SD8 - A Study of the Feasiblility of Establishing Comprehensive Hearing Screening Programs in Virginia Public Schools

  • Published: 1989
  • Author: Department of Education
  • Enabling Authority: Senate Joint Resolution 5 (Regular Session, 1988)

Executive Summary:
The 1988 General Assembly passed senate Joint Resolution 5, directing the Department of Education to study the feasibility of establishing comprehensive hearing screening programs in Virginia's public schools. Such a program should be based upon the successful regional hearing screening program, Project HEAR (Hearing Education and Resources).

This study looked to a number of sources: current state guidelines and regulations, current state practices with regard to hearing screening comprehensive hearing conservation programs which have been established both in Virginia and other states, and the literature which connects the occurrence of recurrent otitis media to language, learning and behavior difficulties in children. The following statements summarize the findings and conclusions reached by the Task Force upon which their recommendations are based.

1. The purpose of a screening program is to identify individuals who are likely to have a disorder. Puretone screening and tympanometric screening are used in a hearing screening program to identify the possible presence of different types of hearing, both of which require follow-up to assess medical status and determine if educational performance is affected.

2. The results of Project HEAR (Hearing Education and Resources) indicated that: (1) Mass hearing screenings can be conducted on children in grades K through 3 at an average cost of $1.24 per screening; (2) hearing screenings can be completed in two minutes per child; (3) results of the hearing screenings revealed that 11% of the children tested failed 2 screenings and were identified as being "at risk" for possible hearing loss: and (4) a significant number of students (5%) was found to be in need. of medical attention following the physician's screening.

3. Hearing loss is known to affect language development and academic performance. The earliest possible identification and intervention is necessary to minimize the effects.

4. Recurrent otitis media has been found to negatively impact upon language development, academic achievement and behavior in a high number of children. Prevention of recurrent otitis media can play an important part in the prevention of language and academic problems in children.

5. A high percentage of students enrolled in handicapped programs for the learning disabled have a history of otitis media.

6. Current regulations for the testing of hearing in the schools of Virginia are addressed in both special education regulations and requirements for general health screenings. No single document clearly delineates all requirements with regard to hearing testing, and as a result, there is confusion regarding hearing screening requirements.

7. The vast majority of Virginia's school divisions are attempting to meet what they consider to be the minimum requirements for hearing screening.

8. Many school divisions are not complying with the requirement that the hearing of all students referred to special education be assessed.

9. The forms used to report hearing status lack the precision necessary to insure that hearing has been screened and/or remediated.

10. Initial school hearing testing is done currently by either nurses, speech-language pathologists, or combined efforts of these professionals in most school systems. Audiologists are not generally involved in mass screening of hearing.

11. Speech-language pathologists report spending anywhere from several days to an entire month completing hearing screenings. This represents time lost from providing therapeutic services. Students identified as speech-language impaired with an IEP cannot be denied services while a hearing screening program is completed.

12. A program which utilizes both puretone and tynpanometric screening is needed in order to identify both children with sensorineural hearing loss and those with fluctuating conductive hearing loss accompanied by middle ear abnormalities.

13. The majority of Virginia school divisions do not currently use tympanometry as a screening procedure. Most divisions use puretone screening alone or supplement puretone screening with tympanometry when a child fails puretone screening. Used in this manner, tympanometry functions as a second level diagnostic procedure.

14. Most school divisions use 25db as the pass criteria for puretone screening. Such procedures would fail to identify approximately 50 to 70% of the children with abnormal middle ear status. Without identifying the hearing loss the children are "at risk" for experiencing language and learning deficits.

15. Impedance screening, or tympanometry, is a fast, accurate, noninvasive procedure for identifying middle ear disorders.

16. Tympanometric screening was successfully incorporated into school screenings through Project HEAR with costs averaging $1.24 per child per screening (excluding equipment costs). The cost effectiveness of incorporation of tympanometry into existing puretone screening programs has been demonstrated in other school divisions.

17. Follow-up procedures are a vital part of any screening program and must be addressed by the designers of the program. No follow-up is mandated by the laws which require mass hearing screening in specified grade levels. The degree of follow-up currently undertaken depends solely on the commitment of the personnel at the local level.

18. Parental, community, and school personnel education are important aspects of a comprehensive hearing health care program. Without cooperation from these areas, medical follow-up and educational modifications will not occur, making a program essentially useless.

19. School screening programs should attempt to reach preschool children since (1) early identification of hearing loss is crucial (2) prevalence of middle ear disorders is greatest among preschoolers: and (3) untreated, early onset recurrent otitis media may have more serious long-term educational implications. This can be addressed via community education as part of the Child Find program and screening of all preschool children enrolled in the local division.

The following recommendations are made:

1. A statewide comprehensive hearing conservation program should be established to provide hearing health care services to children served by the school systems of Virginia.

2. A comprehensive hearing conservation program would consist of identification, referral, in-service education for teachers, and involvement of parents and members of the local medical community.

3. It is recommended that the Supervisor of Health services should be responsible for coordinating the program at the state level, in cooperation with the Supervisor of Speech-Language and Hearing Impaired Programs.

4. It is recommended that a person should be identified in each local educational agency who is to be responsible for coordination of a comprehensive hearing screening program at the local level. This person should be responsible for execution of the hearing screening, administration of in-service and educational programs, and implementation of referral and follow-up procedures.

5. It is recommended that audiologists, registered nurses and/or speech-language pathologists should be responsible for on site supervision and execution of puretone and tynpanometric screening. These persons must have expertise in the administration and interpretation of puretone and tympanometric screening. The use of speech-language pathologists should not cause cancellation of therapy services for any identified speech-language impaired student. Other staff may be used as needed, following proper training, and with a previously identified specialist on-site.

6. It is recommended that the state provide start-up funds to all local education agencies to initiate a comprehensive hearing screening program.

A) This should amount to a grant of $3, 000 for the purchase of 1 tympanometer for every 1000 students in grades K, 1, 2 & 3, and all preschool handicapped students. This would not supplant tympanometers the school divisions currently own. This should amount to a total equipment cost of approximately $750,000.

B) Start-up costs should also include intensive training of school divisions in executing hearing screening programs. Initial training costs of $75,000 should be funded. This should include personnel to complete hands-on training, and development of a "trainer of trainers" manual for audiologists.

7. It is recommended that screening should be provided to students as follows:

Puretone Screening:

• all students in grades K, 3, 7 and 10
• all new students
• all students referred to the Child study Committee and/or special education supervisor
• pre-schoolers identified in Child Find procedures
• any student referred by the teacher
• any student failing tympanometry
• all students failing in previous years

Tympanometry:

• all students in grades K-3
• all students referred to the Child study
• Committee and/or special education supervisor
• all new students in grades K-3
• any student referred by the teacher
• preschoolers identified in Child Find procedures
• all students receiving special education services
• all students failing in previous years

8. All Kindergarten and new students must be screened within the first sixty days of a school year. Hearing screenings involving puretone and tympanometry should be conducted for all students being assessed to determine eligibility for special education immediately following referral to the supervisor of special education. Early screening allows sufficient opportunity within the 65 days timeline. The time line for all other screenings and referrals is to be decided by the local educational agency.

9. Certain protocols are recommended for screening procedures to insure greatest validity and reliability of screening results.

10. The types of equipment purchased for school screening purposes should meet certain criteria.

11. A two phase in-service training program should be included as part of a comprehensive hearing screening program. Such an in-service program should include (1) training screening participants and (2) informing teachers of the effects of hearing loss on language and learning and of the accommodations which can be made to accommodate the hearing loss.

12. Referral and follow-up should be monitored by the designated program coordinator.

13 Children "at risk" should not be placed in "open" classrooms due to the high noise levels present in these settings.

14. Form "MCH 213 B: School Entrance Physical & Immunization Certificate" should be revised to require evaluation of hearing, to ensure that hearing is normal. The form should also cue the physician to report a history of otitis media.

15. Form "LF.011: Summary of Physical Defects and Corrections" should be revised to specify the nature of the "ear deficit".