Los Angeles Unified School District Division of Special Education

1. Los Angeles Unified School District Division of Special Education Schools for All Children Audiologic Resource Unit Donnalyn Jaque-Antón Associate Superintendent

2. Overview • Audiometry or Audiology ?? • Types of Hearing Loss • Degrees of Hearing Acuity • Reading the Audiogram • Educational Implications of Hearing Loss • The Unfair Hearing Test • Help for Students with Hearing Loss • ARU Services • The ARU Referral Process • The DHH Referral Process • Contacts • Acknowledgements • Resources

3. Educational Audiology ProgramAudiologic Resource Unit (ARU)

4. Audiometry Student Health & Human Services Travels to schools Screens hearing Refers to audiology (ARU) as needed Audiology Division of Special Education Works in a permanent sound booth Provides comprehensive evaluation of hearing Refers to DHH as needed LAUSD System: Audiometry and Audiology

5. LAUSD System: Audiometry and Audiology • Audiometrists go to schools and screen the hearing of students • Ifthe student fails this hearing screening… • She/he may be referred for a more comprehensive audiological evaluation by an Educational Audiologist in a sound room (at the ARU)

6. Types of Hearing Loss • Conductive • Usually not permanent • Often treated medically • Left untreated, loss may become permanent • Affects outer and middle ear

7. Conductive loss = Problem in outer and/or middle ear

8. Types of Hearing Loss • Sensorineural • Permanent hearing loss • Affects inner ear (sensory), and/or • Auditory nerve (neural)

9. Sensorineural loss = problem with inner ear (cochlea) and/or nerve

10. Types of Hearing Loss • Mixed Hearing Loss: combination of • sensorineural (permanent) AND • conductive (usually temporary)

11. Mixed loss Problem in outer and/or middle ear along with problem with inner ear and/or nerve

12. Degrees of Hearing Loss • Normal Hearing ~ 0-15 decibels • Minimal (Borderline) ~ 16-25 decibels • Mild ~ 26-40 decibels • Moderate ~ 41-70 decibels • Severe ~ 71-90 decibels • Profound ~91+ decibels

13. Audiogram (graph of hearing status) low pitchhigh pitch (FREQUENCY) soft = RIGHT EAR threshold of hearing (DECIBELS) = LEFT EAR threshold of hearing loud

14. Frequency (pitch) Low pitch High pitch soft Loudness (decibels) Average conversational speech level loud

15. = RIGHT EAR (Remember red/round = RIGHT) • Student can hear sounds BELOW the line • Student will have difficulty hearing sounds above the line

16. = LEFT EAR • Student can hear sounds BELOW the line • Student will have difficulty hearing sounds above the line

17. = RIGHT EAR = LEFT EAR You may see both ears on the same audiogram This audiogram indicates a mild to moderate loss in the rightear and a moderate to profound loss in the left ear.

18. Educational Implications of Normal Hearing • Child detects complete speech signal even at soft conversational level • Good hearing does not preclude auditory processing problems

19. Educational Implications of Minimal (Borderline) Loss Child with a cold or the consistent mouth breather… • May have difficulty hearing • Faint or distant speech • At a distance • If classroom is noisy • May miss portions of fast-paced interactions • May fatigue more easily because of listening effort

20. Educational Implications of Fluctuating (conductive) Loss • Hearing ability may change daily • Typical of listening with fluid behind eardrum • Can “hear” but misses fragments of the message • May be accused of “daydreaming” or “not paying attention” • Speech and listening/attention skills may be affected if child experiences chronic fluctuating hearing acuity before age 7 years

21. Educational Implications of Mild Loss • Degree of difficulty experienced depends on • Noise level in classroom • Distance from teacher (speaker) • Configuration of hearing loss • May miss portions of fast-paced interactions and classroom discussions • Student often accused of • Not paying attention • Hearing when s/he wants to • Increased fatigue from listening effort

22. Educational Implications of Moderate Loss • Difficulty understanding conversational speech at a distance of 3 feet • Needs face to face communication • Needs structure and vocabulary controlled • Communication characterized by • Delayed receptive and expressive language • Limited vocabulary • Articulation errors

23. Educational Implications of Moderate-Severe Loss • Communication significantly affected • Marked difficulty in verbal communication in both one to one and group situations • Social interaction is increasingly difficult • Communication may be characterized by • Delayed receptive and expressive language • Limited vocabulary • Articulation errors • Possible impact on self-esteem

24. Educational Implications ofSevere Loss • May hear loud noises one foot from ear • If loss is pre-lingual in onset, oral language and speech may not develop spontaneously or will be severely delayed • If hearing loss is progressive or sudden, speech may deteriorate

25. Educational Implications of Profound Loss • Most students cannot depend solely on listening for communication access • Degree and configuration of loss will affect speech skills • If loss is pre-lingual in onset, oral language and speech will not develop spontaneously or will be severely delayed • If hearing loss is progressive or sudden, speech may deteriorate

26. Unfair Hearing Test

27. Children with Hearing Loss Need …Our Help! • Early intense intervention is essential for receptive and expressive language development • Students need appropriate and consistent amplification for all their waking hours from an early age • Classroom acoustics need to be arranged to the student’s advantage… (think about things that make it easier for YOU to hear in a group situation)

28. Help for Students with Hearing Loss • Flexible/preferential classroom seating • Amplification/FM systems • Personal hearing aids • Personal FMs • Classroom speaker system • Personal speaker system • Acoustic modifications of classroom

29. Audiologic Resource Unit (ARU) Services • Provides audiologic evaluations for any child residing within the geographic boundaries of LAUSD, infant to age 22 • Educational Audiologists provide designated instruction and services (DIS) to Deaf and Hard of Hearing Special Day Programs to • Ensure properly functioning amplification systems • Support teacher in developing skills for use of residual hearing

30. Audiologic Resource Unit (ARU) Services • Provides resource to DHH Itinerant Program regarding • Residual hearing • Amplification systems • Provides counseling to parents regarding • Hearing loss • Amplification • Services and resources available to the student

31. Audiologic Resource Unit (ARU) Services • Provides professional development to District staff and outside agencies • Refers for possible assistance through California Children’s Services (CCS) for coverage of hearing aids and hearing health care services

32. Referral Process For Students with Suspected Hearing Loss • Begins with a referral to the ARU If... • Student fails hearing screening (at school, by Audiometry) OR • Student has an audiogram from outside facility OR • Student has known hearing loss OR • Parent/school requests audiologic evaluation

33. LOS ANGELES UNIFIED SCHOOL DISTRICT DIVISION OF SPECIAL EDUCATION AUDIOLOGIC RESOURCE UNIT (213) 241 - 8258 REFERRAL FOR ARU SERVICES Student Name: _______________________________________ Birth date: ________________ Address: ____________________________________________ Home Phone: ______________ Parent/Guardian: _____________________________________ Work phone: ________________ School: ___________________________ Loc.District: _______ Home language: _____________ REASON FOR REFERRAL  Failed hearing screening (Date____________)  D HHitinerant assessment; 3rd Year (Date ________________)  Hearing loss suspected Comments___________________________________________ Student is receiving special education services  No  Yes If yes, please specify program:  Special Day Class _________________(Please attach a copy of current IEP)  Itinerant DHH ___ LAS ___ RSP ___ APE ___ VH ___ Comments:________________________________________________________________________ • Fill in all identifying information • Include reason for referral • Identify special education services student is receiving, if any • Include any other information to assist the audiologist

34. PERTINENT HEALTH INFORMATION: (per health office) MEDICAL • chronic ear infections  PE tubes  Other _________________________________  under private medical care; Physician ________________________________________ Comments: ____________________________________________________________________ AUDIOLOGIC Has the student had a recent AUDIOLOGIC evaluation?  No  Yes If yes, Date/Location____________________________ and please forward a copy of evaluation to: AUDIOLOGIC RESOURCE UNIT AMPLIFICATION STATUS: Does the student have hearing aids?  No  Yes, Right_______ Left________ Dispenser______________________________ Is the student using amplification on a consistent basis?  No  Yes Comments: ______________________________________________________________________ • Student’s health history has important implications for referral process…. please fill this out as fully as possible • Information from outside service providers is essential to appropriate diagnosis and management of hearing impairments…if they have had private hearing tests please attach a copy!

35. STUDENT PERFORMANCE: (per classroom teacher) SPEECH & LANGUAGE Is a speech/language problem suspected?  No  Yes If yes, Comments____________________________________________________________________ ACADEMICS  Above grade level  At grade level  Below grade level Comments:_________________________________________________________ ATTENTION Good work habits  Completes assignments  Short attention span  Easily distracted  Follows oral directions Comments:_________________________________________________________ BEHAVIOR Well-behaved  Cooperative  Helpful  Easily frustrated  Behaves inappropriately  Relates well with peers  Interacts with peers inappropriately Comments:_________________________________________________________ Referred by ________________________________ Date ___________________ School Designee Received by ________________________________ Date ___________________ Audiologic Resource Unit • Student’s performance provides valuable information for establishing testing conditions… we may need two audiologists to test this student reliably • Remember… although you know the student, the educational audiologist has only the information you provide

36. Referral Process for DHH Services • Based on the hearing evaluation, the ARU determines whether • Student has normal hearing, ending DHH referral process • Student’s hearing loss may adversely affect academic performance and/or access to the core curriculum, necessitating a referral to DHH for assessment to determine eligibility for DHH services

37. Referral Process for DHH Services • ARU will • Complete a report of each student tested • Complete page 1 of “Request for Special Education Assessment” and • ARU will mail the above to • School • DHH Office

38. Referral Process for DHH Services • School will: • In order to make sure all areas of parental concerns are addressed the school will assist parent in completing page 2 of Request for Special Education Assessment: “Student Information Questionnaire” • The school will generate Assessment Plan within 15 days, including all areas of suspected disability

39. Referral Process for DHH Services • School will • Check areas specific to DHH assessment • Academic-DHH assessor • Communication-DHH assessor and/or speech-language pathologist • Health-nurse/doctor • Send copy of signed Assessment Plan and Student Information Questionnaire to DHH Program, Beaudry-16th Floor

40. Referral Process for DHH Services • When signed Assessment Plan is received the DHH Assessor will contact school to arrange DHH Assessment to determine if • Hearing loss impacts access and progress in standards based core curriculum • Hearing loss impacts communication skills adversely affecting educational performance

41. Referral Process for DHH Services • Once all assessments are completed, school will • Contact all committee members • Schedule and complete IEP within 50 day time-line • Student’s eligibility, determination of services and placement will be discussed at the IEP Team Meeting

42. For Assistance Please Contact Audiologic Resource Unit 333 South Beaudry Avenue-16th Floor Los Angeles, California 90017 (213) 241-8053 Marilyn Geffeney, Coordinator, ARU / DHH (213) 241-8225 Roe Saxman, Senior Audiologist (213) 241-8258

43. Acknowledgements • Authors • Marilyn Geffeney, Coordinator ARU / DHH • Roe Saxman, Senior Educational Audiologist • Sandy Keaton, Educational Audiologist • Patty Klein, Educational Audiologist • With input from the Audiologic Resource Unit Educational Audiologists • Technical Assistance • Kate Brandon, Coordinator in Instructional Initiatives • Daniel Gumarang,Instructional Technology Advisor

44. Resources • American Academy of Audiology (AAA) audiology.org • American Speech-Language-Hearing Association (ASHA) asha.org • Educational Audiology Association (EAA) edaud.org • California Academy of Audiology (CAA) caaud.org Disclaimer: These sites have been chosen for educational and professional purposes. LAUSD does not endorse of guarantee any information contained in these sites. Getting Through, recording from Zenith Radio Corp Hearing Loss Simulation, Med Rx Inc.