American Speech-Language-Hearing Association

Colorado Hearing Screening Requirements for Newborns and School-Aged Children

The following information summarizes hearing screening programs for newborns and school-aged children.

The information has been collected by researching individual state statutes, regulations, policy documents, and by contacting each state. The information is reviewed on an annual basis. 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.

Newborn Screening

Screening

Newborn hearing screening should be conducted on no fewer than ninety-five percent of the infants born in hospitals. Every licensed or certified hospital shall educate the parents of infants born in such hospitals of the importance of screening the hearing of newborn infants and follow-up care. Education shall not be considered a substitute for the hearing screening.

The advisory committee on hearing in newborn infants shall determine which hospitals or other health care institutions in the state of Colorado are administering hearing screening to newborn infants on a voluntary basis and the number of infants screened.

Intervention

Guidelines indicate once a newborn has been confirmed by an audiologist to have a hearing loss, the audiologist should notify:

  1. Parents
  2. Primary Care Provider/Medical Home
  3. Regional Colorado Hearing Resource (CO-Hear) Coordinator

All infants with confirmed hearing loss should be followed audiologically every three months through age 2 and then every six months through age 5 or until hearing is stable. Audiologists should then:

  1. Review results of the diagnostic audiologic assessment, implications of the audiologic diagnosis, and recommendations for intervention with the parents including:
    • Amplification options including hearing aids, cochlear implants and FM systems
    • Information regarding the importance of early intervention and communication strategies
    • Information regarding the need for medical follow-up
    • The availability and importance of parent-to-parent support (e.g., Colorado Families for Hands & Voices) and deaf/hard of hearing role models
    • Information and referral for funding assistance, if necessary
    • The Colorado Resource Guide for Families of Children Who are Deaf/Hard of Hearing (available from Colorado Families for Hands & Voices.
  2. Initiate the amplification process, if appropriate (given parental choice and medical considerations) after medical clearance for amplification has been obtained.
  3. Discuss additional specialty evaluations (e.g., genetics, ophthalmology, and child development) with the parents and the infant’s primary care physician as appropriate.
  4. Referral to the Regional Colorado Hearing Resource (CO-Hear) Coordinator for entry into the local Part C system and for specific information regarding intervention options and resources. Note that Part C requires this referral to occur within 48 hours of the diagnosis. This referral is for all infants with hearing loss, including those with unilateral hearing loss.
  5. Complete the Audiological Assessment reporting form and send it to the Colorado Department of Public Health and Environment, Health Care Program for Children with Special Needs (HCP). 

Standards/Protocols

Guidelines indicate that Auditory Brainstem Response and Otoacoustic Emissions are the most effective tests for newborn hearing screening.

Tracking/Reporting

Every licensed or certified hospital shall report annually to the advisory committee concerning the following:

  • The number of infants born in the hospital
  • The number of infants screened
  • The number of infants who passed the screening, if administered
  • The number of infants who did not pass the screening, if administered

School-Age Screening

Ages/Populations Screened

  1. All students in grades kindergarten, one, two, three, five, seven, and nine, or comparable secondary levels
  2. All transfer students entering without current screening records, within two months of school enrollment
  3. All students who have failed the previous year’s screening and who were not cleared by an audiologist
  4. All students receiving special education and/or related services (students who are being assessed for special education services should have been screened within the preceding twelve months)
  5. All children enrolled in public-funded early childhood programs
  6. All infant and preschool children upon referral through existing community Child Find processes.

Who Can Screen

Teacher, principal, or other qualified person authorized by the school district. The hearing identification program will be supervised by a Colorado Department of Education licensed audiologist.

Training for Screeners

The Hearing Screening Training Checklist should be used to validate whether an individual is appropriately trained to perform hearing screening.

Type of Testing

  1. An individual pure tone air-conduction screening or other appropriate screening procedure [e.g., otoacoustic emissions (OAE), auditory brainstem response (ABR)] that is appropriate to the age and developmental abilities of the child.
  2. A more comprehensive screening for children who are at risk which includes visual inspection of the ear and acoustic immittance (tympanometry) measurement.
  3. Test frequencies and screening levels:
    • 500 Hz–20dB for preschool through 5th grades; (tympanometry may replace 500 Hz for preschool–3rd grade); 25dB is acceptable if ambient noise levels are high; 500 Hz is optional for 6th–12th grades if negative history of hearing loss 
    • 1000 Hz–20dB
    • 2000 Hz–20dB
    • 4000 Hz–20dB
    • 6000 Hz–25dB for 6th–12th grades (optional for all other grades)

Equipment Standards

  • Audiometers used for screening are calibrated to ANSI S3.6 1996 specifications, are checked for calibration at least annually, and are recalibrated when necessary; listening checks are performed daily.
  • Acoustic immittance instruments are checked against manufacturer specifications at least annually and recalibrated when necessary; calibration is verified daily.

Follow-up Protocols and Documentation

  1. Rescreening for all pure tone referrals within the same session or within two weeks of the initial screening using the same frequencies, levels, and referral criteria.
  2. An optional threshold screening, conducted by an audiologist or person specifically trained in threshold audiometry, may be performed. Acoustic immittance measurements for all students who refer from the first two screenings are added at this time if not previously conducted.
  3. Audiologic assessment for all students who are referred by the rescreening and/or threshold screening with consideration for the following exceptions:
    a. Individuals who have known hearing problems which are stable and neither medically nor educationally significant.
    b. Individuals identified with abnormal middle-ear function (including ear canal obstruction) who may be referred for medical treatment without an audiological assessment.
  4. Referral for an otologic examination by a physician for individuals with abnormal immittance measurements and/or abnormal visual or otoscopic inspection, when the condition persists with hearing loss following a 4- to 6-week interval.
  5. Additional follow-up procedures to ensure that individuals who are referred for school audiology services: audiologic assessment, medical treatment, or who need annual monitoring of their hearing status receive the recommended service.
  6. Additional follow-up for individuals who were referred for medical treatment which include follow-up hearing and acoustic immittance measurements to determine if further medical intervention is warranted. Students with persistent medical conditions may require additional educational monitoring.
  7. Notification to teachers regarding individuals who are referred for audiologic assessment or medical treatment.

Documentation procedures include:

  1. Screening results recorded on each individuals cumulative health record and/or student database.
  2. Filing results of audiological assessment in the individuals cumulative record and/or health records.
  3. Documentation of individuals referred for medical evaluation in order to encourage parental support and response to the medical referral. 
  4. Documentation of all individuals with non-medically, non-educationally significant hearing loss (e.g., a mild loss at a single frequency) in order that those individuals may be tested and monitored in subsequent school years.

Resources

For further information on hearing screening requirements, visit these websites:

Questions regarding state advocacy issues? Call ASHA at 800-498-2071 and ask for the State Advocacy Team.

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