T3 Referral, Notification & Reporting

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ARIZONA T3 HOW TO TRAIN HEARING SCREENERS

RENEWAL CURRICULUM: REFERRAL/NOTIFICATION

AND REPORTING

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Referral/Notification and Reporting Learning Objectives

Understand the results of hearing screening methods.Know appropriate responses to screening outcomes.Demonstrate principles of effectively communicating with parents. Understand documentation and tracking procedures.Know how to report screening results to ADHS.Understand the role of community resources.

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Pure Tone ScreeningTo pass a pure tone screening, a child must respond to each of these four frequencies at the screening level in both ears:

25 dB HL 500 Hz20 dB HL 1000 Hz20 dB HL 2000 Hz20 dB HL 4000 Hz

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TympanometryTo pass a three-frequency, pure tone hearing screening with tympanometry, the child:

Responds to the pure tone screen at 1000 Hz, 2000 Hz and 4000 Hz at 20 dB in each ear, andReaches a point of maximum immittance in each ear within the range of +100 mm H2O to -200 mm H2O in each ear.

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Otoacoustic Emissions (OAE) To pass the otoacoustic emissions screening:

Reproducibility must be greater than 50% in each ear; andThe response must present no less than 3 dB above the noise floor at a minimum of three frequencies.

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Documentation Requirements

The Arizona DHS Hearing Screening Rules contain requirements for:

referring children who do not pass the second hearing screening test,notifying parents, andmaking reports to the agency.

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Referrals

All referrals are made to the parent/guardian for follow-up with one or more of the following:

AudiologistPhysicianPrimary care practitioner

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Referral Conditions If a child fails 2nd pure tone and school has an audiologist, screener may consult with the audiologist.If one of “Four Reasons NOT to Screen” is present, refer to primary care practitioner or physician. If a child fails 2nd pure tone and school has no audiologist and parents have insurance, refer to parent who will refer to physician and/or an audiologist for further evaluation.If a child fails the 2nd pure tone and no school audiologist and no insurance, parents may need assistance in finding care; discussed further in Resources section. If a child passes pure tone and fails tympanometry, refer to primary care physician/may be middle ear problem. If a child passes tympanometry and fails pure tone, refer to an audiologist/may be hearing loss.If only pure tone or OAE are used without tympanometry, refer to either an audiologist or health care provider.

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Good Listening SkillsAssure privacy.Show interest in their concerns.Be attentive.Minimize distractions.Welcome their questions. Try to imagine what the parent is feeling. Resist the temptation to quickly give advice or make judgments beyond your expertise. Allow parents to clarify the meaning of the screening results, and facilitate their efforts in taking the next steps required to evaluate the child’s hearing.

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“How Do You Say It?”Activity

Parents want you to appreciate their concern for their child’s health.Parents want clear and accurate information.Parents want you to recognize that they want the best for their child.

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Notifications

Each of the child’s teachersPerson responsible for school’s special education services

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Specific Program Documentation

Class Screening ResultsHearing Re-screening ListIndividual Hearing Screening Results

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Diagnostic and Support Services

Private health insurance plan or HMOLocal health departmentSchool nurseAudiologist contracted with school district Audiologist in private practice or on staff of hospital or clinicAHCCCSKidsCareASDB Regional Cooperative ProgramsCCRS

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Early Childhood Resources

Parent Outreach ProgramArizona Early Intervention ProgramArizona Council for the Hearing ImpairedADHS Sensory Program

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Hearing Screening Program Report

Enrolled at the time of the first screeningDid not have a first screeningHad a first screeningDid not pass a first screeningHad a second screeningDid not pass the second screeningWere evaluated by an audiologistWere evaluated by a physician or primary care practitionerWere first diagnosed as deaf or hard of hearing during the current school yearWere diagnosed as deaf or hard of hearing during a prior school year

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ADHS Sensory ProgramReported results help the Sensory Program evaluate how successful our state is in identifying children with hearing loss and in providing timely and appropriate educational and medical follow-up and management.