Audiology in Schools What to expect Jennifer Famularo Craig, Au.D., CCC-A

What is Audiology Audiology- The science or study of hearing: hence Audiologist, one who specializes in audiology. Audiology- The science or study of hearing: hence Audiologist, one who specializes in audiology. A branch of science dealing with hearing: specifically therapy of individuals having impaired hearing. A branch of science dealing with hearing: specifically therapy of individuals having impaired hearing.

Purpose 1. Why do schools need access to school based audiology services? 2. What does legislation say about audiology services in our schools? 3. What types of services can a school based audiologist provide?

IDEA 2004 Part B Deafness Deafness a hearing impairment that is so severe that the child is impaired in processing linguistic information through hearing, with or without amplification, that adversely affects a child’s educational performance. a hearing impairment that is so severe that the child is impaired in processing linguistic information through hearing, with or without amplification, that adversely affects a child’s educational performance. Section (c) (5) Section (c) (5)

IDEA 2004 Part B Hearing impairment Hearing impairment 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. 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. Section (c) (5) Section (c) (5)

IDEA 2004 defines AUDIOLOGY 1. Identification of children with hearing loss: 1. Identification of children with hearing loss: 2. determination of the range, nature, and degree of hearing loss, including referral for medical or other professional attention for the habilitation of hearing: 2. determination of the range, nature, and degree of hearing loss, including referral for medical or other professional attention for the habilitation of hearing: 3. provision of habilitative activities, such as language habilitation, auditory training, speech reading, hearing evaluation and speech conservation. 3. provision of habilitative activities, such as language habilitation, auditory training, speech reading, hearing evaluation and speech conservation.

4. creation and administration of programs for prevention of hearing loss; 4. creation and administration of programs for prevention of hearing loss; 5. counseling and guidance of students, parents, and teachers regarding hearing loss; 5. counseling and guidance of students, parents, and teachers regarding hearing loss; 6. determination of the child’s need for group and individual amplification, selection and fitting an appropriate aid, and evaluating the effectiveness of amplification. 6. determination of the child’s need for group and individual amplification, selection and fitting an appropriate aid, and evaluating the effectiveness of amplification. Section (c)) (1) Section (c)) (1) IDEA 2004 Audiology definition continued…

Related Services 34CFR300.34(b) Exception: services applied to children with surgically implanted devices including cochlear implants Related services do not include a medical device that is surgically implanted, the optimization of that device’s functioning (e.g. mapping), maintenance of that device, or the replacement of that device. Related services do not include a medical device that is surgically implanted, the optimization of that device’s functioning (e.g. mapping), maintenance of that device, or the replacement of that device. Nothing in paragraph (b)(1) of this section- Nothing in paragraph (b)(1) of this section- Limits the right of the child to receive related services Limits the right of the child to receive related services Limits the responsibility of a public agency to appropriately monitor and maintain medical devices Limits the responsibility of a public agency to appropriately monitor and maintain medical devices Prevents the routine checking of an external component of a surgically-implanted device to make sure it is functioning properly. Prevents the routine checking of an external component of a surgically-implanted device to make sure it is functioning properly.

What does this mean? Mapping is not required by schools Mapping is not required by schools Does not affect provision of any other related services that might support the CI (speech therapy, assistive technology/FM) Does not affect provision of any other related services that might support the CI (speech therapy, assistive technology/FM) Requires monitoring to make sure the device is working. Requires monitoring to make sure the device is working.

Hearing aids (IDEA) Each public agency MUST ensure that hearing aids worn in school by children with hearing impairment, including deafness, are functioning properly. Each public agency MUST ensure that hearing aids worn in school by children with hearing impairment, including deafness, are functioning properly. Section (a) (2) Section (a) (2)

Implications for Schools School needs to provide evidence of monitoring plan of Hearing aids and cochlear implants ( and specify in IEP) School needs to provide evidence of monitoring plan of Hearing aids and cochlear implants ( and specify in IEP) Who is monitoring procedure? Who is monitoring procedure? Who will do it? Who will do it? Where will it be done? Where will it be done? How often? How often? What will happen if the device is not working? What will happen if the device is not working?

Considerations of special factors The IEP Team Must: 34CFR (2) (iv-v) The IEP Team Must: 34CFR (2) (iv-v) Consider the communication needs of the child, and in the case of a child who is deaf or hear of hearing, consider the child’s language and communication needs, opportunities for direct communication 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. Consider the communication needs of the child, and in the case of a child who is deaf or hear of hearing, consider the child’s language and communication needs, opportunities for direct communication 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. Consider whether or not the child needs assistive technology devices and services. Consider whether or not the child needs assistive technology devices and services.

What that implies… Schools must have documentation of considerations and actions regarding: Schools must have documentation of considerations and actions regarding: Identification of student’s primary language and communication Identification of student’s primary language and communication Opportunities for direct communication with peers and professional personnel in the student’s language and communication mode Opportunities for direct communication with peers and professional personnel in the student’s language and communication mode Opportunities for direct instruction in the student’s language and communication mode Opportunities for direct instruction in the student’s language and communication mode Student’s needs for assistive technology and assistive technology services. Student’s needs for assistive technology and assistive technology services.

Section 504 Any person who Any person who Has a physical or mental impairment that substantially limits one or more major life activities (Learning, hearing, speaking, etc) Has a physical or mental impairment that substantially limits one or more major life activities (Learning, hearing, speaking, etc) Is discriminated against based upon a record of such impairment, or Is discriminated against based upon a record of such impairment, or Is discriminated against based upon being regarded as having such an impairment. Is discriminated against based upon being regarded as having such an impairment.

Section 504… a little more 504 provides accommodations not modifications 504 provides accommodations not modifications For children who are deaf and hard of hearing this means: For children who are deaf and hard of hearing this means: Note taker Note taker Tape recorder Tape recorder Outlines of course content Outlines of course content Study guides Study guides Seating Seating

Classroom Talk time Classrooms are auditory-verbal environments where listening is the primary modality for learning. (Flexer, 1995) Classrooms are auditory-verbal environments where listening is the primary modality for learning. (Flexer, 1995) Audiologist are uniquely qualified to ensure that all students have adequate access to auditory information. Audiologist are uniquely qualified to ensure that all students have adequate access to auditory information.

Importance of Hearing The classroom acoustic environment can affect a child’s ability to understand the teacher The classroom acoustic environment can affect a child’s ability to understand the teacher Students spend at least 45% of day in activities that require listening (Berg, 1993) Students spend at least 45% of day in activities that require listening (Berg, 1993) On any given day, 43% of students could fail a hearing test(Flexer, 1989) On any given day, 43% of students could fail a hearing test(Flexer, 1989) Even acoustically treated rooms still may need to consider the distance and noise issues. Even acoustically treated rooms still may need to consider the distance and noise issues.

Access Communication Regardless of communication philosophy, teachers and parents of children with hearing loss are motivated by the same goal: Regardless of communication philosophy, teachers and parents of children with hearing loss are motivated by the same goal: Establishing excellent communication competence. Establishing excellent communication competence.

What to look for and ask… 1. Is the chosen methodology working to enhance communication development? 1. Is the chosen methodology working to enhance communication development? 2. Is this child a functional communicator? 2. Is this child a functional communicator? 3. Does this child have a broad range of people with whom he or she can communicated? Does his communications method broaden rather than narrow his ability to interact with other people? 3. Does this child have a broad range of people with whom he or she can communicated? Does his communications method broaden rather than narrow his ability to interact with other people? 4. Is the child’s communication supportive of literacy development and academic success? 4. Is the child’s communication supportive of literacy development and academic success? 5. Using this communication system, is the child making steady and measureable progress in language, listening, and speech overtime? 5. Using this communication system, is the child making steady and measureable progress in language, listening, and speech overtime?

Classroom Characteristics what characteristics typify school programs that emphasize meaningful auditory integration? Educators consistently communicate the message that sound has a meaning, and there is a reason to listen! Educators consistently communicate the message that sound has a meaning, and there is a reason to listen! Educators convey strong expectations for listening all day. They project a “listen even when I have not specifically told you to listen” attitude. Educators convey strong expectations for listening all day. They project a “listen even when I have not specifically told you to listen” attitude.

Acoustic factors that affect learning DistanceNoiseReverberation DistanceNoiseReverberation Dimensionsstudentslinoleum Dimensionsstudentslinoleum Large sizeheatingWindow Large sizeheatingWindow Lecturingair conditioningcinderblock Lecturingair conditioningcinderblock Traffichard ceilings ComputersDesks Other classes

What can we do to help? Reduce noise levels Reduce noise levels Remove noise source Remove noise source Increase distance from noise Increase distance from noise Reduce areas of hard reflective surfaces Reduce areas of hard reflective surfaces Increase areas of soft, sound absorbing surfaces Increase areas of soft, sound absorbing surfaces Acoustic tiles Acoustic tiles Carpet Carpet Drapes Drapes Tennis balls on chairs Tennis balls on chairs

Increase speech signal Use FM sound system Use FM sound system Teachers voice drops 6 dB with each doubling in distance from student’s microphone Teachers voice drops 6 dB with each doubling in distance from student’s microphone Smaller class size and preferential seating with help ( usually not enough) Smaller class size and preferential seating with help ( usually not enough) FM ensures the signals are optimal for auditory learning FM ensures the signals are optimal for auditory learning

FM…. What is it? Teacher wears a mic / transmitter Teacher wears a mic / transmitter Frequency tuned receiver is worn by the student Frequency tuned receiver is worn by the student The teacher’s voice is transmitted wirelessly to the receiver via radio waves. (coupled to the student’s hearing aid or cochlear implant) The teacher’s voice is transmitted wirelessly to the receiver via radio waves. (coupled to the student’s hearing aid or cochlear implant) Teacher’s voice is sent directly to the student, regardless of distance. Teacher’s voice is sent directly to the student, regardless of distance.

Benefits of FM Improves listening in noisy environments Improves listening in noisy environments Overcomes distance problems Overcomes distance problems Eliminates reverberation problems Eliminates reverberation problems Disadvantage: some children are not good at reporting problems with FM Disadvantage: some children are not good at reporting problems with FM

School Audiology Services what to expect! Hearing loss Prevention/ Conservation Hearing loss Prevention/ Conservation Screening/ Management of Hearing Screening programs Screening/ Management of Hearing Screening programs Audiological evaluations Audiological evaluations Management of Auditory Processing Disorders Management of Auditory Processing Disorders Amplification analysis and troubleshooting Amplification analysis and troubleshooting Classroom amplification Classroom amplification

Audiology Services Cont… Classroom acoustics Classroom acoustics Counseling and guidance for students and parents Counseling and guidance for students and parents Professional development for School Personnel Professional development for School Personnel Part of the IEP team and goals Part of the IEP team and goals

Any Questions? Jennifer Famularo Craig, Au.D., CCC-A Jennifer Famularo Craig, Au.D., CCC-A The Western PA School for the Deaf The Western PA School for the Deaf