kate salathiel, au.d. educational audiologist lapeer ... · pdf fileeducational audiologist ....

Kate Salathiel, Au.D. Educational Audiologist

Lapeer County Intermediate School District Lapeer, Michigan

ksalathiel@lcisd.k12.mi.us

◦ Customer Service To create a supportive and collaborative relationship

that facilitates implementation and follow through of professional recommendations

◦ Hearing Assistance Technology (HAT) To use best practice guidelines and resulting data to

ensure maximum benefit of classroom instruction

◦ Knowledge of the Law To validate recommendations and justify expenditures

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

Goal: Maximum background noise of 35 dB (A weighted) and reverberation time of 0.6 seconds for unoccupied classrooms, and a minimum sound insulation requirement between classrooms and adjacent spaces (Thibodeau, 2009)4 .

Reality: Average background noise - 60 dB5, Reverberation time - .5-1.26

11-15% of school aged children have low or high frequency hearing loss of at least 16 dB or greater in one or both ears (Niskar, 1998)7

Children with hearing loss perceive speech in an incomplete manner due to filtering and limitations of technology.

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

As distance between teacher and student

doubles, sound decreases by 6 dB (For example, a teacher speaking at an 60 decibels 3 feet out into the front of the classroom, will be heard at 54 decibels 6 feet into the

room; 48 decibels 12 feet into the room and so on).

www.classroomhearing.org/acoustics.html visit this website for demonstration of the

inverse square law and more great information.

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

FM systems ◦ incorporated in/routed through amplification

devices ◦ used for students with hearing loss

Low gain FM systems ◦ only FM receiver gain control ◦ used for minimal/mild and unilateral hearing loss, and auditory processing weaknesses.

Soundfield systems ogeneral education technology o addresses immature auditory system, middle ear

problems, and noise and distance issues

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

Hearing Aids • Analog • Digitally programmable • Digital

FM systems (receivers) • HA+Audioshoe+FM • HA+integrated FM • Cochlear implants • Loops/streaming • Desktop

FM systems (transmitters) • Traditional • Dynamic • Microphones

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

Kindergarten Classroom, 8 students 9-12 years of age, mild to severe hearing loss, tested using HINT sentences under four conditions with a + 10 s/n ratio (Anderson, 2004).9

Speech perception scores: ◦ HA only - 82% ◦ Infrared Soundfield - 83.1% ◦ Desktop Soundfield - 93.5% ◦ Personal FM - 94.4%

HAT in Everyday Classrooms, MSU

Presentation, 9-24-10

Individuals with Disabilities Education Act (IDEA)

Section 504 of the Rehabilitation Act of 1973 Americans with Disabilities Act (ADA)

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

◦ Regulations published in 2006

◦ At a minimum, schools must follow federal rules

and regulations ◦ State rules - more provisions but not less For example: Federal 3-21 years MI 0-26 years

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

Ensures that all students with disabilities receive a Free and Appropriate Public Education (FAPE) in their Least Restrictive Environment (LRE)

The LRE requirements states “to the maximum extent appropriate, children with disabilities, including children in public or private institutions or other care facilities are educated with children who are nondisabled” (300.114).

Least Restrictive vs. Language Rich

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

Regulation 300.105 states in part that “each public agency must ensure that assistive technology devices or assistive technology services, or both, are made available to a child with a disability if required as a part of the child’s special education, related services, and supplementary aids and services. On a case-by-case basis, 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”.

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

Clinical audiologists-manage personal devices, can make recommendations for “consideration”

Educational Audiologist/team- must ensure devices meet needs in educational setting

Evidence Based Practice ◦ Not just for audiologists but for educators too! ◦ RtI, progress monitoring, AT

Educational Audiologist ◦ school’s best resource for recommending and

maintaining HAT through best practice guidelines

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

Helps connect the dots for administrators and team members. There must be alignment of recommendations for accommodations, services and technology with IDEA regulations.

Develop and include administrators in Hearing Assistance Technology (HAT) plan.

Reduces “sticker shock.” Outline cost of “service plan” vs. “pay to

repair”

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

Public agency must ensure hearing aids are

working properly Public agency must ensure that the external

component of implanted devices are working properly

Public agency is not responsible for post surgical maintenance, programming and replacement.

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

Section 504 of the Rehabilitation Act of 1973 is a civil rights law that prohibits discrimination on the basis of disability, and guarantees individuals with disabilities equal access to an education as well as equal access in the employment setting for any program activity that receives federal financial assistance.

http://www.gpoaccess.gov/uscode 29 USC 794

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

Physical or mental impairment which substantially limits a major life activity ◦ These include learning, caring for oneself, performing

manual tasks, walking, seeing, hearing and working ◦ Jan 2009 amendment - grant eligibility to those who use

hearing aids, cochlear implants and assistive technology. Eligibility determination need not entail extensive analysis and that it be expansive rather than stingy (Zerkel, 2009)3

Documentation of such impairment. 1.2% of school aged kids k-12 grade prior to

amendment. HAT in Everyday Classrooms, MSU

Presentation, 9-24-10

Pertains to individuals in all settings and provides for

accessibility for individuals with disabilities ◦ Employment ◦ State and local government ◦ Public accommodations ◦ Commercial facilities ◦ Transportation ◦ Telecommunications

Current law references a “mitigating device” such as a hearing aid or cochlear implant to be considered in determining protection under this law.

42 usc 12101 et. Seq. http://www.gpoaccess.gov/uscode

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

Purpose Regulatory Considerations Personnel Considerations Equipment and Space Considerations Candidacy, Selection, Implementation Fitting and Verification Procedures Implementation and Validation

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

Cheryl Deconde-Johnson, Ed.D.-Chair Vicki Anderson, Au.D. Arthur Boothroyd, Ph.D. Leisha Eiten, MA Sandra Gabbard, Ph.D. Dawna Lewis, Ph.D. Linda Thibodea; Ph.D.

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

Guidelines developed based on evidence from peer

reviewed literature, non–peer reviewed literature and on consensus practice.

For the growing child, optimal learning and

communication require clear speech, developmentally appropriate language, and received speech 20 dB above interfering noise and reverberation. The real world typical fall short of this ideal.

Excerpts from RM-HAT guidelines

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

Contains many specific references to IDEA and Section 504 related to the provision of assistive technology and support services.

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

Audiologists are singularly qualified to select and fit all forms of amplification for children

Audiologists must… ◦ have additional expertise and test equipment

necessary for all components for the process ◦ use current standards of practice for pediatric

population ◦ be knowledgeable in federal and state laws for

identification, intervention and education.

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

Must plan for regular replacement of diagnostic equipment

Must ensure that HAT devices reflect current technology (life cycle-similar to cell phone or PDA)

See guidelines for additional requirements

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

Step 1- Potential candidacy- ◦ hearing loss, auditory processing deficit, learning

disability, ANSD, Language/attention deficit, ESL Step 2-Implementation Considerations ◦ in or out of school use, acoustic environment,

social/emotional, functional abilities, support Step 3- Device Considerations and Selection ◦ audiological, developmental, listening environment,

technology, funding, device determination

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

Step 4- Fitting and Verification Goals • Audibility and intelligibility • Speech recognition commensurate with

performance in ideal listening setting • Full audibility of self and others • Reduced effects of noise, reverberation and

distance • Consistent signal regardless of head movement

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

Coupling FM systems can be complicated, time consuming, and possibly impact output and gain characteristics of personal hearing technology.

“I ask the question - I guess because I've

been around for so long now...at what point are we making FM so complicated that no one will be able to use it? Just a little vent, sorry.....”

Mike Macione, Educational Audiologist, Jackson ISD, Michigan

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

Orientation and Training can include: Implications of hearing loss Basic function of device Appropriate use of device Benefits and limitations of device Care and Maintenance Basic troubleshooting and process for reporting Self monitoring/listening check Self advocacy/Advocacy Classroom Orientation

HAT in Everyday Classrooms, MSU

Presentation, 9-24-10

Focus on both staff and student Full on demonstration Present simple skills first Practice skill Role play the skill set Set clear and specific goals

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

Use easy to understand format Recall is proportionally reduced when a large

amount of information is given Information presented first tends to be

remembered better (primacy effect) Categorize information Supplement with written and graphic

materials Avoid extensive verbal instruction Develop process for accountability

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

A program to promote communication access and hearing assistance technologies for teens and young adults ◦ Workplace barriers and solutions ◦ Extensive 504, IDEA and ADA resources ◦ Self advocacy and determination ◦ College planning, funding and accommodations ◦ Coping strategies for teens ◦ MyGap resources for students and families ◦ And MUCH MUCH more!!!

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

◦ Ongoing process that ensures that the child/youth is receiving optimal speech input from others and that his or her own speech is adequately perceived.

Self assessment LIFE, CPQ Observation Questionnaire ELF, CHILD, SIFTER, MAIS, FAPI and CHAPS Evaluation FLE, Ling Six Sound Test See RM-HAT guidelines for validation measures and references

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

Monitoring ◦ Plan must be established to ensure that the

recommended HAT device is functioning properly ◦ Repairs timely ◦ Acceptable loaners provided Document ◦ person who will monitor ◦ location of monitoring ◦ when and how often ◦ procedures to monitor ◦ process when device malfunctions

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

Employed school-based Audiologists Surveyed student equipment ◦ HA-right ear n=478 ◦ HA-left ear n=472 ◦ FM n=212

56.8% of all prescribed amplification was in

use and functioning satisfactorily

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

Provide the tools to gather quantifiable data that can provide baseline information and demonstrate progress and mastery of fitting goals

When HAT is recommended, it should be included in the child’s IEP with features rather than brand name/manufacturers indicated

IEP should include goals to address HAT such as independent use or self advocacy

Discontinuation of HAT should prompt team meeting to discuss issues and formally remove HAT services from IEP

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 State 1.60% 1.60% 1.60% 1.60% 1.60% 1.50% 1.50% 1.40% 1.50% 1.40% 1.40% 1.40% 1.30% 1.30% County 2.60% 2.00% 2.20% 2.70% 3.40% 3.30% 2.70% 2.80% 2.50% 1.80% 1.50% 1.50% 1.50% 1.50%

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

3.00%

3.50%

4.00%

Special Education State & County HI Percentages

State

County

Full auditory access now attainable Children with hearing loss are general

education students first “push in” verses “pull out” - guard against

creating curriculum casualties Allow the teacher to teach General education teacher ◦ “Content expert”

Special education staff member ◦ “Access expert”

HAT in Everyday Classrooms, MSU Presentation, 9-24-10

HAT in Everyday Classrooms, MSU Presentation, 9-24-10