California Hearing Screening Requirements for Newborns and School-Aged Children
The following information summarizes hearing screening programs for newborns and school-aged children.
This information has been collected by researching individual state statutes, regulations and policy documents, and by contacting each state. Please be advised that regulations and policy may change at any time, so always check with your state for the most up-to-date information.
Every general acute care hospital with licensed perinatal services shall administer to every newborn, upon birth admission, a hearing screening test for the identification of hearing loss. Every general acute care hospital that has not been approved by the California Children's Services (CCS) program and that has licensed perinatal services that provide care in fewer than 100 births annually shall, if it does not directly provide a hearing screening test, enter into an agreement with an outpatient infant hearing screening provider certified by the department to provide hearing screening tests.
Parents of all newborns and infants diagnosed with a hearing loss shall be provided written information on the availability of community resources and services for children with hearing loss, including those provided in accordance with the federal Individuals with Disabilities Education Act (20 U.S.C. Sec. 1400 et seq.), through the reporting and tracking system follow-up procedures. Information shall include listings of local and statewide nonprofit deaf and hard-of-hearing consumer-based organizations, parent support organizations affiliated with deafness, and programs offered through the State Department of Social Services, Office of Deaf Access, State Department of Developmental Services, and the State Department of Education.
- Infant hearing screening services in the well-baby nursery shall be performed using automated FDA-approved otoacoustic emissions and/or auditory brainstem response screening equipment that detects a mild (30–40 dB) hearing loss in infants and newborns.
- Facilities must ensure that infants who refer from automated auditory brainstem response are not rescreened with otoacoustic emissions as either an inpatient or an outpatient.
- Infant hearing screening services in the ICNN shall be performed using automated FDA-approved auditory brainstem response screening equipment that detects a mild (30–40 dB) hearing loss in infants and newborns.
- Use of screening equipment shall be in accordance with manufacturer’s protocols and stated norms.
- The choice of equipment shall be reviewed by a CCS-approved audiologist, or by an audiologist with equivalent training and experience, and reflect knowledge of professional peer-reviewed literature and current audiological practice. The hospital shall obtain written confirmation from the manufacturer that the equipment meets the criteria.
- Equipment and all related components shall be calibrated in accordance with the manufacturer’s recommendation and a log shall be kept documenting the dates of calibration, repair or replacement of parts.
- Disposable components of the equipment shall not be reused.
- There shall be adequate space for performing the screening procedures and for equipment storage. A quiet environment shall be available for repeat hearing screenings prior to discharge, when necessary.
Each hospital certified as an Inpatient Infant Hearing Screening Provider shall report to DHCS, or its designee, data on all infants receiving neonatal services, in a format and frequency specified by DHCS.
Each pupil shall be given a hearing screening test in kindergarten or first grade and in second, fifth, eighth, tenth or eleventh grade and first entry into the California public school system.
Who Can Screen
- School audiometrist
- Public health nurses and credentialed school nurses
Training for Screeners
Satisfactory completion of required training in audiology, audiometry and hearing assessment at an accredited university or college. Such training must include a minimum of eight quarter hours, or equivalent, academic and practical preparation in audiology, identification audiometry and hearing assessment in courses approved by the Hearing Conservation Specialist of the State Department of Health Services. If the applicant completed the required training more than five years prior to the date of application for registration, the applicant must have had at least one year of verified supervised experience in the interim in the administration of hearing tests to school children in the public or parochial schools, or in other tax maintained educational institutions in this State. Verification will be documented in writing by the applicant's supervisor.
Public health nurses and credentialed school nurses may either fulfill the requirements of subsection (a) or demonstrate satisfactory completion, at an accredited university or college, of a four quarter hours, or equivalent, hearing assessment course approved by the Hearing Conservation Specialist of the Department of Health Services.
Type of Testing
- Pure tone audiometric screening tests shall be conducted at a level not to exceed 25 decibels and shall include the frequencies 1000, 2000 and 4000 Hertz. A pupil's failure to respond to any of the required frequencies constitutes a failure of the screening test. Individual tests may be used for pupils of all ages. Group tests may only be used for pupils who demonstrate reliable results.
- Pure tone air conduction threshold tests shall include the frequencies 500, 1000, 2000 and 4000 Hertz and shall be given to
- All pupils who fail the screening tests;
- All pupils who are to be considered for further audiological or otological evaluation.
- Care of equipment.
- Audiometric testing personnel shall be trained in the proper care of the testing equipment.
- Biological checks.
- Audiometric testing personnel shall maintain continuous surveillance of the audiometer used, by performing biological checks as follows:
- Daily. A brief biological check of the audiometer shall be made each day the audiometer is in use. The check shall consist of testing each earphone on a person with stable audiometric thresholds that do not exceed 25 decibel hearing level at any frequency tested between 500 Hertz and 4000 Hertz and comparing the test results with the subject's baseline audiogram. The subject may be the audiometrist.
- Monthly. A detailed biological check of the audiometer which includes a careful listening test of earphones to insure that the audiometer displays no evidence of
- Cross talk,
- Signal distortion,
- Transient clicks,
- Abnormal noise, or
- Intermittent signal.
- Calibration. An electroacoustic calibration check of audiometers shall be made at least every 12 months, or more frequently if indicated by the biological checks, and meet or exceed the specifications outlined in Subsections 1 through 4.9.2., American National Standards for Audiometers published by the American National Standards Institute (ANSI), Inc. (published in 1969).
- A calibration chart, showing proof of performance, shall be kept with the audiometer.
Follow-up Protocols & Documentation
- Referral. The schools shall provide the parents or guardians of children who fail the hearing tests with a written notification of the test results and recommend that a medical and audiological evaluation be obtained whenever the test demonstrates:
A hearing level of 30 decibels or greater for two or more frequencies in an ear at 500, 1000, 2000 or 4000 Hertz, or a hearing level of 40 decibels or greater for one of the frequencies tested, 500 through 4000 Hertz, on two threshold tests completed at an interval of at least two weeks; or
- There is evidence of pathology, such as an infection of the outer ear, chronic drainage, or a chronic earache.
- Dates and results of all screening hearing testing shall be recorded on each pupil's health record. Copies of all threshold tests shall be filed with the pupil's health records.
- Each school shall prepare an annual report of the school hearing testing program using Annual Report of Hearing Testing forms, PM 100, provided by the State Department of Health Services with copies to the district superintendent and the county superintendent of schools.
The information contained herein was collected and summarized annually. For detailed information on hearing screening requirements, visit these websites:
Newborn Screening Statute: Cal. Health & Safety Code §124115
Newborn Hearing Provider Standards
School-Age Screening Statute: Cal. Health & Safety Code §1685
School-Age Screening Regulations: Cal. Code Regs. tit. 17, §2950
School-Age Hearing Audiometry Guidelines [PDF]
Questions regarding this document? Call ASHA at 800-498-2071 and ask for the State Advocacy Team.