1. Introduction to Aural Rehabilitation
Lisa Bowers, Ph.D. CCC-SLP

2. Audiologic Rehabilitation Services in the School Setting
Chapter Eight

3. Creation of an Individual(ized) Education Plan (IEP)
Not all children with hearing loss receive an IEP
Reserved for children performing below grade level and experiencing speech/language difficulties
504 Plan
Child does not need specialized instruction or support
No Special Ed Courses
Child needs accommodations to have access to education
FM System
Hearing Aids
Preferential Seating
Modification vs. Accommodations

4. IEP starts at age 3 and goes through age 21
Early Intervention is from Birth to 3 (IFSP)
School-New Multidisciplinary Team
Special Ed Teacher
General Ed Teacher
Administrator must be invited
Depending on what services the child is eligible for—different people will be the “Primary” on the IEP

5. Individualized Education Plan (IEP)
Should include the following:
Family’s preferred mode of communication
Child’s current level of performance
Present Level
Child’s strengths
Always start off with a strength statement
Child’s linguistic needs
Academic progress
Social/emotional needs
Appropriate accommodations to ensure learning

6. Outline of an IEP List of things that should be included in a formal IEP
1) Statement of present level of performance 2) Statement of annual goals 3) Short-term instructional objectives 4) Special Education and related services to be provided 5) Extent of participation in the regular educational program 6) Projected date for services to begin 7) Anticipated duration of services 8) Appropriate criteria to determine if objectives are achieved
IEP meeting once a year
Eligibility diagnostic every 3 years

7. 9) Evaluation procedures to determine if objectives are achieved
10) Schedules for review
11) Assessment information
12) Placement justification statement
13) Statement of how special education services are tied to the regular education program
Least restricted environment-Placement Justification
IEP Forms and Templates differ from county to county

8. Example IEP - includes current status, annual goals and short-term objectives
Domain
Status
Annual Goal
Short-term Objective
Audiologic
Can discriminate two utterances that differ in syllable length and intonation, such as “Hello” from “How are you?”
To achieve closed-set identification of monosyllabic everyday words
Will correctly identify a spoken word when presented in the context of four then six alternatives with 80% accuracy
Language
Does not use bound morphemes such as –ed or -ing
To establish consistent use of word endings in expressive and written communication
Will demonstrate use of past tense endings in 80% of written samples and in 70% of spontaneous and spoken language samples
Speech
Neutralizes vowels and omits final word consonants
To improve speech intelligibility
Will distinguish between /i/, /a/, and /u/ in imitated speech tasks with 80% accuracy, and produce final consonants in at least 50% of words spoken during a spontaneous speech task
Psychosocial
Does not follow classroom rules
To demonstrate grade-appropriate classroom behavior
Will receive positive reinforcements for adhering to classroom regulations, and accumulate 100 pts during 3 mo period
Educational
Reading is delayed by one grade level; can read aloud but has reduced comprehension
To improve reading comprehension
Will demonstrate comprehension on 85% of grade-appropriate reading samples
Written in a way so that another person could come up with a procedure to work on goals/objectives if you’re absent

9. Goals and Objectives
REMEMBER, Goal is the desired aim or outcome and objective is a measurable result expected within a particular time period
SMART

10. Role of the Audiologist
Test hearing and speech.
Maintain listening device and ALDs.
Assess central auditory function.
Assess classroom acoustics and make recommendations.
Provide direct speech perception training.
Consult with multidisciplinary team.
Serve as educational audiologist in school system.

11. Educator’s Role Provide academic instruction
Provide assessment and diagnosis
May or may not have background in deaf education
Make modifications to regular education curricula
Manage learning environment
Manage student behavior and social skills

12. SLP’s role

13. School and classroom placement
Direct services: SLP in Classroom
Indirect services: consult with teacher and audiologist
Resource: Sp. Ed. Teacher, smaller group setting
Self-Contained: moderate to sever intellectual disability for academics; mainstreamed for others (recess, lunch, athletics, etc.)
Becoming a thing of the past

14. Equipment every school SLP needs:
1) Hearing aid stethoscope for listening check
2) Hearing Aid Battery tester
3) Air blower to remove moisture and wax from tubing
4)Extra supplies (batteries)
Hearing aids/Cis need to be checked on a daily basis

16. Strategies Teachers can use with HI children in classroom:
Use visual aids
Get student’s attention before speaking
Encourage all students to help minimize the noise level in the classroom
Face student when talking and avoid covering mouth
Providing handouts to provide context cues
Preferential seating

17. Segmental Errors with Significant Hearing Loss
Vowels errors
Neutralization and nasalization
Substitutions
Prolongations
Consonants errors
Voiced/Voiceless confusions
Substitutions, omissions, and distortions
Consonant cluster errors
Visible consonants produced better

18. Assessment of Hearing Impaired Children
Areas of testing by SLP:

19. Speech Assessment Collect speech sample Evaluate intelligibility
Imitation or spontaneous
Evaluate intelligibility
Rate, record, or transcribe
Method of measuring speech influences intelligibility
Segmental speech production testing
Suprasegmental speech production testing

20. Articulation/Phonology
Articulation: GFTA- 2 (Goldman-Fristoe Test of Articulation)
-CAAP(Clinical Assessment of Articulation and Phonology)
-Arizona 3
-CID Phonetic
Inventory
Phonology:
KLPA-2(Khan-Lewis Phonological Analysis, Second Edition)
HAPP-3 (Hodson Assessment of Phonological Patterns)

21. Language Assessment
Language tests according to form, content, or pragmatics
Form= Test for Auditory Comprehension of Lang (TACL) or Oral and Written Lang skills (OWL)
Content= Peabody Picture Vocabulary Test (PPVT)
Function= Pragmatic Content Analysis
SKI-HI Language Development Scale
The Clinical Evaluation of Language Fundamentals (CELF-4)
TOUGH!! IF YOU WANT A CHILD TO QUALIFY USE THIS TEST!!
Obtain language sample and analysis
Type-Token Ratio (TTR)
# of total words used compared to different words
Mean Sentence Length (MSL)
Mean # of words per sentence

22. Reading Skill Assessment
Develop instructional goals and objectives
Few assessments designed for hearing loss
May be different for HI students
Difficult to compare how doing compared to peers
Grade levels compared to hearing children
Examine pre-literacy skills
Reading readiness
Reading and language comprehension
Phonology, syntax, semantics
Decoding
Phonological awareness
Alphabetic principles, letter knowledge, concepts about print

23. Auditory Tests Tests that focus on use of audition in language:
TACL (Test for Auditory Comprehension of Language)
TARPS (Test of Auditory Reasoning and Processing Skills)
TAPS-R and TAPS-UL (Test of Auditory Processing Skills)
APT-HI (Auditory Perception Test for the Hearing Impaired)
MUSS (Meaningful Use of Speech Scale )
TAC(Test of Auditory Comprehension)

24. Examples of Speech Therapy goals with HI child:
“Increase awareness suprasegmental aspects of speech.”
“Improve speech intelligibility in spontaneous communication”
“Increase vocalizations that have appropriate speech characteristics.”
“Will imitate the suprasegmental variables of loudness, duration, and pitch/intonational contours.”

25. Language Therapy content, form and pragmatics are addressed in development of language intervention plan
Increase or improve the following:
Parent-child communication
Comprehension of complex concepts
Vocabulary
World knowledge and self-expression
Use of syntax and pragmatics
Narrative skills