Los Angeles Unified School District

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

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Educational Audiology ProgramAudiologic Resource
Unit (ARU)
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LAUSD System Audiometry and Audiology

• 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

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LAUSD System Audiometry and Audiology

• Audiometrists go to schools and screen the
  hearing of students
• If the 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)

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Types of Hearing Loss

• Conductive
• Usually not permanent
• Often treated medically
• Left untreated, loss may become permanent
• Affects outer and middle ear

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Conductive loss Problem in outer and/or middle
ear
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Types of Hearing Loss

• Sensorineural
• Permanent hearing loss
• Affects inner ear (sensory), and/or
• Auditory nerve (neural)

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Sensorineural loss problem with inner ear
(cochlea) and/or nerve
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Types of Hearing Loss

• Mixed Hearing Loss combination of
• sensorineural (permanent)
• AND
• conductive (usually temporary)

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

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Audiogram (graph of hearing status)

• low pitch
  high pitch
• (FREQUENCY)

soft
RIGHT EAR threshold of hearing
(DECIBELS)
LEFT EAR threshold of hearing
loud
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Frequency (pitch)
Low pitch
High pitch
soft
Loudness (decibels)
Average conversational speech level
loud
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RIGHT EAR (Remember red/round RIGHT)

• Student can hear sounds BELOW the line
• Student will have difficulty hearing sounds
  above the line

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LEFT EAR

• Student can hear sounds BELOW the line
• Student will have difficulty hearing sounds
  above the line

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RIGHT EAR
LEFT EAR
You may see both ears on the same audiogram This
audiogram indicates a mild to moderate loss in
the right ear and a moderate to profound loss in
the left ear.
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Educational Implications of Normal Hearing

• Child detects complete speech signal even at soft
  conversational level
• Good hearing does not preclude auditory
  processing problems

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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

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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

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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

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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

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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

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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

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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

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Unfair Hearing Test
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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
  students advantage (think about things that
  make it easier for YOU to hear in a group
  situation)

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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

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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

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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

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Audiologic Resource Unit (ARU) Services

• Provides professional development to District
  staff and outside agencies
• Refers for possible assistance through California
  Childrens Services (CCS) for coverage of hearing
  aids and hearing health care services

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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

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• 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

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• 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 ________________________________________
  ______________________________

• Students 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 impairmentsif they have had private
  hearing tests please attach a copy!

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• 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
  

• Students 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

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Referral Process for DHH Services

• Based on the hearing evaluation, the ARU
  determines whether
• Student has normal hearing, ending DHH referral
  process
• Students 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

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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

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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

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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

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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

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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
• Students eligibility, determination of services
  and placement will be discussed at the IEP Team
  Meeting

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For Assistance Please Contact

• Audiologic Resource Unit
• 333 South Beaudry Avenue-16th Floor
• Los Angeles, California 90017
• [phone]
• Marilyn Geffeney, Coordinator, ARU / DHH
• [phone]
• Roe Saxman, Senior Audiologist
• [phone]

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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

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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.