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From Clinic to Classroom: Helping Families of Children With Hearing Loss Navigate the Educational Environment

September 2017

Donna Fisher Smiley

Introduction

Clinic-based audiologists often are called upon to help families of children who have hearing loss navigate the education system. Families rely on input from their hearing health care team to know how to advocate for their child's needs and negotiate auditory and communication access in the educational setting. The information provided to families by the clinic-based audiologist needs to be accurate and, at the same time, empower the family to advocate for the accommodations their child requires. For example, it is not accurate to tell a family that every child with hearing loss will need special education under an individualized education program (IEP). That statement could set a family up for an adversarial relationship with school personnel. However, it would be accurate (and empowering) to provide the family with strategies to advocate for appropriate accommodations in the classroom—accommodations related to their child's hearing loss. 

The Paradox

Audiologists who serve the pediatric population want to be helpful to families and their children with hearing loss. Achieving compliance or adhering to recommendations related to amplification (i.e., hearing aids, cochlear implants, bone-anchored implants, and/or hearing assistive technology) is usually at the top of the list for the clinic-based audiologist. Audiologists' desire for compliance/adherence to amplification recommendations is grounded in evidence. (See the Outcomes for Children with Hearing Loss study website and publications at OCHL Study.

However, compliance with amplification recommendations relies heavily on the family (and the child, depending on the age). The same is true in advocating for appropriate accommodations and modifications in the educational setting. The clinic-based audiologist can write letters and send lists of accommodations to school personnel, but, ultimately, the family (parents or guardians) is in the best position to advocate for what the child needs at school. Therein lies the paradox; audiologists have the knowledge and skills related to hearing, hearing loss, and how hearing loss affects speech, language, and auditory development. But family members are the ones who will have to convey the strengths, weaknesses, and needs of the child to school personnel. The availability of school-based audiology services across the United States varies widely (Richburg & Smiley, 2009). If the student and family will have access to an educational audiologist within their school system, then that should provide some additional supports to convey the message about the needs of a student with hearing loss. Regardless, the family must be equipped with accurate information and the tools to communicate the needs of their child to school personnel.  

Equipping Families With Tools to Talk to School Personnel

Audiologists who serve pediatric patients in their practices will want to have some standard information at the ready to provide to families. Spending time developing a packet of information that can be shared with the educational team is worth the effort. For example, a handout or resource related to the child's specific hearing loss and the potential effects of that hearing loss on speech, language, and academic outcomes will alert a teacher or other school-based professional to the potential issues that might be encountered by the child. Via her website, Supporting Success for Children with Hearing Loss, audiologist Karen Anderson offers single-sided handouts describing different hearing loss configurations (e.g., mild hearing loss, severe hearing loss, unilateral hearing loss, high-frequency hearing loss). Families can use these free downloadable handouts ( http://successforkidswithhearingloss.com/relationship-hl-listen-learn/) to inform the education team about the impacts of hearing loss.

Another piece of information that will be useful to families as they advocate for their child's communication needs at school is a current audiogram, with the hearing loss described fully in terms that are usable by school personnel. Audiological acronyms are not useful to non-audiologists—nor is an audiogram with little to no interpretation of the results. Also, if you serve pediatric patients, it is useful to provide as much speech perception testing as possible and to link those test results to real-life listening situations. For example, aided speech perception testing in a quiet environment at normal conversational input levels is useful. However, the additional information gleaned from speech perception testing that varies the input levels of the speech (e.g., 35 dB HL to simulate very quiet speech), adds background noise (varying the speech-to-noise ratio [SNR] to simulate listening in a classroom), and utilizes different speech materials from single words to sentences can help families explain and support their child's need for hearing assistive technology in a tangible way that school personnel can see. Providing a short narrative comparing the different speech perception conditions could be the evidence that a family offers to support the child's need for hearing assistive technology. 

Families are usually given in-depth information about the use, care, and maintenance of the amplification that their child is using. Manufacturers of hearing aids and implantable devices have made many resources available online about their devices. It is helpful to have a scaled-down version of how to troubleshoot these devices—something that is easy to access and understand. It may take some time on the front end but, whenever possible, audiologists should provide families with a one-page basic reference about the child's device that can be shared with school personnel. 

Families may need information that assists them in understanding federal regulations and laws related to children and individuals with disabilities. This can be challenging for the clinic-based audiologist who hasn't worked in the educational arena and may not feel up to speed on the nuances of special education and disability rights regulations. One of the basic tools that you can provide to a family with a child who has hearing loss is information related to the differences between the Individuals with Disabilities Education Improvement Act of 2004 (IDEA) and Section 504 of the Rehabilitation Act of 1973. If a family can go in to the school environment with some basic knowledge of these two regulations and an understanding of the differences, they will be better prepared to ask and advocate for what their child with hearing loss needs in the academic setting. Understood.org has a user-friendly webpage with a side-by-side comparison of these two regulations. Although this webpage is not specifically for children with hearing loss, the information is applicable. Providing families with this resource, either as a web link or as a handout in your practice, can help them to be better educated about federal regulations and protections available for their child with hearing loss. Arkansas Children's Hospital has an adapted version of this website that we use as a handout for parents which shows the major differences between IEPs and 504 plans (The difference between, n.d.). 

Helping Families Help Themselves: A Case Study

When family members of children with hearing loss express concerns about school-related issues to the clinic-based audiologist, we want to respond in a supportive manner, without overstepping our role. The tendency may be to jump in and try to solve the problem for the family. However, coaching the family on how to solve the issue at the local level will prove to be more beneficial to them and their child. 

Following is a case example and suggestions on how to coach a family to be solution oriented.

History/Presentation of the Problem: You see a child and family in your clinic. The child has severe sensorineural hearing loss in both ears and wears hearing aids. The family complains that "the teacher isn't doing anything" to help their child. 

Strategies: As we coach families to advocate for their children with hearing loss, we need to encourage them to think about WHAT the concerns are for their child and WHO needs to hear those concerns. Ask families to think about specific concerns and to write them down. If they are having trouble getting to specific concerns, they probably need more time to get organized before trying to speak to the school. Examples of specific concerns might be that the child has no idea what they are supposed to do to complete their homework; or the child is not wearing hearing aids at school. Nonspecific concerns might include things like "the school just isn't doing enough" for him or her. Once the family has identified specific concerns, encourage the family to talk to school personnel about those concerns using the proper channels. When we counsel families about how to advocate for their children, it is best to encourage them to follow the "chain of command" as much as possible within the school. It is always best if parents talk to the teacher first—just as we would want a family to talk to us (as the clinic-based audiologist) if they have concerns before they go to our supervisor. If talking to the teacher doesn't resolve the problem, the parent should go to the next level. If the child has an IEP, the family should seek out the special education designee in the child's school and/or the special education supervisor for the district/local education agency. If the child does not have an IEP, but does have a 504 plan, the parent should talk to the building-level 504 coordinator. Lastly, if there is no 504 plan in place OR the 504 coordinator does not resolve the issue, the family should go to the principal, who is usually considered to be the instructional leader in a building. 

Solution-Oriented Coaching: Encouraging families to identify specific concerns or requests that can be backed up with evidence will be more effective and will result in better outcomes for the student. Telling a family to jump straight to legal action when they can't identify specific concerns truly sets them up for failure—and earns the audiologist a bad reputation with the educational system. The most important tip that we can give a family is to encourage them to communicate with school personnel. If they have a question or a concern, it will not be resolved if they don't communicate with those who can provide solutions to the issues or questions. 

Conclusion

Clinic-based audiologists who serve pediatric patients and their families are wise to think ahead about how to address concerns that families will have regarding the child's everyday life with hearing loss. Providing families with resources, tools, and strategies not only provides a service to the child and his or her family but also helps them learn skills to be the best advocates for their needs.   

About the Author

Donna Fisher Smiley, PhD, CCC-A, is the coordinator for the Educational Audiology/Speech Pathology Resources for Schools (EARS) Program at Arkansas Children's Hospital. She has practiced audiology in the areas of pediatrics and school-based audiology for more than 25 years. Currently, she is serving on the coordinating committee for ASHA Special Interest Group 9 (Hearing and Hearing Disorders in Childhood). 

References

Individuals with Disabilities Education Improvement Act of 2004, 20 U.S.C. § 1400 et seq.(2004).

Rehabilitation Act of 1973, 29 U.S.C. § 701 et seq. (1973).

The difference between IEPS and 504 Plans. (n.d.) Retrieved from https://www.understood.org/en/school-learning/special-services/504-plan/the-difference-between-ieps-and-504-plans

Richburg, C. M., & Smiley, D. F. (2009). The "state" of educational audiology revisited. Journal of Educational Audiology, 15, 63–73. 

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