or more typical school settings,
“Strong
that are well-designed and including a setting similar to that of
Evidence”
implemented. your schools/classrooms.
Step: 2. If the intervention is not backed by “strong” evidence, is it backed by “possible” evidence of effectiveness?
Types of studies that can comprise “possible” evidence: Types of studies that do not comprise “possible” evidence:
Chapter 14
■■ Randomized controlled trials whose quality/quantity are ■■ Pre–post studies
good but fall short of “strong” evidence; and/or ■■ Comparison-group studies in which the intervention and
■■ Comparison-group studies in which the intervention and comparison groups are not closely matched
comparison groups are very closely matched in academic ■■ “Meta-analyses” that include the results of such lower-
achievement, demographics, and other characteristics. quality studies.
Step 3. If the answers to both questions above are “no,” one may conclude that the intervention is not supported by
meaningful evidence.
Recognizing the lack of research that met these stan- Technology, and Arizona State University addressed literacy
dards in deaf education, Luckner, Sebald, Cooney, Young, development focused on kindergarten through second-grade
and Muir (2005) conducted a meta-analysis of the research interventions culminating in activities and curricula that are
in literacy and found that the commonly used approaches available on the CLAD website.
were determined by tradition and anecdotal reports. Another Response to intervention (RtI) or Multi-Tiered Systems
study by Easterbrooks (2005) corroborates the Luckner et al. of Support (MTTS), while not designed for children who are
findings. Easterbrooks summarizes: DHH, should result in improvements in instruction in the
general education classroom due to its focus on scientifically
Research available in the area of literacy . . . . is rife with based instructional methods and progress monitoring pro-
speculation, pseudo-empirically based for the most part, cedures. RtI/MTSS also addresses the failure-based model
deferential to a belief system, and characterized by many that has existed in special education by providing early

488 Chapter 14
intervening support to students with hearing and/or listen- lar situations exist locating specialized instructional support
ing conditions (e.g., unilateral and slight hearing losses, un- personnel (i.e., related service providers) who have the ex-
derdeveloped listening skills, auditory processing problems) pertise and experience to work effectively with students who
who may not qualify for special education but who could are deaf or hard of hearing. Furthermore, the communication
benefit from strategic support to prevent potential frustra- methodologies used by deaf and hard of hearing students
tion and eventual failure. (More information on RtI/MTSS is involve many different skills, making it difficult to find a sin-
located in Chapter 11, Developing Individual Plans.) gle professional who is capable of offering the full range of
communication approaches and instructional methodologies.
This problem becomes even more difficult when a school
Students Not Eligible for Special Education district has only a few DHH children who are spread from
Early intervention, together with cochlear implants and ad preschool to high school. As mentioned previously, interme-
vanced hearing technology have improved access to lan- diate school districts, area education agencies, and BOCES,
guage and communication for many students. These services are examples of how regional programs can address special
have resulted in a growing number of students with reduced education and other specialty services. Additional layers of
hearing who are not eligible for special education under this problem that affect retention of staff often include:
IDEA at age 3 years. This group includes students with hear-
ing levels in the minimal, mild, or unilateral range and those ■■ extensive travel in rural areas (more car time than teach
with single-sided deafness. As a result, there are more stu- time is a frequent reality) and winter driving conditions;
dents in general education classrooms who rely on 504 plans ■■ part-time positions due to low numbers;
for their support services, more students who need the inter- ■■ lack of support from administrators who do not under-
ventions afforded by RtI/MTSS, and more students outside stand issues associated with the education of children
of the count (i.e., required special education tracking) and who are deaf or hard of hearing;
protections of special education. We must remember that all ■■ inadequate supervision;
of these students are at risk for academic and social prob- ■■ working in isolation without a mentor or a group of col-
lems that can pop up at any time but especially as instruction leagues to discuss and problem-solve student and work
becomes more complex. Schools, therefore, need to work issues; and
diligently to closely monitor these students to prevent the ■■ stress and frustration trying to provide quality programs
education system from “disabling” them. Both 504 and RtI/ with limited resources.
MTSS provide mechanisms to develop and provide supports
for these students if used appropriately. Other students may
not be served by special education because their parents do Parent and Family Engagement
not approve of the services offered to them or other reasons. Family engagement in school matters is important for all
Instead they may choose placement in their neighborhood students but becomes even more critical for parents of deaf
school in the general education classroom or in a private and hard of hearing students because of the communication
Chapter 14
school. As one parent stated, “the laws that are present to pro issues associated with reduced hearing. Consider that 89%
tect children often also restrict what they may need” (T. Ed- of children with reduced hearing are born to parents where
wards, personal communication, April 22, 2010). Regardless at least one is hearing (Gallaudet Research Institute, 2010).
of how and where they are supported, schools need to have It is not surprising then that, without training, families lack
a monitoring system for all students with reduced hearing the knowledge to support their children and effectively par-
to ensure that they are each on track to make their annual ticipate in their child’s educational program. As the long-
achievement benchmarks. term “case managers” of their child’s academic experience,
this can result in a loss of quality control over their child’s
program and progress. Parent counseling and training is a
Maintaining Teacher of the Deaf and related service support that, although available to these fam
Related Service Provider Positions ilies, is generally underutilized.
Staffing challenges complicate many of the issues faced by Parent participation in IEP meetings is generally re-
schools trying to provide quality programs and services. The ported to be high, but parent-teacher conferences less so.
low incidence nature of reduced hearing adds an additional While many parents take advantage of school-sponsored
factor affecting the schools ability to have enough deaf and special programs pertaining to issues related to their child’s
hard of hearing students to justify a full-time equivalent hearing status and education, teachers report that those fam-
(FTE) position for a teacher of the deaf. Further complicating ily members who might benefit the most often do not at-
this problem are teacher shortages; many teacher of the deaf tend. Schools are also challenged to maintain involvement
positions go unfilled due to lack of applicants, which may of parents as their children move on to the secondary level.
also be impacted by the closing of several teacher of the deaf In addition, seeking parent participation in school-wide ac-
personnel preparation programs in the past few years. Simi- tivities and encouraging parents to become parent mentors

and leaders is difficult. Time constraints due to work, single- used in instruction to promote learning in and out of school.
parenting, and other issues that keep parents from being Use of these technologies as well as hearing assistance de-
involved result in feeling disconnected from these larger vices, classroom and video captioning, distance video equip-
school activities and understanding how their children are ment, and computers can make the difference between as-
included and accommodated. Communication challenges similation and isolation and ultimately, success and failure.
for Deaf and non-English-speaking families further compli- While these technologies are available, they are often unde-
cate school involvement. Chapter 3, Partnering With Fami- rutilized due to lack of familiarity of their operation and use
lies, further addresses some of these areas. by staff, technological difficulties with the setup or use of
equipment, and the cost associated with acquiring the equip-
ment. The provision of assistive technology also comes with
Early Hearing Detection and Intervention a requirement that the technology is necessary for a child to
and Early Childhood Education meet his/her IEP goals by increasing, maintaining, or im-
The benefits of EHDI programs are well documented (John- proving his/her functional capabilities. With technological
son, 2006; Yoshinaga-Itano, Sedey, Coulter, & Mehl, 1998). improvements has come a blurring of “personal” devices
However, not all states have specialized early intervention and those that are considered “assistive” technology. For
programs for families with children who are deaf or hard of example, remote microphone hearing assistance technology
hearing, and there are many concerns regarding the quality used to be housed in a body-worn device, then an ear-level
and expertise of early intervention providers. While these is- device that booted to a hearing aid, and now is integrated
sues need to be addressed within the Part C system, the frag- within the hearing aid itself. Educational audiologists have
mentation between Part C and Part B programs can result in to sort out which components are “assistive” technologies,
inconsistencies in services for children and their families. and which are “personal,” and how monitoring and mainte-
When children transitioning from early intervention nance will be handled. Another complication has stemmed
services (Part C) to preschool (Part B) with age-appropriate, from the increase in surgically implanted devices, such as
or near age-appropriate skills, the challenge for the school cochlear implants. The 2004 IDEA regulations specifically
program becomes how to sustain the gains of EHDI pro- excluded these types of devices as assistive technology. See
grams. Preschool services are often not specialized to deaf Chapter 8, Hearing Instruments and Remote Microphone
and hard of hearing program needs due to low numbers and Technology, for more information on these issues.
a variety of communication modes. At this age, parents pre-
fer not to have their children transported across significant
distances to take advantage of center-based programs that Deaf Versus Hard of Hearing
are designed for deaf and hard of hearing children. Typical Another question to explore is how deaf children are differ-
services outside of metropolitan areas are usually provided ent from hard of hearing children. Often the question boils
within a noncategorical special education preschool setting, down to functionality and whether a child functions in a
an at-risk community preschool such as Head Start, or a gen- primarily visual way or whether the child desires to use au-
Chapter 14
eral community preschool. The special education services dition, either as a primary mode of communication or to
are usually delivered by an early childhood special educator supplement what the child receives visually. A basic ques-
with support from an itinerant teacher and a speech-language tion that should be asked of individuals is how they view
pathologist. Communication access may be limited, particu- themselves. From a programming standpoint, however, the
larly in situations where the child is a sign language user. differences are significant. For functionally deaf children,
Although inappropriate from a developmental perspective, the need for access to visual communication is clear; there
an educational interpreter may also “interpret” for the non- is no argument from the school whether they need to pro-
signing providers. These common scenarios often stagnate vide a sign language interpreter, whether they need special
the growth afforded by the early intervention program and education services and support, or whether they benefit
result in children entering kindergarten with a greater gap from being around other deaf students. But hard of hear-
than when they began preschool. ing students are neither deaf nor hearing, and in fact, they
may function as either depending on the situation. Providing
communication access seems clear—support both auditory
Technology and visual modes—but convincing teachers of the impact of
For students who are deaf or hard of hearing, technology reduced hearing when an individual speaks intelligibly and
plays a key role in supporting both auditory and visual learn- acts like he or she hears sometimes but not at other times can
ing. The common use of computers, tablets, Smart Boards, be difficult. Convincing administrators that these students
digital cameras, and a variety of apps including video phone need both hearing assistance technology and, at times, an
apps, as well as e-mail and the Internet has resulted in greater educational interpreter, is often a challenge. The number of
access to information for all individuals with hearing differ- functionally hard of hearing children has expanded with the
ences than ever before. Furthermore, these technologies are increasing number of children receiving cochlear implants.

490 Chapter 14
These students and their unique profiles continue to chal-

lenge us, and they represent the largest group of children Ten Essential Principles for
who have hearing differences. Effective Education of Deaf
The education of students with hearing differences is
at an important juncture. As a result of several initiatives
and Hard of Hearing Students
over the past 5 years, school programs have the opportunity 1. Each student is unique.
to make significant, systemic changes in how services are 2. High expectations drive educational program-
determined and delivered. While the formula that improves ming and future employment opportunities.
a child’s chances of success is becoming clearer, schools re- 3. Families are critical partners.
main challenged to implement the elements of that formula 4. Early language development is critical to cogni-
consistently within the educational setting as well to respond tion, literacy, and academic achievement.
to the factors that continue to have a negative impact on this 5. Specially designed instruction is individualized.
opportunity. 6. Least restrictive environment (LRE) is student
based.
7. Educational progress must be carefully
monitored.
NATIONAL ASSOCIATION OF 8. Access to peers and adults who are deaf or
STATE DIRECTORS OF SPECIAL hard of hearing is critical.
9. Qualified providers are critical to a child’s
EDUCATION: TEN ESSENTIAL success.
PRINCIPLES FOR EFFECTIVE 10. State leadership and collaboration are essential.
EDUCATION OF DEAF AND
HARD OF HEARING STUDENTS
The National Association of State Directors of Special
Education (NASDSE) has published the third edition of its serving deaf and hard of hearing students to review and dis-
Educational Service Guidelines for Students who are Deaf cuss current practices, identify gaps, and develop improve-
and Hard of Hearing, Optimizing outcomes for students who ment plans.
are deaf or hard of hearing (NASDSE, 2018). Chapter 1 Of interest to educational audiologists, this guidebook
identified 10 essential principles for effective education of describes audiological assessment, auditory environment ac-
students who are deaf or hard of hearing. These principles cess, hearing assistive technology and services, and roles
were intended to inform local and state administrators about and responsibilities of the educational audiologist.
their responsibility to ensure a FAPE to deaf and hard of In addition to the instructive content, this guidebook
Chapter 14
hearing students. They also serve as important reminders carries significance in that it represents the position of the
for service providers, including educational audiologists, as association of state special education directors. These in-
we advocate for these students. These principles offer some dividuals are key players in local, state, and federal policy
resolution to the discussion of critical issues. development for special education. These guidelines are
This third edition offers a blueprint for Optimizing out- the work of a broad base of contributors. The guidelines as
comes for students who are deaf or hard of hearing. Chap- well as a pdf fillable version of the checklist are available to
ters describe recommended practices in the following areas: download at no charge (http://www.nasdse.org).
■■ Federal Laws and Policies
■■ Early Identification and Intervention
■■ Assessment
■■ Evaluation and Eligibility
■■ Goals, Services, and Placement Nuggets from the Field
■■ School Environment Access and Accommodations
■■ Postsecondary Transition: From Part B to Education, Every educational audiologist as well as other deaf
Training, Employment, and Independent Living education service providers should always have a
■■ Personnel copy of the NASDSE Guidelines (also known as the
The guidebook ends with a self-assessment based on the purple book) reference handy. Try placing it on the
recommended practices in the book, Implementation: Deaf table during an IEP meeting to display your current
and hard of hearing program and service review checklist. knowledge of recommended practices.
This checklist is intended as a tool for professional teams

WHAT IS RESEARCH SAYING? Academic Status and Progress of Deaf and Hard-
of-Hearing Students in General Education Class-
There is a growing body of research on a variety of areas in rooms. Antia, S., Jones, P., Reed, S., & Kreimeyer, K.
deaf education. A summary of current research is beyond (2009). Journal of Deaf Studies and Deaf Education,
the scope of this chapter. Rather, we have listed some of 14(3), 293–311.
the federally funded research projects with links to further Social outcomes of students who are deaf and hard of
review their goals and outcomes as well as a brief summary hearing in general education classrooms. Antia, S. D.,
of key points in Table 14–2. Jones, P., Luckner, J., Kreimeyer, K. H., & Reed, S.
(2011). Exceptional Children, 77(4), 489–504.
■■ Longitudinal Study of Mainstream Deaf and Hard of
Validity and Reliability of the Classroom Participa-
Hearing Students (U.S. Department of Education CDA
tion Questionnaire with Deaf and Hard of Hearing
84.324C, University of AZ, Longitudinal Study of Aca-
Students in Public Schools. Antia S., Sabers, D., &
demic and Social Status of Deaf and Hard of Hearing
Stinson, M. (2007). Journal of Deaf Studies and
Students Attending General Education Classes in Pub-
Deaf Education 12(2), 158–171.
lic Schools, 2001–2006 [Shirin Antia PI]). Published
studies include:
TABLE 14–2 Key Points From Selected Federally Funded Research Projects
Research Key Points

Academic Outcomes ■■ On average, reading, language/writing, and math scores within the low average range as compared to
(Antia et al., 2009) peers.
■■ Math >33% scored average to above average.
■■ Reading and writing, 50% to 60% scored in the average range.
■■ Over 5 years, on average, students made a year’s growth in 1 year in reading and math; writing more
than 1 year’s growth.
■■ Teachers rated 70% to 80% of students’ achievement to be in the average to above average range in
academic competence compared to classmates.
■■ Classroom participation—on average, students ranked themselves as “almost always” understanding
their teachers and classmates.
Social Outcomes ■■ Social Skills and Problem Behaviors questionnaire completed annually (Social Skills Rating System,
(Antia et al., 2011) Gresham & Elliott, 1990).
Chapter 14
Social Skills: Over 5 years, on average, teachers rated 80% of students as average or above average;
students rated themselves similarly.
Problem Behaviors: Teachers rated <15% as having above-average problem behaviors—similar to
general population.
■■ Interviews
Students report social life more difficult as they transitioned to middle school.
Making new friends, adapting to several teachers, becoming more self-reliant, feeling singled-out due
to hearing loss.
Most difficulties resolved within a year or two.
CLAD ■■ A variety of research-based interventions have been shown to promote vocabulary development and
literacy development in deaf and hard of hearing children.
VL2 ■■ Research Briefs summarize benefits of fingerspelling, visual attention, eye gaze and joint attention,
bilingualism for language and literacy development.
OCHL ■■ Children’s language is impacted by what they hear.

■■ Hearing aids support language development.
■■ Aided audibility matters.
Listening Fatigue ■■ Increased listening effort and fatigue can negatively affect the ability to learn in school.
■■ Even for speech that is accurately recognized, school-age children with hearing loss require more time
for processing information.

492 Chapter 14
■■ Center on Literacy and Deafness (CLAD) (https://clad

.education.gsu.edu/). LEAD-K
■■ Visual Language and Visual Learning (VL2) (Gallau-
det) (http://vl2.gallaudet.edu/about/overview/). Kindergarten-Readiness = Lifetime Success! All
■■ Outcomes of Children with Hearing Loss (OCHL); Out- children are born ready to learn; however, far too
comes of School Age Children who are Hard of Hearing many deaf children are deprived of early language
(OSACHH), Complex Listening Skills in School Age development and are not kindergarten ready. Re-
Hard of Hearing Children (https://ochlstudy.org/). search has shown that language deprivation or de-
■■ Listening and Learning Lab (Vanderbilt University): lays between ages 0 and 5 years is the main cause
Listening Fatigue in School-Age Children (https://my of many deaf children’s eventual reading, academic,
.vanderbilt.edu/listeninglearninglab/). and social struggles. The type of language-rich en-
vironment and the quality of interaction to which
The research demonstrates that outcomes of deaf and children are exposed in the first five years of life
hard of hearing students are improving. The 5-year longi- greatly influence the outcomes of their adult lives.
tudinal study provided evidence of better academic per- (http://www.infantva.org/documents/LEAD-K
formance (Antia, Jones, Reed, & Kreimeyer, 2009). The -Website-At-A-Glance-FAQ.pdf ).
approximately 150 DHH students in this two-state 5-year
study found that their average academic performance was
within one standard deviation of grade level.
To summarize, there is evidence that children whose
hearing status is identified early, who participate in special-
ized early intervention programs, who participate in extra- the IFSP or IEP team’s responsibilities for deciding on actions
curricular school activities, who are motivated and able to to address language delays that are discovered.
advocate for themselves, and who have friends and appropri- At the time of publication, legislation has passed in Cali-
ate social skills are more likely to have a better outcome that fornia, Hawaii, Kansas, Oregon, South Dakota, Georgia, Indi-
those who do not have these experiences and skills. ana, Louisiana, Texas, and Maine. As momentum grows, it is
expected that more states will pass legislation that addresses the
early language acquisition and literacy development of young
deaf and hard of hearing children. Successful legislative efforts
LEGISLATIVE INITIATIVES have resulted when all concerned constituents within a state
IN DEAF EDUCATION have collaborated to share a common purpose and solution.
This legislation is needed to increase accountability to supple-
Current state initiatives in deaf education are typically fo- ment IDEA. Currently, the required Part C and Part B annual
cused in three areas: language and literacy accountability, performance data reported by states to the U.S. Department of
Deaf Child Bill of Rights, and hearing aid insurance. Education each year is not disaggregated. Therefore, there are
Chapter 14
no state or national level data on outcomes for deaf and hard of

Language Acquisition and hearing children. It is hoped that the long-term benefits of this
assessment and analysis will be improved services to infants
Literacy Accountability and young children, and as a result, language and literacy out-
This initiative stems from a grassroots movement, Language comes for kindergarten readiness will also improve.
Equality and Acquisition for Deaf Kids, LEAD-K, to promote
kindergarten readiness literacy skills for children who are deaf
and hard of hearing through American Sign Language and Deaf Child Bill of Rights
English. This movement was founded on the premise that all Since the first DCBR legislation passed in South Dakota in
children who are deaf or hard of hearing will benefit from 1993, 21 other states have passed similar bills. As discussed
both languages. The basis for this assertion stems from re- earlier, the DCBR lays out the specific components of the
search from the Visual Language and Visual Learning Center Communication Plan (example in Appendix 14–A) that is
(VL2) at Gallaudet University (https://vl2.gallaudet.edu) stat- part of each deaf and hard of hearing student’s IEP. The
ing that the lack of early and fully accessible visual language DCBR is important because it requires a specific discussion
exposure may contribute to poor reading levels in deaf chil- and documentation of the student’s language and communi-
dren. To address the LEAD-K goal (see text box), proposed cation needs, opportunities for direct communication with
state-level legislation requires a periodic language evalua- peers and professional personnel in the student’s language
tion of children from birth to age 5 years that is reported to a and communication mode, and the student’s academic level
statewide database and published in summary form as well as and full range of needs, including opportunities for direct
reported individually to parents. Specific procedures for the instruction in the student’s language and communication
assessment process are to be determined by an appointed state mode. The Communication Plan can be the basis for includ-
advisory committee. The legislation is not intended to usurp ing peer activities.

Hearing Aid Insurance ■■ evaluate instructional programs;

■■ document students’ achievement;
To close a gap in hearing aid funding, 26 states have passed
■■ evaluate professionals; and
legislation requiring insurance companies to cover hearing
■■ evaluate schools and school districts.
aids for children. Each state’s regulations have different stip-
ulations for how often, how much, and the upper age cap.
The NCHAM website (http://www.infanthearing.org) pro- Another categorization is method of assessment: formal
vides talking points for parents and professionals and sam- assessments usually use prescribed materials and include
ple legislation as resources for states that are pursuing hear- standardized measurement data (e.g., norms, reliability,
ing aid insurance. and validity), while informal measures can be observation,
self-assessment, teacher designed, or any combination but
would not have standardized data. Standardized tests can
also be criterion referenced or norm referenced. Criterion-
EDUCATIONAL ASSESSMENT referenced tests measure how well an individual performs
against an objective or criterion as compared to norm-
Student assessment involves multiple levels based on the pur-
referenced tests that are designed to compare students
pose and type of assessment. One categorization of assess-
against each other, resulting in a standard bell curve distribu-
ment is by purpose: statewide accountability for state perfor-
tion. One problem with interpretation of tests that measure
mance purposes, diagnostics for special education eligibility
in different ways is comparison of test score formats. The
and program planning, and curriculum-based measurement
chart in Figure 14–2 compares distribution of scores from
for progress monitoring. As the need for accountability has
a normal curve, percentiles, and selected standard scores.
increased, so has the role of assessment. Luckner and Bowen
A list of definitions for common assessment terminology
(2006) identified the following reasons for assessment:
is in Appendix 14–B. Appendix 14–C contains a summary
■■ identify student needs; of psychoeducational, language, and communication as-
■■ plan instruction; sessments that are often used with deaf and hard of hearing
■■ evaluate student progress; students.
Chapter 14
FIGURE 14–2 Normal curve, percentiles, and selected standard scores.

494 Chapter 14
Several states have developed assessment guidelines advocate and be personally responsible for their communi-
specifically for deaf and hard of hearing students. The Michi- cation access needs (see Chapter 11, Developing Individual
gan quick reference assessment guide (Michigan Department Plans, for more information). Appendix 10–E, Audiology
of Education-Low Incidence Outreach) contains an extensive Self-Advocacy Checklists, details a suggested schedule for
list of assessments and resources in the areas of audiology, the development of self-advocacy competencies by elemen-
language and vocabulary, functional listening, use of am- tary, middle school, and high school.
plification, academic/vocational performance, and personal The assessments contained in Phonak’s Guide to Ac-
adjustment and transitions. This guide (downloaded from cess Planning (GAP) (https://www.phonakpro.com/us/en
https://mdelio.org/sites/default/files/documents/DHH/Ser /resources/counseling-tools/pediatric/guide-to-access-plan
viceDeliveryTools/AssesmentResourceGuide/Assessment ning/guide-to-access-planning.html) are also useful tools
_Resource_Guide_for_Students_Who_are_DHH_Aug_2018 to identify skills that students have acquired and those that
.pdf) is intended to accompany the Michigan Educational still need to be learned. A planner accompanies each assess-
Impact Matrix for students who are Deaf or Hard of Hear- ment for documenting skills that are targeted in the assess-
ing (Appendix 5–L). Similarly, the Ohio Outreach Center ment. The MyGAP Transition Checklist covers 12 areas:
for Deafness and Blindness (https://deafandblindoutreach hearing loss and hearing technology, communication needs
.org/) at the Ohio Center for Autism and Low Incidence and accommodations, social skills, functional skills, money
(OCALI) published Guidelines for the assessment and edu- management, survivor skills, work-related skills, communi-
cational evaluation of students who are deaf or hard of hear- cation skills, school-/work-related grooming skills, health
ing (2017). and safety, recreational, and education/training after high
school. This comprehensive tool is useful for students who
have global needs for developing skills that will lead to
independence.
TRANSITION PLANNING Knowledge about the Americans with Disabilities Act
(1990) and the ADA Amendments Act of 2008 may not
Transition to postsecondary education and employment can have been stressed earlier in a student’s education, but in-
be a stressful time for students and their parents. However, formation is crucial for students to have as they transition
when students have had opportunities to learn about their to adulthood. Table 14–3 contains a brief list of differences
legal rights and resources for independence throughout their between IDEA, legislation that provides entitlement for edu-
education, the transition planning process may be easier. cation to students with disabilities, and ADA, a civil rights
Self-determination and self-advocacy training should begin law that provides for access and prohibits discrimination,
very early in life, but it is imperative that students who are that illustrates clearly the varying philosophies of each type
deaf or hard of hearing refine those skills before leaving of legislation.
high school. IDEA requires that transition planning begin These items clearly illustrate a move from institutional
for students with disabilities no later than 16 years of age.2 responsibility for right to education toward adult responsi-
Chapter 14
Students who are deaf or hard of hearing should participate bility to advocate for educational and access rights. Students
in developing the goals and objectives for their transition who are knowledgeable about their rights and responsibili-
IEPs, and educational audiologists should be involved in ties can become empowered adults who are increasingly
helping students acquire the necessary skills to be able to successful advocates for themselves throughout adulthood.
TABLE 14–3 Comparison of Basic Individuals with Disabilities Education Act (IDEA) and Americans
With Disabilities Act (ADA) Rights
IDEA ADA
■■ Right to education ■■ Right to access/reasonable accommodations
■■ District identification ■■ Student self-identified
■■ Evaluation borne by district ■■ Student bears cost of evaluation
■■ District develops educational plan ■■ No requirement for a plan
■■ District responsible for implementing plan ■■ Student responsible for requesting and ensuring
■■ Built-in accountability accommodations
■■ No accountability required
2
34 CFR §300.320.

BEST PRACTICE CONSIDERATIONS Table 14–4 suggest more specific types of accommodations
and services that may be provided within each of these tiers.
FOR EDUCATING CHILDREN Identifying students by tiers provides a snapshot of the
AND YOUTH WHO ARE DEAF overall range of performance levels as well as associated
needs. This information helps program staff match up the
OR HARD OF HEARING needs of students with the services they will receive, de-
termine teacher caseloads, and identify where additional
Know Your Students resources may be needed.
One of the first steps in planning educational services is
knowing who the students are in your school district, their
general performance levels, and IEP or Section 504 services.
The tiered model of educational services in Figure 14–3 is an
adaptation of the RtI/MTSS model to represent a continuum Nuggets from the Field
of services for educating deaf and hard of hearing students
regardless of special education status and to incorporate Universal Design for Learning (UDL) is becoming
Universal Design for Learning (UDL) strategies (see Chap- a necessity for teachers who need to address the
ter 7 for more on UDL). Students in Tier 1, Core Instruction, multiple learning needs within the complex makeup
have minor or no documented adverse effects of their hear- of their classrooms. For many students with specific
ing status. They may be served by an IEP or 504 plan for learning needs, these whole-class strategies are both
accommodations. Tier 2 students are performing within 1 to effective and efficient. However, for students with re-
2 years of their grade level and receive specialized instruc- duced hearing, universal and targeted supports are
tion mostly within the general education classroom environ- not always “enough.” Students with reduced hearing
ment. Tier 3 students are further behind and require more often require intensive, individualized interventions
intensive services including individualized direct instruction in addition to the Tier 2 and Tier 3 supports already
from the teacher of the deaf/hard of hearing. Deaf students in place in their classrooms. (K.Yuskow)
with significant other disabilities are included in this tier.
Chapter 14
FIGURE 14–3 Tiered model of program services and supports. (From Johnson, Cheryl DeConde. [2016]. Educational advocacy across the
curriculum In M.P. Moeller, D. Ertmer, & C Stoel-Gammon, Promoting Language & Literacy in Children who are Deaf or Hard of Hearing.
Baltimore, MD: Paul H. Brookes Publishing Co. Inc. Reprinted by permission.)

496 Chapter 14
TABLE 14–4 Core, Targeted, and Intensive Intervention Strategies for Students Who Are Deaf or Hard of Hearing
Tier 3:
Intensive, Individualized
Interventions (All students require
Tier 1: special education, and all services must
Core Universal Interventions Tier 2: be noted on Individualized Education
(All students; Preventive, Proactive) Targeted Group Interventions Program IEP)
■■ Staff awareness of signs of hearing Tier 1 Interventions plus: Tier 1 and 2 interventions plus:
and listening problems ■■ In service for staff and students ■■ Individualized instruction
■■ Hearing identification procedures regarding implications of reduced ■■ Expanded core curriculum
■■ Hearing loss prevention education hearing ■■ Determine interventions with
■■ Consideration of acoustical and visual ■■ Testing/exam accommodation and parent and student input
access (e.g., lighting, captioning) in the modifications ■■ Individualized accommodations
classroom and reduction of auditory/ ■■ Small group vocabulary development
■■ Monitoring for use of appropriate
visual distractions and literacy support personal and hearing assistive
■■ General classroom communication ■■ Targeted accommodations to provide technology
accommodations to enhance communication access (e.g., priority ■■ Receptive, expressive, and/or
spoken information (e.g., slower seating) pragmatic language intervention
pace, provision of processing time, ■■ Note-taking support
■■ Expanded training and consultation
paraphrase, acoustic highlighting) ■■ Remote microphone hearing assistive to general educators about deaf
■■ Classroom audio distribution system technology education and the roles of other
in classrooms with high ambient noise ■■ Monitor implementation of support service providers
levels accommodations and use of assistive ■■ Team meetings to assure
■■ Multisensory reading techniques technology to ensure appropriate use interventions are implemented
■■ Frequent checks for comprehension (when used) appropriately
■■ Experiential education opportunities ■■ Discuss and problem-solve concerns ■■ Resources for specialized
■■ Predictable routine with structure and with parents/student assessments/consultation
paired with language
■■ Graphic organizers
■■ Monitor learning rate and level of
performance
■■ Problem-solve to adjust strategies
Chapter 14
Adopt Program Standards and hard of hearing students (e.g., educational audiologist,
teacher of the deaf/hard of hearing, educational interpreter,
Prior to conducting a review of deaf education programs,
speech-language pathologists, counselor, psychologists, and
supports, and services, it is helpful to have professional stan-
any other specialists that are part of the team). Adding a
dards or recommended practices as a guide. The NASDSE
parent or two is also beneficial. The program review pro-
Educational Service Guidelines (2018) serve this purpose.
cess also provides an opportunity to educate others regard-
While the development of standards such as these is impor-
ing basic program parameters and the need for refinement or
tant to guide state and school district practices, the standards
more significant changes. Appendix 14–D lists the NASDSE
may lack evidence that substantiates their benefit. To the
program review areas and the accompanying prompts. The
degree possible, standards should contain this evidence and
actual program review checklist with the gap analysis can
research that justifies their practice as well as determines
be downloaded (http://www.nasdse.org). The program areas
which standards are most critical to improving student and
and questions in the checklist are based on the 10 essential
family outcomes.
practice areas of the uigdelines.
Conduct a Program Review

A periodic review of programs and services is necessary
Identify Evidence-Based and
to discuss practices, identify gaps, and plan and imple- Consensus-Based Practices
ment program improvements. A thorough review should be Given the lack of evidenced-based practices, many teachers
completed by the multidisciplinary team that serves deaf focus on consensus-based practices, that is, ones that we

agree are good practices to implement with deaf and hard Department of Education first drafted an ECC for deaf and
of hearing students even though we lack sufficient scientific hard of hearing students in 2004. This draft was revised
evidence to support their use. However, several federally and published in 2010 identifying and defining the areas
funded research projects have resulted in more knowledge below. The 2019 update of Iowa’s ECC can be downloaded
of evidence-based practices. The best-kept secret is the web- at: https://educateiowa.gov/sites/files/ed/documents/ECC
site at http://www.deafed.net. Among other resources, this -DHH-April2019.pdf:
website contains a list of top 20 recommended practices in
■■ Audiology
literacy, math, and science.
■■ Career Education
■■ Communication
Utilize Progress Monitoring ■■ Family Education
■■ Functional Skills for Educational Success
Progress monitoring is a process of collecting ongoing data
■■ Self-Determination and Advocacy
to monitor skills that are important for students to be suc-
■■ Social-Emotional Skills
cessful in school. The results of the data are used to adjust
■■ Technology
instruction to increase performance. These performance
benchmarks must be an integral part of instruction and need In addition to adding these curricular areas, our next
to be conducted frequently to monitor progress in core aca- challenge is who will teach them, and where will we fit the
demic subjects including language, reading, and math. De- instruction into the school day. Denver Public Schools de-
pending on the child’s performance levels, measurements veloped their version of the DHH Expanded Core Standards
may occur weekly, biweekly, or monthly, or as needed by a including how each team member will address each one
child. Curriculum-based measurements (CBM) can take as (Figure 14–4).
little as 1 minute and are often part of the content curriculum
(i.e., reading or math program). Common CBM measures
include DIBELS, AIMS WEB, and Ed Check-Up. The lat- Utilize Deaf and Hard of Hearing
ter is managed through the University of Minnesota and in- Peers and Role Models
cludes performance data on students who are deaf and hard Students benefit from being with peers as well as adults who
of hearing (https://charts.intensiveintervention.org/progress have similar lived experiences. From these opportunities,
-monitoring/children%E2%80%99s-education-services students see and learn how various situations are handled
-inc-formerly-edcheckup-standard-reading-passages). Stu- and how accommodations are used. They also see that deaf
dent performance data should be graphed so that the data are and hard of hearing adults have successful employment and
readily understood by parents and school staff. quality lifestyles.
Incorporate Expanded Core Curricula Engage Parents and Caregivers
Chapter 14
Another component of quality programming involves the Parents are critical partners in their children’s education.
expanded core curricula (ECC). These topics expand on the However, they also have work and family obligations. Chap-
required school curricula to address specific instruction in ter 3 discusses the importance of family involvement and
areas that are unique to deafness and hearing loss. The Iowa ideas for engaging and keeping them engaged.

498 Chapter 14
DHH Expanded Core Standards At-a-Glance
Standards Concepts & Skills
1. Functional 1. Speech Perception

Auditory Performance Utilize audible speech information in a variety of conditions to access
learning (accessibility of speech only; no skill development)
2. Auditory Development
Demonstrate auditory skills which follow a developmental hierarchy
3. Functional Listening
Exhibit active listening across all environments
2. Language & 1. Receptive Language
Communication Demonstrate receptive language skills within the context of
communication competencies
2. Expressive Language
Demonstrate expressive language skills within the context of
communication competencies
3. Pragmatics
Demonstrate appropriate pragmatic language in communication
interactions
3. Academic Skills 1. Concept Development & Comprehension
Identify main ideas and recognize, understand and make inferences using
background knowledge and context
2. Organization & Study Skills
Use organizational, decision-making, and problem solving skills to manage
time, materials, communication and assignments
4. Social 1. Self-Esteem & Self-Concept
Develop self-awareness and self-determination, manage their emotions,
and utilize support networks
2. Personal & Interpersonal
Demonstrate appropriate social interactions and develop positive
relationships
Chapter 14
5. Self-Advocacy & 1. Understanding Hearing Loss

Technology Understand and manage personal hearing information
2. Technology Management
Understand and manage personal and/or hearing assistive technology
3. Environmental Management & Access
Understand, choose, and implement accommodations to support access
4. Resources & Community
Demonstrate knowledge of and ability to use and access resources,
understand their rights within the legal system, and prepare for post-
secondary life
Deaf & Hard of Hearing Expanded Core Standards

Denver Public Schools, June 2019
FIGURE 14–4 Expanded core standards and hearing team roles for implementation.

1. FUNCTIONAL AUDITORY 2. LANGUAGE & 5. SELF-ADVOCACY &
3. ACADEMIC SKILLS 4. SOCIAL
PERFORMANCE COMMUNICATION TECHNOLOGY
FIGURE 14–4
Audiologist Audiologist Audiologist Audiologist Audiologist
 Speech perception  Observation of  Initial academic review at  Observation and/or  Promote advocacy
assessment communication and identification of hearing assessment of classroom regarding technology
 Select, fit, instruct, verify, language skills loss to determine need for participation and management
(continued)
and manage hearing services interaction  Assistive technology
technology Teacher of Deaf/HH  Consultation on access to services
 Environmental/acoustical  Vocabulary & language verbal instruction Teacher of Deaf/HH
assessment and assessment and  Assessment and Teacher of Deaf/HH
management instruction Teacher of Deaf/HH development of social  Assessment and
 Liaison to clinical  Pragmatics assessment  Liaison to special educator skills related to hearing instruction of self-
audiologist or medical and instruction  Support around loss advocacy skills related to
professional  Functional skills instructional impact of  Consultation on access to hearing loss
 Funding resources for development hearing loss participation and social  Transition planning related
personal hearing  Development and  Direct services as they communication to hearing loss
technology implementation of relate to hearing loss
Communication Plan impact Collaborative Collaborative
Teacher of Deaf/HH  Sign language support to  Provide information on  Consultation on access
 Auditory skills assessment staff as needed Collaborative DHH social gatherings to skills related to self-
and instruction  Liaison to SLP  Consultation regarding students and families advocacy and technology
*bold = direct service

impact of hearing loss on  Shared role with mental use
Collaborative Collaborative learning and access to health providers around  Provide community
 Consultation and core instruction behavior and affective resources specific to
HEARING TEAM SERVICES & ROLES

 Consultation regarding
instruction around communication access and  Recommend instructional needs hearing loss
auditory access needs accommodations and/or  Shared transition role with
 Consultation and  Potential shared role with modifications counselors and special
instruction around use SLP or ELA  Collaborate to determine educators
and care of technology  Partner with educational LRE/placement needs of
 Listening checks interpreter student
 Recommend  Shared role with
accommodations and/or educators in building
modifications
 IEP case management is provided by the school level team
 Case managers should consult with Teachers of the Deaf and Audiologists about documentation within Enrich
 Communication Plan will be completed by the Teacher of the Deaf
 Educational audiologists attend and consult on all 504 Plans
Educational Considerations for Students Who Are Deaf or Hard of Hearing
Deaf & Hard of Hearing Expanded Core Standards

Denver Public Schools, June 2019
499
2/25/2020 4:45:54 AM
Chapter 14
500 Chapter 14
SUMMARY School Climate

■■ Identification and development of every student’s po-
In many cases, children who are deaf or hard of hearing are
tential through individualized assessments, appropriate
excelling in school and receiving quality services including
placements, and ongoing encouragement from school
access to deaf and hard of hearing peers and adult role mod-
staff.
els. Others are not receiving an adequate education. They do
■■ Maintenance of a safe and orderly school where staff
not have access to a full range of program options or educa-
and students demonstrate respect for each other and are
tional opportunities that match their needs. School districts
free of fear, and where the code of conduct is well pub-
are trying, but the combination of low incidence and high
licized, fair, and uniformly enforced.
cost hampers even the best intentions. If the achievement
gap is to be closed, education for deaf and hard of hear- School Organization
ing students must address the problems and put resources
■■ Smaller classes, preferably with 18 or fewer students
toward implementing solutions.
particularly in the earlier grades.
Schwartz (2001) compiled a list of practices that re-
■■ Equitable grouping of students that places students of
search has shown to be effective in closing achievement gaps
color, in proportion to their numbers, in high-ability
for students in general. While you might think the list is
classes in the early grades and in higher tracks and col-
dated, it actually remains relevant today. Her list provides
lege prep.
strategies in state and district roles, early childhood devel-
opment, school climate, school organization, teaching and Teaching and Learning
learning, school management, and family supports. Fol-
■■ Provision of increased instructional time in reading,
lowing is a list of a few of the major topics with strategies
mathematics, and other basic skills.
included. Imagine the benefits to deaf and hard of hearing
■■ Provision of supplemental individualized education
children and youth if these strategies were implemented.
supports, including tutoring by professionals or trained
State and District Roles adult volunteers and peers; after-school, weekend, and
summer programs; and intensive in-school aid for re-
■■ Development and implementation of accountability
tained students.
standards to ensure high quality and good performance
■■ Provision of learning resources, such as reading spe-
of all administrators and educators.
cialists; computer technology and staff trained in its
■■ Dissemination of existing research-based instructional
use; and books for a student library, advanced text-
programs with demonstrated success to individual
books, consumable workbooks, and other high-quality
schools and dissemination of information about effec-
print materials.
tive instructional strategies and exemplary practices that
are effective in diverse class rooms.
Early Childhood
Chapter 14
■■ Provision of high-quality preschool programs that fos-

SUGGESTED READING
ter young children’s development of social and school National Association of State Directors of Special Education.
readiness skills, develop their interest in learning, and (2018). Optimizing outcomes for students who are deaf or hard
orient them toward academic achievement. of hearing: Educational services guidelines (3rd ed.). Alexan-
■■ Active recruitment of families to family literacy programs. dria, VA: Author. http://www.nasdse.org

APPENDIX 14–A
Colorado Individualized Education Program Communication Plan
Communication Plan For Student Who Is Deaf/Hard of Hearing or Deafblind
The IEP team has considered each area listed below, and has not denied instructional opportunity based on the amount
of the child’s/student’s residual hearing, the ability of the parent(s) to communicate, or the child’s/student’s experience with
other communication modes. To the extent appropriate, the input about this child’s/student’s communication and related
needs as suggested from adults who are deaf/hard of hearing has been considered. 300.324(a)(2)(IV) 4.03(6)(A)
1. Language and Communication
1. a. The child’s/student’s primary language is one or more of the following.
Check all that apply.
Receptive Expressive
  English
  Native language (ASL, Spanish etc), specify ___________________
  Combination of several languages
  Minimal language skills; no formal primary language
Describe:
Action Plan, if any:
1. b. The child’s/student’s primary communication mode is one or more of the following. Supports 300.116(e).
Check all that apply and if more than one applies, explain.
Receptive:
 Auditory  American Sign Language  Signing Exact English/Signed English
 Speechreading  Cued Speech/Cued English  Conceptual signs (Pidgin Signed English or
Chapter 14
 Fingerspelling  Gestures Conceptually Accurate Signed English)
 Tactile/objects  Picture symbols/pictures/photographs
 Home signs
 Other, please explain _____________________________________________________
Expressive:
 Spoken language  American Sign Language  Signing Exact English/

Conceptual signs (Pidgin Signed English  Fingerspelling Signed English
or Conceptually Accurate Signed English)  Home signs  Gestures
 Tactile/objects  Pictures symbols/pictures/
 Cued Speech/Cued English photographs
 Other, please explain
____________________________________________________
Explanation for multiple modes of communication, if necessary:
501

502 Chapter 14
Communication Plan For Student Who Is Deaf/Hard of Hearing or Deafblind
1.
c. What supports are needed to increase the proficiency of parents and family members in communicating
with the child/student? Parent Counseling Training 300.34(8)(i) and (iii)
Issues considered:
2.
Describe the child’s/student’s need for deaf/hard of hearing adult role models and peer groups in sufficient numbers of
the child’s/student’s communication mode or language. Document who on the team will be responsible for arranging
for adult role model connections and opportunities to interact with peers. (Section 3. 22-20-108 CRS II) 300.116
Placement Determination
Opportunities considered: ECEA proposed 4.03(6)(a)(iii)
3.
An explanation has been given of all educational options provided by the administrative unit and available for the child/
student. Placement determination 300.115 and 300.116
Placements explained:
Describe how the placement options impact the child’s communication access and educational progress:
4.
Teachers, interpreters, and other specialists delivering the communication plan to the child/student must have demon-
strated proficiency in, and be able to accommodate for, the child’s/student’s primary communication mode or language.
ECEA 3.04(1)(f)
Considerations:

Chapter 14
5.
The communication-accessible academic instruction, school services, and extracurricular activities the child/student will
receive have been identified. The team will consider the entire school day, daily transition times, and what the child/
student needs for full communication access in all activities.
Considerations 300.324(a)(2)(iv) Communication plan, 300.107 Non-academic settings, 300.101 FAPE:

APPENDIX 14–B
Assessment Terminology
Achievement Test—an objective examination that measures Functional Assessment—refers to assessments that reflect how
educationally relevant skills or knowledge about such sub- an individual actually performs in his/her customary environ-
jects as reading, spelling, or mathematics. ment or situation rather than in a structured assessment setting.
Age Equivalent—the estimated age level that corresponds Grade Equivalent—the estimated grade level that corre-
to a given score. sponds to a given score.
Age Norms—values representing typical or average perfor- Informal Test—a nonstandardized test that is designed to
mance of people of age groups. give an approximate index of an individual’s level of ability
Aptitude—an individual’s natural or acquired disposition to or learning style; often a teacher-constructed test.
perform certain tasks. Inventory—a catalog or list for assessing the absence or
Average—a statistic that indicates the central tendency or presence of certain attitudes, interests, behaviors, or other
most typical score of a group of scores. Most often, average items regarded as relevant to a given purpose.
refers to the sum of a set of scores divided by the number of Item—an individual question or exercise in a test or evalu-
scores in the set. ative instrument.
Battery—a group of carefully selected tests that are admin- Norm—performance standard that is established by a refer-
istered to a given population, the results of which are of ence group and that describes average or typical performance.
value individually, in combination, and totally. Usually norms are determined by testing a representative
Body of Evidence—a compilation of materials and docu- group and then calculating the group’s test performance.
ments that profile a person’s knowledge, skills, and abilities Normal Curve Equivalent—standard scores with a mean
Ceiling—the upper limit of ability that can be measured by of 50 and a standard deviation of approximately 21.
a particular test. Norm-Referenced Test—an objective test that is standard-
Composite Scores—reflect performance of a combined ized on a group of individuals whose performance is evalu-
group of subtests. ated in relation to the performance of others; contrasted with
Content Standards—describe what all teachers should criterion-referenced test.
teach and what students should know and be able to do. Objective Percent Correct—the percentage of items mea-
Chapter 14
Criterion-Referenced Test—a measurement of achieve- suring a single objective that a student answers correctly.
ment of specific criteria or skills in terms of absolute levels Percent Score—the percentage of items that are answered
of mastery. The focus is on performance of an individual as correctly.
measured against a standard or criteria rather than against
Percentile—the percentage of people in the norming sample
performance of others who take the same test, as with norm-
whose scores were below a given score.
referenced tests.
Performance Standards—describe the expected perfor-
Curriculum Based Measurement—a set of systematic and
mance that meets content standards.
data-based procedures that enable educators to make deci-
sions to plan for instruction; used to monitor student perfor- Performance Test—designed to evaluate general intelli-
mance in reading, writing, and math. gence or aptitudes. Consists primarily of motor items or per-
Diagnostic Test—an intensive, in-depth evaluation process ceptual items, because verbal abilities play a minimal role.
with a relatively detailed and narrow coverage of a specific Progress Monitoring—a method for quickly and frequently
area. The purpose of this test is to determine the specific learn- assessing student performance; a component of curriculum-
ing needs of individual students and to be able to meet those based measurement.
needs through regular or remedial classroom instruction. Published Test—a test that is publicly available because it
Domain-Referenced Test—a test in which performance has been copyrighted and published commercially.
is measured against a well-defined set of tasks or body of Rating Scales—subjective assessments made on predeter-
knowledge (domain). Domain-referenced tests are a specific mined criteria in the form of a scale. Rating scales include
set of criterion-referenced tests and have a similar purpose. numerical scales or descriptive scales. Forced choice rating
Frequency Distribution—is a record of how often each scales require that the rater determine whether an individual
value (or set of values) of the variable in question occurs. demonstrates more of one trait than another.
503

504 Chapter 14
Raw Score—the number of items that are answered correctly. Standard Deviation—a measurement of the spread or dis-
Reliability—the extent to which a test is dependable, stable, persion of a set of data.
and consistent when administered to the same individuals on Standard Score—a score that is expressed as a deviation
different occasions. Technically, this is a statistical term that from a population mean.
defines the extent to which errors of measurement are absent Standardized Test—a form of measurement that has been
from a measurement instrument. normed against a specific population. Standardization is obtained
Scaled Score—scores that are adjusted to reflect the perfor- by administering the test to a given population and then calculat-
mance of the sample group. ing means, standard deviations, standardized scores, and percen-
Screening—a fast, efficient measurement for a large popu- tiles. Equivalent scores are then produced for comparisons of an
lation to identify individuals who may deviate in a specified individual score to the norm group’s performance.
area, such as the incidence of maladjustment or readiness Stanine—one of the steps in a 9-point scale of standard scores.
for academic work. Subtest Scatter—refers to the variability in scores of the
Specimen Set—a sample set of testing materials that are subtests or components parts of a test.
available from a commercial test publisher. May include a Validity—the extent to which a test measures what it was in-
complete individual test without multiple copies or a copy tended to measure. Validity indicates the degree of accuracy
of the basic test and administration procedures. of either predictions or inferences based upon a test score.
Chapter 14
Note. The majority of these definitions are from A glossary of measurement terms, ERIC Digest. (1989). Extracted July 21, 2007, from www
.ericae.net/edo/ed315430.htm. (This publication was prepared with funding from the Office of Educational Research and Improvement (OERI),
U.S. Department of Education, under contract R-88-062003. The opinions expressed in this report do not necessarily reflect the position or
policy of OERI or the Department of Education. Permission is granted to copy and distribute this ERIC/TM Digest.)

APPENDIX 14–C
Summary of Psychoeducational, Language,
and Communication Assessments
NAME OF TEST AREAS TESTED AGE/GRADE RANGE GENERAL COMMENTS
Brigance Inventories Assesses preacademic, academic, Birth to adulthood Criterion-referenced tests.

and vocational skills. Comprehensive and ongoing
assessment. Results from many of
these tests are lists of skills mastered
and not mastered by the student.
On others, grade equivalents may be
found. Each test includes instructional
objectives that may be useful for
writing IEPs. Additionally, some tests
now have optional standardized
scoring conversion software.
Woodcock-Johnson, All academic areas including 2 to over 90 years The tests are norm-referenced.
Fourth Edition academic knowledge. Scores Allows for intra-achievement variation
(WJ IV), Tests of help measure performance (preschool to procedures. When used along with
Achievement levels, determine educational university graduate the other WJ IV batteries, it provides
progress, and identify individual students) comparisons including general
strengths and weaknesses. intellectual ability to achievement,
scholastic aptitude to achievement,
oral language to achievement, and
academic knowledge to achievement.
Chapter 14
The tests requiring the use of
phonological skills (e.g., Word Attack,
Oral Reading) may be invalid for
some DHH students and when used
to compare with achievement, should
be interpreted with great caution.
Kaufman Test of Educational Individually administered 4 to 25 years This test is norm-referenced. Some
Achievement, Third Edition assessment of academic Pre-kindergarten of the early reading items ask a
(KTEA-3) achievement. through 12th grade+ student to demonstrate an action
that can be challenging to explain
to emergent readers. Some of the
early letter identification and spelling
items require the student to identify
the sound that corresponds to a
letter, which may be invalid for some
DHH students. Additionally, the oral
composites and subtests involving the
identification of nonwords may be
invalid for some DHH students.
(Continues)
Note. From L. Coyner Magee, PhD, School Psychologist, Amphitheater Public Schools, Tucson, Arizona, and S. Boehm, PhD, School Psychologist,
Arizona State Schools for the Deaf and the Blind, 2019. Used with permission.
505

506 Chapter 14
NAME OF TEST AREAS TESTED AGE/GRADE RANGE GENERAL COMMENTS
Qualitative Reading Assesses prior knowledge, Emergent to high Allows for a more diagnostic view
Inventory, Sixth Edition reading comprehension, retelling school of reading performance; stories
(QRI-6) abilities, and story recall. are categorized by grade level.
Comprehension questions focus Independent, instructional, and
on both implicit and explicit frustration levels are determined.
aspects of each story. Both narrative and expository
passages are provided at each level.
KeyMath 3 Diagnostic Designed to provide a 4–6 to 21–11 years This test is norm-referenced.
Assessment (KeyMath-3 DA) diagnostic assessment of skill in Designed to assess understanding and
mathematics. application of math concepts from
counting through algebraic equations.
Wechsler Individual Individually administered 4–0 to 19–11 This test is norm-referenced. The oral
Achievement Test, assessment of all academic areas Pre-kindergarten composites and subtests involving the
Third Edition (WIAT-III including oral language. through 12th grade identification of pseudowords may be
invalid for some DHH students.
Test of Silent Reading A measure of silent reading 1st through This test is norm-referenced. The
Efficiency and efficiency and comprehension 12th grade form selected for administration is
Comprehension (TOSREC) with connected text that can be based on the student’s grade level,
administered individually or to which can result in frustration for
a group. students reading well below grade
level.
Test of Silent Word A measure of silent word reading 6–3 to 24–11 This test is norm-referenced. This
Reading Fluency, fluency that can be administered test is primarily a measure of word
Second Edition (TOSSRF2) individually or to a group. identification, word comprehension,
and silent reading fluency. The
normative sample included a
subgroup of DHH individuals
(n = 197).
Chapter 14
COGNITIVE AND EXECUTIVE FUNCTIONING ASSESSMENTS

NAME OF TEST AREAS TESTED AGE RANGE GENERAL COMMENTS
Children’s Color Trails Test Assesses sustained attention, 8 to 16 years Directions can be presented in a
(CCTT) sequencing, and other executive nonverbal format.
functions while reducing reliance
on language and diminishing the
effects of cultural bias and
parental verbal report.
Brief Rating Inventory Provides information regarding 5 to 18 years There are parent and teacher
of Executive Function executive functions in the home questionnaires as well as a self-
(BRIEF-2), School Age and and school environments. report questionnaire for students
Self-Report 11 to 18 years of age. This measure
provides information on a child’s
executive functioning, and the
scoring program that accompanies
the test can be helpful in generating
recommendations and IEP goals.
There are also preschool and adult
versions of the BRIEF-2.


Wechsler Intelligence Scale Assesses intellectual 6–0 to 16–11 Traditional measure for assessing
for Children, Fifth Edition functioning by sampling verbal intellectual functioning. With this test,
(WISC-V) comprehension, visual spatial an ancillary nonverbal index can be
abilities, fluid reasoning, working calculated. Caution should be used
memory, and processing speed. when administering the verbal and
working memory subtests as they
may not be valid for some DHH
students.
WISC-V, Integrated Individually administered test for 6–0 to 16–11 14 subtests that complement core
assessing cognitive processes. tests of the WISC-V. The subtests
Designed to be administered extend the information about
with or following the WISC-V. the cognitive processes and test-
taking behaviors that may affect
performance on the WISC-V. This test
contains a variety of subtests that can
help when assessing DHH students,
including visual working memory
subtests.
Wechsler Adult Intelligence Individually administered test of 16 to 90–11 Traditional measure for assessing
Scale, Fourth Edition intelligence/cognitive ability. intellectual functioning. Caution
(WAIS-IV) should be used when administering
the verbal and working memory
subtests as they may not be valid for
some DHH students.
Wechsler Nonverbal Scale Nonverbal assessment of 4 to 21–11 The subtests are similar to those
of Ability (WNV) cognitive ability. seen in other Wechsler batteries.
The test content is not dependent
on acquired language. The directions
are pictorial and require only minimal
spoken or signed communication
Chapter 14
by the examiner. Students are not
required to speak or sign to convey
their answer. Manual includes mean
performance data for a group of deaf
individuals (n = 37) and a group of
hard of hearing individuals (n = 48).
Leiter International A nonverbal individually 3 to 75+ The Leiter-3 is a nonverbal test of

Performance Scale, administered test of intelligence. intelligence that is administered
Third Edition (Leiter-3) through modeling and without
language. This test includes cognitive
scales as well as attention and
memory scales.
Stanford Binet Intelligence Individual assessment of 2 to 85+ Provides information on nonverbal

Scales, Fifth Edition (SB5) intelligence and cognitive abilities. reasoning. Caution should be used if
administering the verbal subtests as
they may not be valid for some DHH
students.
(Continues)

508 Chapter 14

Reynolds Intellectual Individual assessment of 3 to 94 This assessment has nonverbal and

Assessment Scales, cognitive functioning. visual memory subtests. Caution
Second Edition (RIAS-2) should be used if administering the
verbal and auditory memory subtests
as they may not be valid for some
DHH students.
Kaufman Assessment Individual assessment of 3 to 18–11 This test is grounded in two

Battery for Children, processing and cognitive abilities. theoretical models of intelligence.
Second Edition, Normative Updated normative information
Update compared to the KABC-II. Can be
(KABC-II NU) used to obtain a nonverbal index
(NVI). The NVI is composed of
subtests that may be administered
in pantomime and responded to
motorically to permit the valid
assessment of students who
are DHH, have language-related
difficulties, or do not speak English.
Differential Abilities Scale, Individually administered 2–6 to 17–11 Administration procedures are
Second Edition (DAS-2) assessment of cognitive functioning. straightforward and easy when
assessing DHH preschool and school-
age children. Test includes clusters
for nonverbal reasoning, spatial ability,
and a special nonverbal composite.
Manual includes mean performance
data for a group of DHH children
(n = 35). Optional DVD with signed
standardized sentences available.
Universal Nonverbal Individually administered 5 to 21-11 Directions are provided using

Intelligence Test (UNIT2) assessment of nonverbal standard gestures. Students are not
Chapter 14
reasoning and visual memory. required to respond to or provide

linguistic responses.
Rapid Automatized Individually administered measure 5-0 to 18-11 Quick and easy to administer and
Naming/Rapid Alternating designed to estimate an individual’s score. Naming speed is one of the
Stimulus Tests (RAN/RAS ability to accurately and rapidly see two best predictors of reading
Tests) and name a visual symbol (naming difficulties. The test does not rely on
speed). phonemic awareness which is difficult
for many DHH students.

VISUAL MEMORY/VISUAL MOTOR/VISUAL PERCEPTUAL ASSESSMENTS

Beery-Buktenica Measures the degree to which 2 to 100 years The VMI helps assess the extent
Developmental Test of visual perception and motor to which individuals can integrate
Visual-Motor Integration, behavior are integrated in their visual and motor abilities.
Sixth Edition (VMI) children. The test presents the examinee
with drawings of 24 geometric
forms, arranged in a developmental
sequence, from less to more
complex. The test can be individually
or group administered in just 10
to 15 minutes. Two supplemental
tests, the Visual Perception and the
Motor Coordination Test, can each
be administered in approximately
5 minutes or less.
The Bender Visual-Motor A nonverbal, standardized 4 to 85 years In addition to the quantitative

Gestalt Test, Second Edition perceptual motor test that screens information gleaned from this
(Bender-II) for visual motor integration measure, one can also obtain
dysfunction. Measures recall, significant qualitative information, e.g.,
motor and perception ability. planning and organization on paper.
Children’s Memory Scales Assesses dimensions of memory 5 to 16 years Both immediate and delayed visual
(CMS) and learning. memory can be assessed.
Wechsler Memory Scales, This test measures major 16 to 90 years This edition has seven subtests
Fourth Edition (WMS-IV) dimensions of memory functions; including a general cognitive screener.
immediate and delayed. There are tests to assess visual
sequential and visual spatial memory
with reduced motor components.
Also provides recognition as well as
recall subtests. Caution should be
used when administering the verbal
subtests with some DHH students.
Chapter 14
Wide Range Assessment of This test measures visual 5 to 90 years A variety of visual memory (recall
Memory and Learning memory, visual recognition, and and recognition subtests) as well as
(WRAML2) auditory memory, and it has visual spatial attention. Caution should
learning subtests. be used when administering the
verbal subtests with DHH students.

510 Chapter 14
BEHAVIORAL ASSESSMENTS
Clinical Assessment of Assesses psychosocial strengths 2 to 18 years Good psychometric properties; can
Behavior (CAB) (Teacher and weaknesses as well as problem be completed in a relatively short
and Parent Forms) behaviors period of time. The CAB is closely
aligned with diagnostic criteria found
in the DSM-IV-TR and IDEA.
Conners, Third Edition Assesses cognitive, behavioral, and 6 to 18 years Assists in evaluating attentional
(Conners 3) (Teacher, emotional problems with a focus on (Teacher and disorders, learning disabilities, and
Parent and Self-Report ADHD and comorbid disorders Parent Forms) behavior problems.
Forms) 8 to 18 years
(Self-Report)
Behavior Assessment Assesses behavior patterns, adaptive 2 to 21 years A variety of forms, including a
Scale for Children, and maladaptive (Teacher and (Teacher and Parent questionnaire for children 6 years
Second Edition (BASC-3) Parent forms); Self-Report provides Forms) of age and older. Parent and Self-
(Teacher, Parent, and Self- information about the student’s 6 years through Reports are also available in Spanish.
Report [SRP] Forms) emotions and feelings college age (SRP) Prior to administering the SRP with
a student, it will be important to
have an accurate assessment of the
student’s reading level.
Vineland Adaptive A series of items in progressive order Birth to 90 years Provides supporting documentation
Behavior Scales, Second of developmental difficulty designed when determining developmental or
Edition (VABS-3) to measure the successful stages of intellectual disabilities.
(Teacher and Parent social competence from infancy to
Rating Forms; Parent adult life
Interview Formats)
Adaptive Behavior Assesses all 10 specific adaptive skills Birth to 89 years Incorporates current American
Assessment System areas specified in the Diagnostic and Association of Intellectual Disabilities
(ABAS-3) Statistical Manual of Mental Disorders, (AAID) guidelines for evaluating
Fourth Edition (DSM-IV ) the three general areas of adaptive
behavior (Conceptual, Social,
Chapter 14
Practical). This assessment also

provides supporting documentation
when determining developmental or
intellectual disabilities.

LANGUAGE AND COMMUNICATION ASSESSMENTS

Receptive English Skills Receptive ASL Skills
Language: ASL Classifiers Receptive Test—University of Colorado
Clinical Evaluation of Language Fundamentals (CELF) ASL Syntax Test—University of Colorado
Test of Language Development (TOLD) ASL Vocabulary Test—University of Colorado
Cottage Acquisition Scales for Listening, Language, and Speech American Sign Language Development Observation Record
(CASLLS) American Sign Language Proficiency Assessment (ASLPA)
Test of Written Language (TOWL) The MacArthur Communicative Development
Vocabulary: Inventory for American Sign Language
Peabody Picture Vocabulary Test (PPVT) Communication Analysis System (CAS)
Receptive One—Word Picture Vocabulary Test (ROWPVT) SKI-HI Language Development Scale
Functional Listening Evaluation (FLE) Test of American Sign Language (TASL)
Test of Auditory Comprehension of Language (TACL)
Expressive English Skills Expressive ASL

Clinical Evaluation of Language Fundamentals (CELF) ASL Syntax Test—University of Colorado
Expressive One Word Vocabulary Test (EOWPVT) American Sign Language Development Observation Record
Cottage Acquisition Scales for Listening, Language, and Speech The American Sign Language Proficiency Assessment (ASLPA)
(CASLLS)
Test of Language Development (TOLD)
Communication Matrix (for students with severe cognitive
disabilities who may also have hearing loss)
The Word Test 2
Chapter 14

APPENDIX 14–D
National Association of State Directors of Special Education (NASDSE)
Implementation: Deaf and Hard of Hearing Program
and Service Review Checklist1
Purpose
This checklist synthesizes the essential recommended practices identified in Chapter 1 and further described in the subse-
quent chapters of these Educational Service Guidelines for Students who are Deaf or Hard of Hearing. The purpose of this
checklist is to provide a practical and systematic method for schools and programs to reflect upon their current practices,
stimulate serious conversations about them and guide improvements that impact student outcomes. The content of each
chapter in this volume provides expanded and detailed information on the recommended practices that are described. This
checklist is not exhaustive; the areas that follow can be expanded and/or additional items can be added at the discretion
of the reviewing team.
How to Use
This checklist encompasses the ten essential areas outlined in this volume that support educational programs and outcomes
for students who deaf or hard of hearing. To get started with your review:
1. Identify your review team. The team should include staff who provide services and supports to students and supervi-
sors or other administrative decision makers responsible for the programs and services. Parent participation in the
review team is also highly recommended.
2. Review each item, evaluating whether the practice is in place, partially in place or is currently not available. Provide
documentation for your responses. Due to the length of the checklist, consider completing the it over multiple sessions.
3. Based on the findings, develop next steps using the form at the end of the checklist.
The proposed steps should be the basis for an improvement plan with prioritized objectives, activities, identification of
required resources, timelines, persons responsible and measurable outcomes that verify that improvements will have the
intended results. The full descriptions of practices contained in the Guidelines may be used as goals for improvement plans.
Chapter 14
1. Considering the Unique Needs of Each Student

Students who are deaf or hard of hearing are diverse, encompassing a wide range of abilities, learning styles and often
co-occurring disabilities. Schools are required to make available a full continuum of services individualized to the needs
of each student for full engagement in all the school’s programs, including educational and extracurricular activities.
This area considers how the school recognizes that reduced hearing of any level can result in language, learning, social,
emotional and/or communication access barriers and understanding how these factors interact with one another. The
recognition of each child’s unique situation is paramount to appropriate assessment and services.
A. Is the impact on language, learning, social, emotional and/or communication access of each student’s hearing status
considered?
■■ regardless of hearing level or whether one or both ears are affected?
■■ whether co-occurring disabilities or other challenges are present?
■■ when language appears on target and speech is clear?
■■ whether sign language is used for communication?
1
Download fillable PDF form from http://www.nasdse.org
512

B. Are the cultural values and goals of the student and his/her family represented and integrated in the services and programs
that are determined?
C. Are educational services available to students who are deaf or hard of hearing:
■■ to support individual language and communication modes;
■■ to address the unique ways that students learn.
2. Expectations, Educational Programming, and Future Employment

When children who are deaf or hard of hearing are provided access to appropriate language, learning and academic op-
portunities that are designed to enhance their abilities, they can -- and do -- attain high levels of achievement that also
increase later employment opportunities.
This section examines how programs and staff facilitate student learning. Expectations for student achievement, how
programming is determined and delivered and how progress is monitored are key components.
A. Are students who are deaf or hard of hearing actively engaged in their own transition planning?
B. Is instruction determined by the individual student’s profiles, the IEP, and modified based on student’s progress and
instruction subsequently modified to meet the student’s needs?
C. Is there an expectation for data-driven instruction and evidenced-based practices?
D. Do opportunities exist within the school district for specialized instruction in areas unique to deafness and reduced
hearing e.g., the expanded core curriculum (academic areas of reading, math, and writing, communication and language
development (signed, spoken or both), auditory and listening skill development, use of technology, self-determination
and self-advocacy, social skills, deaf studies, and transition)?
E. Are supports in place specifically for underserved populations e.g., students with additional disabilities or challenges,
from non-English speaking homes, from diverse cultural and ethnic backgrounds, from rural areas) or for children who
are struggling learners?
F. Are universal design for learning strategies employed that result in accessible assessment, instruction and activities for
all students regardless of their communication mode or learning style?
G. Whether provided through the local school district or another agency, are providers of early intervention services for chil-
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dren and their families birth to age 3 knowledgeable in early childhood deaf education, including assessment of language
and communication development (signed, spoken, or both) and strategies for developing skills in these areas?
H. Are developmental milestones, including language, assessed at regular intervals in the early intervention program?
I. Are the quantity and quality of the assessments at transition from Part C to Part B thorough enough to identify gaps in
language, listening, communication and learning skills?
J. Do transition services from Part C to Part B inform and enable families to support their children?
K. Are preschool services structured to provide the specialized support necessary?
L. Does your district provide supports for pre-school children who were eligible for early intervention services but are
transitioning out of that program and are not eligible for Part B services, e.g., providing supports under the ADA or 504?
M. Are teachers and specialized instructional support personnel provided professional development opportunities and ongo-
ing mentoring regarding the variety of needs of, and appropriate practices for, students who are deaf or hard of hearing,
including those students with co-occurring disabilities?
N. Are teachers and specialized instructional support personnel provided support for implementation of curricular and in-
structional practices?
O. Are students who are deaf or hard of hearing, who are not eligible for special education, supported in their general educa-
tion classrooms through an appropriate 504 Plan?

514 Chapter 14
P. Are all students supported by the “effective communication” provisions of the Americans with Disabilities Act?
Q. Are post-high school transition supports and services available that are specialized for students who are deaf or hard of
hearing?
3. Families as Critical Partners

High levels of family involvement contribute to positive results for children. Parents have the right to be informed and
engaged participants in their child’s educational program as well as being respected for their preferences and choices.
Transition from early intervention to school age services, elementary to middle school and from high school to post-
secondary training and education are particularly vulnerable times.
This area addresses practices that include parents in all levels of planning and decision-making, including providing
accessibility for parents who require accommodations. Opportunities for parents to meet and share experiences, as well
as the availability of specific parent counseling and training services through the IEP, are important components of edu-
cational programing for students.
A. Are specific strategies used to include parents in all levels of planning and decision making for their children?
B. Are parents’ preferences and choices valued throughout educational planning?
C. Are specialized activities and programs available for parents, such as:
 Meeting with other parents of deaf or hard of hearing children?
 Social events specifically for families of children who are deaf or hard of hearing?

Transition support (e.g., early intervention to preschool, elementary to middle school, middle school to high school,
high school to post-secondary education and training)?
D. Are parent counseling and training services routinely provided through the IEP to assist parents to support their child’s:

Language development, whether  Social-emotional development?
signed, spoken or both?  Academic progress?
 Literacy development?  Other_______________________?
 Communication ability?
E. Are parents and families involved in discussions about a student’s eligibility for a obtaining a regular diploma, or lack
Chapter 14
thereof, at IEP meetings before and during high school?

F. Are specific strategies used to include parents of children who are deaf or hard of hearing in general school activities?
4. Language and Communication Access

Early language development is critical to cognition, literacy and academic achievement. Language competence, whether
spoken and/or signed, is the foundation upon which social-communication and social-cognitive skills are developed.
While development begins at birth, it continues through preschool, elementary school and beyond as academic and social
language skills evolve. Even if language ability is on target at age three when children typically transition into preschool,
attention must be maintained through these critical and vulnerable years so that consistent, full access to language is
provided and gaps are immediately identified.
This area addresses how individual language and communication needs are considered and accommodated in the student’s
learning environment, including the application of the “special factors” or the Communication Plan. Universal design,
classroom acoustics, instructional technologies and other access requirements are included in the considerations.
A. Do your schools collaborate with the local or state early intervention program to ensure the early intervention program
is meeting the language and communication needs of the children and their families?

B. Is the assessment of language at the time of each transition, (e.g., from early intervention to preschool, kindergarten,
middle school, high school, post-secondary education and employment) and all other times, comprehensive to identify
all gaps?
C. Regarding the language and communication needs addressed in the IEP: According to the requirements of IDEA, are the
child’s language and communication needs considered?
D. Regarding the language and communication needs addressed in the IEP: According to requirements of IDEA, are op-
portunities for direct communication with the child’s peers and professional personnel in the child’s language and com-
munication mode considered?
E. Regarding the language and communication needs addressed in the IEP: According to requirements of IDEA, are the
child’s academic level and full range of needs considered?
F. Regarding the language and communication needs addressed in the IEP: According to requirements of IDEA, are op-
portunities for direct instruction in the child’s language and communication mode considered and implemented?
G. Regarding the language and communication needs addressed in the IEP: According to requirements of IDEA, are the
student’s needs for assistive technology devices and services considered and provided, where appropriate?
H. Are communication opportunities available in each student’s language and communication mode?
I. Are communication opportunities flexible based upon the access needs of each classroom or activity?
J. Is there a continuum of placement opportunities available for students whose language and/or communication mode(s)
cannot be met within available school services?
K. Are specific strategies used to ensure full communication access in the classroom? Outside of the classroom (at school)?
In extracurricular activities?
L. Are staff familiar with the principles of universal design for learning and specific strategies that support students who are
deaf or hard of hearing?
M. Do classrooms meet the ANSI S12 acoustical recommendations for noise and reverberation levels in classrooms?
N. Do schools comply with the “effective communication” provisions of the Americans with Disabilities Act?
5. Individualized Specially Designed Instruction and Evidence-based Practices
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Instruction and accommodations should be individually designed to help students use their strengths to become confident
and independent. Assistive technologies provide critical access that can mitigate the effects of deafness or reduced hear-
ing. Although students who are deaf or hard of hearing have diverse needs, there is a growing body of specific evidenced-
based practices as well as practices utilized in general education and special education that can be modified for students
who are deaf or hard of hearing. Use of evidenced-based practices increases accountability for instruction and learning.
This area addresses how staff determine its approaches to instruction, use of curriculum and assistive technologies, and
how progress is monitored to ensure the effectiveness of instruction. Support for general education teachers and special-
ized instructional support personnel to understand the language, communication and literacy needs of their students is
also important to ensure the IEP goals and accommodations are implemented as intended.
A. Are decisions about programs and strategies that are used with students guided by recent research and evidence-based
practices?
B. Is training provided to general education teachers, specialized instructional support personnel and others to understand
the language, communication and literacy needs of their students?
C. Are classroom technologies used to enhance instruction?
D. Does the use of assistive technologies include a functional evaluation as to whether the technologies are appropriate,
effective and beneficial to the student, both in the classroom and in other environments?

516 Chapter 14
E. Do parents and students have a voice and choice in the assistive technologies and accommodations that are recommended?
F. Is there a monitoring plan to ensure that hearing aids, cochlear implants and other hearing assistance technologies used
by students are working consistently as required by IDEA.
G. Is there an annual budget to purchase hearing and other assistive technologies so that they can be replaced as technology
advancements are made?
H. Is training provided to the student, staff and parents on the use of the technologies and accommodations?
I. Are general educators and other staff trained and supported so that technologies and accommodations are implemented
as intended?
J. Are instructional supports and accommodations available and provided to students on 504 Plans?
K. Is there a person on the educational team responsible for monitoring 504 plans? If so, do other school personnel know
who this person(s) is?
6. Least Restrictive Environment (LRE)

The LRE is driven by a student’s language, communication, academic and social needs. Full inclusion may not be the LRE
for students who are deaf or hard of hearing. An environment is restrictive unless it provides full, direct and clear access
to meaningful language, communication, instruction and social opportunities. Decision makers must be knowledgeable
about the full continuum of available options, including special schools for the deaf on a full or part-time basis.
This area considers appropriate components of an LRE for students who are deaf or hard of hearing.
A. Are decision makers aware of the unique language, communication, academic and social needs of students who are deaf
or hard of hearing?
B. Are decision makers aware of all educational placements in the state that are available to students who are deaf or hard
of hearing? If an appropriate placement is not available in the state, are decision makers aware of possible out-of-state
placements?
C. Are relevant school staff knowledgeable about strategies for addressing the requirements of the IEP, including full access
to instruction? (see #4 above, Language & Communication Access).
D. Does the recommended placement provide full, direct and clear access to meaningful language, communication, instruc-
Chapter 14
tion and social opportunities?

E. Do funding mechanisms support placements in the appropriate settings?
F. If a student is placed in a specialized setting, is transportation provided on an equitable basis?
7. Educational Progress, Accountability and Oversight

Language, literacy, academic progress and social emotional wellness should be monitored frequently and reported ac-
cording to the same requirements for all students. For most students who are deaf or hard of hearing, goals and services
should minimally result in one year’s growth in one year based on relevant assessment and progress monitoring tools.
This area considers the knowledge of the responsible administrator(s) regarding deaf education issues, the knowledge of
staff in current practices and how they work together to support each other and ensure appropriate services within the
program, including student assessment and progress monitoring, and program development and evaluation. Appropriate
accountability and oversight measures are essential to ensuring that the findings of a self-assessment are analyzed and
discussed with the goal focused on high quality educational opportunities for students who are deaf or hard of hearing.
A. Does the program/school administrator(s) have knowledge of best practices in deaf education, educational interpreting,
educational audiology and other practices specific to students who are deaf or hard of hearing?

B. Does the program have a mechanism in place to evaluate providers of services to students who are deaf or hard of hearing
such as sign language interpreters?
C. Is the administrator(s) committed to high quality programs and services to meet the unique needs of its students?
D. Are efforts in place to maximize the use of funds to support services for students who are deaf or hard of hearing?
E. Is the district/school aware of the availability of Medicaid funds to support students who are deaf or hard of hearing? If
so, are the funds being accessed and used to o support these students?
F. Are programs and services routinely evaluated? Is there an on-going process and are there resources for reviewing stu-
dent outcomes, developing, recommending, implementing and monitoring individual student and district-wide service
improvements?
G. Is statewide assessment data disaggregated by disability to track and analyze performance of students to inform program
and service improvements?
H. Do teachers and administrators have high expectations for all students?
I. When students are not achieving progress on their benchmarks, how is the situation evaluated? Are IEP modifications
made to the services, placement or other facets of the program?
J. Is the IEP developed based on individual student needs rather than available services?
K. Is common planning time available for school district or agency-wide programming, including placements and disciplines
to establish common knowledge, maintain communication and ensure continuity of services?
L. Is the deaf education team provided opportunities to meet periodically to discuss roles and responsibilities, share ideas
and current practices and to attend training specifically related to their professional capacity?
M. Does the supervision process include individuals with expertise in the same areas as the service providers being super-
vised and evaluated?
8. Access to Peers and Adults who are Deaf or Hard of Hearing

Children and youth need ongoing access to students and adults like them. If students use ASL, signs or cued speech, flu-
ent adult and student signers with whom they can communicate effectively are especially critical. Adult role models are
beneficial to self-awareness, social communication and overall social and emotional wellness as well as learning about
access and other personal technologies.
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This area considers program considerations to promote peer and adult interactions.
A. Are opportunities for direct communication with peers and professional personnel in the child’s language and commu-
nication mode, as required by IDEA‘s Special Factors requirements, documented in the IEP?
B. Are peer social opportunities with similar age and grade-level students who are deaf or hard of hearing provided and
supported? Consider:
■■ How often?
■■ With whom (with the school district, with other schools, regional)?
■■ Who organizes?
■■ What types of activities?
C. Is access to professional personnel provided in the child’s language and communication mode provided?
D. Are adults who are deaf or hard of hearing utilized as mentors? If so, consider:
■■ How often?
■■ What type of training do they receive?
■■ Who organizes?
■■ What types of activities?

518 Chapter 14
9. Qualified Providers
Early intervention providers, teachers of the deaf and specialized instructional support personnel are the primary provid-
ers supporting students throughout their developmental and educational programs. These providers must meet professional
standards that include minimal qualifications and ongoing performance evaluations and be provided relevant professional
development opportunities.
This area considers staffing and staff shortages as well as specific efforts to recruit and retain them.
A. Are all staff (e.g., early intervention providers, teachers of the deaf/hard of hearing, educational audiologists, educational
interpreters, speech-language pathologists, school psychologists) associated with service delivery to students who are
deaf or hard of hearing appropriately licensed/certified and trained regarding the unique needs of this population?
B. Is relevant professional development available to all staff on a regular basis?
C. Are all providers appropriately evaluated by a professional from their field?
D. Are efforts being made to recruit and retain early intervention providers, teachers of the deaf/hard of hearing and special-
ized instructional support personnel? Are there any special provisions or incentives for these providers?
E. Are additional supports provided to staff who serve students in rural areas to address their travel, working in isolation
and other conditions unique to rural settings?
10. State leadership and Collaboration

Strong state and local leadership with effective collaboration among key stakeholders (parents, deaf and hard of hearing
consumers, state and local educators, university teacher preparation programs and advocacy organizations) is key to
successful systems of delivery of programs and services. To provide a perspective on how students who are deaf or hard
of hearing are performing from year to year, the state department should report annual student assessment results for
language and literacy.
This area considers components of various collaboration efforts.
A. Do the various state agencies, programs and schools for the deaf collaborate to provide a seamless continuum of place-
Chapter 14
ments, services and supports for children and their families through age 21?
B. Is there a core group of strong deaf education leaders and parents in the state to promote high quality educational services?
C. Does this group of leaders consider the state’s unique context, student assessment performance and other key indicators
when addressing issues and providing guidance to the state, local school districts, teachers, professionals and families?
D. Does the school district maintain connections with the state department of education, schools for the deaf, and entities
that provide professional development in deaf education and associated areas?
E. Does the school district collaborate with advocacy and other family support organizations for information that can lead
to successful administrative, procedural and legislative changes to improve outcomes for students who are deaf or hard
of hearing?

CHAPTER 15
Collaborative School–
Community Partnerships
CONTENTS
Establishing and Maintaining Relations With Community Resources

Identifying and Interfacing With Community Resources
Identifying Resources Through a Community Survey ■ Potential Community Partners
■ Updating the Community Resource Survey
Marketing and Advocacy for Educational Audiology Programs

Increased Name Recognition ■ Broadened Visibility of Services ■ Increased Knowledge of Program Outcomes
■ Internal Marketing ■ External Marketing
Chapter 15
“My team members!”
519

Developing and Fostering Creative Collaborative Efforts

Information and Materials to Share ■ Facilitating Interprofessional Collaboration ■ Fostering Creative
Community Collaboration
Legal and Ethical Issues
Summary
Appendices
15–A Sample Community Resource Survey Form (Text/Online)
15–B Service Clubs That Support Programs for Persons With Disabilities (Text)
15–C Sample Cover Letter to Community Resources (Text/Online)
15–D Community Education and Marketing Resources (Text)
15–E School and Community Survey of Educational Audiology Services (Text/Online)
15–F Sample Survey: Educational Audiology Services (Text/Online)
15–G Marketing/Advocacy Outcomes Log (Text/Online)
15–H EARS—School Contract Template (Text)
15–I Implant Center/School/Therapist/Parent Information Exchange Form (Text/Online)
15–J Characteristics That Foster Successful Collaboration (Text)
KEY TERMS Providing leadership through collaboration can help ensure

that all deaf and hard or hearing infants, toddlers, children,
Collaboration, interprofessional collaboration, internal mar- and youth are promptly identified, evaluated, and provided
keting, external marketing, messaging with appropriate intervention. Collaboration has been de-
scribed as a process to reach goals that cannot be achieved or
reached efficiently by acting alone. Collaboration is a means
to an end, not an end in itself. Primary reasons for educa-
tional audiologists to develop and maintain collaborative
KEY POINTS partnerships within their communities include the following:
■■ Knowledge of community options and development ■■ Positive community relationships lead to more efficient
of community partnerships can prevent duplication of service delivery for students, families, and the local
services and lead to more efficient and cost-effective school system.
Chapter 15
educational audiology programs and services. ■■ Knowledge of options in the community can prevent
■■ Collaborative community relationships prevent road- duplication of services and lead to more cost-effective
blocks to information sharing and facilitate referral and service delivery.
intervention processes for deaf and hard of hearing stu- ■■ Collaborative community relationships facilitate effi-
dents and their families. cient exchange of information, thus easing the referral
■■ Positive community relationships enhance and broaden process for medical, audiological, educational, and in-
support from local leaders, parents, and other service tervention follow-up for students with reduced hearing
providers. and listening.
■■ Educational audiologists must be visible and clear ■■ Collaborative systems can provide families with broader
about who we are, what we do, and the value of these and more rapid access to identification, information,
services within the educational setting. support networks, and appropriate service options.
■■ Successful educational audiology programs require ■■ Community collaboration facilitates support from local
name recognition, visible services, and positive student leaders, parents, and other service providers when fund-
outcomes. ing crises occur.
520

Collaborative School–Community Partnerships 521
■■ Community members can assist in establishing priori- IDENTIFYING AND INTERFACING

ties when services must be cut or altered.
WITH COMMUNITY RESOURCES
Knowing the existence of community resources and
ways to access and obtain their support in the design and de- Identifying Resources Through a
livery of educational audiology services is invaluable. Ques-
Community Survey
tions to be asked during this process include the following:
Completing a survey to identify the current status of community-
■■ What audiology services are available within this based audiology resources and their target population(s) is
community? a critical first step in developing a network for community
■■ Are there gaps in existing audiology services? collaboration. This process will identify gaps in services
■■ Could an educational audiology program fill gaps that and highlight and prioritize those gaps that the educational
have been identified? audiology program can address. Because it is much more
■■ What strategies can be used to facilitate collaboration difficult to modify or eliminate a service (even one that is a
with community resources? duplication) once it has been delivered, priority service gaps
■■ How can community and educational audiology pro- should be addressed as quickly as possible.
grams support and enhance each other and achieve im- If the educational audiology program already exists but
proved outcomes for deaf and hard of hearing children? a formal community survey has never been completed, time
This chapter addresses these questions by suggesting spent to identify costly and unnecessary service duplication
strategies to identify, inform, and interface with existing is critical. After survey information is analyzed, it should
community resources. In addition, techniques are described become clear when services such as functional listening
to assist educational audiologists in the development of rela- skill assessment, classroom observation, or onsite support
tionships with community resources that can foster ongoing for recommended accommodations are not available. Docu-
collaboration. mentation can facilitate the development or expansion of
an educational audiology program to address these gaps in
student services. An alternate approach to a formal survey
described by Zombek et al. (2017) was used in the develop-
ment of the Northeast Ohio Consortium for Children with
ESTABLISHING AND Cochlear Implants (NOCCCI). Their initial and follow-up
interagency meetings used a brainstorming approach to de-
MAINTAINING RELATIONS scribe program strengths and weaknesses and develop strat-
WITH COMMUNITY RESOURCES egies to address mutual concerns. Three communication
exchange forms were developed to facilitate collaboration
An early report from the North Central Regional Educa- between schools and CI centers and are available for down-
tional Laboratory (1993) identified the following guidelines load online (http://noccci.weebly.com).
as necessary for effective collaboration:
■■ involvement of all key players;
■■ visionary leadership that is willing to take risks and fa-
cilitate change;
■■ shared vision and expected outcomes for children and
Chapter 15
families;
■■ ownership at all levels with commitment to change; Service Gap or Duplication?
■■ communication and decision-making processes that ac-
cept conflict and address it constructively; and
■■ individual and agency goals for collaboration that in- If a hearing aid bank or loan program already ex-
clude designation of both time and funds for collabora- ists in the community and can be made accessible
tive activities. to students who need loaner hearing aids, it may
require less time and expense for the educational
Although the above guidelines were developed a num- audiology program to phase into this existing pro-
ber of years ago in the context of government policy, they gram than it would require to establish a duplicate
have direct application to the development of collaborative bank within the school facility. If no hearing aid bank
partnerships between educational audiologists and their lo exists, then this is a gap in services that the educa-
cal communities. It is important to keep these guidelines in tional audiologist may wish to make a top priority.
mind when initiating and participating in collaborative ac-
tivities similar to those described in the following sections.

522 Chapter 15
Potential Community Partners agencies, processes, and guidelines vary in states and local
districts (http://www.infanthearing.org/states). It is critical
A community resource survey should list all programs and
for educational audiologists to become knowledgeable about
agencies that deliver audiology services in the community,
EHDI programs within their local communities and to sup-
as well as potential resources for financial and volunteer
port and promote early detection and intervention services.
support for an educational audiology program. Following
The following list contains suggested strategies for educa-
are sample questions to answer through a resource survey:
tional audiologists related to collaboration with community
■■ What services are offered by each individual and agency? EHDI programs:
■■ Who is eligible to receive these services?
■■ Identify the contact person who is in charge of the local
■■ What do these services cost?
EHDI program as well as the follow-up portions of the
■■ Are there limitations on the frequency or quantity of
program.
the services?
■■ List the birthing and follow-up testing sites and contact
■■ Does the service provider take third-party reimburse-
person for each.
ment? If so, what type?
■■ Identify the screening and follow-up testing protocol
■■ When and where are these services available?
that is used.
■■ Who offers related medical services? Where, and at what
■■ Identify the funding source(s) and current fees that are
cost?
charged to families, if any.
■■ What is the process for referrals to these individuals
■■ Identify the information that is given to parents at the
and agencies?
time of the initial screening and in what form this infor-
■■ How is information shared with these individuals and
mation is provided (obtain copies of all forms and any
agencies?
additional written information provided).
■■ What agencies or organizations might provide support
■■ Offer to collaborate and be a resource for the local
for additional audiology services?
EHDI program.
At a minimum, a community survey should include the
Nationwide, newborn hearing screening programs re-
areas and resources listed in Table 15–1. A brief description
port that up to 50% or more of infants who fail their initial
of each target area follows, and a sample format for compil-
screening are lost to follow-up (cdc.gov 2016), and this may
ing the survey information is included as Appendix 15–A.
be an area of need that educational audiologists can help
address. In states where the EHDI program is managed by
an agency other than the state department of education, in-
Early Hearing Detection and Intervention Programs teragency sharing of information can present challenges. In
Every state and territory in the United States has early hear- these situations, it is critical for educational audiologists to
ing detection and intervention (EHDI) programs, but lead work with the agency involved to facilitate permission for
release of information. Where there are interagency agree-
ments on a statewide level, these should include the shar-
ing of names and potential contact information for families
TABLE 15–1 Target Areas for Educational Audiology in order to help reduce loss to follow-up rates. Educational
Community Resource Survey audiologists can assist families in understanding screen-
■■ Early hearing detection and intervention screening programs ing and diagnostic information and navigating referrals
when they have this information. Some states (e.g., Geor-
Chapter 15
■■ Child Find programs

gia) have an EHDI system where babies are given an ID
■■ Early intervention programs and providers
tracking number at birth in order to include as many chil-
■■ Hospitals and outpatient rehabilitation facilities
dren as possible in their outcome follow-up data without
■■ Physicians compromising confidentiality. Educational audiologists can
■■ Community-based audiologists provide additional information concerning educational risks
■■ Cochlear implant centers resulting from reduced hearing and suggest or collaborate
■■ Public health clinics in the development of resources designed for parents (see
■■ University training programs EHDI e-book in Recommended Resources at the end of this
■■ Service clubs chapter).
■■ Parent support groups
■■ Advocacy organizations
Other Child Find Programs
■■ Child care agencies If additional programs within the community include the
■■ Recreation services
identification of hearing status in children, the educational
audiologist’s community survey activity should provide for
■■ Corporate resources
the following:

■■ List and identify any program (e.g., Head Start) not in- TABLE 15–2 Potential Pediatric Hearing Services Available
cluded in any other category that screens children for From Hospital Programs or Outpatient Rehabilitation Facilities
hearing in the community.
■■ Hearing screening
■■ Identify the name, address, and phone number of the
■■ Behavioral auditory assessment
contact person.
■■ Electrophysiologic auditory assessment
■■ Describe screening protocol and personnel used.
■■ Identify what happens to children who refer from com- ■■ Auditory processing evaluation and management
munity or agency screenings. ■■ Cochlear implant evaluation
■■ Cochlear implant programming
For example, the local shopping mall may sponsor an
■■ Assessment of vestibular function
annual health screening day that includes pure-tone hearing
■■ Otologic assessment
screening administered by local Kiwanis Club members. Is
■■ Otologic treatment
information kept in a master file, given to parents, or avail-
able for service providers? Are parents given a list of refer- ■■ Cochlear implant surgery
ral sources in the community, as well as notified that free ■■ Personal hearing instruments (evaluation, fitting, dispensing)
screenings and audiolology evaluations may be obtained ■■ Osseointegrated device programming, fitting, dispensing
through their children’s school districts (see text box)? Is ■■ Remote microphone hearing assistive technology (RM HAT)
this a program that has one or more gaps that the educational (evaluation, fitting, dispensing)
audiologist could fill (e.g., assistance in training and super- ■■ Aural (re)habilitation (individual, group)
vision of those who screen hearing, provision of written ■■ Listening and spoken language (LSL) therapy
information about hearing challenges and the educational ■■ Intervention incorporating American Sign Language (ASL) or
audiology program services, referral forms)? Best practice other sign language systems
calls for educational audiologists to be involved in the de- ■■ Family support groups
sign or implementation of any community hearing screening ■■ Parent–infant programming
project that includes children and youth.
Hospitals and Outpatient Rehabilitation Facilities

■■ identifying the individual in charge of receiving and
Many community hospitals provide hearing services to the disseminating information from the educational setting.
pediatric population. Relevant information for educational
audiologists may be obtained by Services for children may include (but are not limited
to) those identified in Table 15–2.
■■ listing and describing each program provided through
the local hospital(s) and rehabilitation facilities on an
outpatient basis; Physicians
■■ cross-referencing any newborn screening program pro- Physicians are a key resource for both referral and treatment
vided by the hospital if it has already been described; of pediatric hearing conditions. Newborn hearing screening
■■ identifying the contact person for program services; protocols require information to be sent to the infant’s medi-
■■ identifying the individual to contact for reimbursement cal home (e.g., family physician, pediatrician, community
questions; health department). It has been reported that pediatricians
■■ clarifying the schedule and any restrictions for services do not make follow-up referrals for more than half of the
(e.g., days, hours, interpreter availability);
Chapter 15
children who refer from hearing screenings in their office
■■ noting availability and access to medical personnel if (Halloran, Wall, Evans, Harden, & Woolery, 2005). The de-
requested; velopment of EHDI programs has increased referrals of in-
■■ identifying the most efficient way for the school system fants and toddlers from medical homes, but information and
to share written reports and recommendations; and activities that target medical personnel related to referrals of
school-aged children continue to be crucial and include the
following initial steps:
Although services under IDEA, Part C, may not be ■■ Develop a current list of otologists (identifying those
provided by the local education department, it is who specialize in pediatrics, neuro-otology, and cochlear
helpful for educational audiologists to collaborate implants), pediatricians, general and nurse practitioners,
as early as possible with families whose deaf and and any other medical personnel who see children and
hard of hearing child will be transitioning to school are within a reasonable geographic distance for families.
services by three years of age. ■■ List each physician’s primary office, address, and phone
number, as well as any satellite offices and the days
available.

524 Chapter 15
■■ List audiologist(s), if employed in physician offices, Public Health Clinics

and cross-reference to audiology services under a pri- Educational audiologists need to know if public health is
vate practice audiologist category. designated by state law as the responsible agency for child-
■■ If third-party payments (e.g., Medicaid) are not univer- hood hearing screening (see Chapter 4, Hearing Screening
sally accepted in the community, this information should and Identification). In some states, there is a legal mandate
be noted for each physician provider. for state-managed health department involvement, but in
other cases, their responsibility has been taken on “by de-
fault.” Questions to be answered for public health hearing
Community Audiologists screening programs include the following:
Information about services provided by local audiologists is
■■ Are there multiple mandates for school-age children,
vital for community resource surveys completed by educa-
resulting in overlap of services or program duplication?
tional audiologists. The following strategies can be helpful
■■ Are all residents eligible, and is there a cost for these
in obtaining accurate information:
services?
■■ List each audiologist’s name, address(es), phone num ■■ What are the clinic hours, and do they schedule
ber(s), and schedule, if not full time in one office. appointments?
■■ Identify physician by name only, with day(s) available ■■ Is every service available during all hours of operation,
at this site. or are specific days or times reserved for pediatric hear-
■■ Describe audiology services and any specialized equip- ing screening?
ment and services designed for children (e.g., visual ■■ What protocol is used for identification of hearing sta-
reinforcement audiometry, sedated auditory brainstem tus, what personnel are involved, and at what ages are
response, CI programming, sign language interpreters, screenings completed? (See Chapter 4, Hearing Screen-
listening and spoken language therapy). ing and Identification, for more information on screen-
■■ Identify options for reimbursement and fee schedule, ing methods and follow-up.)
if available. ■■ Do health clinic personnel come to the schools to do
■■ Include audiologists in private practice, as well as those health screenings, and how are results provided to the
in private or nonprofit clinics in this section. school district?
■■ Is there a protocol in place to track children who refer?
Cochlear Implant Centers For each community, there is a need to identify the
The increasing number of children using cochlear implants pediatric population eligible for assessment and treatment
has resulted in a critical need for collaboration among through the local public health clinic. Clarify information
center-based cochlear implant audiologists and educational that is provided to parents of children who refer from the
audiologists. The Educational Audiology Association’s hearing screening and the recommendations that are made.
(EAA’s) position statement, Educational audiologists and Identify a primary contact person for child health within
cochlear implants (2005), emphasizes recommendations each community clinic that serves children from the local
and strategies for ongoing communication and collabora- school system. Provide the contact individual with current
tion for students who use cochlear implants in learning en- information on educational audiology services available
vironments. At a minimum, information collected for each within their district and offer to collaborate with their pro-
implant center that may serve students in school systems grams to best serve students within the local schools.
Chapter 15
with educational audiologists should include:

University Training Programs
■■ name and address of the implant center;
Postsecondary training programs in speech-language pathol-
■■ name and phone number of the primary contact person;
ogy and audiology often provide hearing services for the
■■ phone number for scheduling appointments (if different
community at large. Educational audiologists should obtain
from above);
and summarize information about any college or university
■■ names of surgeon(s);
program within the local community by:
■■ names and contact numbers of audiologist(s);
■■ devices currently being implanted, programmed, and ■■ listing audiology services provided for children, the
serviced; cost, and reimbursement options available for clients;
■■ resources accepted for reimbursement; ■■ identifying advantages versus restrictions related to ob
■■ center-based and outreach habilitation services and retaining services through a training program (e.g., do
sources, if available; and they have access to the latest equipment and technol-
■■ related provider names and contact information (e.g., ogy? do assessments take longer but cost less? do they
speech-language pathologist [SLP], educational consul- require fees in a lump sum, or can payment schedules
tant, social worker, etc.), if available. be arranged? can they provide services off campus?

what is their availability during university vacation that allows for quick and efficient updating. Information on
schedules?); and audiology services available in the community can be in-
■■ identifying a contact person with a phone number and cluded in presentations to parent groups, community service
checking to see if this is the same contact person for clubs, or government groups and is most useful in presenta-
the general public; if not, list the public access phone tions to school administrators who are responsible for fund-
number as well. ing school services. A visual graphic clearly demonstrating
that educational audiology services address gaps in service
Service Clubs and do not duplicate other services in the community pro-
Service clubs can provide significant support to educational motes good will among professionals and helps in lobbying
audiology programs. Following are suggestions for collect- for financial support for the educational audiology program.
ing relevant information for this community resource:
List all service clubs with chapters in the local commu-
■■
nity that have hearing as an official club focus. A list of MARKETING AND ADVOCACY
national organizations that currently emphasize hearing FOR EDUCATIONAL
is included in Appendix 15–B.
■■ Identify the contact person and phone number for infor-
AUDIOLOGY PROGRAMS
mation about current projects and potential funds that Historically, marketing has been perceived as selling, and
might support educational audiology and/or deaf and most of us did not select the profession of educational audiol-
hard of hearing students. ogy because of a desire to sell either ourselves or products.
■■ Note the fiscal year for each club and the procedure for More recently, we have begun to understand that the provision
making financial requests. of information concerning our programs and services is con-
■■ Identify the program chair, regular club meeting day sidered a form of marketing, and this messaging is vital if ed-
and time, and dates for program planning for the year. ucational audiology programs are to continue and/or expand.
Marketing and advocacy is a matter of perception and
Other Community Resources not a product. In today’s climate of escalating health care
Additional categories of community resources available to costs and reduced government budgets, it is critical that ed
the educational audiology program should be included in ucational audiologists be clear about who we are, what we
the community resource survey with information identify- do, and the value of these services within the educational
ing the type of support, personnel involved, and ways to setting. School-based audiologists recently reported that
contact for collaboration. These might include but are not limited understanding of their role by others was second
limited to parent support groups, parent or professional ad- only to budget constraints as a primary professional chal-
vocacy groups, technology funding resources, sign language lenge (American Speech-Language-Hearing Association
classes, childcare, churches, and recreational services de- [ASHA], 2018). Whether the educational audiology pro-
signed to include deaf and hard of hearing students. gram has been in place or has just been initiated, it is criti-
cal to educate school personnel and community resources
about the program. Members of the community often are
Updating the Community Resource Survey unaware that audiology services are mandated and available
A community resource survey requires annual updating be- free of charge to children through the school district. As a
cause services and personnel change frequently. After a func- result, they often do not know how to access or support these
Chapter 15
tional format has been devised, updating previously listed services.
resources should take brief e-mails or telephone calls, with Messaging by educational audiologists serves two pri-
more time required only for new resources. Updating can be mary purposes of marketing and advocacy—increasing the
completed by e-mail, with a couple of follow-up e-mail re- visibility of educational audiology services and educating
minders to increase response rates. If no response is received, specific target audiences concerning the implementation and
a follow-up telephone call will be necessary. If pertinent
questions are listed beforehand, updating a list of community
resources is an activity that could be handled by a volunteer
or paraprofessional unless direct contact with the educational For educational audiology to remain an integral and
audiologist is needed to facilitate ongoing collaborative rela- vital part of education, and to prevent others from
tionships with specific community providers. Annual survey defining our practice parameters, continuous ad-
information should be summarized in a format that lends vocacy, both within and outside of individual school
itself to presentations. Useful presentation formats include districts, is necessary.
multimedia and PowerPoint slides, and, whenever possible,
the layout and content should be computerized in a format

526 Chapter 15
importance of these services. Questions to be addressed to vices. Too often our programs are justified by the number of
facilitate professional communication and advocacy efforts students screened, the number of assessments completed,
include: and the number of hearing aids analyzed. There is an ongo-
ing need for evidence-based advocacy that clarifies the ben-
■■ What are the goals for marketing educational audiology?
efits that students and school systems receive from a com-
■■ Who are the target audiences?
prehensive educational audiology program. Data related to
■■ What types of information should be disseminated?
outcomes might include improved test scores, higher gradu-
■■ What strategies are most effective for disseminating
ation rates, and decreased costs of educating students within
information?
general education. For educational audiology programs to
■■ How can the success of messaging and advocacy efforts
continue and thrive, documenting and disseminating out-
be assessed?
come data should be a routine part of marketing, messaging,
Marketing and advocacy goals for educational audiolo- and advocacy efforts.
gists can be summarized under three broad areas: increased
name recognition, increased visibility of services, and in-
creased knowledge of program outcomes.
Internal Marketing
Internal marketing efforts for an educational audiology prac-
tice should target all individuals who are employed by, op-
Increased Name Recognition erate within, or make decisions related to the school sys-
In traditional marketing, name recognition gives the percep- tem. These individuals include teachers, support personnel,
tion that a product is better because more people are familiar building administrators, central office personnel, school
with its name. If buyers do not know a product’s name, how board members, and other district employees, as well as
will they know to buy it or even take a look at it? Similarly, students and parents. Each audience will dictate the content
if school administrators are not familiar with the term ed- and strategies used, depending on audience members’ spe-
ucational audiology, they will have difficulty relating the cific job responsibilities or connection to the school system,
program’s value to their school system. If teachers do not and educational audiologists need to educate themselves on
know the services that are available through the educational the broader responsibilities of each target audience. For ex-
audiology program, they may make inappropriate referrals ample, the school board looks at the big picture, and board
or not use the program at all. If community resources have members need to have clear evidence that the educational
not heard or seen the title “Educational Audiologist,” profes- audiologist is viewing the whole educational program and
sional collaboration can be more time consuming because not just his or her small part of it. With an audience-targeted
of a need for repeated descriptions of services. Kasewurm perspective, educational audiologists might include more
(2005) writes, “You must stay in front of your patients con- fiscal data when giving a presentation to administrators re-
sistently if they are going to remember you when that need sponsible for budget approval and provide referral informa-
arises” (p. 31). Clearly, a top goal for marketing educational tion in a handout prepared for classroom teachers.
audiology is increasing name recognition both within and Internal marketing by the educational audiologist fre-
outside of the educational community. quently takes place through the provision of inservice ses-
sions for school employees and during teacher conferences
Broadened Visibility of Services on specific students. Therefore, it is critical for the audi-
ologist to be a highly visible member of the school special
A second goal that can facilitate collaboration is increased education team. Strategies to use during these activities are
visibility of services. What services fall under the scope
Chapter 15
discussed in Chapter 9, Case Management and Habilita-

of educational audiology, and what services are provided tion, and Chapter 13, Supporting the Educational Team.
in the current program? Although the initial focus may be One target audience frequently overlooked consists of the
on visibility of present services, it is important to educate
school personnel and the community at large about addi-
tional services that should be included in a comprehensive
educational audiology program (e.g., gaps identified through Nuggets from the Field
a needs assessment). If a comprehensive educational audiol-
ogy program is in place, the objective would be to maintain Invite school board members to have their hearing
visibility of services so the program will continue to meet tested; while you have their attention, you can dis-
existing and future needs. cuss the importance of audibility for learning, dem-
onstrate your equipment, and provide an over
Increased Knowledge of Program Outcomes view of your educational audiology services to
A third goal targets increased awareness and understanding the children of the district.
of the results and outcomes for educational audiology ser-

targeted, a few essential pieces of information should be

Primary Marketing and shared at every opportunity:
Advocacy Goals for ■■ the words educational audiology and educational
Educational Audiology audiologist;
■■ a listing of services currently available through the edu-
Name recognition cational audiology program; and
Visibility of services ■■ a contact name, address, e-mail, and phone number with
Knowledge of program outcomes text access, and website (if available) for additional
information.
Topics of interest to community groups are listed in
Table 15–3.
Audiology program details and deaf and hard of hear-
students themselves. Although deaf and hard of hearing stu- ing demographic data, as well as fiscal and budget informa-
dents would be considered our consumers, do they know tion, are critical in planning marketing efforts targeted at
us as educational audiologists? Are their parents aware that program administrators. Specific information on this topic is
an educational audiologist is located within the school dis- discussed in Chapter 16, Program Development, Evaluation,
trict to assist with the assessment and management of the and Management.
classroom environment? Chapter 10, Supporting Wellness Although planning is essential to ongoing marketing
and Social-Emotional Competence, contains suggestions for and advocacy efforts, many of us have had unexpected pro-
providing information to deaf and hard of hearing students, motion opportunities presented to us. If the educational au-
and prevention activities described in Chapter 12, Preven- diologist is already doing some or all of the activities listed,
tion of Noise-Induced Hearing Loss and Tinnitus in Youth, a formal marketing plan can be completed quickly and then
can serve to increase awareness among all students within a updated as needed. Suggestions to help prepare for these
general education classroom. spur-of-the-moment opportunities are described, together
The responsibilities of school employees vary, but each with strategies and activities that offer opportunities for in-
educational staff member is a potential resource for student creased awareness and collaboration with a variety of com-
referral and program advocacy. For this reason, each of the munity resources (Table 15–4).
three primary goals should be addressed during all internal Begin a collection of PowerPoint slides, brief videos,
marketing efforts by the educational audiologist (see Box). and other visual aids that would augment a presentation
More information on internal marketing can be found in Chap
ter 13, Supporting the Educational Team.
TABLE 15–3 Suggested Topics for Community Presentations
External Marketing ■■ Overview of Hearing Function
External marketing can facilitate community collaborative ■■ What Is an Audiologist?
efforts by targeting audiences made up of those individuals ■■ Local Educational Audiology Program
in the community who are not employees of the school sys- ■■ Local Educational Programs for Deaf and Hard of Hearing
tem. These groups include community services clubs, parent Students
support groups, professional organizations, private or public ■■ Technology Advances in Hearing Aids
Chapter 15
agencies, other educational institutions, and the news media. ■■ Hearing and Visual Assistive Technology
External audience members can serve as referral sources,
■■ Cochlear Implants (joint program with cochlear implant
funding and legislative advocates, and financial supporters center personnel)
in addition to providing assistance with public relations and
■■ Early Hearing Detection and Intervention (EHDI)
collaborative service provision.
■■ Medical Treatment and Educational Effects of Ear Infections
(joint program with physician)
■■ The Americans with Disabilities Act (ADA)
DEVELOPING AND ■■ Deaf Culture (joint program with Deaf adults, teens,
FOSTERING CREATIVE interpreters)
Sign Languages
COLLABORATIVE EFFORTS ■■
■■ Hearing Ear Dogs

Noise, Music, and Hearing Conservation
Information and Materials to Share ■■
■■ Recreational Audiology
Although detail, format, and transmission of the educational
■■ Communication Methodologies
audiologist’s message will vary with the particular audience

528 Chapter 15
TABLE 15–4 Strategies to Increase Community Awareness of questions during many types of meetings. Another good re-
Educational Audiology source is the EAA’s school-based audiology advocacy series
(see online resources), that includes brief overviews designed
■■ Writing letters
to be shared with nonaudiologists (e.g., supervisors, teachers,
■■ Developing and disseminating brochures
other related service professionals, parents) on topics such as
■■ Giving presentations
classroom acoustics, hearing assistance technology (HAT),
■■ Writing articles hearing screening, noise, and hearing loss prevention.
■■ Giving radio or TV interviews Incorporate the words educational audiology or educa-
■■ Disseminating public service announcements tional audiologist into a visual during every presentation.
■■ Providing public acknowledgments Our experience suggests that sooner or later an audience
■■ Using business cards and stationery member will ask, “What’s an educational audiologist?” or
■■ Website information and online resources “What’s the difference between an educational audiologist
and other audiologists?” Responding to these questions will
give you a golden opportunity to market the profession in-
when the opportunity arises. Obtain permission from parents formally on the spot.
to use photographs of students whenever pictures are taken. Use stationery and a signature that identifies your edu-
Slides, videos, and photographs personalize your message cational audiology program by name and title for all on-
and help it to be remembered. line and print correspondence, including reports on student
Develop a one-page handout or brochure identifying assessment.
the services provided that includes a contact name, address, Always carry a stack of business cards that provide your
e-mail, and phone number with text access, and website (if updated contact information. They are easily carried and dis-
available). Keep this handout current, and make sure it is tributed and should identify you as an educational audiolo-
concise, makes effective use of white space, and appears gist for increased name and title recognition. These can be
professional. This activity should be a priority for every photographed into phone business card apps that make you
educational audiology program. If funds are not available readily accessible.
through the school system, brochures can be funded by spe- Create a collaborative marketing and advocacy calendar
cific grants from parent groups, community organizations, that identifies ideas and activities for developing, organizing,
or professional organizations. If the community includes a and disseminating relevant marketing and advocacy infor
college or technical school, talk with the instructors of jour- mation once or twice a month throughout the year with ideas
nalism or business classes to see if a brochure could be a col- for community collaboration. Attempt to target one area of
laborative class project. Some larger high schools may also educational audiology from your job description or the EAA
have the computer capability to design or print brochures, a Professional Practices position statement (see online re-
win-win experience that serves as internal marketing. sources) each month. This calendar can also be an ideal place
Many manufacturers and professional organizations to identify dates for proposed service club or other commu-
now provide messaging that can be adapted for use by edu- nity presentations, as well as a place to log contacts with your
cational audiologists. A partial listing of these resources is legislators. A list of written communication techniques is in-
included in Appendix 15–D, but it is important for read- cluded in Table 15–5, but this list is by no means exhaustive.
ers to update this listing, because it may change frequently. It may be obvious by now that any printed material dis-
New materials typically are made available by professional seminated by an educational audiologist can and should serve
organizations annually in anticipation of target months (e.g., the purposes of collaborative marketing and advocacy. Cover
Chapter 15
May as Better Hearing and Speech Month; October as Audi- letters including a one-page flyer or colorful brochure listing
ology Awareness Month), and many of these materials can educational audiology services should be sent annually to
be personalized and downloaded at no cost. Carry a few edu- all identified community resources (see Appendix 15–C).
cational audiology brochures at all times, distribute them at
any presentation, and include them in an annual update sent TABLE 15–5 Marketing Materials in Print Formats
to community professionals and agencies.
Maintain a computer file of current research that sup- ■■ Brochures
ports educational audiology programs and list the services ■■ Business cards
you now provide or would like to include in the future. This ■■ Professional stationery
information can then be readily accessed for a handout or ■■ Information letters to parents, teachers, and students
annual update for community partners as well as program ■■ Laminated index cards
administrators. ■■ Consumer surveys
Use the handout, “16 Reasons Why Your School Needs ■■ Letters to the editor
an Educational Audiologist” (see online resources). Keep a
■■ Newsletter columns and articles
few copies with you at all times; it can be used in response to

If your school district or regional educational agency has a bring a different level of expectancy to materials we pro-
website, ask how your program information might be ac- duce, and an unfamiliar eye can be very helpful.
cessed online, and add a link to educational audiology infor-
mation if this is permitted. Community surveys can also be Presentations
used to market an educational audiology program by bring- Useful presentation formats include multimedia, Power-
ing attention to services that may be available but have not Point, and videos; whenever possible, the layout and content
been used (Appendices 15–E and 15–F). should be computerized in a format that allows for quick
Letters to the editors of local newspapers are an excel- and efficient updating. Information on educational audi-
lent cost-free method to increase public awareness, and if ology services can be included in presentations to parent
there is a newsletter or other ongoing print or online commu- groups, community service clubs, or government groups and
nication system within the local Deaf and/or hard of hear- is very useful in presentations to local administrators who
ing community, consider submitting a brief column for each are responsible for funding school services. A visual graphic
issue. If there is a local or regional program for deaf and clearly demonstrating that educational audiology services
hard of hearing students, consider developing a monthly or address gaps in service and do not duplicate other services in
quarterly newsletter for both students and parents includ- the community promotes collaboration and helps in lobby-
ing “Tips from Your Educational Audiologist.” Teachers of ing for financial support for the educational audiology pro-
deaf and hard of hearing students may want to collaborate gram. Invite audiology colleagues to share in community
in this project as a way to address written language develop- presentations—another way to promote collaboration and
ment. Student self-advocacy skills also can be incorporated differentiate the educationally relevant services provided in
through writing for newsletters. Computers and desktop the school’s educational audiology program from clinical
publishing apps make production of newsletters and other services provided in the community.
promotional materials relatively easy. The suggestions given for developing and conducting
inservice presentations described in Chapter 13, Supporting
Style and Content of Print Materials the Educational Team, can be applied to any formal talk by
It is important to remember that print materials designed educational audiologists. Consider the following suggestions
for effective messaging and advocacy should be brief and when organizing a general presentation to potential commu
eye-catching and highlight the primary information to be nity partners:
conveyed. Identify no more than three bits of information
1. Determine the primary message and no more than two
to be remembered, and then highlight the most important
additional pieces of information for your audience to
information through font size, style, and color contrast.
remember at the end of the session.
Another way to approach the development of any printed
2. If you do not know much about your audience, ask one
marketing information is to target one bottom-line message
or two questions in the beginning that will help to shape
and a small number of points to support it. Photographs are
your presentation. Sample questions include, but are not
eye-catching, but they can date your print material. If this
limited to, those listed in Table 15–6.
is something you might use for more than 1 year, critically
evaluate any current data and illustrations with the future in
mind. Before mass producing and distributing print material, TABLE 15–6 Sample Audience Questions*
show it to one or two individuals who share characteristics
of your target audience and ask them to tell you what they ■■ Who has children (or grandchildren) in XYZ school district?
remember about what they just read. As professionals, we How many of you have heard the title Educational Audiologist?
Chapter 15
■■
■■ Do any of you know someone who uses hearing aids?

■■ Has anyone here ever seen a cochlear implant?
■■ How many of you have a child with a hearing problem?
Marketing and Advocacy Tips ■■ Has anyone here ever seen or used captioned TV?
■■ Have any of you ever used sign language?
■■ Attend a school board meeting and offer to pro
■■ Who here listens to music using earphones?
vide hearing tests for members.
■■ Include educational audiology or educational au- ■■ Have any of you ever used a telephone relay system?
diologist in all written and oral communication. ■■ Has anyone used an app such as ClearCaptions to
■■ Create a plan for unexpected opportunities to communicate with a deaf or hard of hearing person? What
other related apps have you used?
market and advocate for educational audiology.
■■ Create and use materials that are brief, visually ■■ Has anyone here had a conversation using a sign language
interpreter?
striking, and have critical information highlighted.
*Questions can be modified to target different audiences (e.g., ages, professions)
and to bring up information you plan to cover.

530 Chapter 15
Target your questions to the content you want to pro- 2 weeks is typically more useful in assessing the effective-
vide but involve your audience by personalizing your ness of these efforts. Appendix 15–G includes a sample for-
information. If the audience is a service club whose mat of such a follow-up log, and a similar log can be easily
members have participated in community projects in incorporated into your community advocacy calendar.
the past, thank them for those efforts before mention- Documenting the time spent on developing written mar-
ing how they might provide support for the educational keting material or putting together a presentation can also
audiology program you represent. help educational audiologists decide if a particular activity
3. Describe your time and strategy for handling listener was worth the effort. Financial support is easy to document,
questions at the beginning to avoid interruptions (e.g., but other benefits can be less tangible or immediate. Did the
allot the last 5 minutes to questions but provide index news media print an announcement of your presentation,
cards for the audience to jot down their questions as and did they cover it in person? Did they take and/or pub-
they occur). lish a photograph? An ongoing file of any media coverage
4. Supplement oral presentations with eye-catching visual provides resource material for future community marketing
materials (e.g., videos or slides) whenever possible. A and advocacy efforts.
picture of a baby turning to look at a sound will be re- Finally, set realistic expectations and realize that mar-
membered far better than a description of testing tech- keting is a process, not an overnight solution. Budgets are
niques or a photo of equipment used by educational planned far in advance, and competition for financial support
audiologists. One name recognition technique is to intro- for new or expanded programs can be very tight. Not every-
duce yourself and your presentation by showing a video one who learns about educational audiology services will
segment of a student saying, “This is Ms. X, my edu- have a need for them immediately, but an effective messag-
cational audiologist.” The same activity could be done ing and advocacy campaign can help familiarize audiences
without video by showing a slide of a student while with our value to school systems and the students we serve.
playing the same recorded introduction.
5. If you use PowerPoint to supplement your presentation,
be sure to review the design guidelines in Table 13–3
Facilitating Interprofessional Collaboration
and remember to obtain parent permission for any iden- It has been said that collaboration is on a continuum begin-
tifiable student photos or videos. ning with networking and progressing through coordination
6. Send a notice of any external marketing presentation to and cooperation to collaboration (Figure 15–1).
the local news media and invite them to attend. Include Interprofessional collaboration occurs when individuals
your business card and program brochure and offer to from two or more professions with differing professional
write a brief article or be interviewed on the topic you backgrounds work together to achieve common goals. In
plan to cover. the health care field, collaborative interprofessional practice
7. When being interviewed, have your key messages down (IPP) occurs when multiple health workers from different
in concise sound bites. professional backgrounds work together with patients, fami-
8. Human interest stories are always well received. Main- lies, caregivers, and communities to address the local health
tain a list of students and families who are willing to care need to deliver the highest quality care. A framework of
assist in presentations or interviews by the local media. four core competencies for interprofessional education and
9. Always repeat your primary message at the end of your collaborative practice is described in Table 15–7.
presentation and provide print material (described pre- Educational audiology can be perceived as duplication
viously) that reiterates the target information for the of, and in competition with, other services provided in the
Chapter 15
audience to take with them.

10. Finally, assessment of marketing and advocacy effec-
tiveness is a critical component of any marketing plan.
Did you achieve your goals? Which techniques were Collaboration or Cooperation?
most successful, and which were productive? Including
a question on the consumer survey asking how the com- COOPERATION—Initiated by one party in a
munity respondent learned of the educational audiology group to achieve goals of initiating party
program is one evaluation technique that is easy to in- COLLABORATION—Relationship between two
corporate into this strategy. Offer to provide more busi- or more parties for mutually beneficial goal achieve
ness cards or brochures, and, if the audience responds ment that allows participants to remain true to
positively, they are collaborating in your efforts to in- their respective missions
crease awareness of your program.
NASDSE, 2018, p. 62
After a targeted mailing or a presentation, a log of your
telephone and written inquiries and referrals for a period of

FIGURE 15–1 Collaboration continuum. (From E. Miller, 2015, Audiology Today, 27, pp. 10–11.)
TABLE 15–7 Framework for Interprofessional Education and it was addressed. Collaborative professional presentations
Collaborative Practice are another way to help clarify audiology options within the
community for the presenters as well as the audience.
■■ Values and Ethics: Work with individuals of other
Take every opportunity to emphasize that a priority of
professions to maintain a climate of mutual respect and
shared values
the educational audiology program is to avoid duplication of
services. This point can lead to an expanded client base for
■■ Roles and Responsibility: Use the knowledge of
one’s own role and those of other professions to assess
the non-school-based audiologists because the educational
and address the health care needs of the patients and audiologist can and should serve as a “bridge” between clin-
populations served ical audiology and educational services rather than replacing
■■ Interprofessional Communication: Communicate with or duplicating clinical assessment and follow-up. When the
patients, families, communities, and other health professionals educational audiology program includes opportunities for
in a responsive and responsible manner that supports a similar or identical assessments, parents may choose to use
team approach to health maintenance and the treatment of both resources, and continued interprofessional collabora-
disease tion is required. Parent permission is often cited as a barrier
■■ Teams and Teamwork: Apply relationship-building values to collaboration. When meeting with parents, it should be
and the principles of team dynamics to perform effectively in emphasized that collaboration between all parties involved
different team roles to plan and deliver patient-/population- typically results in better outcomes for students with hear-
centered care that is safe, timely, efficient, effective, and ing or listening difficulties. One collaborative approach used
equitable by the EARS program, an educational audiology outreach
Note. From Interprofessional Education Collaborative Expert Panel (2011).
program with multiple school districts and the Arkansas
Children’s Hospital, involves use of a letter to families list-
ing their available educational audiology services. This let-
community. Identifying the roles and responsibilities of the ter emphasizes that these services are not intended to du-
school program and their relationship to community re- plicate or replace the student’s clinical audiology services
sources will clarify how the programs support one another (see Appendix 15–H). Educational audiologists who use
Chapter 15
yet preserve their uniqueness. Each professional contacted this strategy will need to include their own list or descrip-
should be asked for his or her input concerning gaps in au- tion of services together with their local community provid-
diology services within the community and for ways the ers. Meeting legal obligations for sharing information (see
educational audiologist can support other programs so that Legal and Ethical Issues section later in this chapter) can be
all services can best complement each other for maximum facilitated when educational and clinical audiologists work
student outcomes. By seeking input directly from the other together with parents as collaborative team members with
audiologists in the community, the fear that educational au- the goal of improving outcomes for students with suspected
diology services are meant to replace private services can and/or diagnosed hearing and listening challenges.
be alleviated and sharing of information can be facilitated. It is important that all parties—students, parents, clini-
If a concern is expressed (e.g., loss to follow-up for EHDI cal audiologists, and other professionals—understand the
refers), it should be addressed as quickly as possible, espe- school’s focus on the impact of hearing and auditory func-
cially if the program is just beginning. The incorporation tion on learning outcomes and communication access within
of a service not currently available and referral to an exist- educational environments. For students with reduced hear-
ing source are ways of addressing concerns. Send a note to ing, this focus includes determining the impact of noise,
the professional who expressed the concern describing how distance, fatigue, auditory-visual challenges, type and use

532 Chapter 15
of personal hearing instruments and assistive technology,

classroom accommodations and modifications, and direct
instructional services. For services to be most appropriate Nuggets from the Field
for students assessed by clinical and educational audiolo-
gists, ongoing communication regarding individual students
Collaboration with other professionals is a must—not
is essential (Eubanks, 2009; Kooper, 2003). When technol-
just communicating with others, but truly collaborat-
ogy to be used in a learning environment is recommended
ing to improve student outcomes.
and dispensed by a clinical audiologist, collaboration with
the educational audiologist is required for maximum student
benefit in the classroom (Madell & Flexer, 2018).
Students who use cochlear implants typically receive
their initial fitting and follow-up programming through a TABLE 15–8 Opportunities for Creative Community
cochlear implant center. For students who use cochlear im- Collaboration
plants in educational settings, the use of a standard form ■■ Otology clinics
containing information specific to each student is crucial for ■■ Leasing facilities and equipment
accurate monitoring for both the school and the cochlear ■■ Student practica and preceptorships
implant center. Appendix 15–I contains a sample form de-
■■ Research
veloped initially for use in Colorado. Additional examples
■■ Special projects
of collaborative forms can be found in the educational re-
■■ Vocational opportunities
sources compiled by cochlear implant manufacturers (e.g.,
Robbins, 2003) as well as on the NOCCCI website cited ■■ Newborn screening
earlier. Sharing information among family members, center- ■■ Unique community needs
based professionals, and educational staff is critical to maxi- ■■ Contractual services
mize benefit from use of cochlear implants in learning en- ■■ Producing public or parent information
vironments, and it is a priority for educational audiologists ■■ Monthly interagency staffing or team meetings
to facilitate good working relationships with implant center
audiologists. Additional information on educational audi-
ologists and cochlear implants can be found in Chapter 8,
Hearing Instruments and Remote Microphone Technology, Table 15–8 and briefly discussed in the following sections
and Chapter 9, Case Management and Habilitation. represent a few ideas that have worked for some commu-
When schools contract for some of their services from nities. This list is not exhaustive and should be expanded
community audiologists, services should be delineated in and updated for each school district or regional educational
the contract and duplication avoided (ASHA, 2002; EAA, cooperative.
2012). If community audiologists are not under contract, the
educational audiologist can help to clarify the responsibili- Otology Clinics
ties for each professional. For example, onsite amplification Collaborate with public health organizations to arrange for
management is required under IDEA1 as well as is neces- monthly otology clinics to be held at their facility or another
sary for optimum use of residual hearing in the classroom. central location. As health care delivery systems change in
When this is a designated responsibility of the educational the future, including more telehealth options (see Chapter 17,
audiologist, monitoring and maintenance are implemented Reflections and Future Directions), this may be a cost-effective
Chapter 15
more often, repairs typically can be completed without the way to obtain medical examinations and follow-up for chil-
student missing school, replacement parts can be obtained dren who do not have access to this service through other
more quickly, and appropriate loaner aids can be provided means. Involving university students or parent volunteers to
when necessary. Using this approach, personal hearing in- assist with these clinics will also foster collaborative part-
strument follow-up programs become more efficient and nerships with these segments of the community.
cost effective for everyone involved.
Leasing Facilities and Equipment
A school system may want to consider renting audiology
Fostering Creative facilities from a university program or private practice for
Community Collaboration assessment of students closer to the local school or for ac-
There are as many ways to collaborate creatively as there cess to equipment not available within the school program.
are individuals attempting to do so. Suggestions listed in University training programs may offer state-of-the-art tech
1
C.F.R.§300.113.

nology that a local district cannot afford to purchase, and other resources for student use. When possible, these banks
many university programs are required to document com- should involve community audiologists and be accessible
munity service to earn a portion of their funding. Cost sav- to consumers of all ages who need hearing aids but cannot
ings can occur when avoiding large expenditures for audi- afford their purchase. Classroom audio distribution systems
ology equipment, but input may not be requested from the (CADS), packaged hearing conservation programs, program
educational audiologist if additional equipment is being brochures, and videos can also be an outcome from collab
considered for purchase. When arranging such agreements, oration with community resources. Service clubs are not
school systems need to be open to collaborative solutions for only a source of funding, but club members may also have
maintenance expenses as additional use by the educational connections for publishing at a discounted fee, resources
audiologist could result in increased maintenance costs. Fi- for photography and illustrations, and additional ideas and
nally, availability of university or private practice facilities options for inexpensive dissemination of materials. Educa-
during vacation periods should be a part of discussions ex- tional audiologists may also benefit from membership in ser-
ploring this option for a collaborative partnership. Shared vice clubs. In addition to participating in community-based
services utilizing a mobile unit are another opportunity for services, it is another opportunity to increase awareness
collaboration between clinical and educational audiologists. about education audiology.
Student Practicum and Preceptor Sites Vocational Opportunities

Another option for collaborative partnerships with university Collaboration with local service club members can result
training programs is establishing on-campus or off-campus in invaluable vocational connections for secondary students
opportunities for students to obtain practicum hours under the looking for job information or job placements. Community
supervision of educational audiologists. Academic programs members often are willing and eager to be available for pre-
often need deaf and hard of hearing clients as well as addi- sentations to classes or interviews by students. Vocational
tional supervisory personnel. All professional organizations, placements should be coordinated through the school and
including the EAA, support increased practicum experiences the local Vocational Rehabilitation Services office to take
for students in actual work environments, but this option is advantage of the federal Workforce Innovation and Oppor-
only viable when the educational audiologist has the current tunity Act (WIOA) programs. These connections can pro-
credential required for audiology supervision. The develop- vide opportunities for educational audiologists to increase
ment of AuD programs has generated additional needs for awareness of methods for achieving accessibility in work
preceptor sites, and an increasing number of educational au- sites. Use of vocational placements and interaction among
diologists have obtained or are currently enrolled in advanced students and community members can also facilitate transi-
degree programs. Participation of qualified educational au- tion planning for high school students who are deaf or hard
diologists in the preceptor process appears to be a win-win of hearing.
proposition for the profession and for students with reduced
hearing. Chapter 2, Roles and Responsibilities of Educational Early Hearing Detection and Intervention
Audiologists, provides a detailed discussion of practice areas Every state and territory in the United States has now estab-
that could be included in onsite experiences, and offering to lished an EHDI program, but these programs are adminis-
speak to related undergraduate classes in science or educa- tered under a variety of state agencies as designated by each
tion increases name recognition and provides opportunities state. This often creates challenges for designing services
for recruitment of future educational audiologists. that are specific for families with deaf and hard of hearing
Chapter 15
infants and toddlers. Collaboration by educational audiolo-
Assistance with Research gists with EHDI programs promotes increased awareness of
Partnering for grant proposals is a third way for audiology the needs of deaf and hard of hearing children within EHDI
training programs to collaborate, and this can benefit both the programs as well as school systems. Educational audiolo-
educational audiology program and advanced degree educa- gists can foster continuity during the transition between
tion settings. Assisting with research can result in access to community-based and school-based programming and can
personnel and equipment that school districts are unable to help to lower age of identification and improve student out-
fund, as well as help to provide additional evidence supporting comes within a targeted community.
educational audiology services and student outcomes. Partner-
ing may also facilitate the university’s access to deaf and hard Solutions for Unique Community Needs
of hearing students who may be subjects in research studies. Community resources can be brought together to brainstorm
solutions for specific problems, such as special transporta-
Service Clubs tion needs, sign language materials and classes, interpreter
Collaboration with local service clubs can result in the de- requests, and the provision of mental health and other ser-
velopment and maintenance of loaner hearing aid banks or vices delivered outside the school setting. Many of us have

534 Chapter 15
TABLE 15–9 Focus Areas for Community Support During tional Rights and Privacy Act (FERPA, Appendix 1–C),
Funding Crises and questions have come up about the interactions of these
two pieces of legislation, especially when hearing or other
■■ Advocacy
medical issues may be involved. Typically, when a medical
■■ Lobbying
provider is identified as a member of the educational team,
■■ Individual and corporate contributions
the ongoing sharing of information among team members
■■ Assistance with fundraising activities is not considered a violation of privacy after permission is
■■ Ideas for alternate funding sources obtained from the parent or legal guardian. Parents should
■■ Collaborative grant developent always be advised and asked for input or concerns when
information is being shared in order to avoid potential road-
blocks that can limit effective interagency collaboration.
experienced funding crises when unanticipated needs arise, Educational audiologists should familiarize themselves with
and community support can be invaluable during these times currently evolving implementation regulations for HIPAA
(Table 15–9). Finally, the sharing of community resources and clarify concerns with their school district administra-
typically results in the most efficient and cost-effective solu- tors and legal counsel when issues arise. Additional ques-
tions so that all citizens can benefit. tions are discussed in a guidance document jointly produced
by the U.S. Department of Education and the Department
Producing Public or Parent Information of Health and Human Services, which can be accessed at
Chapter 3, Partnering With Families, describes the devel- https://www2.ed.gov/policy/gen/guid/fpco/doc/ferpa-hipaa
opment of a parent resource packet that resulted from a -guidance.pdf
collaborative effort in Colorado. Community audiologists Common barriers to collaboration are time, trust, and
worked together to develop the contents, initial production turf (Miller, 2015). It is important to recognize potential
and mailing costs were underwritten by the Colorado De- conflict of interest and professional bias issues if commu-
partment of Education, and duplication costs were absorbed nity resources are used for services or equipment as a part
by individual audiologists who disseminated information to of the educational audiology program. All appropriate com-
their clients. This is an excellent example of a product that munity resources, such as otology clinics and community
can be the result of effective community collaboration. hearing aid banks, must be given the opportunity to par-
Awareness of the opportunities previously described ticipate in programs to avoid the perception of referral bias.
is a first step toward developing collaborative partnerships, But school responsibility versus private responsibility for
but keeping the characteristics listed in Appendix 15–J as a audiology services must be spelled out in the contract to
foundation throughout any collaborative activity will help avoid conflict-of-interest situations that arise when the same
to ensure success. audiologist fulfills the school contract as well as the private
audiology services in a community (ASHA, 2002; EAA,
online resources). In situations where educational audiol-
LEGAL AND ETHICAL ISSUES ogy services are provided through a collaborative agreement
with community resources, familiarity with current profes-
Compliance with the Health Insurance Portability and Ac- sional guidelines regarding ethical standards and conflicts
countability Act (HIPAA, 1996) is paramount for privacy of of interest is of utmost importance. For true collaboration
medical records, making the sharing of information among based on trust to occur, potential barriers resulting from per
medical and educational facilities and agencies challenging. sonal and professional biases should be recognized, explored,
Chapter 15
Educational personnel are governed by the Family Educa- and discussed.
SUMMARY can be enhanced by increased awareness of services through

marketing and professional advocacy, leading to a wider va-
Collaboration is a process that develops from broadened riety of available resources and support. From decreasing the
awareness of program staff, services, and outcomes and age of identification to increasing the number and extent of
includes jointly developing and agreeing to a set of com- opportunities for secondary students with reduced hearing,
mon goals and directions, shared responsibility for achiev- results from community involvement in educational audiol-
ing these goals, and use of the strengths and expertise of ogy programs are only as limited as one’s willingness and
each collaborator to achieve jointly agreed-upon outcomes. ability to collaborate with school, parents, teachers, special
Community collaboration is an essential component of any support personnel, relevant community agencies, organiza-
comprehensive educational audiology program. Programs tions, and other professionals.

SUGGESTED READINGS digitalcommons.usu.edu/cgi/viewcontent.cgi?article=1104

&context=jehdi
AND RESOURCES Kooper, R. (2003). Coordination between the school audiologist
and the cochlear implant audiologist. Audiology Today, Focus-
Bendure, V. (2019). Hone your skills for a great interview with the Topic, FT3-5.
press. Audiology Today, 31(2), 80–83. Madell, J., & Flexer, C. (2018). Maximize children’s school out-
Early Hearing Detection and Intervention (EHDI) e-book. (2019). comes: The audiologist’s responsibility. Audiology Today, 30(1),
Chapter 20. Retrieved from http://jehdi.usu.edu 18–26.
Educational Audiology Association (EAA). (2005). Educational National Association of State Directors of Special Education
audiologists and cochlear implants. Retrieved from http://edaud (NASDSE). (2018). Outcomes for students who are deaf or
.org/position-statements/ hard of hearing: Educational service guidelines (3rd ed.). Al-
Educational Audiology Association (EAA). (2009, revised). Rec- exandria, VA: Author.
ommended professional practices for educational audiologists. Patterson, D., Grenny, J., Maxfield, D., McMillan, R., & Switzler, A.
Retrieved from http://edaud.org/position-statements/ (2007). Influencer: The power to change anything. New York,
Educational Audiology Association (EAA). (2010). Sixteen rea- NY: McGraw-Hill.
sons why your school needs an educational audiologist. Re- Robbins, A. (2003). School input form for cochlear implant cen-
trieved from http://edaud.org/position-statements/ ters. Tools for Schools, Educational Support. Retrieved from
Educational Audiology Association (EAA). (2010). School-based https://advancedbionics.com
advocacy series (Educational and Clinical Partnership). Re- Smiley, D. (2019). What’s this we “hear” about the EARS pro-
trieved from http://edaud.org/advocacy-series/ gram at Arkansas Children’s Hospital? Educational Audiology
Educational Audiology Association (EAA). (2012). Guidelines for Review. Spring, 6.
developing contracts for school‐based audiology services. Re- Wolfgang, K. (2019). The power of partnerships: Audiologist/phy-
trieved from http://edaud.org/position-statements/ sician collaboration improves patient care. The Hearing Jour-
Heassler, A. (2018). Audiology, interprofessional collaboration, nal, 72(6), 28–32.
and school health services. Audiology Today, 30(5), 14–27. Zombek, L., Brotman-Comoracki, S., Dunay, J., Halter, K., &
Joint Committee on Infant Hearing (2019). Year 2019 Position Scott, M. (2017). Improving communication among profes-
Statement: Principles and Guidelines for Early Hearing Detec- sionals working with children with cochlear implants. Retrieved
tion and Intervention Programs. The Journal of Early Hearing from https://www.ASHA.org
Detection and Intervention, 4(2), 1–44. Retrieved from https://
Chapter 15

APPENDIX 15–A
Sample Community Resource Survey Form
PART I—PROGRAMS/AGENCIES/HOSPITALS/CLINICS
Comments
Program Name Contact (Personnel, public/private,
Address, Phone Services (describe) Fees Schedule (Name, phone) funding constraints)
PART II—LOCAL PHYSICIANS

Name Comments
Address, Phone Satellite Office(s) Schedule Audiologist(s) (Reimbursement)
Chapter 15
536

PART III—COMMUNITY AUDIOLOGISTS

Name Comments (Special equipment,
Address, Phone Services Schedule Communication and/or pediatric skills)
PART IV—SERVICE CLUBS

Club Name/Contact Program Chair
Address, Phone Meeting Time Fiscal Year Phone Special Projects (describe)
Chapter 15

APPENDIX 15–B
Service Clubs That Support Programs for Persons With Disabilities
(*Organizations With Nationally Designated Hearing Projects)
Business & Professional Women’s Clubs National Federation Quota International Inc.*
2012 Massachusetts Avenue NW 1420 21st Street NW
Washington, DC 20036 Washington, DC 20036
(202) 293-1100 (202) 331-4694
https://www.quota.org
Civitan International
P.O. Box 130744 Rotary International
Birmingham, AL 35213-0744 (205) 591-8910 1 Rotary Center
(800) CIVITAN 1560 Sherman Avenue
https://civitan.org Evanston, IL 60201
(847) 866-3000
Kiwanis, International https://www.rotary.org
3636 Woodview Trace
Indianapolis, IN 46268-3196 Sertoma International*
(317) 875-8755 1912 East Myer Boulevard
(800) 549-2647 Kansas City, MO 64132
https://www.kiwanis.org (816) 333-8300
https://sertoma.org
Lions Clubs International*
300 22nd Street Telephone Pioneers
Oak Brook, IL 60523-8842 Pioneers Headquarters
(620) 571-5466 930 15th Street, 12th Floor
https://www.lionsclubs.org Denver, CO 80202
(303) 571-1200
Pilot International (800) 872-5995
102 Preston Court http://www.telecompioneers.org
Macon, GA 31210-5768
(478) 477-1208
https://www.pilotinternational.org
Chapter 15
Often, local chapters of these organizations are listed in the phone book, or you can contact your Chamber of Commerce to
obtain contact information for local civic organizations. An Internet search can also identify local, state, and regional service
clubs that may support projects related to hearing and hearing loss. Meeting dates and contact persons are often listed on
community or Chamber websites.
538

APPENDIX 15–C
Sample Cover Letter to Community Resources
[Name of Program]
Sample Cover Letter to Community Resources
Dear
This letter is to follow up on our conversation last week when we discussed the ___________ Educational Audiology Program.
We provide the following services for children birth through 21 years of age who live in the ________________________
School District:
Hearing screenings
Comprehensive audiological evaluations
Hearing aid orientation and management
Loaner hearing aids
Provision of hearing assistance technology and support for the classroom
Habilitation services for educational needs related to hearing status
Educational programs on noise and hearing conservation
We are continuing to work with other local professionals and agencies to ensure that all children who have hearing challenges
are identified as early as possible and to help families obtain the necessary equipment and services once a hearing need is iden-
tified. This year we have been able to add testing equipment that is appropriate for very young children who cannot be tested
by traditional methods. As I mentioned last week, ___________________ has joined our audiology staff to concentrate on
hearing evaluations and rehabilitation for preschool children and other students who are difficult to test, because these services
have not been available anywhere else in our region.
The _________________ Educational Audiology Services are provided at no direct charge to families and children who are resi-
dents of _____________ school district. I have enclosed a brochure and several referral forms. Please call us at _____________,
if you need more forms or additional information.
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Thank you again for your time last week.
Sincerely,
Encl.: (Brochure or flyer)
539

APPENDIX 15–D
Community Education and Marketing Resources
American Academy of Audiology (AAA) Educational Audiology Association (EAA)

11480 Commerce Park Drive, Suite 220 700 McKnight Park Drive, Suite 708
Reston, VA 20191 Pittsburgh, PA 15237
(800) AAA-2336 (800) 460-7322
https://www.audiology.org http://edaud.org
http://www.howsyourhearing.org Downloadable handouts on educational audiology; advo-
YouTube video demonstrating hearing loss; “Turn it to the cacy statements; videos and teacher resources on pediatric
left” campaign materials; brochures and written information hearing loss, noise, classroom acoustics
on audiology, hearing loss, prevention, infant hearing loss
Hearing Health Foundation
Alexander Graham Bell Association for the Deaf and Hard 363 Seventh Avenue, 10th Floor
of Hearing (AGBell) New York, NY 10001
3417 Volta Place NW (212) 257-6140 (V)
Washington, DC 20007-2278 (888) 435-6104(TTY)
(202) 337-5220 https://hearinghealthfoundation.org
info@agbell.org Funds hearing research and publishes free consumer re-
https://www.agbell.org source magazine
Materials related to newborn hearing screening, hearing loss,
parent and childhood education, legislation, and indepen- Hearing Loss Association of America (HLAA; formerly
dence through listening and spoken language SHHH)
7910 Woodmont Ave., Suite 1200
American Speech-Language-Hearing Association (ASHA) Bethesda, MD 20814
2200 Research Boulevard (301) 657-2248 (V), (301) 657-2249 (TDD)
Rockville, MD 20850-3289 https://www.hearingloss.org
(301) 296-5700 Voice/TDD (800) 498-2071 Brochures and downloadable materials on hearing loss, am-
https://www.asha.org plification, assistive technology, the Americans with Dis
Brochures and posters on school audiology, noise and hear- abilities Act (ADA) and other related legislation; video on
ing loss prevention, ear infections, newborn hearing screen- how we hear; link to National Institute on Deafness and
ing; client education toolkit; audiology media kit; resources Other Communication Disorders (NIDCD)
on hearing assistive technology; some materials available in
multiple languages International Hearing Dogs, Inc.
5909 E. 89th Avenue
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Better Hearing Institute (BHI) Henderson, CO 80640

1444 I Street (303) 287-2277 (V/TDD)
Washington, DC 20005 https://www.hearingdog.org
(703) 642-0580 Voice (800) EAR-WELL TDD Information on obtaining and training hearing dogs
https://www.betterhearing.org
Educational arm of the Hearing Industries Association. Vid- National Association of the Deaf (NAD)
eos on hearing loss, noise-induced loss, and amplification; 8630 Fenton Street, Suite 820
communication milestones and childhood hearing loss Silver Spring, MD 20910-4500
(301) 587-1788 Voice
Dogs for the Deaf, Inc. (301) 587-1789 (TTY)
10178 Wheeler Road https://www.nad.org
Central Point, OR 97502 Information on deafness, Deaf culture, and sign language;
(800) 990-3647 (V) civil rights and legislation; technology and telecommunication
(541) 826-9220 (TTY)
https://dogsforbetterlives.org/
540

National Captioning Institute (NCI) National Institute on Deafness and Other Communication
3725 Concorde Parkway, #100 Disorders (NIDCD)
Chantilly, VA 20151 31 Center Drive, MSC 2320
(703) 917-7600 Bethesda, MD 20892-2320
https://www.ncicap.org (800) 241-1044(V); (800) 241-1055 (TTY)
Nonprofit organization providing closed-captioning services https://www.nidcd.nih.gov
to TV networks, program producers, advertisers, and other Free downloadable publications on topics from A to Z re-
organizations in public and private sectors lated to speech and hearing; infographics on noise and hear-
ing loss prevention, hearing loss and hearing aid use in chil-
National Information Center on Deafness (NIDCD) dren and adults, current news and information on research,
Gallaudet University hearing and communication-related information.
NICD, Dept. P-94
800 Florida Avenue, NE
Washington, DC 20002
(202) 651-5000 (V/TDD)
http://www.clerccenter.gallaudet.edu/infotogo
Brochures, downloadable information, and videos on hear-
ing and hearing loss, infant assessment, universal hearing
screening, otitis media, prevention, and most other hearing
related topics
Chapter 15
Local distributors and/or equipment manufacturers will frequently provide brochures, written information and demo models
for new equipment and assistive devices.
Additional resources focusing on noise and hearing loss prevention can be found in Chapter 12, Prevention of Noise-Induced
Hearing Loss and Tinnitus in Youth.

APPENDIX 15–E
School and Community Survey of Educational Audiology Services
School District Date

Name of Individual Completing Survey
Affiliation or Title

Directions: The outcomes statements below represent the goals of our program to assist children with hearing challenges
and those who support them. We need your help to determine how well we are doing. Please use the following scale to rate
each of these outcomes:
1 = In place and working well
2 = In place but needs more work or modification
3 = Developing
4 = Not present at this time
NA = Not applicable
1. Children/youth with auditory disorders are identified at birth or within a reasonable time of the event that 1 2 3 4 NA
caused the hearing disorder.
2. Children/youth within the schools and community are able to access free and appropriate audiology services. 1 2 3 4 NA
3. Children/youth receive audiological evaluations within 30 days of referral from screening. 1 2 3 4 NA
4. Children/youth receive audiology services that are relevant to the education setting and that accurately 1 2 3 4 NA
identify the parameters (e.g., listening in quiet, noise, distance, and without visual cues; use of hearing assistance
technology) associated with the auditory disorder.
5. Children/youth receive the necessary medical attention required to habilitate medically treatable hearing 1 2 3 4 NA
problems in a timely manner.
6. Teachers, parents, and appropriate other professionals understand the communication and learning implications 1 2 3 4 NA
of a child/youth’s auditory status based on both traditional and functional parameters of assessment.
7. Children/youth with auditory challenges have appropriate accommodations in their educational settings to 1 2 3 4 NA
ensure opportunities for full access in all components of their educational program.
8. Children/youth with reduced hearing have access to appropriate instrumentation, including personal and 1 2 3 4 NA
Chapter 15
assistive devices that provide full access to all communication within the learning environment (e.g., teachers,
students, themselves) and that function properly on a consistent basis.
9.
Children/youth have full access to auditory and spoken information in their educational environment 1 2 3 4 NA
regardless of mode of communication.
10. Children/youth with auditory challenges have access to services that promote their ability to communicate
with their peers, teachers, and others in their environment. 1 2 3 4 NA
11. Children/youth with auditory disorders have positive self-concepts. 1 2 3 4 NA
12. Children/youth with auditory disorders are able to advocate for their listening and communication needs. 1 2 3 4 NA
13. Families are encouraged and supported to fully participate in their child/youth’s education. 1 2 3 4 NA
542

Please identify the major strengths of the educational audiology service program:
Please identify your major concerns about the educational audiology service program:
Please provide any comments that would be helpful for us to know.
How did you first learn of the_[insert school district/Cooperative name}__________ educational audiology services?
Thank you for assisting us in improving our educational audiology program. Add your email or other contact infor-
mation below, and you will receive current information on our services.
Email:
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Other contact:

APPENDIX 15–F
Sample Survey: Educational Audiology Services
School District Date

Name of Individual Completing Survey
Agency or Clinic Name
Directions: Please rate the indicated service according to the following scale:
1 = In place and working well
2 = In place but needs modification
3 = Developing
4 = Not present at this time
NA = Not applicable
1. Educational audiology services are coordinated with community-based
services to increase family access to services. 1 2 3 4 NA
2. Educational audiology services support community resources in the 1 2 3 4 NA
development and delivery of the following:
High-risk registry 1 2 3 4 NA
Newborn screening 1 2 3 4 NA
Follow-up services to identify and manage infants, toddlers, and children 1 2 3 4 NA
with reduced hearing
Information for families regarding service and equipment options for deaf 1 2 3 4 NA
and hard of hearing children
3. Educational audiology services have ongoing communication with community resources. 1 2 3 4 NA
4. Please identify the major strengths of the educational audiology service program:
5. Please identify your major concerns about the educational audiology service program:
6. How did you first learn of the___________________________ educational audiology services?
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Thank you for assisting us in improving our educational audiology program. Add your contact information, and you
will receive current information on our services.
544

APPENDIX 15–G
Marketing/Advocacy Outcomes Log
Date Date
Marketing/Advocacy Strategy Requested Implemented Audience Response
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Key to responses: 1 = Referral or request for specific service

2 = Request for information
3 = Request for repeat presentation
4 = Financial or other program support
5 = Other (describe)
545

APPENDIX 15–H
EARS—School Contract Template
School-Based Audiology Services

School Year ____ -_____
The __________________________________________ School District is contracting with the

Educational Audiology/Speech Pathology Resources for Schools (EARS) Program at Arkansas
Children’s to provide school-based, educational audiology services to our students.
The EARS audiologist(s) may be involved in the following throughout our district:
• Hearing device check-up and maintenance

• Consultation regarding interfacing student’s personal amplification with school-
owned classroom amplification systems
• Communication with the student’s clinic-based audiologist regarding a student’s
hearing devices
• Communication with the student’s teacher(s) and other school personnel
regarding a student’s hearing and hearing device as it is relevant to his/her
education,
• Reviewing student audiological and other evaluation data with school personnel
as is relevant to his/her educational needs
• Conducting hearing evaluations as requested by the district, with written
parental permission
• Performing ear mold impressions as requested by a child’s clinic-based
audiologist, with parental permission
• Consulting with school personnel regarding educational accommodations and
modifications appropriate for students with hearing loss and/or auditory
processing disorders
Please note that these services do not, and are not intended to, take the place of the services
Chapter 15
provided by your child’s clinic-based audiologist. Services provided by your child’s clinic-based
audiologist will not be duplicated at school. Regular follow-up visits and communication with
your child’s clinic-based audiologist are essential for managing your child’s hearing needs. Our
goal in having school-based audiology services here at our school is to provide school staff with
the on-site technical assistance that they need to educate your student as well as to improve
communication between schools and clinic-based audiologists. Our goal is that having these
services will result in better educational outcomes for our students with hearing loss.
For questions regarding this partnership, please contact:

___________________________________ (Name of district personnel)
___________________________________ (School District)
___________________________________ (Phone or email address)
Note. Adapted from a form used by the EARS Program @ Arkansas Children’s Hospital.
546

APPENDIX 15–I
Implant Center/School/Therapist/Parent Information Exchange Form
This form has been designed to facilitate communication among the child’s implant center, relevant school personnel, private
therapist, and parents. Please keep a copy of this form in the child’s folder at each location and use it to evaluate and monitor
performance to assist with programming adjustments. When questions and/or concerns arise, please contact the Implant Center
immediately. Otherwise, at least quarterly updates are recommended.
Date Completed/Updated:
Child/Student: DOB: AGE:
Implant Make/Model: Date of Activation:
Speech Processor: Serial #: ____________ Ear:
Hearing Aid: Serial # ____________ Ear:
School Personnel
Primary Contact:_____________________________ Title:
Address:
Phone: _______________ Fax: email:
Best way to communicate:  phone  fax  email  text Best time to communicate:
School of Attendance:
Teacher: text/email:
Educational Audiologist text/email:
Speech-Language Pathologist: text/email:
Cochlear Implant Center Audiologist

Center Name:_____________________________ Otologist:
Audiologist:
Address:
Phone: Fax: email:
Chapter 15
Private Therapist
Name: Center:
Address:
Phone: Fax: email:
547

548 Chapter 15
Forms sent to:  teacher  parent

 educational audiologist  other_______
Device Settings and Behavioral Expectations/Observations

Feedback Form
Please complete this form and FAX to implant center audiologist prior to next appointment.
Name: Date:
Date of next device appointment (recommended or scheduled):
Program 1 Program 2 Program 3 Program 4
Vol/Sensitivity: ____/____ ____/____ ____/____ ____/____
Description:
(Circle Primary Program)
Behavioral
Expectations by
Implant Center:
Observation by
 School
 Therapist
 Parent
 Other
Potential Indicators for Program Adjustment or Referral to Implant Center1

School and/or parents should refer back to the implant facility for adjustments or consultation when any of the following be-
haviors are noted:
School Therapist Parent
1. Decrease in auditory responsiveness or change in attending behavior
2. Change in frequency of vocalization, voice quality and/or vocal intensity
3. Reduction in distance hearing
Chapter 15
4. Increased requests for repetition or use of “What?” or “Huh?”

5. Emergence of persistent disruptive or withdrawn behavior
6. “Slushy” production of formerly mastered speech sounds
7. Omission or confusion of consonants that were formerly present
8. Prolongation of vowels
9. Any signs of physical discomfort or skin irritation associated with the implant
10. Aversion to sound or reluctance to wear processor
11. Presence of facial nerve stimulation (eye or facial muscle twitches, etc.)
12. Lack of progress
13. Other
1
Adapted from Colorado Cochlear Implant Consortium, Colorado Department of Education, and Marilyn Neault PhD,The Children’s Hospital
of Boston.

APPENDIX 15–J
Characteristics That Foster Successful Collaboration
■■ Recognizing the validity and value of multiple perspectives, especially the perspectives of families and individuals who
have experienced deafness or other hearing conditions and the students themselves
■■ Understanding the social construction of deafness in various communities and how that impacts the context that partners
and entities bring to collaborative relationships
■■ Recognizing that “expertise” comes in many forms and may be expressed in a variety of ways
■■ Conscientiously and continuously working to reduce the “professional as sole expert” perception
■■ Recognizing that, while all collaboration partners can contribute equally to a collaboration, not all partners can contribute
in the same way
■■ Having a willingness to share power and decision-making authority
■■ Recognizing that collaboration yields greater benefits than any entity could achieve alone
■■ Recognizing that there will be new learning in the process of collaboration for all participants
■■ Continuously focusing on how the collaboration positively impacts the education of deaf and hard of hearing students
rather than on the entities themselves
Chapter 15
549

CHAPTER 16
Program Development,
Evaluation, and Management
CONTENTS
Program Development
Laying the Foundation ■ Needs Assessment ■ Planning
Program Evaluation
Assessment of Existing Audiology Services ■ Planning for Improvement ■ Implementation of New Services
■ Measuring Effectiveness ■ State Model Evaluation Systems
Chapter 16
Teacher views: “I will be effective if . . .”
551

Program Management
Annual and Monthly Scheduling ■ Day-to-Day Scheduling ■ Office Support ■ Data Management ■ Forms
■ Budget and Finances ■ Facilitating Meetings ■ Challenges
Summary
Suggested Reading and Resources
Appendices
16–A Self-Assessment: Effectiveness Indicators for School-Based Audiology Services (Online)
16–B Goal Prioritization Worksheet (Online)
16–C Long-Range Planning Form (Online)
16–D Logic Model Planning Form (Online)
16–E1 Educational Audiology Workload Analysis Form (Text)
16–E2 Educational Audiology Workload Analysis Fillable Form (Online)
16–F Recommended Outcomes and Evidence for Educational Audiology Tier 1 Services (Text)
KEY TERMS When developing new educational audiology services

or expanding existing ones, the educational audiologist must
Program development, program evaluation, SWOT analy- have a clear idea of what needs to be changed and how these
sis, logic plan, specialized instructional support personnel changes can be accomplished. Therefore, one of the most
(SISP), standards, outcomes, workload important aspects of the practice of audiology, or for that
matter, any business, is the evaluation of the effectiveness
of the services that are provided and the planning process to
determine modifications or additions to the program. Like-
KEY POINTS wise, the day-to-day program management is also critical to
the efficiency of services. Data collected for this purpose are
■■ Educational audiologists must be integral members of
useful anytime services are questioned or require justifica-
school multidisciplinary teams.
tion. Unfortunately, because of time limitations, most of us
■■ Educational audiology programs benefit from commu-
typically make decisions based on immediate needs with-
nity support and collaboration.
out thoughtful regard for their impact on our total service
■■ Evaluation and planning are necessary to manage and
package. The formal evaluation and planning process can be
grow educational audiology services.
thought of much like an Individualized Education Program
■■ Data, evidence, and a roadmap for moving forward
(IEP). The resulting long-range plan (usually a 1- to 3-year
show administrators that audiologists have done their
plan) can provide a systematic method for developing and
homework and provided documentation administrators
improving services and be extremely helpful when working
can use to support their position.
with school administrators to request equipment or person-
Educational audiologists have been employed in school nel or to enhance services.
systems since even before the passage of Pl 94-142 in 1975, This chapter is divided into three components: program
Chapter 16
yet there are still many communities and states in which edu- development, program evaluation, and program manage-
cational audiology services are minimal or nonexistent. Few ment. Although management is ongoing (i.e., day-to-day
states have developed specific guidelines that ensure there is program operations), the sequence of development and
at least one educational audiologist for every 10,000 students evaluation may vary depending on the current status of the
in a school system, as recommended by the Educational Au- audiology program. For example, if the audiologist is just
diology Association’s (EAA) Recommended professional setting up a program, it would be appropriate to start with
practices for educational audiology (2009) and the American program development activities. But if there is an existing
Speech-Language-Hearing Association’s (ASHA) Guidelines program, an evaluation process should occur first to shape
for audiology service provision in and for schools (2002). the development phase.
552

Program Development, Evaluation, and Management 553
PROGRAM DEVELOPMENT ■■ an ability to project future program directions

(visioning);
Program development begins with building a support base ■■ knowledge of the community;
and conducting a needs assessment. After the results of the ■■ an ability to run effective meetings, synthesize informa-
needs assessment are summarized, a plan for services can tion, and build consensus;
be developed. ■■ flexibility;
■■ good organizational skills and attention to detail;
■■ sense of humor;
Laying the Foundation ■■ trusted reputation and credibility within the educational
Building the foundation for program development should and medical communities; and
include collecting evidence that supports the need for ser- ■■ ability to learn quickly.
vices, developing effective leadership skills, and garnering
support for services. The Educational Audiologist as a
Member of the School Team
Gathering Supporting Documentation Although there may only be one educational audiologist in a
Guidelines of existing professional standards related to audi- school district, his or her role must be an integral part of the
ology services in the schools should be gathered as the first larger plan for services that involve screening programs for
step in program development. Together these documents identification of potential disabilities (child find services),
provide the foundation for standards of practice that each assessment, and direct services to students with hearing dif-
local school district audiology program should follow. These ferences. For either screening or direct services, the larger
may include the following: team may include nurses, teachers, early childhood special-
ists, speech-language pathologists, and other support service
■■ EAA documents; and personnel such as psychologists, counselors, social workers,
Educational audiology scope of practice (Appen and assistants. Within these teams, the audiologist must be
dix 2–C) able to garner support for the importance of comprehensive
Supporting students who are deaf and hard of hear- educational audiology services so that the entire team can
ing: Shared and suggested roles of educational audi- advocate for the program. Although educational audiologists
ologists, teachers of the deaf and hard of hearing, and may be independent and autonomous for decisions about
speech-language pathologists (Appendix 2–A); and specific audiology components, they must be able to work
■■ other professional guidelines in specific areas such as effectively as team members while providing leadership for
screening, assessment, amplification, and habilitation as audiology programs within the schools.
well as any educational audiology guidelines developed
by local state departments of education. The National Support From Key Decision-Makers
Association of State Directors of Special Education’s
Within the School District or Local Education Agency
Optimizing outcomes for students who are deaf or hard
Perhaps the most critical element when establishing or ex-
of hearing: Educational service guidelines (2018) con-
panding the educational audiology program is gaining sup-
tains several references to roles and responsibilities of
port from the key decision-makers, particularly the school’s
educational audiologists.
or local education agency’s (LEA) administration. During
the steps of program development, planning, and evaluation,
Leadership Skills it is important that local administrators are aware of the ac-
Effective leadership skills are an important feature in the tivities. As a result, they will feel involved in the process and
development and implementation of any program. A good will more likely support the recommendations. Any activities
leader should have the ability to motivate, stimulate, facili- educational audiologists can do to make the local administra-
tate, and influence. The following characteristics are found tors aware of needed services or changes will be beneficial.
in effective leaders: Every opportunity to capitalize on specific situations that
arise should be used as an example for reinforcing or modify- Chapter 16
■■ effective communication skills—written, oral, and
ing the program. Examples of activities to promote aware-
listening;
ness of the educational audiology program include
■■ an understanding of successful team dynamics and abil-
ity to work as a team member; ■■ providing formal presentations;
■■ knowledge of administrative issues, including budgeting; ■■ having informal discussions over time;
■■ an understanding of the bigger pictures of special education ■■ providing information on the requirements of the fed-
and general education, including current trends and issues; eral and state laws;
■■ knowledge of audiology, health, and deaf education is- ■■ sharing articles, practice guidelines, and other relevant
sues and trends; information;

554 Chapter 16
■■ arranging for visits to neighboring districts; ■■ influencing university training program curricula (Au-
■■ inviting principals, supervisors, school board members, diologist [AuD], speech-language pathologist [SLP],
or others to accompany the audiologist during all or teacher of the deaf and hard of hearing [TODHH]).
part of the school day, and providing a courtesy hearing
Initiatives that are presented from a body of individuals
evaluation; and
representing these various practice and service areas should
■■ encouraging parents and students to express their sup-
provide substantial support toward the development of au-
port, both orally and in writing.
diology services in the schools as well as pediatric audiol-
Administrative endorsement of specific plans proposed ogy and other support services statewide. See Chapter 15,
by the educational audiologist is critical for changes to Collaborative School–Community Partnerships, for more
occur. Administrators should believe that the recommended information about collaborative partnerships.
changes are possible and that they can help facilitate them.
They need data concerning cost-effectiveness and informa-
tion documenting that the changes will improve services to Needs Assessment
the students in their district. A formal needs assessment has a variety of functions including:
■■ analyzing the current status of audiology program
State Department of Education In addition to support components;
within the district, contact with the state department of edu- ■■ analyzing existing resources (equipment, staff, budget)
cation representatives who have responsibility for audiology necessary for educational audiology services;
as a special education related service can have long-term ■■ determining perceived strengths and challenges of the
benefits. If no one at the state level has specific audiology existing services by school and community-based con-
responsibility, the educational audiologist should identify sumers and parents;
a consistent contact person at the state department to dis- ■■ helping educate school, community, and parents on is-
cuss questions, concerns, and needs. If significant numbers sues related to educational audiology services;
of inquiries occur over time, state department officials may ■■ obtaining input on strategies to deal with the issues; and
begin to recognize the need for a specific person with audi- ■■ stimulating discussion, consensus, and actions to ad-
ology expertise to be part of their staff. If an educational au- dress the identified program needs.
diologist joins the state special education department team,
A needs assessment should include:
the leadership of that individual should result in significant
improvements statewide through training, policy develop- ■■ data on national and local demographics, including the
ment, and monitoring activities. incidence of hearing differences and a description of
Another helpful alliance is with the state agencies that the characteristics of the existing population of students
oversee the Early Hearing Detection and Intervention ( EHDI) with reduced hearing;
and early intervention programs. With the growth of EDHI ■■ performance data on existing components of audiology
programs, it is important that educational audiologists are part services;
of both the Part C and Part B systems in their communities to ■■ survey input from school-based consumers (nurses,
help build continuity of services across the programs and to teachers, regular education, and special education ad-
facilitate the transition of services for families. The exact role ministrators—usually principals and special education
of educational audiologists with Part C varies in each state coordinators), community-based consumers (agencies,
depending on how services are structured within the agencies. physicians, and audiology and speech-language clin-
ics), and parents; and
■■ evaluation of community resources for services for chil-
Statewide Collaboration Collaboration of all entities that
dren and youth with reduced hearing.
support pediatric audiology and deaf/hard of hearing ser-
vices provides a mechanism for communication and colle- The type of needs assessment conducted should be de-
giality. These include state professional organizations, uni termined by the type of information required and how it will
Chapter 16
versity training programs, children’s hospitals, pediatric be used. There may also be different formats for the various
audiology centers, deaf/hard of hearing service agencies, groups that are queried. For example, a parent needs assess-
and parent organizations. Collaboration benefits include: ment may be a survey and contain less specific information
than one completed by school staff. For audiology services,
■■ increasing understanding of the scope of educational
both specific program components and the service-delivery
audiology services;
system should be assessed. The systems-related areas include:
■■ providing a network to develop unified positions on vari-
ous audiology practices including educational audiology; ■■ comprehensiveness of services;
■■ providing a forum to discuss practice challenges and ■■ accessibility of services;
service gaps; and ■■ coordination of services;

■■ continuity of services; Planning should begin with a vision, specifically, what a rea-
■■ accountability for services; sonable program of educational audiology services should
■■ efficiency of services; and be like, based on legal mandates and local needs. The vi-
■■ collaboration with school and community. sion may include several components that more specifically
describe the program. The vision should also be consistent
The protocol, Self-Assessment: Effectiveness Indicators
with your school or agency’s mission statement, which de-
for Audiology Services in the Schools (Appendix 16–A, on-
scribes current goals and how they are achieved. An exam-
line), is useful for both needs assessment and program evalu-
ple of a vision statement for educational audiology services
ation. This tool is based on specific program components
might be as follows:
and service-delivery systems for educational audiology,
identified as effectiveness indicators, in a self-assessment Comprehensive educational audiology services are
format. The rating status for each component can be identi- available to all children and youth in [Name of School
fied as “accomplished,” “emerging,” “a goal,” or “not appli- District] in order to promote full access to communica-
cable at this time.” There is also space on the form for com- tion, enable full participation in learning in all settings,
ments and action plan activities. Another tool, School and and maximize use of residual hearing.
Community Survey of Educational Audiology Services (Ap-
pendix 15–E), can be used to survey other groups regarding The next step might be to further define what these pa-
performance toward meeting outcomes for the program. rameters would look like, such as,
After it has been completed, the needs assessment data
should be compiled, analyzed, and shared with appropri- Specifically, students will receive educational audiol-
ate groups. These should include members of teams with ogy services that will reflect:
whom the educational audiologist works most closely (e.g., ■■ sufficient resources (staff, equipment, materials,
nurses, TODHH students, and SLPs) as well as immediate budget, and space) to provide consistent services
supervisors. The results should then be used to guide the and meet assistive technology needs of students;
planning phase. ■■ team collaboration within the schools to address and
support the needs of students with hearing and lis-
SWOT Analysis tening deficits;
An effective quick needs assessment can be conducted using ■■ a partnership between parents and school to maxi-
a SWOT analysis (strengths, weaknesses, opportunities, and mize benefits of educational audiology services;
threats) format as illustrated in Figure 16–1. This format works ■■ collaborative efforts with community agencies, clin-
well as a brainstorming activity with a small group of people to ics, and services that support children with hearing
analyze audiology services or any other aspect of a program. differences;
The SWOT analysis does not require the level of evidence or ■■ current professional audiological assessment and
detail that a more formal needs assessment uses. It can also be intervention practices; and
used to get the evaluation and planning process started. ■■ access to appropriate technology.
Along with the vision, a goal is needed to provide direc-
Planning tion for the plan. An example of a goal might be as follows:
The planning process is a time to dream about what should
be, that is, to think about optimal services and situations. Implementation of a comprehensive audiology program for
all children, birth through 21 years of age, within 2 years,
that addresses the six areas of audiology as defined by the
Individuals with Disabilities Education Act (IDEA).
The plan for educational audiology services is similar

to the short-term objectives of an IEP. We find that plans
are best laid out for 1 to 3 years with specific yearly activi- Chapter 16
ties. As part of the development of the plan, any parameters
that might affect or limit the ability to conduct certain ac-
tivities should be identified. Insufficient financial resources
and staff are a common limitation to program development.
Inclusion of an administrator during the planning not only
facilitates the process but may also help engender support
for the activities. The plan should also include an introduc-
tion that profiles demographic and needs assessment data for
FIGURE 16–1 SWOT analysis. the district, as well as a brief historical overview of past and

556 Chapter 16
current educational audiology services, staff, and resources considered working documents. To summarize, the program
if the program currently exists. development activities should:
Activities should be prioritized (see Appendix 16–B,
online, for a goal prioritization form) to determine those that ■■ lay the foundation by providing standards and guide-
can be achieved immediately, or within a reasonable period lines for audiology services in the schools and develop-
of time (first-year goals), and that fit into the longer-term ing a support base of key individuals and groups;
plan (second, third years). Figure 16–2 illustrates the use of ■■ include data from a needs assessment including surveys
the goal prioritization worksheet identifying goal #3 with of various potential consumers of the school’s audiol-
the highest rating and therefore the most likely to be suc- ogy services or from a SWOT analysis;
cessful. Activities should be determined for each component ■■ develop a program vision and goal(s) based on assess-
of the audiology services program. Figure 16–3 contains a ment results;
sample format for a 1- to 3-year action plan (only 2 years are ■■ develop a long-range plan that identifies specific activi-
shown in this sample) including potential audiology compo- ties in each of the program component areas;
nents (see Appendix 16–C, online, for a blank worksheet). ■■ prioritize activities for determination of placement
Long-range plans must be reviewed at least annually to within the plan (e.g., first year versus second year);
evaluate progress and determine the appropriateness of the ■■ determine budget implications and any other limiting
activities as they were laid out. Revisions should occur as parameters to the activities planned; and
part of the evaluation activity. Similar to IEPs and Individual ■■ conduct an annual review that includes necessary
Family Service Plans (IFSPs), the plans should always be adjustments.
Chapter 16
FIGURE 16–2 Goal prioritization worksheet.

1ST YEAR 2ND YEAR

PROGRAM
GOALS BUDGET/ BUDGET/
COMPONENT ACTIVITIES ACTIVITIES
RESOURCES RESOURCES
Increase 1. Facilitate 2–3 lunch 1. 1.5 hrs 1. Continue quarterly 1. 1.5 hr/lunch
communication meetings with /lunch (3) lunches. (3)
with other audiologists to discuss 2. 1 hr/ 2. Report on progress of
audiologists in school and private audiology target goal.
Community the service relationships. visit 3. Identify goal for 2nd
Collaboration community. 2. Invite private year.
audiologists to visit
school clinic facility
3. Identify specific goal to
work on for year.
Increase heath 1. Conduct inservice for 6 hrs (3 hrs 1. Conduct classroom 1. 5 hrs for
teacher’s Middle School health prep & 3 hrs of observations of classroom
understanding teachers. inservice/ Dangerous Decibels observations
Prevention of hearing loss 2. Conduct Dangerous workshop activities. 2. 3 hrs for
prevention. Decibels workshop for 2. Conduct follow-up DD workshop
teachers. workshop for heath
teachers.
Increase use of 1. Implement OAE 1. $2000 for 1. Analyze screening data 1. 5-10 hrs.
OAEs in Child screening protocol for OAE. and protocol.
Find screening. use in Child Find. 2. 2 hrs 2. Make adjustments to
2. Purchase automated training protocol as needed.
OAE screener. 3. Time for
Identification
3. Train nurse(s) to do screening.
screening.
4. Implement screening,
monitoring, & referral
criteria.
Improve 1.Develop awareness 1. 8-10 hrs to 1. Provide teacher 50 hrs
Habilitation
management of materials for MMUSD develop consultations to target
Students with 2.Create database that materials MMUSD students
MMUSD profiles all MUSSD 2. 40 hrs to
students including create
performance levels. profile.
Increase use of 1. Purchase and install 1. $15,000.00 1. Purchase and install $2000.00
CADS in K-3rd CADS for 1st grade 2. 2 hrs/class CADS for remaining 1st
grade classrooms in 5 schools = 30 hrs grade classrooms in 5
classrooms. (15 classrooms/ systems) schools (15 classrooms/
2. Conduct pre- & post systems) and conduct
listening evaluations on pre- & post listening
targeted students in evaluations.
classrooms. 2. Present pre-post data
Amplification from 1st year to school
principals, parent-
teacher organizations,
& other groups to
garner support to
prucahse additional
systems for K, 2, 3rd
grade classrooms.
Chapter 16
Improve 1. Performa Work Load 25 hrs 1. Provide essential 8 hrs
Program efficiency of Analysis for school year. services according to
Development & time to provide 2. Review & prioritize priority list.
Management most critical audiology services. 2. Review priority list of
audiology services; make
services. necessary adjustments.
FIGURE 16–3 Sample long-range planning format.

558 Chapter 16
FIGURE 16–4 Logic model plan.
Logic Model Planning is also useful for describing organizations and projects for
Another type of planning process that works well for educa- grants and project development. Because the work is sum-
tional audiology programs is the logic model. This model fol- marized within the model, and generally limited to a single
lows a sequence of actions, hence “logic,” that lead to the de- page, the graphic representation is particularly effective
sired outcomes. As shown in Figure 16–4, the model begins when sharing with administrators, funders, or other groups.
with a description of current or needed resources, followed Appendix 16–D contains a Logic Model planning form.
by activities (which are later prioritized), outputs that are
products that will result from the activities, and short-term
outcomes and long-term outcomes that define the anticipated PROGRAM EVALUATION
impact the work will have. This model is an effective process
to organize planning and analysis of an organization and its Periodic evaluation of existing audiology services is a neces-
programs or when designing outcomes-based evaluations. It sary process for every educational audiology program. Just
like IEPs, a comprehensive evaluation should occur at least
every 3 years with reviews conducted at the end of each
school year. Evaluation promotes change in a systematic
Chapter 16
fashion where areas of concern are identified, and appropri-

ate planning occurs to facilitate the change. The program
A logic model is a graphic depiction (road map) that evaluation process overlaps with program development in
presents the shared relationships among the re- many areas as illustrated in Figure 16–5.
sources, activities, outputs, outcomes, and impact for
your program. It depicts the relationship between
your program’s activities and its intended effects.
Assessment of Existing Audiology Services
https://www.cdc.gov/eval/logicmodels/index.htm The first step in an evaluation is to consider all components
of the existing program to determine potential gap areas.
The self-assessment should include all necessary services

for students within the school system, whether currently part Workload Analysis
of the program or as suggested in national or state guide- A workload analysis provides quantitative information
lines. Current resources and systems information, including about how the audiologist’s time is organized providing
accessibility, coordination, continuity, accountability, and a more accurate representation of responsibilities. The
efficiency of services as well as collaboration between the model in Figure 16–6 illustrates specific activities orga-
school and community should also be addressed. Review nized in the categories of direct student services, support
of the educational audiology program can be performed student services, and programmatic and administration du-
using quantitative and qualitative methods; in fact, both are ties (Johnson, Cannon, Oyler, Seaton, Smiley, & Spangler,
recommended. 2014). This approach can be useful when comparing how
time spent fits with the priorities of the program. It is also
useful when documenting the need for additional full-time
equivalent (FTE) or other staff support for the program. The
example in Figure 16–7 details the workload areas showing
how time varies by month, a function of changing priorities
throughout the school year, as well as whether there is suf-
ficient time in the week to meet the needs of the students
and provide other audiology support services. A form for
summarizing the monthly workload time is presented in Ap-
pendix 16–E1. The online Appendix 16–E2 contains a fillable
spreadsheet for daily reporting of the workload activities. By
calculating the workweek minutes allotted your FTE (1 FTE =
2,400 min/week) and comparing to the workload actual
time, the audiologist can determine whether he or she is over
or under the allotted time per week. Potential benefits of a
workload approach (adapted from Schraeder, 2019) include:
■■ more accurate representation of responsibilities and al-
location of time;
■■ improved quality of services;
■■ increased opportunities for collaboration;
■■ fewer staff vacancies;
■■ reduced litigation;
FIGURE 16–5 Program planning process. ■■ cost savings;
Chapter 16
FIGURE 16–6 Workload analysis model.

560 Chapter 16
Audiologist:______________________________________ Date:_______________
District/BOCES/Agency:____________________________ Current FTE:_____

For each area below, estimate the numbers of hours/month that you are engaged in that
activity. You may use the blank lines to insert additional activities that are not identified.
WORK AREA JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
Direct Service:
5 5 5 5 5 4 4 5 5 20 10 5
Screening
Follow-up Screening 10 10 5 5 0 0 0 0 5 10 20 20
Assessment - 24 24 24 24 24 20 4 20 24 24 24 24
Audiological
Assessment - 10 6 4 5 4 0 0 10 12 12 10 8
Functional 0 0
Assessment - APD 12 12 12 12 12 8 0 0 7 10 12 12
Classroom Acoustic 2 5 2 0 5 0 0 8 4 4 2 2
Measurements
Habilitation/ Co- 5 5 5 5 5 2 0 0 5 5 5 2
Teaching
Prevention 5 2 2 2 2 0 0 0 0 0 2 0
2
Counseling (parents, 12 10 10 10 8 0 0 5 5 8 8 4
students)
Teacher/Staff
Consultation (e.g., 15 15 15 20 20 4 2 20 18 15 0 0
observation, inservice)
HAT Evaluation & 6 4 4 5 2 0 0 18 18 5 5 0
Fitting/Validation
HAT 4 2 1 3 1 0 0 6 6 1 2 0
Orientation/Training
Equipment
6 3 3 3 5 25 0 20 18 13 5 3
Chapter 16
Troubleshooting &
HAT Management
Indirect Service:
HAT monitoring 2 2 2 2 2 1 0 1 3 2 2 2
0 0
FIGURE 16–7 Sample workload analysis.

Equipment Calibration 2 0 0 0 0 1 0 0 1 0 0 0
Equipment Ordering 1 0 0 0 1 5 0 0 0 2 0 0
0
Report Writing 6 8 8 10 9 6 0 0 8 8 6 6
Multidisciplinary
Team Collaboration 5 5 5 5 5 2 0 5 5 5 5 5
IEP/504 Development 6 4 4 5 5 1 8 7 5 4 2 1
IEP/504 Meetings 6 4 4 5 6 1 8 8 5 5 5 1
Planning/Prep/Schedul 8 8 6 6 6 6 2 1 8 8 6
ing 0
Documentation/ 5 4 4 5 4 5 1 5 4 4 4 3
Record Keeping
Community Meetings 1 1 2 1 2 2 0 3 1 1 2 1
Administrative:
Travel (between 4 4 4 4 4 2 0 5 4 4 4 2
schools)
Travel
Requests/Travel 1 1 1 1 1 1 0 1 1 1 1 1
Reimbursement 1
Professional 3 1 1 8 1 0 2 0 8 0 0 0
Development
Staff Meetings 4 4 4 4 4 2 0 2 4 4 4 4
TOTAL HOURS
(40 hr work week = 169 149 139 157 143 98 29 162 177 175 158 114
roughly 160 1
hrs/month) 7
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
Chapter 16
FIGURE 16–7 (Continued)

562 Chapter 16
■■ increased ability to identify students needing services; goal or goals, activities to meet the goals, and a timeline
■■ increase in consultations with teachers and parents; for accomplishing the goals. The plan should contain both
■■ better staff morale; short- and long-term activities that can be contained in a
■■ increased ability to integrate IEP goals with classroom 1- to 3-year plan (see Figure 16–3 for a sample long-range
curricula; and planning format and Figure 16–4 for a logic model plan).
■■ better management of time and responsibilities. Development of the components and activities for the plan
should be based on the needs that were identified in the as-
Program Component Review sessment and the comparison of existing services to those
The Audiology Effectiveness Indicators self-assessment tool required or desired. Particular attention should be paid to
contained in Appendix 16–A takes a more qualitative ap- including a plan for the purchase of new equipment and the
proach to program improvement. Within the context of pro- replacement of old items. The high costs of equipment often
gram review, this self-assessment provides a comprehensive require at least 1 to 2 years of advance budget planning.
snapshot of program strengths, components that are devel- When developing and prioritizing goals (see Appendix 16–B
oping, and those that may be targeted as goals. As described for a sample prioritizing worksheet) and activities, the fol-
earlier, this assessment should lead to a goal prioritization lowing questions should be considered:
process using the prioritization worksheet (sample in Fig ■■ How will the goal or activity be accomplished?
ure 16–2 and form in Appendix 16–B). For further consid- ■■ Who will be responsible for implementing the goal or
eration in the program improvement plan, data from school activity?
and community consumers should be obtained to provide ■■ What current resources can be used to accomplish the
the perspective of these partners. Appendix 15–E, School goal or activity?
and Community Survey of Educational Audiology Services, ■■ What additional resources, especially financial, will be
is based on the audiology program outcomes located in Ta needed?
ble 16–1. When considering a program from an outcomes ■■ How will the goal or activity be implemented?
perspective, the services that impact these outcomes may ■■ When will the goal or activity be completed, or will it
reflect not only the responsibilities of the educational audi- be ongoing?
ologists but also the support of these other partners. These ■■ How will achievement of the goal or activity be
components of program review are summarized as follows: measured?
1. Workload Analysis—completed by the school ■■ What is the evidence that demonstrates full implemen-
audiologist(s). tation of the goal?
2. Self-Assessment—completed by the school audiol
ogist(s)—may also include primary team members
(e.g., SLP, TODHH). Implementation of New Services
3. School and Community Survey of Educational Audiol- After the administrators have approved the plans for improv-
ogy Services—completed by partners who share in the ing the educational audiology services in the school district,
education for children with reduced hearing, including the audiologist can begin to implement the changes in the
teachers (regular and special education), other special program. It is important to remember that these changes
education providers (e.g., nurses, speech-language pa- will be effective only if they are supported by other mem-
thologists, psychologists), administrators (principals bers of the educational staff. The audiologist must be care-
and special education coordinators or supervisors), ful to educate all personnel and parents about the services
community agencies, community audiology and com- and why they are important for the students. Changes in
munication disorders clinics, physicians, and parents. the educational audiology program should be implemented
After all data have been collected, they should be sum- in a systematic manner as determined in the 1- to 3-year
marized in a report that includes a brief synopsis of the pro- plan to ensure adequate resources and necessary support to
gram, resources, demographic data, and any other appro- promote the program’s success. Administrators should al-
priate supporting information. The results should be shared ways be kept informed of program developments and the
Chapter 16
with the audiologist’s immediate supervisor, deaf education effects of the changes. Their support will more likely con-
teachers, and other members of the team serving deaf and tinue when they feel informed and have evidence support-
hard of hearing students in the school district, and any other ing the benefits for students. Instituting program improve-
appropriate individuals. ments requires ongoing attention to marketing on the part
of each educational audiologist, which should be included
in the plan. (See Chapter 13, Supporting the Educational
Planning for Improvement Team, and Chapter 15, Collaborative School–Community
As with program development, improvement planning Partnerships, for more specific information on advocating
should reflect the desired student outcomes, followed by a for educational audiology programs.)

Measuring Effectiveness cluded and monitored when providing services to stu-

dents with auditory challenges in the schools;
Outcome measures tell us whether program goals have been
■■ identify evidence-based practices;
accomplished. The major questions to ask when determin-
■■ recommend tools that, if used, allow for comparing data
ing effectiveness are (a) “Does the program make a differ-
across districts and states;
ence?” and (b) “What would have happened in the absence
■■ serve as a Gold Standard of supports and services for
of the program?” To determine effectiveness accurately, the
students with auditory deficits (e.g., essential compo-
relationship between cause and effect should be as close as
nents of services for children, families, teachers, and
possible. As program efficacy continues to be scrutinized,
other support professionals);
we need to monitor our effectiveness more closely. Outcome
■■ provide data and evidence to support a rationale to in-
measures are one way to evaluate program effectiveness.
crease staff to meet students’ need (e.g., educational
EAA’s recommended outcomes for educational audiology
audiologist or teacher of deaf and hard of hearing stu-
services, illustrated in Figure 16–8, are the result of a multi-
dents, assistive technology support);
year project that brought together a core group of pediatric
■■ provide data and evidence to justify caseloads/workloads;
and educational audiologists to develop outcomes, perfor-
■■ have accountability for personnel performance evaluations;
mance indicators, and measurement tools and strategies. The
■■ provide an outcomes-based standard of practice for
outcomes have two levels: Tier 1 outcomes are the primary
self-reflection or self-assessment for staff and program
responsibility of the educational audiologist, and Tier 2 out-
development (e.g., where are we currently and where
comes include other members of the multidisciplinary team.
do we need to improve, and what supports and tools or
Data collection on the Tier 1 outcomes continues. The asso-
levers are needed to better support student outcomes in
ciated performance indicators used for data collection are in
students who are deaf or hard of hearing);
Appendix 16–F. Outcome measures may serve the following
■■ align with federal regulations (IDEA, ADA); and
purposes:
■■ help guide content for AuD personnel preparation
■■ identify the impact of educational audiology services programs.
on student outcomes;
■■ provide special education directors and state depart- These outcomes may also be part of a program effec-
ments of education a framework of what should be in- tiveness evaluation as outlined in Table 16–1. This process
Chapter 16
FIGURE 16–8 Educational Audiology Association outcomes at a glance.

564 Chapter 16
TABLE 16–1 Evaluation of Audiology Program Effectiveness: Process and Outcome Evaluation Questions
Part 1. Process/Formative Evaluations

1. Monitoring Daily Tasks
■■ Are audiology service obligations being met?
■■ Are audiology services taking place? How and when?
■■ Are the audiologist(s) and support personnel working when they should?
■■ Is the audiology program administered efficiently?
■■ Are daily audiological activities carried out efficiently?
■■ Are the audiologist(s) and support personnel adequately trained for their duties?
2. Assessing Audiology Program Activities

■■ What is done to whom? What audiology activities are occurring?
■■ Who is the target of each activity: numbers and types of individuals (e.g., students, staff, parents)?
■■ How well is the audiology activity implemented?
■■ How could the activity be done more efficiently?
■■ Were the students, teachers, parents, physicians, and other consumers satisfied with the audiology services?
■■ Does the audiology program have a favorable image?
Part 2. Outcome and Summative Evaluations

3. Enumerating Audiology Program Outcomes
■■ What are the results of the audiology activities described in #2?
■■ Should different audiology activities be substituted?
■■ Have audiology program goals and objectives been achieved?
■■ What happens to students with auditory disorders? How do students function differently as a result of program changes and
improvements?
■■ Have unanticipated outcomes also occurred, and are they desirable?
■■ What audiology activities might be continued to ensure their future occurrence?
4. Measuring the Effectiveness of Audiology Services

■■ What would have happened to students, staff, and parents in the absence of the audiology service?
■■ What are the factors that may have contributed to the changes documented in #2?
■■ How cost effective is the audiology program?
5. Assessing the impact of services on the prevention, identification, and management of students with hearing differences.
■■ What changes are evident as a result of the audiology services?
■■ Have the students’ abilities to function improved as a result of the program?
■■ What new knowledge has been generated for the field of audiology or deaf education as a result of these services?
considers evaluation in two phases: (a) process or forma- 3. Identify the services that presently exist and are func-
tive measures (monitoring of daily tasks and assessment tioning well.
of program activities) and (b) outcome or summative mea- 4. Identify the services that are either needed as gaps or
sures (identifying outcomes, measuring their effective- need improvement.
Chapter 16
ness, and assessing the impact of the audiology services 5. Determine how to develop the services that are needed
program). or improve the services that exist.
In summary, the program evaluation process includes 6. Evaluate the services and their effectiveness based on
the following steps: prevailing professional standards and best practices.
1. Review school/community needs for audiology services.
2. Evaluate the various models that might be used to pro-
vide the services. (See Chapter 2, Roles and Responsi- State Model Evaluation Systems
bilities of Educational Audiologists, for information on Several states have created state systems for evaluat-
service delivery models.) ing teachers to document instructional impact on student

achievement and outcomes. A few states have also devel- that address professional practice and student learning over
oped systems for specialized instructional support person- time. Performance is rated in a 5-level rubric: basic, par-
nel (SISP). These evaluation systems remain controversial tially proficient, proficient, accomplished, and exemplary.
for SISPs because their roles typically are to support class- The evaluation requires multiple measures that are obtained
room learning rather than provide direct instruction. Edu- on multiple occasions and are to be based on student per-
cational audiologists in Colorado, along with other SISP, ception measures, where appropriate and feasible, peer
were tasked by the Colorado Department of Education with feedback, parent or guardian feedback, and student support
developing a relevant evaluation model describing practices documentation. The complete rubric is available at https://
of effective educational audiologists. The resulting evalua- www.cde.state.co.us/educatoreffectiveness/specialservices
tion, summarized in Table 16–2, is based on five standards providers.
TABLE 16–2 Colorado Rubric for Evaluating Educational Audiologists
Quality Standard 1: Element A. Audiologists demonstrate knowledge of current developmental science, the ways
Audiologists demonstrate mastery in which learning takes place, and the appropriate levels of intellectual, social, and emotional
of and expertise in the domain development of their students.
for which they are responsible.
Element B. Audiologists demonstrate knowledge of effective services and/or specially designed
instruction that reduce barriers to and support learning in literacy, math, and other content areas.
Element C. Audiologists integrate evidence-based practices and research findings into their services
and/or specially designed instruction.
Element D. Audiologists demonstrate knowledge of the interconnectedness of home, school, and
community influences on student achievement.
Element E. Audiologists demonstrate knowledge of and expertise in their profession.
Quality Standard II: Element A. Audiologists foster safe and accessible learning environments in which each student has a
Audiologists support and/ positive, nurturing relationship with caring adults and peers.
or establish safe, inclusive, and
Element B. Audiologists demonstrate respect for diversity within the home, school, and local and
respectful learning environments
global communities.
for a diverse population of
students. Element C. Audiologists engage students as unique individuals with diverse backgrounds, interests,
strengths, and needs.
Element D. Audiologists engage in proactive, clear, and constructive communication and work
collaboratively with students, families, and other significant adults and/or professionals.
Element E. Audiologists select, create, and/or support accessible learning environments characterized
by acceptable student behavior, efficient use of time, and appropriate behavioral strategies.
Quality Standard III: Element A. Audiologists provide services and/or specially designed instruction aligned with state
Audiologists plan, deliver, and/or and federal laws, regulations and procedures, academic standards, their districts’ organized plans of
monitor services and/or specially instruction, and the individual needs of their students.
designed instruction and/or
Element B. Audiologists utilize multiple sources of data, which include valid informal and/or formal
create environments that facilitate
assessments, to inform services and/or specially designed instruction.
learning for their students.
Element C. Audiologists plan and consistently deliver services and/or specially designed instruction
that integrates multiple sources of data to inform practices related to student needs, learning, and
progress toward achieving academic standards and individualized student goals.
Chapter 16
Element D. Audiologists support and integrate appropriate available technology in their services and/
or specially designed instruction to maximize student outcomes.
Element E. Audiologists establish and communicate high expectations for their students that support
the development of critical-thinking, self-advocacy, leadership, and problem-solving skills.
Element F. Audiologists communicate effectively with students.
Element G. Audiologists develop and/or implement services and/or specially designed instruction
unique to their professions.
(Continues )

566 Chapter 16
Quality Standard IV: Element A. Audiologists demonstrate that they analyze student learning, development, and growth
Audiologists reflect on their and apply what they learn to improve their practice.
practice.
Element B. Audiologists link professional growth to their professional goals.
Element C. Audiologists respond to complex, dynamic environments.
Quality Standard V: Element A. Audiologists collaborate with internal and external stakeholders to meet the needs of
Audiologists demonstrate students.
collaboration, advocacy, and
Element B. Audiologists advocate for students, families, and schools.
leadership.
Element C. Audiologists demonstrate leadership in their educational setting(s).
Element D. Audiologists contribute knowledge and skills to educational practices and their
profession.
Element E. Audiologists demonstrate high ethical standards.
PROGRAM MANAGEMENT work schedules to accommodate parent’s work schedules,

and extended school year schedules, as well as their own
The day-to-day operation of school audiology programs re- personal needs. Setting up appointments that include eve-
quires effective organization and management. This section ning or Saturday hours may result in days in which work
addresses many of the operational aspects of the program, hours are between 12:00 and 8:00 pm or trading a weekday
including scheduling, office support, data management, and for work on a Saturday. Other options may include summer
budgeting. Suggestions for justifying one’s program are also workdays that are paid either through additional contract
addressed. time or by trading days during the regular school year for
workdays during the summer (known as “comp” time). The
latter option provides summer coverage without increasing
Annual and Monthly Scheduling workdays and, therefore, has no budget implications for the
It is helpful to lay out an annual schedule of monthly activi- school district.
ties so that necessary advance preparation and scheduling
can occur. The activities in the schedule should align with
those of the workload analysis. This schedule should include Office Support
the months of the year that certain activities should be com- Program support and audiology assistants can make the day-
pleted. Table 16–3 describes a sample monthly schedule of to-day and overall operations of the program run efficiently.
activities. This schedule should be provided to the audiolo- Activities that consume a great deal of time that can easily
gist’s immediate supervisor so that the supervisor is aware of be handled by a program assistant include:
what will be accomplished at certain points during the year.
■■ scheduling appointments;
■■ data entry and management;
Day-to-Day Scheduling ■■ sending out reports, letters, and forms used for
A monthly calendar should be completed for daily events. monitoring;
Many educational audiologists schedule certain days of the ■■ filing; and
week for “in-house” operations (e.g., hearing evaluations, ■■ fielding requests for information.
auditory processing evaluations, personal hearing instru-
Audiology assistants can be integral to the audiology
ments and hearing assistance technology [HAT] evaluations,
Chapter 16
program operations. Under the audiologist’s supervision, the

and report writing) and “on-site” activities (e.g., follow-up
following sample activities may be conducted by the audiol-
hearing screenings and monitoring of students with otitis
ogy assistant:
media). Because other activities (e.g., equipment setups,
initial IEP meetings, teacher consultations, classroom ob- ■■ hearing screening;
servations, and classroom listening assessments) occur on ■■ personal hearing instruments and HAT performance
an as-needed basis, it is recommended that at least one-half monitoring;
day per week be set aside for these “unscheduled” activities. ■■ HAT distribution;
Another scheduling component concerns flexible work ■■ HAT troubleshooting and minor repairs; and
times. Many school-based audiologists have implemented ■■ end-of-year HAT check-in, test check, and cleaning.

TABLE 16–3 Sample Monthly Schedule of Activities
Month Activity
July Calibrate all audiometers, acoustic immittance, and otoacoustic emission equipment, and conduct other assessment
equipment maintenance.
August 1. Review events calendar and make additions and changes for year.
2. Prepare all hearing assistance technology (HAT) for distribution.
3. Schedule classroom inservices for students.
4. Prepare classroom accommodation cards (see Figure 5–3) and have students write self-advocacy letters
(Appendix 10–C) for their teachers.
5. Distribute equipment to students and classrooms.
6. Set evaluation schedule for year.
7. Set tentative meeting schedule for year (Individualized Education Program [IEP] reviews, staff meetings, inservice
dates).
8. Coordinate and set schedule for school screenings.
September 1. Continue to conduct inservices for teachers.

2. Hearing screenings begin.
3. Attend state audiology conference.
October 1. Send out SIFTERs for first monitoring cycle of elementary deaf and hard of hearing students who do not receive
special education services.
2. Begin 4- to 6-week follow-up screenings.
November 1. Conduct first monitoring cycle of secondary deaf and hard of hearing students who do not receive special
education services.
December 1. Catch up on paperwork and enjoy the holidays.
January 1. Review program vision, goals, and activities; make necessary modifications; meet with supervisor or administrator
to discuss changes, need for increased resources, budget issues, and so on.
2. Conduct second monitoring cycle of secondary deaf and hard of hearing students (non-IEP) (at end of first
semester).
February 1. Send out SIFTERs for second monitoring cycle of elementary deaf and hard of hearing students (no IEP).
2. Complete school hearing screenings.
3. Participate in planning for spring regional deaf and hard of hearing student events.
March 1. Submit preliminary budget needs (equipment and staff ) for upcoming school year.
April 1. Review student records for assessments and classroom observations needed before the end of the current year.
2. Update advocacy materials
3. Assist with regional events for deaf and hard of hearing students.
May 1. Determine final HAT needs for the coming year and submit request.
2. Submit final equipment and staff needs for the coming year.
June 1. Check in, clean, and test check all HAT, loaner hearing aids, and other assistive equipment.
2. Send in HAT equipment for annual service.
3. Prepare HAT for summer school programs. Chapter 16
4. Order new HAT and other equipment for coming school year.
5. Prepare school hearing screening schedule for coming year.

568 Chapter 16
Without this support, the audiologist’s time to conduct penses. Audiologists need to work with local school finance
“audiology business” may be limited and does not demon- personnel and special education administration to determine
strate efficient budgeting and delegation of program resources. their responsibility as well as the method used for tracking
these expenses.
Data Management
The audiologist should be part of the school district’s data Facilitating Meetings
tracking system so that basic audiological information is The audiologist will often need to facilitate meetings with
available to school nurses and pertinent school staff as they teachers and other support personnel to provide information
matriculate between grades and from building to building. regarding a student’s hearing and communication needs. Ad-
Data on numbers of students tested (followed at school and ditional meetings might be necessary to set up or review
in the sound booth) and numbers of students with hearing hearing screening programs or to develop program guide-
differences broken down by categories (educationally sig- lines. Because time is valued by most school personnel, the
nificant hearing loss; bilateral, unilateral, high-frequency, audiologist should be mindful of all the participants’ time.
sensorineural, conductive, mixed, auditory neuropathy/dys- Suggestions for facilitating effective meetings follow. Chap-
synchrony, auditory processing deficits [APDs]; those with ters 13 and 14 discuss strategies for working with the educa-
personal hearing instruments; those who use HAT) are very tional team and community partnerships:
important to the evaluation of our services. These data can ■■ Provide ample notification of the meeting and be mind-
be cumbersome and time consuming to track without a data ful of participants’ schedule limitations.
management system. Data management systems can be used ■■ Schedule meetings in a suitable room or workspace
effectively for the following activities: with good lighting and room acoustics and free from
■■ managing school hearing screening results; auditory and other distractions; make sure accommoda-
■■ tracking students with reduced hearing and APDs; tions are provided for participants who request them.
■■ maintaining reports; ■■ Clearly identify the meeting’s purpose.
■■ collecting data on numbers of students screened, types ■■ Have a function for each participant when appropriate.
of hearing differences, other demographics, and follow- ■■ Maintain a pace that gets you through the meeting in
up recommendations; and the time allotted.
■■ scheduling timely reevaluations. ■■ Specify the task(s) to be completed and other follow-up
as a result of the meeting.
■■ Summarize the results of the meeting orally and in writ-
Forms ing (if appropriate) so all participants are clear in their
Forms help the management process by providing a series of understanding of the outcomes and their responsibilities
documents that address the various components of student for follow-up if tasks are assigned.
information gathering and information dissemination in a
consistent manner. Most audiologists now use cloud-based
forms so that information is accessible by pertinent school Challenges
health and education personnel. Forms for various aspects of Regardless of our efforts to include and inform administra-
an educational audiology program can be found in the appen tors of our purpose and rationale in program development,
dices with each chapter. attitudes, philosophies, and budget constraints or cuts often
impede our ability to provide or improve services. If the
barriers can be anticipated, the problems may be easier to
Budget and Finances handle. Consensus building and mediation are two strategies
After a budget has been established for the program op- often used for problem-solving. Other strategies for reduc-
eration and equipment, a mechanism needs to be set up to ing conflict include:
track expenditures. Because of its high cost, a specific plan
■■ establishing a relationship with the individual(s) pre-
for equipment acquisition and replacement should be de-
Chapter 16
senting the conflict;

veloped similar to the computer replacement plans used by
■■ stating your concern in a nonjudgmental manner;
schools. Purchases of equipment, repairs and maintenance,
■■ requesting permission to explore options for solving the
and incidentals and consumables (e.g., batteries, toys for the
problem; and
sound booth and conditioning activities, cleaning materials,
■■ receiving permission to explore these options.
earmold materials, probe tips, and paper for real ear and
immittance measures) should all be tracked. Separate bud- When sharing the concern, it is helpful to be specific
get codes are maintained for major equipment purchases, and brief, and to listen carefully to the individual’s responses.
equipment repairs and maintenance, equipment supplies, of- Always be prepared with your best solutions to address the
fice supplies, copying and postage, and other operational ex- problem. If the problem involves lack of sufficient time and

resources to carry out your responsibilities as identified under k. the number of hours spent for hearing loss preven-
IDEA, engage the help of your supervisor in determining how tion education and the number of students impacted;
to prioritize your time and which services will be eliminated. l. the number of additional consultation hours to support
You may even ask your supervisor to make the prioritization students on 504 plans and those not in special educa-
for you. In these ways, your supervisor shares the responsibil- tion, particularly as it relates to the school’s response to
ity when lack of services cause parent or teacher complaints intervention/Multi-Tiered System of Support initiative;
or other problems. m. the number of other relevant hours of services provided
that are not covered in the previous categories; and
n. the workload analysis data (see Appendix 16–E) that
Justifying the Cost of School-Based Audiology Services. provides additional clarification of how audiology
When administrators and school boards question the ef- time is dispersed.
fectiveness of providing in-house (school-based) audiology
3. Cost comparison
services, the educational audiologist needs to be prepared to
respond quickly with convincing data that are understand- a. Contact at least one (two would provide a range) local
able to persons who are not familiar with our special exper- or area audiologist where services might be contracted
tise and practices. The report should be a factual response to and ask for rates to present comparable costs for the
the information requested. Following are some steps toward services. Some rates will be determined by task (e.g.,
developing a response for this situation. audiological assessment) and others will be for hourly
consultation. Be sure to indicate any services that
1. Identify the legal basis for educational audiology ser-
would not be available through a contracted source.
vices. Appendix 1–D contains the IDEA regulations
b. For comparison, calculate the hourly wage based on
that define audiology services and students who are
each school audiologist’s annual contract. For exam-
deaf and hard of hearing in public education. Provide a
ple, for an annual salary of $65,000 for a 9.5-month
rationale based on the following most critical compo-
contract (195 days), the daily rate would be $333
nents of IDEA for audiology services:
and the hourly rate at 8 hours per day would be $42.
a. 34CFR300.34(c)(1): Definition of Audiology; If there is more than one educational audiologist,
b. 34CFR300.113: Routine checking of hearing aids determine an average rate for all audiologists.
and external components of surgically implanted c. Present the cost comparison data for the school-
medical devices; based and contracted models.
c. 34CFR300.5-.6: Assistive technology pertaining to
4. Emphasize the advantages of in-house services. These
remote microphone HAT. Be sure to include that
include:
only a licensed audiologist is qualified to fit these
devices and perform the associated services. a. established and long-term relationships with school
staff;
2. Summarize data by calculating the following for the
b. ability to provide services “on-demand;”
year to date:
a. the number of audiology evaluations;
b. the number of APD evaluations; A Real Deal …
c. the number of classroom acoustics measurements;
d. the number of remote microphone hearing assistance Cost comparisons can be quite revealing. An un-
technology (RM HAT) fittings; named school district in 2010 performed an analy-
e. the number of RM HAT troubleshooting hours; sis similar to the one outlined here in response to
f. the number of hours for inservicing and supporting the school board’s request for a comparison of “in-
teachers in accommodations and the use of RM HAT house” and “outsourcing” for audiology services. In
or other assistance technology; a school district of approximately 18,500 students
g. the number of hours spent in schools conducting follow- with two full-time audiologists, an audiology tech- Chapter 16
up screening and the number of students seen; nician, and an administrative assistant, the cost to
h. the number of hours spent at Child Find screening outsource was 4.8 times greater than the cost of
clinics and the number of children seen; providing the same services in-house yielding a sav-
i. the number of IEP meetings attended and the num- ings of just over $500,000. In addition to the cost,
ber of hours spent; the specialized training and expertise of the educa-
j. the number of hours providing direct student IEP tional audiologists that complemented the school
services (e.g., auditory habilitation, assistive tech- district’s educational programs were emphasized.
nology training, counseling and self-advocacy train-
ing) and the number of students served;

570 Chapter 16
c. participation in school district inservice programs so Information that clarifies the implications of decisions
services support local school reform initiatives; for all participants is also helpful. The suggested audiology
d. ability to provide support services to general educa- outcomes and evidence in Table 16–1 may provide another
tion teachers and staff so that appropriate strategies format for presenting various components of the program,
are implemented that may prevent special education how they are measured, and how they might be affected by
referrals and services; and reducing or eliminating certain services.
e. flexibility for providing a range of services that sup- Sometimes decisions are made that are ethically un-
port individual student needs. acceptable to the educational audiologist. In this situation
and after all options for resolutions have been attempted,
After the report has been submitted, there should be an the audiologist may decide that this employment situation
opportunity to discuss the information with the administrators is untenable and terminate his or her employment. Unfortu-
or board to ensure that it is appropriately interpreted and un- nately, it is not possible to control all factors that affect the
derstood. Further follow-up may provide opportunities for par- delivery of services in schools. Social values, alterations in
ents, teachers, and other school staff and community members public policies, and fluctuations in economic conditions are
to voice their concerns and comments regarding the situation. often out of our control. The challenges continue.
SUMMARY SUGGESTED READING

Developing and improving program services are essential. AND RESOURCES
Although this aspect of school audiology programs often Readers are encouraged to explore books and resources
receives little attention because of our time limitations, the about leadership and practice management. The theories and
effort spent is usually productive. Furthermore, as resources practices from these sources are readily applied to school-
dwindle, we are experiencing increased scrutiny regard- based audiology services. Seek out the books your adminis-
ing every aspect of the services we provide. This chapter trative team, teachers, and other pertinent professionals are
has provided several options that, whether used together or reading so that you can have common language and under-
individually for a particular situation, will provide critical standing of issues associated with program development and
information for planning and measuring program effective- evaluation.
ness. The resulting data are essential to provide the neces-
sary justification for the development and continuation of
audiology services in the schools.
Chapter 16

Appendix 16–1
Self-Assessment: Effectiveness Indicators for School-Based Audiology Services
Educational Audiologist Date _____
School District _________________________________________________________
STATUS
EFFECTIVENESS INDICATORS A E G NA ACTION PLAN/COMMENTS
I. Community/Family Collaboration:
a. Audiologist conducts on-going awareness
activities regarding hearing differences and
auditory processing deficits (APD)
b. Audiologist networks with local physicians,
audiology practices, hospitals and clinics,
children’s disability programs, and pertinent
audiologists.
c. Audiologist collaborates with other
community agencies dealing with hearing
differences orAPD.
d. Audiologist seeks input from deaf and hard
of hearing community members and groups.
e. Audiologist recognizes and respects the
ethnic and cultural backgrounds of families
and language preferences.
f. All notices and conference notes are
provided to parents in their native language.
g. Audiologist networks “experienced”
parents of deaf and hard of hearing children
A = Accomplished E = Emerging G = Goal NA = Not Applicable at this time. When determining program status, consider the following components of
the service: comprehensiveness, accessibility, coordination, consistency, accountability, efficiency, and collaborative.
Copyright © 2021 Plural Publishing, Inc. All rights reserved. Permission to print for clinical use is granted. The files are NOT allowed to be hosted
electronically without written permission of the publisher.
to support parents of children with newly
diagnosed hearing conditions.
h. Audiologist assists parents to understand
hearing status or APD and to recognize the
importance of accepting their child’s
hearing or APD status.
i. Audiologist maintains regular and frequent,
formal and informal, home-school
communication to ensure coordination and
consistency of services
j. Audiologist helps families understand the
nature and implications of hearing or APD
status and the importance of consistent
communication with their child.
k. Audiologist informs family of community
resources and how to access them; of
available hearing and other assistive devices
such as remote mic systems, phone apps,
and captioning; of functions and
publications for families and deaf and hard
of hearing individuals; and of opportunities
for interaction with deaf and hard of hearing
role models when appropriate.
STATUS
II. Prevention
a. Yearly awareness efforts include
information about normal auditory, speech
and language development, the value of
early identification, and where and how to
obtain screening and audiologic evaluations.
b. Hearing loss prevention education is part of
school curricula (health, science, or other
area) at multiple grade levels.
III Identification
a. A community interagency process for the
identification of reduced hearing is in place
which includes local otologists or ENTs,
pediatricians, family physicians, county
health departments, and audiologists.
b. Hearing screening opportunities are
available year-round.
c. Hearing screening is conducted annually
for all state mandated ages and grade levels
(including children in private schools) or in
accordance with accepted professional
guidelines.
d. Screening is targeted to identify types of
hearing loss by age (e.g., otitis media for
young children and noise-induced hearing
loss for teens).
e. Hearing screening is conducted in
accordance with professionally acceptable
procedures and referral criteria.
f. Audiometers used for screening are
calibrated to current ANSI S3.6
specifications and are checked at least
annually and recalibrated when necessary.
g. Screening facilities are checked for ambient
noise so as not exceed acceptable levels.
h. Hearing screening results are recorded, and
parents and teachers are informed of results.
i. All screening failures are referred for either
audiologic assessment by an audiologist at
no expense to the parents, or for medical
examination.
j. Follow-up procedures exist to ensure that
individuals who are referred for audiologic
assessment or medical treatment or who
need annual monitoring of their hearing
status receive the recommended service.
k. All children who meet the state’s criteria
for educationally significant hearing loss
(ESHL) are referred to either a building
level conference or for a full special
education assessment.
l. Audiologist attends building conferences to
represent unique needs of students who are
deaf or hard of hearing or who have APD.
STATUS
IV. Assessment
a. Assessment is multidisciplinary and
multifaceted and includes at least one
specialist in the area of reduced hearing and
deafness.
b. Audiology assessment is comprehensive
and includes tests targeted to classroom
listening and functional listening skills
(assessment minimally includes: case
history, otoscopic inspection, acoustic
immittance, OAEs, pure tone audiometry,
speech reception or detection threshold,
word recognition or speech discrimination;
speech in noise, quiet, and visual only
conditions are added for students with
ESHL.
c. An APD assessment program is operated
according to professional practice standards.
d. For individuals with personal hearing
instruments and remote mic or other hearing
assistance technology, assessment includes
aided speech testing, electroacoustical
analysis of amplification, and real ear
verification procedures.
V. Amplification
a. Audiologist evaluates and determines the
need for remote mic HAT. (All students
A = Accomplished E = Emerging G = Goal NA = Not Applicable at this time. When determining program status, consider the following
components of the service: comprehensiveness, accessibility, coordination, consistency, accountability, efficiency, and collaborative.
with ESHL should be considered candidates
for amplification until ruled out.)
b. HAT is provided to support all needs
identified in the Individualized Educational
Programs (IEPs).
c. Personal hearing instruments worn by deaf
and hard of hearing students are routinely
checked for proper functioning.
STATUS
VI. Management and (Re)Habilitation
a. Audiologist provides specific, on-going
training related to the development of
communication skills including listening
skill training, expansion of speech and
language, use of personal hearing
instruments and HAT and maintenance.
b. Audiologist is a regular team member for
IEP development.
c. IEPs are developed jointly by staff,
specialists trained in hearing and deafness,
and family members.
d. IEP goals and objectives are written and
implemented for hearing and listening needs
across a variety of environments and
situations.
e. Audiologist provides consultation services
to teachers such as inservice on appropriate
accommodations and technical assistance
regarding equipment.
f. Audiologist provides instruction and
support to students regarding hearing
status, personal hearing instruments and
HAT, accommodations, social-emotional
competence, self-advocacy, and
community resources related to hearing
needs.
STATUS
VII. Program Management and Development
a. Audiologist has a sufficient budget and
resources to carry out audiology IDEA
responsibilities effectively.
b. District minimally employs audiologist at
one per 10,000 students (average daily
membership).
c. Facilities are adequate for all instructional
and related services for students with
reduced hearing or APD including
accommodations for high noise levels, long
reverberation times, lighting, and special
seating.
d. A needs assessment, program evaluation,
and planning process are conducted.
e. Professional practice standards in
audiology are known and used.
f. Audiologist is provided with opportunities
to attend workshops and trainings.
g. Audiologist is evaluated regularly by a
special education supervisor who
understands language, communication and
educational implications of
deafness/reduced hearing or a combination
of a selected peer audiologist and a program
administrator.
Appendix 16–B
Goal Prioritization Worksheet

In the boxes across the top, write the goals or objectives that are under consideration. Rate them using the listed criteria. The higher
the total score, the more likely that the objective will be successful.
Goals/objectives
1 2 3 4 5
Little Great
Litmus Test
To what degree does it
benefit the target
population?
Importance
What is the urgency or
impact?
Control
To what extent do you
have control?
Ease
What is the relative
ease of achieving it?
Time Required
What is the probability
that it can be achieved
within a reasonable
period of time?
Return on Investment
What is the expected
payoff?
Support & Resources
Copyright © 2021 Plural Publishing, Inc. All rights reserved. Permission to print for clinical use is granted. The files are NOT allowed to be hosted electronically
without written permission of the publisher.
What is the degree of
support and availability
of resources?
Total Points:
Appendix 16–C
Long-Range Planning Form1
PROGRAM
GOALS FIRST YEAR SECOND YEAR
COMPONENT
ACTIVITIES BUDGET/RESOURCES ACTIVITIES BUDGET/RESOURCES
1
Activities, budget, and resources may be added for subsequent years to attain desired length of long-range plan.
Appendix 16–D
Educational Audiology Program Action - Logic Model
Inputs Activities Outputs Outcomes Impact

What short term changes
In order to accomplish our In order to be a What outcomes do we
What products or tangible do we expect if these
activities & outputs, we sustainable program, we expect if we accomplish
results will be produced as activities are
have or will need the will accomplish the the activities and outputs
a result of the activities? accomplished? (i.e., short-
following: following activities: (i.e., long-term changes)
term)
Copyright © 2021 Plural Publishing, Inc. All rights reserved. Permission to print for clinical use is granted. The files are NOT allowed to be
hosted electronically without written permission of the publisher.
APPENDIX 16–E1
Educational Audiology Workload Analysis Form
Audiologist: Date:
District/BOCES/Agency: Current FTE:
For each area below, estimate the numbers of hours/month that you are engaged in that activity. You may use the blank lines
to insert additional activities that are not identified.
Direct Service:
Screening
Follow-up Screening
Assessment—Audiological
Assessment—Functional
Assessment—APD
Classroom Acoustic Measurements
Habilitation/Co-teaching
Prevention
Counseling (parents, students)
Teacher/Staff Consultation
(e.g., Observation, Inservice)
HAT Evaluation and Fitting/

Validation
HAT Orientation/Training
Equipment Troubleshooting and

HAT Management
Indirect Service:
HAT Monitoring
Equipment Calibration
Equipment Ordering
Chapter 16
Report Writing
Multidisciplinary Team
Collaboration
IEP/504 Development
IEP/504 Meetings
Planning/Prep/Scheduling
(Continues )
571

572 Chapter 16
Documentation/Record Keeping
Community Meetings
Administrative:
Travel (between schools)
Travel Requests/Travel
Reimbursement
Professional Development
Staff Meetings
TOTAL HOURS
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
Chapter 16

APPENDIX 16–F
Recommended Outcomes and Evidence for Educational
Audiology Tier 1 Services
1. Children/youth access comprehensive educational audiology services as part of their developmental and/or
educational program.
1.a. What was the student membership of the administrative unit (e.g., school district or cooperative/BOCES/
intermediate unit) covered by this survey?
1.b. What was the total audiology full-time equivalent (FTE) serving the student membership in 1.a?
1.c. Based on this student membership, what number (#) and percentage (%) of children had a hearing loss
(based on an audiological diagnosis)?
Evidence
1.d. Based on the number of children with hearing loss, what # and % had hearing loss that met state criteria
for special education services (i.e., educationally significant hearing loss; these students may or may not
be eligible for special education services pending evidence of adverse effect of the hearing loss)?
1.e. What # and % of children with hearing loss received special education services through an IEP?
1.f. What # and % of children with hearing loss were served through a Section 504 plan?
1.g. Indicate the school-based Individuals with Disabilities Education Act audiology services that were available
in your administrative unit; then estimate the percentage of your time spent among each of the six areas
(must total 100%).
2. Children/youth receive diagnostic audiological evaluations within 30 days of referral from screening or another
source.
2.a. How many children were referred for an audiological evaluation from screening and other sources (e.g.,
teacher concern, parent concern, developmental screening)?
2.b. What of children referred received an audiological evaluation?
Evidence
2.c. For the children seen for an audiological evaluation, what was the average number of days from referral to
audiological evaluation?
2.d. For the children seen for an audiological evaluation, what # of children received their audiological evalua-
tion within 30 calendar days of referral?
2.e. When the 30-day criterion was not met, what were the top five reasons? Select from most frequent to least
frequent.
3. Children/youth receive the necessary medical management required to habilitate medically treatable hearing
problems.
3.a. What # of children were referred for medical attention?1
3.b. What # and % of children were referred within 1 week of screening or audiological evaluation for medical
management?1
3.c. What # and % of children referred had access to medical care (e.g., insurance, Medicaid)?
3.d. What # and % of children referred who had medical coverage could not access treatment due to issues with Chapter 16
providers, transportation, parent work schedules, parent follow-through, or other reasons?
Evidence
3.e. What # and % of children received medical attention as a result of the referral?
3.f. What # and % of children received medical attention within 30 days of referral?
3.g. What # and % of children received medical attention within 30 days of referral, but no treatment was
recommended?
3.h. What # and % of medical issues were resolved as a result of the medical referral?
3.i. What # and % of children referred had a questionnaire (e.g., S.I.F.T.E.R., Quality of Life, L.I.F.E.) completed
regarding a resolved medically related hearing problem?
3.j. What # and % of children reported improvement in functioning on the questionnaire?
573

574 Chapter 16
4. Children/youth receive audiological and auditory skill assessments that are relevant to the developmental/
educational setting and accurately identify the parameters associated with the auditory deficit.
4.a. What # of children had an audiological assessment?
4.b. What # and % of children had a comprehensive audiological assessment that was developmentally appropri-
ate (e.g., auditory thresholds, acoustic immittance, acoustic reflexes, basic speech assessment)?
4.c. What # and % of children had an audiological assessment that included speech perception testing in quiet
and noise conditions (e.g., BKB-SIN)?
4.d. What # and % of children received annual follow-up audiological assessments?
4.e. What # of children received auditory processing assessments?
Evidence
4.f. What # and % of children who were assessed had evidence of an AP deficit?
4.g. What # and % of children were administered a functional auditory skills assessment that identified perfor-
mance for listening in noise and distance conditions, with and without visual cues (e.g., Functional Listen-
ing Evaluation or other assessment)?
4.h. What # and % of children were administered a functional auditory skills checklist that addressed listen-
ing and communication performance (e.g., L.I.F.E., Classroom Participation Questionnaire, or another
checklist)?
4.i. What # and % of assessment results were meaningfully conveyed to teachers/educational professionals?
4.j. What # and % of assessment results were meaningfully conveyed to parents?
4.k. What # and % of assessment results were meaningfully conveyed to students?
10. Children/youth with auditory deficits have the opportunity to access appropriate and consistently functioning
hearing instrumentation, including personal and assistive devices that maximize auditory access within their
environment.
10.a. What # and % of children with auditory deficits have obtained the recommended personal hearing instru-
ments (HA, BAHA, CI)?
10.b. What # and % of children used personal hearing instruments at school?
10.c. What # and % of children used personal hearing instruments outside of school?
10.d. What # and % of children with auditory deficits have obtained the recommended RM HAT?
10.e. What # and % of children with auditory deficits used personal RM HAT at school?
10.f. What # and % of children with auditory deficits used personal RM HAT at home?
10.g. What # and % of children with auditory deficits used classroom audio distribution systems (CADS)/
sound-field at school?
10.h. Children with auditory deficits had personal hearing instruments that functioned properly.
10.i. What professionals were responsible for monitoring personal hearing instruments and/or RM HAT device
function?
10.j. What % of these professionals successfully monitored device function (as determined by the audiologist)?
Evidence
10.k. For those children who use personal hearing instruments, what # and % of families successfully monitored
personal hearing instrument function?
10.l. For those children who use personal hearing instruments, what # and % of children, for whom it is devel-
opmentally appropriate, successfully monitored their personal hearing instrument function?
10.m For those children who use RM HAT, what # and % of children successfully monitored their RM HAT
function?
10.n. What # and % of children using RM HAT were administered a functional evaluation in the child’s custom-
ary environment that identified performance for listening in quiet, noise, and distance conditions, with and
without visual cues and with and without the recommended RM HAT device (e.g., Functional Listening
Chapter 16
Evaluation, L.I.F.E., or other assessment)?

10.o. Hearing Aid Verification: What # and % of children had device fittings within an appropriate range (e.g.,
speech mapping verification for HAs fit to DSL targets, OSPL90 not exceeded or set too low)?
10.p. RM HAT Verification: What # and % of children had device fittings that provided transparency and an
appropriate SNR?
10.q. RM HAT Validation: What # and % of children had RM HAT device fittings that provided the intended
benefit (e.g., student had audibility of self and others, RM HAT provided audibility that matched the stu-
dent’s performance in quiet, close conditions, RM HAT interfaced with general classroom technology)?

CHAPTER 17
Reflections and
Future Directions
With Sarah Florence
CHAPTER OUTLINE
Emerging Themes
The Educational Audiologist as an Integral Member of the Multidisciplinary Team ■ The Emphasis on
Accountability, Specific Student and Program Outcomes, and Use of Cost-Effective Strategies to Address
Critical Issues ■ Societal Factors ■ Promoting Hearing Loss Prevention as a Social Health Problem
Remote Audiology Services
Remote Educational Audiology Services Model ■ Remote/Onsite Hybrid Model ■ Remote Support of Onsite
Educational Audiologists ■ Service Considerations ■ Remote Technology Tools
Summary
Chapter 17
Student view: “The future will bring the ability to hear clearly.”
575

576 Chapter 17
KEY TERMS ■■ promoting hearing loss prevention as a social health

problem; and
Multidisciplinary team, accountability, outcomes, wellness, ■■ developing remote audiology practices.
hearing loss prevention, school safety, telepractice, remote
audiology, teleaudiology
The Educational Audiologist as an Integral
Member of the Multidisciplinary Team
KEY POINTS The concept of team membership has been addressed through
out this text. We believe team membership and collaboration
In past editions, we have reflected on current practice and to be one of the most critical roles of educational audiolo
contemplated the future of educational audiology for this final gists that extends well beyond assessment, amplification, and
chapter. Some of these topics were discussed in the article, Individualized Education Program (IEP) participation. We
Shift happens: Evolving practices in school-based audiol- argue that the more invested and involved the educational
ogy (Johnson, Cannon, Oyler, Seaton, Smiley, & Spangler, audiologist can be with the school team, the greater are the
2014), which addressed the influence of common core state rewards for the students. These benefits include:
standards, Response to Intervention/Multitiered Systems of
■■ enhancing awareness that all students with auditory
Support, Universal Design for Learning, and the 21st Century
deficits, regardless of IEP or Section 504 status, can
Learning Framework on school-based audiology practices.
achieve their potential and more when provided appro-
Budget constraints, a growing population to serve, and the
priate accommodations and other necessary supports;
need for school-based professionals to document outcomes
■■ sharing with staff the importance of accommodations and
and benefits of their services were identified as immediate is-
implementing them consistently and as recommended;
sues. These topics, as they have evolved, have been addressed
■■ providing on-demand and just-in-time support to assist
in this text. Looking forward, we propose the following ques-
teachers in equipment use, troubleshooting, and other
tions for consideration, some that surface from the past, as
applications of accommodations;
well as some that are new.
■■ demonstrating the value of good listening environments,
■■ How can we increase the number of educational audi- the importance of listening for learning, and optimal com
ology positions so that all students who have reduced munication access for all students; and
hearing or other auditory difficulties have access to ■■ creating team cohesion and collaborative partnerships
appropriate hearing technology and other support that extend beyond the classroom.
services?
As value is associated with the services of educational
■■ How will technology and technology improvements im-
audiologists, especially from our colleagues in speech-lan-
pact our services in the future?
guage pathology and deaf education, we hope that it results
■■ Are there societal factors that will influence educational
in an increase in the number of educational audiology posi-
audiology practice in the future?
tions. The practice of audiology should be recognized and
■■ Who will we serve and how will our services be
understood as more than assessment conducted solely in a
delivered?
sound booth.
■■ What impact could future changes in the Individuals
with Disabilities Education Act (IDEA) and other fed-
eral and state legislative actions and policy decisions
have on educational audiology services?
The Emphasis on Accountability,
Specific Student and Program
Outcomes, and Use of Cost-Effective
EMERGING THEMES Strategies to Address Critical Issues
The Every Student Succeeds Act (ESSA, 2015) and be-
While reviewing, revising, and updating this edition, sev-
fore it, No Child Left Behind (2001), increased emphasis
eral themes emerged that generally address these questions.
of teacher and related service professionals’ impact on stu-
These topics should be food for thought for educational au-
dent performance. The Educational Audiology Association’s
diologists now and into the future:
(EAA) Outcomes Initiative as well as individual state profes-
■■ the educational audiologist as an integral member of the sional evaluation processes (both addressed in Chapter 16)
multidisciplinary team; have connected services to outcomes in pertinent areas of
Chapter 17
■■ the emphasis on accountability, specific student and educational audiology practice. Data collection for this type
program outcomes, and use of cost-effective strategies of evidence is critical to illustrate the added value of edu-
to address critical issues; cational audiology services in the schools at both local and
■■ societal factors; state levels. Use of documents that delineate practice areas

Reflections and Future Directions 577
among professionals such as EAA’s Shared and suggested address accommodations and preparedness for the school
roles of educational audiologists, teachers of the deaf and procedures. They can also ensure that visual alarms are in
hard of hearing, and speech-language pathologists (Ap- required locations and working. Practice drills are essential,
pendix 2–A) and EAA’s Educational audiology scope of and educational audiologists can observe to offer feedback
practice (Appendix 2–C) are also helpful for ensuring that and provide additional guidance. Of interest is the benefit
students receive all of the services identified in IDEA, as of sign language for communication to avoid audible sound
well as identifying the responsible professional(s) to provide during active shooter incidents.
these services.
Critical issues in deaf education were discussed in
Chapter 14 along with practice considerations. These issues
Promoting Hearing Loss Prevention
are good discussion topics for deaf education team meet- as a Social Health Problem
ings and provide a forum to identify strategies for address- Deanna Meinke (Chapter 12) makes a strong argument for
ing local problems. In addition, the National Association educational audiologists to take on this campaign. While
of State Directors of Special Education’s (NASDSE, 2018) there may be challenges in implementing a comprehensive
third edition of its Educational Service Guidelines, Optimiz- hearing loss prevention education program, educational au-
ing outcomes for students who are deaf or hard of hearing, diologists can increase public awareness, run a pilot project
includes a self-assessment to evaluate services and practices. to identify noise-induced hearing loss via a targeted school
hearing screening program, work with schools and student
groups to control hazardous noise levels at school activities,
Societal Factors and build awareness with state departments of education and
Focus on Wellness local and state legislators.
Through efforts of the World Health Organization, school-
based social-emotional wellness programs, disability com-
munity endeavors, parent organizations, and other advocacy REMOTE AUDIOLOGY SERVICES
groups, an emphasis on wellness and human differences
rather than disabilities has been promoted. This shift is espe- Telepractice, to some degree, should be part of every audi-
cially pertinent to deaf and hard of hearing children because, ologist’s service provision model. It offers the potential to
given early language development opportunities and full ac- expand the number of students served, provide more timely
cess to their learning environments and school experiences, service to students and teachers, and result in more efficient
the opportunity to be well as people with hearing differences use of the audiologist’s time. And yes, it is still possible to
should be expected. Chapter 10, Supporting Wellness and be part of the school team. The following description of re-
Social-Emotional Competence, examines components of mote audiology is provided by Sara Florence, a provider of
wellness and strategies to address them. both onsite and remote educational audiology services.
Remote audiology (i.e., teleaudiology) is an essential
method for meeting the needs of students in a variety of edu-
Technology Acceptance
cational settings. While schools in rural, difficult-to-access
As use and acceptance of personal hearing instruments grow, communities may be the most obvious candidates, remote
can we expect an increase in their acceptance by students? services can effectively be utilized in all schools to some ex-
Technology, appearance, and comfort have improved, includ- tent. Three models of remote educational audiology service
ing special marketing targeted to children and teens. At the implementation are summarized in Table 17–1: remote-only
same time, schools are beginning to offer more opportunities services, remote/onsite hybrid, and remote support of onsite
to bring together students from their individual schools to pro- audiologist(s).
vide social learning activities. Educational audiologists should
capitalize on these opportunities when counseling students.
Remote Educational Audiology
School Safety and Security Services Model
Increasing focus on school safety and security is another Schools that are difficult to access due to geographical loca-
factor that must now be addressed. Ensuring auditory and vi- tion and who require few service hours are challenged to
sual access to alarms, announcements, and other emergency appropriately meet the audiological needs of their students.
notifications and instructions is an unfortunate but necessary They often rely on recommendations and equipment from pri-
consequence of today’s school environments. Deaf and hard vate audiologists, sometimes hours away, in the nearest large
of hearing students as well as sign language interpreters and city. In these situations, remote educational audiology ser-
Chapter 17
other school staff who work with these students must be vices can be a vital bridge between private audiologists and
prepared for active shooter and other emergencies. Edu- the schools/families. One audiologist can potentially provide
cational audiologists can help develop specific emergency services to multiple remote districts without ever physically
steps for teachers and deaf and hard of hearing students that appearing onsite. The student’s private audiologist, or a local

578 Chapter 17
TABLE 17–1 Summary of Remote and Onsite Educational Audiology Services
Remote Only Remote/Onsite Hybrid Remote Support

Remote services All educational audiology ■■ Individualized Education ■■ IEP meetings
services provided offsite Program (IEP) meetings ■■ Troubleshooting
■■ Troubleshooting ■■ Device quotes/ordering
■■ In-service ■■ Information management
■■ Device quotes/ordering
■■ Information management
Onsite services Work with local clinical ■■ Diagnostic testing ■■ Diagnostic testing
Chapter 17
audiologist for testing and ■■ Device fitting ■■ Device fitting

device fitting ■■ Observation ■■ Observation
■■ Troubleshooting ■■ Troubleshooting
■■ In-service/education
clinical audiologist, continues to complete diagnostic test- time is not a factor, these remote services can be provided
ing and fitting of equipment, while the remote educational effectively for a fraction of the cost of additional onsite sup-
audiologist supervises screenings, observes classrooms, at- port. Initial feedback from piloting this model of service is
tends meetings, provides staff in-services, and troubleshoots positive from both onsite audiologists and district personnel.
equipment. Overall, schools reported that the presence and communica-
tion of the audiology team increased.
Remote/Onsite Hybrid Model
A remote/onsite hybrid model may be implemented when Service Considerations
the remote audiologist lives within a reasonable distance Many educational audiology services can be provided effec-
from the schools served. The educational audiologist maxi- tively offsite. Taking into consideration current technologi-
mizes service time and availability by providing some ser- cal capabilities, these services include:
vices onsite and some remotely. Audiological testing, fitting
■■ hearing aid troubleshooting;
of assistive technology, teacher in-service, and classroom
■■ hearing assistive technology recommendations;
observation are onsite services provided during a once a
■■ hearing assistive technology fitting;
month or as-needed visits, and all other support services are
■■ classroom observation;
provided remotely. This model is beneficial in very large
■■ audiogram interpretation;
school districts as well. An onsite presence is critical in
■■ case manager consultation;
larger districts, but remote availability enhances the con-
■■ IEP/504 meeting attendance;
nection to teachers of deaf and hard of hearing students and
■■ device-specific training for teachers;
other school personnel. These connections increase access
■■ teacher of the deaf/hard of hearing in-service and tech-
to timely and appropriate services.
nology updates;
■■ device ordering/quote requests;
Remote Support of Onsite Educational ■■ private audiologist collaboration;
Audiologists ■■ supervision of school hearing screenings; and
■■ remote hearing screenings managed through an onsite
Remote support of onsite educational audiologists is a lesser
facilitator using a hearing screening app.
known model of remote services that has powerful poten-
tial. A fully remote audiologist is employed to supplement Omitted from this list are services that are still most
the services of onsite audiologists that are covering either a appropriately provided onsite and in person. These include
large school district or a large geographical area. Assistance diagnostic assessment, real ear measures in the fitting of
by the remote audiologist allows the onsite audiologist(s) hearing aids, and verification of hearing assistance technol-
to focus efforts on students that require in-person attention ogy (HAT). While remote diagnostic testing and fitting of
or more intensive support. The remote audiologist is avail- HAT are possible, the logistics and equipment cost would
Chapter 17
able to troubleshoot equipment, attend IEP/504 meetings, likely be challenging for most schools at this time. While
request quotes/order equipment, follow-up with personal classroom observation can be conducted remotely, it is more
audiologists, and manage information remotely. Since drive desirable to conduct the initial observation onsite.

Reflections and Future Directions 579
FIGURE 17–1 Remote audiology consultation.
Remote Technology Tools method of screening is conducted with remote supervision

Through the advancement of video streaming technology, from an educational audiologist facilitated by an onsite as-
many professions, including speech-language pathology, sistant. Of course, just as in any school screening program,
behavioral health, psychology, and occupational therapy, there are students who are best screened in person with
have begun to provide therapeutic services remotely. These adaptive techniques. It will be interesting to observe if, with
same technological advancements provide educational au- the introduction of tablet response as opposed to traditional
diologists with a more personal mode of communication hand-raising, the number of students successfully screened
with students, teachers, and other school personnel. Video on the first attempt increases.
connections such as Zoom, FaceTime, Gotomeeting, and As in general teleaudiology, the practitioner must be aware
Google hangouts allow for clear demonstrations during trou- of licensure requirements that differ state to state. It is currently
bleshooting or device training, and shared document folders necessary to be licensed in both the state of residence and the
(e.g., Google Drive, Dropbox) can be securely used to com- state of practice. Some states do have education-specific licen-
municate with an audiology team whether onsite, remote, sure requirements that can complicate the process.
or both (see Figure 17–1). It is important that secure con- Ultimately, as the general profession of audiology
nections are used when working directly with a student or moves toward utilization of remote services to increase ac-
discussing cases that include specific, personal information. cess to high-level audiological care, educational audiolo-
In addition to the streaming software, a stable, high- gists can apply those principles to school services as well.
speed Internet connection and a visual display screen that Remote services should be viewed as an asset rather than a
is large enough to provide enough detail when needed are threat. These methods can assist educational audiologists to
required. If remote programming is desired, remote access more effectively manage time, resources, and travel while
software is needed to control the remote computer. still personally connecting with students and school person-
The use of customizable hearing screening applica- nel, thereby increasing availability and meeting an ideal
tions for school screenings is also a developing trend. This standard of audiological care.
SUMMARY education professionals, must increasingly be accountable

for services through improved student outcomes. Alterna-
The timing for reauthorization of IDEA, together with the tive approaches to more traditional service delivery such
future of regulation or deregulation in general education as remote educational audiology practices need to be ex-
is unknown, and funding of support services is always un- plored for expanding efficient and cost-effective services in
certain. It is expected that audiology services will remain the future. Student performance at school entry continues
Chapter 17
unchanged even though efforts are needed to increase stu- to improve due to earlier identification and intervention,
dent access to educational audiology services in many parts and our challenge now becomes helping to ensure that this
of the country. Educational audiologists, as well as other progress continues. Our expanding responsibilities include

580 Chapter 17
ensuring that listening and access needs of all students are cussed in this chapter and to ensure that fair and equitable
addressed, regardless of IEP, 504, or other support program communication access through appropriate services and
status. Increasingly, there is a need for creativity, flexibil- educational accommodations is provided for all students
ity, and collaboration in educational audiology in order to who are deaf, hard of hearing, or have auditory processing
meet the challenges of emerging themes such as those dis- deficits.
Chapter 17

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Index
Note: Page numbers in bold reference non-text material
AAA. See American Academy of Audiology Americans with Disabilities Act Audiologists
Index
AABR. See Automated auditory brainstem Amendments Act of 2008, 10 community, 524
response case law, 444 counseling role of, 376
ABAS-3. See Adaptive Behavior Assessment checklist, 10, 438 educational. See Educational audiologists
System communication under, 10 full-time equivalent, 4, 5–6, 7
ABEL. See Auditory Behavior in Everyday description of, 9–11 hearing screening and identification
Life eligibility of children for services under, program use of, 96
ABR. See Auditory brainstem response 412–413, 438 public health role of, 451
Accommodations enactment of, 10 scope of practice of, for hearing assistance
classroom, 238–239 individualized education program as technology, 259
individualized education program, 415, criteria for eligibility, 4103 shortage of, 7
424, 432–433 Individuals with Disabilities Education Act Audiology Effectiveness Indicators, 562
student, 386–389 and, comparison between, 494 Audiology support services, 38–39, 441
Acoustic immittance pertinent areas of, 20–22 Audiometry
in hearing assessment, 117 summary of, 30 behavioral observation, 118
in hearing screening programs, 92 Titles of, 10–11 conditioned play, 90, 93, 118
Acoustic Pioneer: Feather Squadron, 205 Amplification devices pure-tone, 91, 92, 95
Acoustics, classroom. See Classroom dispensing of, 14 visual reinforcement, 93, 118
acoustics parental request for, 69 Auditec, Inc., 205
ACPT. See Auditory Continuous Performance Amplifiers, universal, 276 Auditory Behavior in Everyday Life, 146
Test Annual scheduling, 566 Auditory brainstem response
ADA. See Americans with Disabilities Act ANT. See Auditory Numbers Test for auditory processing deficit, 189
Adaptive Behavior Assessment System, 510 APAL. See Auditory Perception of Alphabet automated, 89, 116
Adopt-A-Band, 451 Letters characteristics of, 91
Advocacy, for educational audiology APDQ. See Auditory Processing Domains hearing assessment uses of, 116–117
programs, 525–527, 545 Questionnaire in hearing screening and identification
Advocacy groups, 7 ASHA. See American Speech-Language- programs, 89, 91
Alexander Graham Bell Association for the Hearing Association Auditory Continuous Performance Test, 191
Deaf and Hard of Hearing, 378 Assessment Auditory curricula, 321, 331
American Academy of Audiology auditory processing deficit/disorder. See Auditory developmental checklists, 86–87, 91
auditory processing deficits as defined by, Auditory processing deficit/disorder, Auditory evoked responses, 189
181 assessment for Auditory function, 322–323
classroom acoustics position statement existing educational audiology services, Auditory learning environment
of, 234 558–563 listening in, 221
Clinical Practice Guidelines for Pediatric program development, 554–555 speaking in, 221
Amplification, 282 Assistive technology. See also specific Auditory modality, 181
hearing assistance technology guidelines, 260, technology Auditory neuropathy, 264, 323
263, 265, 267, 282, 288, 288–290, 424 case law regarding, 442–443 Auditory neuropathy spectrum disorder, 324
hearing loss prevention, 451 educational audiologists’ role in, 36, 38–39 Auditory Numbers Test, 120
screening procedures of, 93 hearing. See Hearing assistance technology Auditory Perception of Alphabet Letters, 120
American Psychological Association, 368 hearing aids as, 262 Auditory perception tests, 120
American Sign Language, 321, 359 home use of, 13 Auditory performance, 324
American Speech-Language-Hearing Individuals with Disabilities Education Act Auditory problems self-checklist, 160
Association provisions, 24–25 Auditory processing
auditory processing deficits, 181, 183 visual, 319, 319 behavioral assessment of, 186
classroom acoustics position statement Assistive technology service, 122 central, 187
of, 234 At-risk students, 224, 224 definition of, 181
Guidelines for Audiology Service Provision Attorneys’ fees, 418 domains of, 189
in and for Schools, 40 Audiogram, 131 educational model of, 184, 184–185, 197
hearing assistance technology guidelines, familiar sounds, 138 multidisciplinary tests of, 191–192, 207–209
260 sample, 139–141 neurologic continuum of, 183–184
hearing loss prevention, 451 speech audibility, 143 supplementary tests of, 191–192, 207–209
595
Plural_Johnson_Index.indd 595 2/25/2020 4:53:36 AM

596 Index
Auditory processing deficit/disorder Auditory skills Case law, 441–446

accommodations for, 194, 212–213 development of, 315–316, 321–322, cochlear implants, 258
assessment for, 180, 186–193, 189–190 360–361, 372, 424 hearing instruments, 258
case history, 187–188, 202–204 testing of, 125 Individuals with Disabilities Education
in children, 191–192 Auditory steady-state measurement, 117–118 Act, 431
educational model for, 197 Automated auditory brainstem response, 89, remote microphone technology, 258
electrophysiological tests, 189 116 Case management
observation of student, 192 Automated otoacoustic emissions, 97–98 facilitation of, 313–314
profile from, 192–193, 193, 210–211 personnel in, 313–314
protocol, 188–191 Baha implant, 274 planning of, 312–314
questionnaires for, 186, 199–200 Bamford-Kowal-Bench sentences, 122–123 service coordination in, 312–313
referral, 185–187, 201 Bamford-Kowal-Bench speech-in-noise test, written communication in, 314
resources, 205–206 122–123 Case managers, 314, 488
Index
speech processing tests, 189–191, 190 BASC-3. See Behavioral Assessment Scale CASEL. See Collaborative for Academic,
temporal processing tests, 188–189, 190 for Children Social, and Emotional Learning
audiologist’s role in, 182–183 Beery-Buktenica Developmental Test of CAT. See Children’s Auditory Test
auditory brainstem responses for, 189 Visual-Motor Integration, 509 Center on Literacy and Deafness, 491, 492
auditory evoked responses for, 189 Behavioral Assessment Scale for Children, Centers for Medicare and Medicaid Services
binaural processing tests for, 188, 190 510 description of, 42
central, 181–182 Behavioral assessments, 510 hearing screening recommendations, 82
characteristics of, 186 Behavioral observation, 92, 93 Central auditory nervous system, 181
classroom audio distribution systems for, Behavioral observation audiometry, 118 Central auditory processing
196 Behind-the-ear hearing aids, 272, 274 deficits of, 181–182
cognitive evaluation in, 192 Bender Visual-Motor Gestalt Test, 509 description of, 187
compensatory strategies for, 195 Bias, 61 Central Test Battery, 205
computer-based auditory training Binaural processing tests, 188, 190 Cerumen management, 43
programs for, 195 Biopsychosocial model, 365 CFR. See Code of Federal Regulations
criteria for, 182, 192 BKB-SIN. See Bamford-Kowal-Bench CHAPS. See Children’s Auditory
definition of, 181–182 speech-in-noise test Performance Scale
diagnosis of, 69, 182 Blair sentences, 122 Charter schools, 82
direct treatment of, 195 Bluetooth, 276 CHILD. See Children’s Home Inventory for
habilitation of, 324 BOA. See Behavioral observation audiometry Listening Difficulties
identification and intervention of, 181 Board of Education v. Rowley, 484 “Child Find,” 87–88, 522–523
incidence of, 183–184 Bone conduction hearing aids, 274 Children’s Auditory Performance Scale, 129,
interventions for Bone conduction thresholds, 114–115 146, 199
direct student services, 195 Bone-conduction vibrator, 118–119 Children’s Auditory Test, 120
indirect, 195–196 BRIEF-2. See Brief Rating Inventory of Children’s Color Trails Test, 506
instructional, 195, 216–217 Executive Function Children’s Home Inventory for Listening
multitiered model of, 218 Brief Rating Inventory of Executive Difficulties, 146
overview, 194 Function, 506 Children’s Memory Scales, 509
response to intervention/multi-tiered Brigance Inventories, 505 Children’s Peer Relationship Scale, 376, 378
system of support, 409 BTE hearing aids. See Behind-the-ear Civil rights laws, 9
modifications for, 194, 212–213 hearing aids CLA. See Classroom Listening Assessment
multitiered systems of support for, Budget and finances, 568 CLAD. See Center on Literacy and Deafness
184–185 Buffalo Battery, 205 Classroom
remote microphone hearing assistance Bullying, 370–371 accommodations in, 238–239
technology for, 196 deaf or hard of hearing students’
school-based program for CAB. See Clinical Assessment of Behavior placement in, 483
eligibility for services, 193–194 CADS. See Classroom audio distribution environment of, 220
philosophy of, 185 systems media access in, 240
referral for, 185–187 CADSs. See Classroom audio distribution parental involvement in, 67–68
screening, 185, 187 systems reverberation in, 236–237
team used in, 185 CANS. See Central auditory nervous system speech perception in, 221–223, 222
Section 504 provisions, 194 CAPD. See Central auditory processing teacher collaboration regarding strategies
skill building activities for, 195 deficits for, 319–320, 335–337
speech enhancement in, 195 Caregivers, 497 visual access in, 239–240
team approach to, 182–183 Case coordination, 312 Classroom acoustics
terminology associated with, 181–182 Case history assessment of, 238
Auditory Processing Domains Questionnaire, for auditory processing deficit assessment, at-risk students, 224, 224
199–200 187–188, 202–204 Classroom Acoustics Screening Survey
Auditory Self-Advocacy Checklist, 375, for hearing assessment, 113–114, 114, Worksheet, 235–237, 242–247
390–395 136–137 classroom observation of, 235–236

Index 597
communication access affected by, Cochlear implant centers, 524, 532, 547–548 Community resources
485 Cochlear implants Child Find programs, 522–523
concepts of, 224 auditory benchmarks for, 325 cochlear implant centers, 524
critical distance, 227–228, 237, 244, case law regarding, 258 community audiologists, 524
247 characteristics of, 272 cover letter to, 539
description of, 37, 128, 221 check procedures for, 285–286 early hearing detection and intervention
educational audiologist’s role in, 237–240 in children, 264 programs, 522
guidelines for, 234–235 components of, 275 hospitals, 523, 523
instrumentation programs for, 236 educational audiologists and, 34, 36, 38–39 list of, 540–541
inverse square law, 227–228 FDA approval for, 275 outpatient rehabilitation facilities, 523, 523
measurement of, 235–237 forms for, 275, 532, 547–548 physicians, 523–524
noise, 226, 236 habilitation of, 325–326 public health clinics, 524
points regarding, 228 Individuals with Disabilities Education Act service clubs, 525
Index
properties of, 226–228 monitoring and maintenance of, 326 survey used to identify, 521, 522, 536–537
remote microphone technology and, 267 Individuals with Disabilities Education university training programs, 524–525,
resolutions, 234–235 Improvement Act provisions for, 532–533
resources for, 250–254 12–13, 23, 25 Compensatory strategies, for auditory
reverberation, 226–227 manufacturers of, 331 processing deficit, 195
signal-to-noise ratio, 226 Office of Special Education Programs Computer-based auditory training programs,
software programs for, 236 comments regarding, 261 195, 214–215
studies of, 221 outcomes of, factors that affect, 275 Conditioned play audiometry, 90, 93, 118
teachers affected by, 229–230 remote microphone systems and, 275 Confidentiality, 60
Classroom Acoustics Screening Survey sound processors in, 275 Conformance, 231
Worksheet, 235–237, 242–247 spoken-language benchmarks for, 325 Connors Third Education, 510
Classroom acoustics standard studies regarding, 264 Consensus-based practices, 496–497
adoption of, 231, 234 Code of ethics, 39 Consultants, educational audiologists as, 34
changes in, 230–231 Code of Federal Regulations, 7 Contracted audiology services
classroom audio distribution systems, 231 Cognitive ability, 187 description of, 40, 40
conformance, 231 Cognitive assessments, 506–508 school-based audiology services combined
current status, 230–231 Cognitive processing, 181 with, 40, 40
development of, 230 Cogswell-Macy Act, 18 Costs, of school-based audiology services,
history of, 230 Collaborative for Academic, Social, and 569–570
International Code Council adoption of, Emotional Learning, 367 Council for Exceptional Children, Division
231, 234 Combined school-based and contractual for Communication, Language, and
local adoption of, 234 agreement services, 41 Deaf/Hard of Hearing, 18
state adoption of, 234 Committed listening, 61, 377 Counseling
tolerance verification, 231 Common Children’s Phrases and Nonsense audiologist’s role in, 376
Classroom audio distribution systems, 196, Phrases, 122, 124 coaching in, 377, 377
231, 276, 279–280, 281–282, 317, Communication description of, 375–376
319, 464, 466 accessible, 484–485 educational audiologists’ role in, 37, 38
Classroom Listening Assessment, 127–128, assessments, 505–511 Ida Institute tools for, 396–397
128 case law regarding, 443 parent, 68–69, 422–423, 423
Classroom observation classroom acoustics’ effect on, 485 referral for, 379
checklist for, 320, 323, 340–341 coaching skills in, 377 reflective listening, 376
of classroom acoustics, 235–236 for deaf or hard of hearing students, self-assessment in, 376–377
for habilitation, 320–321 484–485 Cover letter, to community resources, 539
as inservice follow-up, 468 environmental barriers to, 317 CPA. See Conditioned play audiometry
Classroom Participation Questionnaire, 128, expressive, 322 CPQ. See Classroom Participation
146, 155–159, 322 with families, 60–62 Questionnaire
Classroom Performance/Impact individualized education program, Credibility, 60
Questionnaire, 199 421–422, 435–437, 485 Critical distance, 227–228, 237, 244, 247
ClearCaptions, 466 Individuals with Disabilities Education Cross-check principle, 113
Clinical Assessment of Behavior, 510 Act, 421–422, 435–437 Cued speech, 359
Clinical audiology, 40, 41 language and, 359 Culture, 125, 127
COACH concept, 374 modalities of, differing opinions on, 70 Curriculum-based measurements, 497
Coaching parent-to-parent, 65–66
concept organizer for, 480 proficiency in, 485 Dangerous Decibels, 94, 452–453
definition of, 468 receptive, 322 DAS-2. See Differential Abilities Scale
description of, 377, 377 repair training for, 316–317 Data management, 568
educational, 468–469 skills for, 61 Day-to-day scheduling, 566
educational audiologists, 38, 469–470 Communication Plan, 485, 492, 501–502 DCBR. See Deaf Child Bill of Rights
open-ended questions used in, 469 Community audiologists, 524 Deaf Child Bill of Rights, 17, 485, 492

598 Index
Deaf education Digital modulation, 276, 315 as consultants, 34

academic outcomes of, 491 Digital radio frequency, 277 contracted services provided by, 40
accountability, 483–484 Direct intervention, 36, 37–38 counseling role of, 37, 38
assessment of, 493–494 Disability credibility of, 60
best practice considerations for, 495–497 definition of, 411 in decision making, 313
consensus-based practices for, 496–497 hearing impairment as, 412, 443–444 early hearing detection and intervention
critical issues in, 483–490 Individuals with Disabilities Education Act role of, 51–52
expanded core curricula in, 497 definition of, 26 ethical considerations, 39
inclusion, 16–17 infant with, 428 habilitation by, 36, 37–38
key initiatives and events in, 16–18 Rehabilitation Act of 1973 definition of, 9 hearing loss prevention role of, 36, 38
legislative initiatives in, 492–493 special education eligibility and, 410–411 individualized education program role of,
oversight, 483–484 toddler with, 428 418–419, 420–421, 426, 434
parental involvement in, 497 “Disability harassment,” 370 individualized family service plan
Index
program review for, 496 Distortion product otoacoustic emissions, involvement by, 428, 429
progress monitoring for, 497 88–90, 97, 117 as instructional team members, 34
research projects regarding, 491, 491–492 Division for Communication, Language, and learning environment management of,
social outcomes of, 491 Deaf/Hard of Hearing, Council for 237–240
transition planning, 494 Exceptional Children, 18 licensure of, 45
Deaf students DM. See Digital modulation in multidisciplinary team, 576
accountability for, 483–484 DPOAE. See Distortion product otoacoustic onsite, remote support of, 578
best practice considerations for, 495–497 emissions overview of, 32
classroom placement of, 483 DSI. See Dichotic Sentence Identification public health role of, 451
communication and communication access DSTP. See Differential Screening Test for responsibilities of, 35–39, 36–37
for, 484–485 Processing roles of, 33–34, 418–419, 482
consensus-based practices for, 496–497 Due process, 416–418, 417 in schools for the deaf, 34–35
evidence-based practices for, 487–488, as service coordinators, 33
496–497 EAA. See Educational Audiology Association training for, 44–45
Expanded Core Standards for, 497, 498–499 Early childhood education, 489 trust building with family, 60
family of, 488–489 Early Childhood Hearing Outreach, 90, 98 Educational audiology
in general education classrooms, 486, 488 Early hearing detection and intervention challenges associated with, 4–7
hard of hearing students versus, 489 audiologists’ role in, 51–52 clinical audiology versus, 40, 41
National Association of State Directors benefits of, 489 combined school-based and contractual
of Special Education ten essential description of, 17 agreement services, 41
principles for education of, 490 habilitation in, 326–327 community awareness of, 528
oversight of, 483–484 information resources for families, 64 contracted services, 40, 40
overview of, 482–483 management system for, 82 cross-check principle in, 113
parents of, 488–489 parent-to-parent communication, 66 definition of, 4
peer involvement, 497 programs for, 522, 533 delivery of, 318
placement of, 483 support for, 43–44 inclusion effects on, 16
quality instruction for, 485–487 Early intervention presentations, 529–530
role models for, 497 description of, 17 reimbursement for, 42
teacher for, 488 family-centered, 38 school-based, 39–40, 40
technology for, 489 Early intervention service provider, 27–28 in schools, 42–44, 542–543
tier-based strategies for, 495, 496 Early Listening Function, 147 scope of practice, 53–56
“Deaf-blindness,” 13, 26 Early Speech Perception Test, 120 telepractice, 41–42, 577
Deafness Earmolds, 288, 315 Educational Audiology Association, 35, 39,
bill of rights for children with, 17 EARS program, 531, 546 42–43, 45, 83, 86, 451, 469, 524, 563
definition of, 13–14, 26 ECLiPS. See Evaluation of Children’s Educational audiology programs, 525–527
special education eligibility and, 412 Listening and Processing Skills Educational audiology services
Developmental delays Educational assessments delivery models for, 39–42
hearing assessment in children with, 118 description of, 493–494 development of, 552
hearing problems questionnaire for list of, 505–511 remote, 578
students with, 110 terminology associated with, 503–504 surveys for, 542–544
Developmental Index of Audition and Educational audiologists Educational coaching, 468–469
Listening, 147 assessment by, 36, 410 Educational Interpreter Performance
DIAL. See Developmental Index of Audition assistive technology and, 36, 38–39 Assessment, 486
and Listening as case manager, 314 Educationally significant hearing loss, 37
Dichotic listening skills, 188 cerumen management by, 43 EHDI. See Early hearing detection and
Dichotic Sentence Identification, 191 classroom acoustics role of, 237–240 intervention
Differential Abilities Scale, 508 coaching for, 469–470 EIPA. See Educational Interpreter
Differential Screening Test for Processing, coaching role of, 38 Performance Assessment
187, 205–206 cochlear implants and, 36, 38–39 Electroacoustic verification, 282–283

Index 599
Electromagnetic induction, 277 FMLA. See Family and Medical Leave Act teacher for, 488
Elementary and Secondary Education Act, 8 Free and appropriate education, 9, 16, 21, 26, technology for, 489
Empathy, 59 267, 370, 405–406, 413, 443, 486 tier-based strategies for, 495, 496
Endrew F. v. Douglas County School District, Frequency modulation, 276, 277, 315 transition planning, 494
406, 416, 421 Frequency modulation systems, 279, 282, HAT. See Hearing assistance technology
ESEA. See Elementary and Secondary 441–442 Headphones, 98
Education Act Full-time equivalent audiologists, 4, 5–6, 7, Health Insurance Portability and
ESHL. See Educationally significant hearing 488 Accountability Act, 30, 133, 534
loss Functional Auditory Performance Indicators, HEAR checklist, 88, 109
ESPT. See Early Speech Perception Test 147, 321, 325, 343–358 Hearing aids
Ethics, 39 Functional Listening Evaluation, 122, as assistive technology, 262
Evaluation of Children’s Listening and 124–125, 126, 127, 147, 150–153 behind-the-ear, 272, 274
Processing Skills, 199 bone conduction, 274
Index
Every Student Succeeds Act, 8, 29, 184, Graduate training programs, 405 case law regarding, 442
224–225, 323, 483, 487, 576 Growing Up with Hearing Loss, 375, 397 check procedures for, 285–286
Evidence-based practices, 487–488, 496–497 Guide to Access Planning, 424, 494 completely in the canal, 274
Evoked potentials, in hearing assessment, description of, 274–275
117–118 Habilitation, audiological Individuals with Disabilities Education Act
Executive functioning assessments, 506–508 auditory neuropathy spectrum disorder, 324 provisions, 25
Expanded core curricula, 497 auditory processing deficits, 324 insurance coverage for, 493
Expanded Core Standards, 497, 498–499 classroom observation for, 320–321 in-the-ear, 274
Expressive communication, 322 cochlear implants, 325–326 Office of Special Education Programs
Extending conversations, 377 communication repair training in, 316–317 comments regarding, 261
External marketing, of educational audiology counseling in, 317 receiver-in-the-canal, 274
programs, 527 direct services, 314–317, 315 Hearing assessment
early hearing detection and intervention, acoustic immittance testing in, 117
Familiar sounds audiogram, 138 326–327 auditory brainstem response in, 116–117
Families. See also Parents educational audiologists’ responsibilities auditory skills testing, 125
adaptation to hearing loss diagnosis by, for, 36, 37–38 behavioral observation audiometry in, 118
65, 65 fatigue in, 317 behavioral techniques for, 114–116
communication with, 60–62 implementation of, 314–323 bone conduction thresholds in, 114–115
confidentiality issues, 60 indirect services, 317–323 bone-conduction vibrator in, 118–119
early intervention centered on, 38 multiple learning challenges, 324–325 case history in, 113–114, 114, 136–137
educational audiologist’s work with, 38 planning of, 312–314 Classroom Listening Assessment,
empathy for, 59 in single-sided deafness, 323–324 127–128, 128
home visits with, 59 speechreading, 316, 316, 338–339 communication methods for reporting
informational guidance for, 62–66, 72–74 in unilateral hearing conditions, 323–324 results of
interview with, 75–76 Handouts, for inservice, 466–467, 478 audiograms, 131
involvement of, 66–68, 70 Harassment, 370 e-mail, 133
needs interview for, 75–76 Hard of hearing students overview of, 130
positive attitudes with, 59–60 accountability for, 483–484 personal conferences, 132–133
rapport with, 59 best practice considerations for, 495–497 physician letters, 131–132
respect for, 59–60 classroom placement of, 483 privacy issues in, 133
school engagement by, 488–489 communication and communication access teacher letters, 131, 174–176
socioeconomic factors, 60 for, 484–485 telephone conferences, 132–133
trust with, 60 consensus-based practices for, 496–497 texting, 133
Family and Medical Leave Act, 70 deaf students versus, 489 Web-based methods, 133
Family Educational Rights and Privacy Act, evidence-based practices for, 487–488, written reports, 131
30, 60, 133, 427, 534 496–497 cultural considerations in, 125, 127
Family Needs Interview, 423 Expanded Core Standards for, 497, 498–499 in developmentally delayed children, 118
FAPE. See Free and appropriate education family of, 488–489 documentation of, 133
Federal Register, 7 in general education classrooms, 486, 488 educational effects of hearing loss,
Feedback, 61 National Association of State Directors 127–130
FERPA. See Family Educational Rights and of Special Education ten essential evoked potentials in, 117–118
Privacy Act principles for education of, 490 functional listening evaluation, 122,
Fisher’s Auditory Problems Checklist, 129, oversight of, 483–484 124–125, 126, 127, 147, 150–153
199 overview of, 482–483 listening development skills testing, 125
FLE. See Functional Listening Evaluation parents of, 488–489 modifications in
Flutter echoes, 227 peer involvement, 497 pure-tone, 118–120
FM. See Frequency modulation placement of, 483 speech-related, 120
FM system. See Frequency modulation quality instruction for, 485–487 modifications in, for special populations,
systems role models for, 497 118–120, 144–145

600 Index
Hearing assessment (continued ) amplification of, 273 data management, 102

otoacoustic emissions testing in, 116–117 amplifiers for, 276 early childhood, 85–87
otoscopy in, 114 bone conduction, 272 educational screening, 101–102
overview of, 113 candidacy for, 264–265, 289 effectiveness of, 102–103
personal vulnerability during, 133–134 case law regarding, 258 environment for, 99
physiological techniques in, 116–118 in children, 263–271, 264–270 equipment used in, 97–98
privacy issues in, 133 cochlear implants. See Cochlear implants evaluation of, 82
products for, 177–178 digital signal processing strategies for, 273 follow-up procedures, 101–102
pure-tone air conduction thresholds in, hearing aids. See Hearing aids high-risk checklists, 86, 91
114–115 induction loop systems, 280 infants, 85–87, 93, 94
safety during, 133–134 listening environment considerations, 267, infection control in, 98
speech audibility, 116 269–270 Internet-based, 82
speech intelligibility, 116 osseointegrated bone conduction implant, noise levels, 99
Index
speech perception in noise testing, 123 272, 274 nontraditional screening methods, 96
speech recognition personal, 271, 272–273, 274–281 organization of, 99–101
in noise, 123–124 poor use of, in home settings, 70 otitis media and, 86
for sentences and phrases, 122–123 professional practice standards, 258, 260 otoacoustic emissions, 88–90, 91, 95, 96
with visual support, 124 public education and, 260–263 overview of, 81
speech thresholds used in, 115 rationale for, 257 parental involvement in
visual inspection in, 114 regulations regarding, 257–258 notification, 100
visual reinforcement audiometry in, 118 scope of practice guidelines for, 258, 260 as volunteers, 97
without sound booth, 125 signal interference problems, 278 personnel for, 85, 96–97
word recognition ability in, 115, 115–116, types of, 272 preschoolers, 85–87
142 Hearing loss in private schools, 82
Hearing assistance technology acoustic accessibility for, 10 procedures used in, 88–93
adjustment and acceptance of, 286, 288 educational effects of, assessment of, professional guidelines for, 83
American Academy of Audiology clinical 127–130 protocols for, 93–95, 94
practice guidelines for, 260, 263, 265, identification of, educational audiologists’ pure-tone audiometry, 91, 92, 95
267, 282, 288, 288–290 role in, 35, 36 purpose of, 81, 82–85
behavioral verification of, 283 incidence of, 83 records of, 102
in children, 263–271, 264–270 indicators associated with, 109 referrals for, 88
electroacoustic verification of, 282–283 listening and, relationship between, 161–169 resources for, 85
equipment requirements for, 263 noise-induced. See Noise-induced hearing scheduling, 85, 100
evaluation for, 292–297 loss school nurses in, 97
fitting of, 282–283, 289 parents’ adaptation to, 65, 65 school-age children and youth, 87–88,
home use of, 262–263 prevalence of, 81, 83–84, 84–85 93–95, 95
implementation of, 282–288 prevention of school-wide, 87
monitoring of, 284–286, 286–287, 299 awareness and programs for, in school screening room for, 99
in nonacademic settings, 262–263 settings, 451–452 sensitivity of, 82–83, 102–103
overview of, 257 challenges for, 454–455 specificity of, 82–83, 102–103
pediatric evaluation, 295–298 educational audiologists’ role in, 36, 38 speech-language pathologists in, 96–97
rationale for, 257 future directions for, 454–455 state mandates for, 81–82, 87, 104–108
real-ear measurements, 282–283 promotion of, 577 support personnel for, 96–97
remote diagnostic testing and fitting of, 578 public policies for, 454 time considerations, 85
remote microphone. See Remote self-efficacy for, 398 toddlers, 85–87
microphone technology simulation resources for, 476–477 tympanometry, 92, 92, 94–95, 98
scope of practice for, 259, 260 in students with developmental delays, 110 universal newborn, 63, 86, 522
space requirements for, 263 Hearing screening and identification visual inspection, 89, 91
student evaluation, 292–294 activities before screening, 100 Hearing sensitivity
technological advancements in, 263 activities during screening, 100–101 monitoring of, 121
usage plan for, 283 age considerations for, 83 pure-tone air conduction thresholds,
validation of, 283–284 American Academy of Audiology 114–115
verification of, 282–283, 289 procedures for, 93 Hearing status
Hearing impairment audiological evaluation referrals after, 101 educational effects of, 127–130
definitions of, 13–14, 26 audiologists in, 96 Individuals with Disabilities Education
as disability, 412, 443–444 auditory brainstem response in, 89, 91 Act, 412
special education eligibility and, 411–412 auditory developmental checklists, 86–87, 91 information regarding, 322–323
Hearing in Noise Test, 123 behavioral observation, 92, 93 notification card for, 375
Hearing instruments checklist for, 99–100 Heating, venting, and air-conditioning noise,
air conduction, 272 “Child Find,” 87–88 226
American Academy of Audiology clinical in children with disabilities, 96 Hendrick Hudson School District Board of
practice guidelines for, 260 cost effectiveness of, 103 Education v. Rowley, 16

Index 601
HFHL. See High-frequency hearing loss review of, 416 Section 504 and, differences between, 413,
High-frequency hearing loss, 449 revisions to, 416 414
High-risk checklists, in hearing screening and transition planning, 423–424 special education eligibility under, 411
identification programs, 86, 91 transition services, 416 summary of, 29
HINT. See Hearing in Noise Test Individualized education program team transition planning, 423–424, 425, 494
HIPAA. See Health Insurance Portability and description of, 14, 378–379 Individuals with Disabilities Education
Accountability Act meeting of, 406, 414–416, 434 Improvement Act of 2004
Hit It, 378 members/participants of, 415–416 audiology services under, 44
Hospitals, 523, 523 services determined by, 422 hearing sensitivity reevaluation
special education eligibility determinations requirements, 121
I Start/ You Finish, 376 by, 411 provisions of, 12–13
Ida Institute, 65, 375, 396–397 Individualized Family Service Plan Induction loop systems, 280
IDEA. See Individuals with Disabilities components of, 429 Infant Meaningful Auditory Integration
Index
Education Act description of, 409 Scale, 148
Identification, of hearing loss educational audiologist’s involvement in, Infants
educational audiologists’ role in, 35, 36 428, 429 with disability, 428
information about, 63 eligibility criteria for, 428–429 hearing screening and identification
Identity, 367–368 individualized education program and, programs in, 85–87, 93, 94
IEE. See Independent Educational Evaluation differences between, 428 Infection control, in hearing screening and
IEP. See Individualized education program long-range plans and, 556 identification programs, 98
IFSP. See Individualized Family Service Plan parental information about, 65 Inservice, formal
Inclusion Part C services, 429 audiology/amplification equipment
in deaf education, 16–17 purpose of, 429 demonstrations in, 466
description of, 327–328 referral for, 429 classroom observation as follow-up to, 468
Independent Educational Evaluation, 409–410 requirements of, 429–431 content selection for, 462–463
Individualized education program transition planning, 429 continuing contact with participants,
accommodations under, 415, 424, 432–433 Individuals with Disabilities Education Act 467–468
adaptations under, 415 Americans with Disabilities Act and, definition of, 461
Americans with Disabilities Act eligibility, comparison between, 494 evaluation form for, 467, 479
4103 assistive technology evaluation, 265 facilities for, 464–465
amplification goals, 286 case law, 431, 444 follow-up after, 467
communication considerations, 421–422, cochlear implants, 326 handouts used in, 466–467, 478
435–437, 485 communication considerations, 421–422, humor used in, 466
Communication Plan, 485, 492, 501–502 435–437 ice breakers used in, 466
definition of, 26, 419 description of, 5, 11–12 materials for, 463–464, 464
description of, 7 early hearing detection and intervention outline for, 463, 472–475
development of, 415 under, 43 preparation for, 461–465
disagreements about, 69 educational audiologists’ responsibilities presentation tips for, 465–467
due process procedures, 416–418, 417 under, 35 questions during, 465
educational audiologist’s role in, 418–419, eligibility under, 9 resources for, 476–477
420–421, 426, 434 free and appropriate public education, scheduling, 461–462
elements of, 419 405–406 sessions, 463–464
goals, 421, 424, 426 hearing aids, 285 target audience, 462
importance of, 14 hearing disability criteria under, 412 technology for, 464–465
individualized family service plan and, hearing instruments, 257–258 topics for, 463
differences between, 428 hearing loss prevention programs under, Instructional strategies, for auditory
least restrictive environment provisions, 451 processing deficit, 195
422 hearing status under, 412 Instructional team members, educational
meeting, 406, 414–416, 415, 434 inservice statistics, 460 audiologists as, 34
modifications under, 415 least restrictive environment mandate, 16, Internal marketing, of educational audiology
parents 27, 483 programs, 526–527
information for, 65 limitations of, 14 International Code Council, classroom acoustics
participation by, 488 parental services under, 422–423 standard adoption by, 231, 234
services for, 422–423 Part B, 20–29, 43, 327 Internet-based hearing screening programs, 82
placement of child based on, 422 Part C, 23–29, 43, 58, 326, 523 Internships, 45
process of, 405–419 pertinent areas of, 20–22 Interpreting services, 13, 24, 446
assessments, 409–410 principles of, 11–12, 12 Interprofessional collaboration, 314, 330,
concern about the student, 406–409 purpose of, 405, 413 530–532
educational audiology assessment in, reasonable access to public education Interventions, 36, 37–38
410 provisions, 11 Inverse square law, 227–228
referral, 409–410 regulations of, 15 IT-MAIS. See Infant Meaningful Auditory
reevaluations of, 416 Response to Intervention, 184 Integration Scale

602 Index
KABC-II. See Kaufman Assessment Battery Listening Inventory for Education, 148, 199 NAIE. See National Association of Interpret-
for Children LittlEARS Auditory Questionnaire, 148 ers in Education
Kaufman Assessment Battery for Children, Living Well for Teens and Tweens, 375, NASDSE. See National Association of State
508 396–397 Directors of Special Education
Kaufman Test of Educational Achievement, LOCHI. See Longitudinal Outcomes of National Association for the Deaf, 378
505 Children with Hearing Impairment National Association of Interpreters in
KeyMath 3 Diagnostic Assessment, 506 Logic model, 558, 558 Education, 486
Kidpower Teenpower Fullpower Longitudinal Outcomes of Children with National Association of State Directors of
International, 134 Hearing Impairment, 125 Special Education
Long-range planning, 556, 557 description of, 17, 130
Language assessments, 511 Low Incidence Outreach Educational Impact guidelines of, 490
Language competence, 187 Matrix for Students Who Are Deaf or program review areas, 496, 512–518
Language Equality and Acquisition for Deaf Hard of Hearing (DHH), 410 ten essential principles for education of
Index
Kids, 18, 492 Low-frequency hearing loss, 449 deaf or hard of hearing students, 490,
Leadership skills, 553 LRE. See Least restrictive environment 496
LEAD-K. See Language Equality and National Center for Education Statistics, 4
Acquisition for Deaf Kids MAC Battery. See Minimal Auditory National Center for Hearing Assessment and
Learning Capabilities Battery Management, 14, 17
key factors for, 463 Mainstreaming, 327 National Deaf Center on Postsecondary
lighting effects on, 223–224 MAIS. See Meaningful Auditory Integration Outcomes, 320
universal design for, 37, 220, 224–226, Scale National Health and Nutrition Examination
225, 408, 495 MAPA-2. See Multiple Auditory Processing Surveys, 84, 94, 448
Learning environments Assessment National Institute on Deafness and Other
at-risk students, 224, 224 Marketing, of educational audiology programs, Communication Disorders, 65
classroom accommodations, 238–239 525–527, 528, 540–541, 545 Native language, 25–26
educational audiologist’s management of, MCA. See Minnesota Comprehensive NCHAM. See National Center for Hearing
237–240 Assessment Assessment and Management
lighting in, 223–224 Meaningful Auditory Integration Scale, 148 NCLB Act. See No Child Left Behind Act
listening in, 221–223, 223 Mediation, 417 Near-field magnetic induction, 276, 277
Least restrictive environment, 16, 27, 422, Medicaid, 42 Networking, 377–379
444–445, 483 Medicare, 42 Newborn and Infant Hearing Screening and
Legislation. See also specific legislation Mental health Intervention Act, 17
advocacy groups in, 7 characteristics of, 366–367 Newborn hearing screening, 63, 86, 256, 522
deaf education, 492–493 World Health Organization definition of, NHANES. See National Health and Nutrition
initiatives in, 18 365, 366 Examination Surveys
key, 8, 8–15 Mentoring, 460, 468, 470 NIHL. See Noise-induced hearing loss
overview of, 7–8 Michigan Educational Services Matrix, 130, No Child Left Behind Act, 8, 323, 415, 483, 576
Leiter International Performance Scale, 507 170–173 Noise
LFHL. See Low-frequency hearing loss Michigan quick reference assessment guide, awareness and prevention programs for,
Licensure, 45 494 451–452
L.I.F.E. See Listening Inventory for Middle ear disorders, 94, 101 case law regarding, 441
Education Minimal Auditory Capabilities Battery, 120 classroom, 221, 236
Lighting, learning affected by, 223–224 Minimal verbal attending, 377 in classroom acoustics, 226
Ling Six-Sound Check, 285, 300–301 Minimally reduced hearing, 224 definition of, 226
Ling Six-Sound Test, 120, 127, 148 Minimum competencies for educational effective, 227
LiSN-S. See Listening in Spatialized Noise— audiologists, 44 English language learners affected by, 228
Sentences Test Minnesota Comprehensive Assessment, 486 during hearing screening, 99
Listening Minnesota Deaf Education Collaborative, heating, venting, and air-conditioning, 226
committed, 61 486 listening in, 123–124
functional outcome measures for, 146–149 Modifications, under individualized speech perception in, 123
hearing loss and, relationship between, education program, 415 speech recognition in, 123–124
161–169 Monthly scheduling, 566, 567 Noise reduction coefficients, 237
in learning environments, 221–223, 223 Moral disengagement, 370 Noise-induced hearing loss
reflective, 376 MTSS. See Multi-tiered system of support awareness and prevention programs for, in
skills development, 315–316 Multiple Auditory Processing Assessment, school settings, 451–452
Listening Development Profile, 316, 325, 205 challenges regarding, 454–455
332–334 Multi-tiered system of support Dangerous Decibels program for, 452–453
Listening development skills, 125 auditory processing deficits and, 184–185 description of, 83
Listening environment, 267, 269–270 description of, 13, 407–409 epidemiology of, 448–449
Listening fatigue, 491 response to intervention/multi-tiered future directions for, 454–455
Listening in Spatialized Noise—Sentences system of support, 407–409, 413 prevention of, 449–453
Test, 205 MyGAP Transition Checklist, 494 public policies for, 454

Index 603
screening for, 94–95 conferences with, 132–133 goal prioritization worksheet for, 556
screenings for, 453–454 counseling of, 68–69, 422–423, 423, 488 leadership skills, 553
Noise-induced tinnitus deaf education involvement by, 497 logic model planning, 558, 558
epidemiology of, 449 decision making by, 484 long-range planning, 556, 557
prevention of, 449–451 disagreement over individualized needs assessment, 554–555
Nonlinear frequency compression, 273 education program, 69 planning, 555–558, 556–558
Nonsense phrases, 122 due process options for, regarding state department of education, 554
Nonverbal attending, 377 individualized education program, statewide collaboration, 554
Northwestern University Children’s 416–418, 417 support from key decision makers, 553–554
Perception of Speech, 116 empowerment of, 62 supporting documentation, 553
NRC. See Noise reduction coefficients hearing screening and identification SWOT analysis, 555, 555
NU-CHIPS. See Northwestern University program, 97, 100 Program evaluation, 558–565
Children’s Perception of Speech hearing screening referrals by, 88 assessment of existing educational
Index
individualized education program services, audiology services, 558–563
OAEs. See Otoacoustic emissions 422–423 implementation of new services, 562
Occupational Safety and Health Individuals with Disabilities Education Act measuring effectiveness, 563–565, 564
Administration, 30 services for, 422–423 planning for improvement, 562
OCHL. See Outcomes of Children with informational guidance for, 62–66, 72–74 program component review, 562
Hearing Loss involvement of, 66–68 state model evaluation systems, 564–565,
Office of Civil Rights, 10, 413 question prompt list for, 77 565–566
Office of Special Education Programs, 261 resources for, 72–74 workload analysis, 559, 559–561
Office support, 566, 568 tips for working with, 71 Program management, 566–570
OME. See Otitis media with effusion volunteering by, 97 annual and monthly scheduling, 566
Open-ended questions, 469 Parent’s Evaluation of Auditory/Oral budget and finances, 568
OSEP. See Office of Special Education Performance of Children, 149 challenges for, 568–570
Programs PBIS. See Positive Behavioral Interventions data management, 568
OSHA. See Occupational Safety and Health and Supports day-to-day scheduling, 566
Administration Pediatric Speech Intelligibility Test, 122 facilitating meetings, 568
Osseointegrated bone conduction implant, Peer group, 378, 378 justifying cost of school-based audiology
272, 274 Peer mentors, 379 services, 569–570
Otitis media Personal conferences, 132–133 monthly scheduling, 566, 567
auditory processing deficits and, 183 Personal hearing instruments office support, 566, 568
hearing screening and, 86 dispensing of, 42 Progress monitoring, 497
Otitis media with effusion, 86, 87 in schools, 42 PSI test. See Pediatric Speech Intelligibility
Otoacoustic emissions Phonak’s Guide to Access Planning, 424, 494 Test
automated, 90 Physicians Psychoeducational assessments, 505–511
distortion product, 88–90 as community resource, 523–524 Public health clinics, 524
equipment for, 97–98, 98 hearing assessment results given to, 131–132 Pure-tone air conduction thresholds, 114–115
hearing assessment uses of, 116–117 hearing screening referrals by, 88, 101 Pure-tone audiometers, 97
hearing screening uses of, 88–90, 91, 95, 96 referrals from, 88, 101, 523–524 Pure-tone audiometry, 91, 92, 95
transient-evoked, 88–90 PL 94–142. See Individuals with Disabilities
Otology clinics, 532 Education Act QRI-6. See Qualitative Reading Inventory
Otoscope, 98 PL 108–446. See Individuals with Disabilities Qualitative Reading Inventory, 506
Otoscopy Education Improvement Act Questions, 61, 67
hearing assessment uses of, 114 Placement and Readiness Checklists, 67,
video, 114 321, 422 RAN/RAS Tests. See Rapid Automatized
Outcomes of Children with Hearing Loss, Positive attitudes, 59–60 Naming/Rapid Alternating Stimulus Tests
491, 492 Positive Behavioral Interventions and Rapid Automatized Naming/Rapid
Outpatient rehabilitation facilities, 523, 523 Supports, 408 Alternating Stimulus Tests, 508
Output limiting, 273 Preschool Screening Instrument for Targeting Rapport, 59
Educational Risk, 149 Receptive communication, 322
Paraphrasing, 61, 377 Preschoolers, hearing screening and Recorded speech, 342
PARC. See Placement and Readiness identification programs in, 85–87 Referrals
Checklists Presentations, 529–530 auditory processing deficits, 185–187, 201
Parents. See also Families Prevalence, 81, 83–84, 84–85 counseling, 379
activities for, 68 Private providers, school-based audiology for hearing screening and identification
adaptation to hearing loss diagnosis by, 65, 65 services influenced by, 69–70 programs, 88
amplification requests by, 69 Private schools, 82 individualized family service plan, 429
classroom support by, 67–68 Program development, 553–558 parents, 88
committee/task force work by, 67 educational audiologist as school team physician, 88, 101
communication modalities and, 69 member, 553 teacher, 88
communication with, 60–62, 65–66 foundation, 553 Reflective feedback, 61, 377

604 Index
Rehabilitation Act of 1973 Reverberation hospitals, 523, 523

Section 504. See Section 504 classroom, 236–237, 246–247 list of, 540–541
Section 508, 29 in Classroom Acoustics Screening Survey outpatient rehabilitation facilities, 523,
Relocatable classrooms, 232–233 Worksheet, 242–247 523
Remote audiology description of, 222, 226–227 physicians, 523–524
hearing assistance technology testing and speech perception affected by, 229 public health clinics, 524
fitting through, 578 Reverberation time, 227, 229, 231, 233, service clubs, 525
onsite educational audiologists support, 578 243–244 survey used to identify, 521, 522,
remote/onsite hybrid model, 578 Reynolds Intellectual Assessment Scales, 508 536–537
services model for, 577–578 RIAS-2. See Reynolds Intellectual Assessment university training programs, 524–525
tools for, 579 Scales development of, 527–534
Remote microphone technology RM HAT. See Remote microphone ethical issues, 534
accessory, 271 technology facilitation of, 530–532
Index
for auditory processing deficit, 196 Role models, 379 fostering of, 527–534, 549
behavioral verification of, 283 RT60. See Reverberation time interprofessional, 530–532
candidacy for, 264–265, 266–267, 270 RtI. See Response to intervention leasing facilities and equipment, 532–533
case law regarding, 258 RtI/MTSS. See Response to intervention/ legal issues, 534
in children, 263–271, 264–270 multi-tiered system of support materials used in, 527–530
classroom audio distribution systems, 276, otology clinics, 532
279–280, 281–282 SAC-A. See Self-Assessment of presentations, 529–530
cochlear implants and, 275 Communication—Adolescent research assistance, 533
description of, 69, 112 SCAN-3, 205 service clubs, 533, 538
developmental considerations for, 269 School(s) student practicum and preceptor sites, 533
device determination, 271 contract template for, 546 tips for, 549
device selection considerations for, 265, deaf or hard of hearing students’ Schools for the deaf, 34–35
267, 271 placement in, 483 Screening
eligibility for, 319 disagreement over individualized auditory processing deficit, 185, 187
fitting goals for, 276 education program, 69 hearing. See Hearing screening and
funding for, 271 educational audiology services in, 42–44, identification
implementation worksheet for, 303–310 542–543 noise-induced hearing loss, 453–454
incidental reports about, 285 family involvement in, 488–489 Screening Instrument for Targeting
inservice use of, 464 hearing screening and identification Educational Risk, 102, 128–129, 149
in learning environment assessment, 238 programs in, 87 SDLMI. See Self-Determined Learning
monitoring of, 284–286 instructional leadership in, 484 Model of Instruction
in nonacademic settings, 262–263 medical services in, case law regarding, 446 Section 504 of Rehabilitation Act of 1973
options for, 258 noise awareness and prevention programs accommodations, 432–433
orientation regarding, 283 in, 451–452 auditory processing disorders, 194
personal, 276, 278–279, 279 parental involvement in, 488–489 bullying under, 370
public education funding of, 260–263 personal hearing instruments in, 42 case law, 446
scope of practice for, 259, 260 safety and security in, 577 description of, 9–10, 426–427
selection of, 319 services plan, 427–428 educational audiologist and, 427
signal-to-noise ratio, 271 supervision in, 484 eligibility of children for services under,
studies regarding, 265 School-age children, hearing screening and 412–413, 427
technological advancements in, 263 identification programs in, 87–88, Individuals with Disabilities Education Act
test kit for, 285 93–95, 95 and, differences between, 413, 414
tips for enhancing, 302 School-based audiologists pertinent areas of, 20–22
training about, 283 description of, 32 purpose of, 413
transmission modes for, 276, 277 internships, 45 remote microphone technology, 271
transmitters, 278, 279 School-based audiology services sample plan, 439–440
types of, 274 contractual agreement services and, 41 summary of, 29
usage plan for, 283 costs of, 569–570 transition planning/services, 424, 425
validation of, 283–284, 284 description of, 39–40, 40 Self-advocacy and transition skills for
Resiliency, 369 private provider influence on, 69–70 secondary students who are deaf or
RESOURCES for Families of Children with School–community collaborative partnerships hard of hearing, 374
Hearing Loss in Colorado, 64 barriers to, 534 Self-advocacy skills, 371, 374–375, 424
Respect, 59–60 community resources Self-assessment, 376–377
Response to intervention Child Find programs, 522–523 Self-Assessment Effectiveness Indicators for
description of, 13 cochlear implant centers, 524 Audiology Services in the Schools, 555
Individuals with Disabilities Education community audiologists, 524 Self-Assessment of Communication—
Act, 184 cover letter to, 539 Adolescent, 128, 376
Response to intervention/multi-tiered system early hearing detection and intervention Self-blaming, 370
of support, 407–409, 413, 487, 495 programs, 522, 533 Self-confidence, 368–369

Index 605
Self-determination, 369–371, 373–374 services plan, 427–428 Teaming, 468

Self-Determined Learning Model of specially designed instruction as, 9, 28, 410 Technology
Instruction, 371, 381–382 students not eligible for, 488 acceptance of, 577
Self-efficacy, 398 Specialized instructional support personnel, assistive. See Assistive technology
Self-esteem, 196, 368–369, 369 38, 565 deaf or hard of hearing students’ use of, 489
Sensitivity, 82–83, 102–103 Specially designed instruction, 9, 28, 410 hearing assistance. See Hearing assistance
Sensory-based impairments, 408 Specific learning disabilities, 183 technology
SERT. See Sound Effects Recognition Task Specificity, 82–83, 102–103 remote microphone. See Remote
Service clubs, 525, 533, 538 Speech audibility, 116 microphone technology
Service coordination, 312–313 Speech intelligibility Teleaudiology, 577
Service coordinators, 33 description of, 116, 187 Telephone conferences, 132–133
Services plan, 427–428 speech sounds and, 226 Telepractice, 41–42, 577
SETT framework, 238, 239, 248–249 Speech Intelligibility in Noise test, 123 Temporal processing tests, for auditory
Index
S.I.F.T.E.R. See Screening Instrument for Speech perception processing deficit, 188–189, 190
Targeting Educational Risk in classroom, 221–223, 222 TEOAE. See Transient-evoked otoacoustic
Sign language, 24, 34 noise and, 123, 228–229 emissions
Signal-to-noise ratio, 226, 229, 271 points regarding, 228 Test of Silent Reading Efficiency and
Significant Other Assessment of reverberation effects on, 222, 229 Comprehension, 506
Communication—Adolescent, 128, 376 signal-to-noise ratio effects on, 226 Test of Silent Word Reading Fluency, 506
Single-sided deafness, 323–324 Speech processing tests, 189–191, 190 Tinnitus, noise-induced
SISP. See Specialized instructional support Speech reception threshold, 115 epidemiology of, 449
personnel Speech recognition prevention of, 449–451
Skill building activities, for auditory in noise, 123 Toddlers
processing deficit, 195 for sentences and phrases, 122–123 with disability, 428
SLDs. See Specific learning disabilities visual support used in, 124 hearing screening and identification
SLPs. See Speech-language pathologists Speech thresholds, 115 programs in, 85–87
SMART goals, 426 Speech-language pathologists Tolerance verification, 231
SNR. See Signal-to-noise ratio auditory processing, 181 TOSREC. See Test of Silent Reading
SOAC-A. See Significant Other Assessment hearing screening and identification Efficiency and Comprehension
of Communication—Adolescent program use of, 96–97 Training
Social cognitive theory, 370 scope of practice of, for hearing assistance of educational audiologists, 44–45
Social communication skills, 370 technology, 259 of hearing screening and identification
Social competence, 369–370, 383–385 Speechreading, 316, 316, 338–339 program support personnel, 97
Social-emotional development SPIN test. See Speech Intelligibility in Noise test Transient-evoked otoacoustic emissions,
components of, 368 SPL. See Sound pressure level 88–90, 97, 117
findings regarding, 367 SSI. See Synthetic Sentence Identification Transition planning, 423–424, 494
identity, 367–368 Stanford Binet Intelligence Scales, 507 Transition services, 13
resiliency, 369 State(s) Trust, 60
resources for, 383–385 mandates from, for hearing screening, Tympanometry
self-confidence, 368–369 81–82, 87, 104–108 equipment for, 98
self-esteem, 368–369, 369 program evaluation systems, 564–565, hearing screening and identification uses
social competence, 369–370 565–566 of, 92, 92, 94–95
Social-emotional learning, 364 Statutes, 7 middle ear disorders diagnosed using, 94
Sound Effects Recognition Task, 120, 120 Student practicum and preceptor sites, 533 otoscope used with, 98
Sound pressure level, 227 Supporting students who are deaf and hard of
S.P. v. Whittier City School District, 410–411 hearing: Shared and suggested roles UDL. See Universal design for learning
Special education of educational audiologists, teachers Unilateral hearing conditions, 323–324
educational audiologist’s role in, 418–419 of the deaf and hearing of hearing, UNIT2. See Universal Nonverbal Intelligence
eligibility for, 410–413 and speech-language pathologists, 35, Test
hearing impairment and, 411–412 47–50, 421 Universal amplifiers, 276
process of, 405–419 SWOT analysis, 555, 555 Universal design for learning, 37, 220,
assessments, 409–410 Synthetic Sentence Identification, 191 224–226, 225, 408, 495
auditory processing deficits, 409 Universal newborn hearing screening, 63,
concern about the student, 406–409 Teachers 86, 256
educational audiology assessment in, 410 checklists for assessment of educational Universal Nonverbal Intelligence Test, 508
eligibility determinations, 410–413 effects of hearing loss, 128–129 University training programs, 524–525,
referral, 409–410 classroom acoustics effect on, 229–230 532–533
response to intervention/multi-tiered hearing assessment letter for, 131, 174–176 “Useful-to-detrimental energy ratios,” 227
system of support, 407–409 hearing assessment results given to, 131
public policy effects on, 7–8 hearing screening referrals by, 88 VABS-3. See Vineland Adaptive Behavior
reduced hearing and, 411–412 scope of practice of, for hearing assistance Scales
referral to, 409–410 technology, 259 Video otoscopy, 114

606 Index
Video streaming, 579 Wechsler Intelligence Scale for Children, 507 WIPI. See Word Intelligibility by Picture
Vineland Adaptive Behavior Scales, 510 Wechsler Memory Scales, 509 Identification Sentences
Visual assistive technology, 319, 319 Wechsler Nonverbal Scale of Ability, 507 WISC-V. See Wechsler Intelligence Scale for
Visual inspection Wellness Children
in hearing assessment, 114 bullying, 370–371 WMS-IV. See Wechsler Memory Scales
in hearing screening, 89, 91 focus on, 577 WNV. See Wechsler Nonverbal Scale of
Visual Language and Visual Learning overview of, 364 Ability
research, 491, 492 perspective on, 365–371 Woodcock-Johnson Tests of Achievement, 505
Visual reinforcement audiometry, 93, 118 self-advocacy skills in, 371, 374–375 Word Intelligibility by Picture Identification
VL2. See Visual Language and Visual self-determination in, 369–371, 373–374 Sentences, 122
Learning research skills and strategies for, 371–375 Word recognition ability, 115, 115–116, 142
VRA. See Visual reinforcement audiometry social-emotional development. See Workload analysis, 559, 559–561, 571–572
Social-emotional development World Health Organization International
Index
WAIS-IV. See Wechsler Adult Intelligence WIAT-III. See Wechsler Individual Classification of Functioning,
Scale Achievement Test Disability and Health, 365, 366
Walsh Bill, 17 Wide dynamic range compression, 273 WRAML2. See Wide Range Assessment of
Wechsler Adult Intelligence Scale, 507 Wide Range Assessment of Memory and Memory and Learning
Wechsler Individual Achievement Test, 506 Learning, 509 Written reports, 131

Jane B. Seaton - Cheryl DeConde Johnson - Educational Audiology Handbook (2021)

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Educational Audiology Handbook

Plural_Johnson_FM.indd 1 2/25/2020 4:55:37 AM

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CHERYL DECONDE JOHNSON, EDD JANE B. SEATON, MS

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Copyright © 2021 by Plural Publishing, Inc.

Typeset in 10/12 Times LT Std by Achorn International

For permission to use material from this text, contact us by

Library of Congress Cataloging-in-Publication Data

Names: Johnson, Cheryl DeConde, author. | Seaton, Jane B., author.

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SECTION I Educational Audiology Practices

CHAPTER 1 Legislative and Policy Essentials 3

CHAPTER 2 Roles and Responsibilities of Educational Audiologists 31

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Combined School-Based and Contractual Agreement 41

CHAPTER 3 Partnering With Families With Janet DesGeorges 57

CHAPTER 4 Hearing Screening and Identification 79

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Screening and Identification Program Considerations 85

CHAPTER 5 Assessment 111

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Case History 113

CHAPTER 6 Auditory Processing Deficits With Lisa R. Cannon 179

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An Educational Model of Auditory Processing 184

CHAPTER 7 Classroom Acoustics and Other Learning Environment Considerations 219

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CHAPTER 8 Hearing Instruments and Remote Microphone Technology

CHAPTER 9 Case Management and Habilitation 311

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CHAPTER 10 Supporting Wellness and Social-Emotional Competence

CHAPTER 11 Developing Individual Plans 403

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CHAPTER 12 Prevention of Noise-Induced Hearing Loss

SECTION II Collaborative Practices and Program Effectiveness

CHAPTER 13 Supporting the Educational Team With Carrie Spangler 459

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Legislative Initiatives in Deaf Education 492

CHAPTER 15 Collaborative School–Community Partnerships 519

CHAPTER 16 Program Development, Evaluation, and Management 551

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Program Evaluation 558

CHAPTER 17 Reflections and Future Directions With Sarah Florence 575

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1. Legislative and Policy Essentials

2. Roles and Responsibilities of Educational Audiologists

3. Partnering With Families

4. Hearing Screening and Identification

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6. Auditory Processing Deficits

7. Classroom Acoustics and Other Learning Environment Considerations

8. Hearing Instruments and Remote Microphone Technology

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9. Case Management and Habilitation

10. Supporting Wellness and Social-Emotional Competence

11. Developing Individual Plans

13. Supporting the Educational Team

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15. Collaborative School–Community Partnerships

16. Program Development, Evaluation, and Management