WEBVTT 1 00:00:00.000 --> 00:00:00.146 2 00:00:00.166 --> 00:00:00.346 Well. 3 00:00:00.366 --> 00:00:02.680 Thanks, Will.I appreciate it. 4 00:00:02.700 --> 00:00:04.946 And, you know, you. 5 00:00:04.966 --> 00:00:06.746 The title says it. All right. 6 00:00:06.766 --> 00:00:08.313 The key role of school nurses, 7 00:00:08.333 --> 00:00:12.346 in conducting the screenings and those annual screenings. 8 00:00:12.366 --> 00:00:16.046 A really important job, in our role as school nurses. 9 00:00:16.066 --> 00:00:20.080 And they really connect when we talk about things like our, 10 00:00:20.100 --> 00:00:24.046 school nursing practice framework and emphasizing our role in public health 11 00:00:24.066 --> 00:00:25.413 and population health, 12 00:00:25.433 --> 00:00:28.380 and just in ensuring that students are healthy and ready to learn. 13 00:00:28.400 --> 00:00:29.913 And that's our motto, right? 14 00:00:29.933 --> 00:00:33.080 And so although, you know, 15 00:00:33.100 --> 00:00:36.580 sometimes I think hearing screening might be a little undervalued. 16 00:00:36.600 --> 00:00:40.880 It really is an essential, role that we have as school nurses, 17 00:00:40.900 --> 00:00:44.046 especially as you're going to talk about with the rising prevalence 18 00:00:44.066 --> 00:00:47.280 of permanent hearing loss that happens throughout childhood. 19 00:00:47.300 --> 00:00:51.313 So why am I here? How did we get together? 20 00:00:51.333 --> 00:00:52.746 A lot of it was serendipity. 21 00:00:52.766 --> 00:00:54.146 A little bit of it was serendipity. 22 00:00:54.166 --> 00:00:59.980 Most of it was, well, reaching out, but, we met at the nursing conference 23 00:01:00.000 --> 00:01:04.480 a couple years back, where, I think 24 00:01:04.500 --> 00:01:09.046 you all, were realizing about, how you might connect with school nurses. 25 00:01:09.066 --> 00:01:11.346 And so I've kind of become that a little bit of that liaison. 26 00:01:11.366 --> 00:01:15.046 I'm. I'm not a hearing expert by any, any stretch of the imagination. 27 00:01:15.066 --> 00:01:18.613 But I am I know a little bit about school nursing. 28 00:01:18.633 --> 00:01:23.180 So it's been a great relationship that the three of us have had here 29 00:01:23.200 --> 00:01:29.313 in trying to bring, the evidence and just kind of talk about the role 30 00:01:29.333 --> 00:01:32.980 of the school nurse and about the overall hearing screening process. 31 00:01:33.000 --> 00:01:33.780 And it's important. 32 00:01:33.800 --> 00:01:36.013 So we'll I'll let you take it away. 33 00:01:36.033 --> 00:01:40.446 Well, in case people don't know why you say you know a little bit about school 34 00:01:40.466 --> 00:01:44.280 nursing, tell us about your background first, Kathy. 35 00:01:44.300 --> 00:01:49.413 All right, well, I am I'm, one of the ways we met is, through my role as the, 36 00:01:49.433 --> 00:01:53.380 I'm your editor for the National School Nurse Journal, your clinical research 37 00:01:53.400 --> 00:01:55.780 research journal that you get every other month in your home. 38 00:01:55.800 --> 00:01:57.346 And I'm also one of the coeditors 39 00:01:57.366 --> 00:02:01.713 of the last two versions of the school nursing comprehensive textbook. 40 00:02:01.733 --> 00:02:05.446 In addition to that, I'm a professor at the University of, 41 00:02:05.466 --> 00:02:08.913 the University of Illinois at Chicago, where, I work in population 42 00:02:08.933 --> 00:02:09.880 health and in school health. 43 00:02:09.900 --> 00:02:14.780 So, I do know I do know a little, a little about about school nursing. 44 00:02:14.800 --> 00:02:17.613 So thanks for making me say it out loud. 45 00:02:17.633 --> 00:02:20.680 Yes, yes, yes. Humility. Humility. 46 00:02:20.700 --> 00:02:23.980 So as as Kathy said, my name is Will Eiserman. 47 00:02:24.000 --> 00:02:29.413 And I'm the affiliate associate director of the National Center for Hearing 48 00:02:29.433 --> 00:02:35.180 Assessment and Management at Utah State University, which is known as NCHAM. 49 00:02:35.200 --> 00:02:40.780 NCHAM is housed within the Institute for Disability Research, Policy 50 00:02:40.800 --> 00:02:45.113 and Practice at Utah State, which is federally funded 51 00:02:45.133 --> 00:02:49.513 as a University center for Excellence on developmental disabilities 52 00:02:49.533 --> 00:02:53.246 with a critical nationwide focus 53 00:02:53.266 --> 00:02:56.913 now, starting in 2001, 54 00:02:56.933 --> 00:03:00.213 I also served as the director of the Early Childhood 55 00:03:00.233 --> 00:03:03.813 Hearing Outreach Initiative, or the Echo Initiative, 56 00:03:03.833 --> 00:03:09.980 and for over 20 years, the Echo initiative served as a national Resource Center, 57 00:03:10.000 --> 00:03:13.480 Technical and Training Resource center on early 58 00:03:13.500 --> 00:03:18.880 hearing detection and intervention, with a focus on supporting early headstart 59 00:03:18.900 --> 00:03:23.013 and Head Start program staff in implementing evidence 60 00:03:23.033 --> 00:03:26.080 based hearing, screening and follow up practices. 61 00:03:26.100 --> 00:03:31.680 Now, since then, we've expanded that scope and we're delighted to be able 62 00:03:31.700 --> 00:03:35.413 to continue to make our resources available, 63 00:03:35.433 --> 00:03:40.980 as well as other learning opportunities like this one, to audiences 64 00:03:41.000 --> 00:03:44.180 that are also involved in, 65 00:03:44.200 --> 00:03:47.180 hearing, screening and follow up 66 00:03:47.200 --> 00:03:51.646 like School-Based screening and nurses who are involved with that. 67 00:03:51.666 --> 00:03:57.113 Additionally, we have participants in our audience from International 68 00:03:57.133 --> 00:04:01.980 Development Foundations, such as Hear the World Foundation, 69 00:04:02.000 --> 00:04:05.980 who have projects all over the developing world, 70 00:04:06.000 --> 00:04:11.013 promoting the identification of children with hearing loss. 71 00:04:11.033 --> 00:04:14.680 So, we're really, really pleased to 72 00:04:14.700 --> 00:04:17.413 to have you all with us today. 73 00:04:17.433 --> 00:04:23.403 Now, Kathy, did you want to say anything more at this point? 74 00:04:23.423 --> 00:04:26.380 75 00:04:26.400 --> 00:04:27.746 Now. Okay. 76 00:04:27.766 --> 00:04:30.746 So we're we're excited, to be able to share 77 00:04:30.766 --> 00:04:33.880 the information and resources that we have now, 78 00:04:33.900 --> 00:04:36.580 what I, what I'd like to, 79 00:04:36.600 --> 00:04:40.480 do is introduce my colleague Terry Foust, 80 00:04:40.500 --> 00:04:43.180 who is a pediatric audiologist and speech 81 00:04:43.200 --> 00:04:47.113 language pathologist who has served as a consultant 82 00:04:47.133 --> 00:04:52.446 and a trainer with the Echo initiative since our very beginning. 83 00:04:52.466 --> 00:04:55.313 And so here's Terry. 84 00:04:55.333 --> 00:04:57.813 Thank you, William. And hello, everybody. 85 00:04:57.833 --> 00:04:59.713 You know, as William, as, 86 00:04:59.733 --> 00:05:03.780 just alluded, he and I with many other echo team staff 87 00:05:03.800 --> 00:05:07.813 as well as local collaborators, we've really provided training in nearly 88 00:05:07.833 --> 00:05:12.480 every state with thousands of staff from all of these settings that William 89 00:05:12.500 --> 00:05:17.080 just referenced, and many other health and education settings as well. 90 00:05:17.100 --> 00:05:20.213 And so we're thrilled to be with you this afternoon. 91 00:05:20.233 --> 00:05:21.113 And we want to 92 00:05:21.133 --> 00:05:26.480 you know, I'm going to turn off my video because I'd rather have you all 93 00:05:26.500 --> 00:05:29.246 looking at other things as we progress here. 94 00:05:29.266 --> 00:05:33.346 I could just remember how to do that. 95 00:05:33.366 --> 00:05:34.480 There we go. 96 00:05:34.500 --> 00:05:37.313 We want to acknowledge right off the bat 97 00:05:37.333 --> 00:05:41.713 how impressed we are by all that you do as school nurse. 98 00:05:41.733 --> 00:05:46.246 Since much of our work over the past 20 years has focused largely 99 00:05:46.266 --> 00:05:49.513 on identifying hearing loss during the first 100 00:05:49.533 --> 00:05:53.146 3 to 5 years of life. 101 00:05:53.166 --> 00:05:54.513 Our experience 102 00:05:54.533 --> 00:05:57.580 and really learning about the role of school nurses. 103 00:05:57.600 --> 00:06:02.313 When I attended the, Nelson conference a couple of years ago, 104 00:06:02.333 --> 00:06:07.080 was the first time I really was exposed to that 105 00:06:07.100 --> 00:06:10.713 full scope of all that you do. 106 00:06:10.733 --> 00:06:13.413 And it was humbling, to say the least. 107 00:06:13.433 --> 00:06:16.980 So Terry and I want to recognize, 108 00:06:17.000 --> 00:06:21.746 that the piece we're talking about today regarding 109 00:06:21.766 --> 00:06:26.380 conducting hearings, screening, and follow up when Children Don't pass 110 00:06:26.400 --> 00:06:31.380 is a small part of your daily and annual response abilities. 111 00:06:31.400 --> 00:06:35.413 And in fact, it's precisely because of this understanding 112 00:06:35.433 --> 00:06:39.746 that we want to offer you information and resources 113 00:06:39.766 --> 00:06:43.746 that will make your hearing screening efforts as effective 114 00:06:43.766 --> 00:06:49.546 and as efficient as possible, while maintaining that overall goal 115 00:06:49.566 --> 00:06:53.146 of making sure that children with permanent hearing, loss 116 00:06:53.166 --> 00:06:57.280 of any type or degree are being identified 117 00:06:57.300 --> 00:07:01.980 and provided with the appropriate supports and services. 118 00:07:02.000 --> 00:07:07.280 So, the work of the Echo initiative is based on the recognition 119 00:07:07.300 --> 00:07:12.180 that each day, children who are deaf or hard of hearing 120 00:07:12.200 --> 00:07:17.913 are attending school and receiving various health care services, 121 00:07:17.933 --> 00:07:20.113 but often without their hearing 122 00:07:20.133 --> 00:07:23.513 related needs being known at all. 123 00:07:23.533 --> 00:07:25.880 You know, hearing loss is often 124 00:07:25.900 --> 00:07:29.280 referred to as the invisible condition. 125 00:07:29.300 --> 00:07:33.513 So the question is, how can we reliably identify 126 00:07:33.533 --> 00:07:39.146 which children have normal hearing and which may not? 127 00:07:39.166 --> 00:07:40.213 And the short answer to 128 00:07:40.233 --> 00:07:44.046 that question is that health care and education providers, 129 00:07:44.066 --> 00:07:47.613 we can be trained to conduct evidence based hearing, screening and follow up 130 00:07:47.633 --> 00:07:52.780 practice just exactly as you see depicted in these, photos on your screen. 131 00:07:52.800 --> 00:07:57.280 Now, the ultimate outcome of a hearing screening program is that we can identify 132 00:07:57.300 --> 00:08:02.880 children who are deaf or hard of hearing, who have not been identified previously. 133 00:08:02.900 --> 00:08:07.646 And we want to keep in mind that hearing like vision, it can be compromised at all 134 00:08:07.666 --> 00:08:12.980 degrees of severity and sometimes only affect one ear or both ears. 135 00:08:13.000 --> 00:08:16.280 Now, you're probably going to recognize the procedure on the right. 136 00:08:16.300 --> 00:08:19.480 That's called pure tone audiometry hearing screening. 137 00:08:19.500 --> 00:08:20.713 And that's historically been 138 00:08:20.733 --> 00:08:24.946 the most commonly used screening method for children three years of age and older 139 00:08:24.966 --> 00:08:29.980 that you'll still see in many, early, care and education settings. 140 00:08:30.000 --> 00:08:33.346 Now, we assume that many of you may be using this method. 141 00:08:33.366 --> 00:08:36.446 Now on the left you'll see the procedure called odor 142 00:08:36.466 --> 00:08:39.780 acoustic emissions, or hearing screening. 143 00:08:39.800 --> 00:08:40.980 This method is newer. 144 00:08:41.000 --> 00:08:45.213 It was introduced in the 1990s, and it was widely adopted 145 00:08:45.233 --> 00:08:48.280 as part of newborn screening during the 2000, 146 00:08:48.300 --> 00:08:51.913 and since then it has gained acceptance as a very useful, 147 00:08:51.933 --> 00:08:56.680 method for screening in early childhood populations, birth to three years of age, 148 00:08:56.700 --> 00:08:58.113 and increasingly recommended 149 00:08:58.133 --> 00:09:01.513 for children 3 to 5 years of age, as well as older children. 150 00:09:01.533 --> 00:09:04.846 And we're going to talk about both of these methods today. 151 00:09:04.866 --> 00:09:07.780 You're going to hear us emphasize 152 00:09:07.800 --> 00:09:10.613 evidence based practices today, 153 00:09:10.633 --> 00:09:14.813 which, includes three components 154 00:09:14.833 --> 00:09:18.580 using recommended methods specific to the age 155 00:09:18.600 --> 00:09:23.013 and developmental levels of the child being screened, 156 00:09:23.033 --> 00:09:24.880 implementing follow up 157 00:09:24.900 --> 00:09:29.380 when children don't pass the screening on one or both ears 158 00:09:29.400 --> 00:09:32.980 in a recommended sequence and timely fashion, 159 00:09:33.000 --> 00:09:35.480 and documenting all screening 160 00:09:35.500 --> 00:09:38.880 outcomes, gathering follow up diagnostic data, 161 00:09:38.900 --> 00:09:42.546 and facilitating access to intervention services. 162 00:09:42.566 --> 00:09:46.146 These three elements are key to making sure 163 00:09:46.166 --> 00:09:50.680 that we're implementing evidence based practices. Now. 164 00:09:50.700 --> 00:09:55.013 All too often, it seems that most of the energy, 165 00:09:55.033 --> 00:10:00.346 time, and resources are put into just that first step. 166 00:10:00.366 --> 00:10:02.680 Conducting the screenings. 167 00:10:02.700 --> 00:10:05.680 But all of those efforts are really 168 00:10:05.700 --> 00:10:11.780 only is worthwhile, as is our capacity to make sure that children 169 00:10:11.800 --> 00:10:16.013 who don't pass are getting the follow up that they need. 170 00:10:16.033 --> 00:10:20.080 And that last component is an essential 171 00:10:20.100 --> 00:10:24.680 indicator of well implemented evidence based practices. 172 00:10:24.700 --> 00:10:28.180 Those responsible for hearing screenings 173 00:10:28.200 --> 00:10:32.113 need to be able to report how many children they screened, 174 00:10:32.133 --> 00:10:36.480 what their pass and fail refer rates were, 175 00:10:36.500 --> 00:10:40.013 and very importantly, they are able to report 176 00:10:40.033 --> 00:10:45.580 how many children were first referred for an ideological evaluation. 177 00:10:45.600 --> 00:10:49.313 How many receive that evaluation, 178 00:10:49.333 --> 00:10:49.946 and how 179 00:10:49.966 --> 00:10:53.280 many were identified with a permanent hearing loss, 180 00:10:53.300 --> 00:10:58.546 and what sorts of support they're receiving in school. 181 00:10:58.566 --> 00:11:00.780 So you can see that evidence based hearing 182 00:11:00.800 --> 00:11:04.013 screening programs are much more than just using the recommended 183 00:11:04.033 --> 00:11:07.846 screening method and screening as many kids as possible. 184 00:11:07.866 --> 00:11:12.280 We know that, like William referenced earlier, that this is a heavy lift 185 00:11:12.300 --> 00:11:15.280 when you have all of the things to do that are on your list. 186 00:11:15.300 --> 00:11:16.746 And we aren't suggesting 187 00:11:16.766 --> 00:11:20.780 that this is necessarily all of your responsibility to implement. 188 00:11:20.800 --> 00:11:24.113 But we do think it is important for you to know what evidence 189 00:11:24.133 --> 00:11:27.880 based practice includes and to help you be effective in making sure 190 00:11:27.900 --> 00:11:32.013 this is what happens for children in your school or schools. 191 00:11:32.033 --> 00:11:36.113 One of the things you'll hear us emphasize is that we want to be, 192 00:11:36.133 --> 00:11:41.013 we want to make sure that we help you think about strategies for making sure 193 00:11:41.033 --> 00:11:44.080 that you're screening efforts are not solely focused on 194 00:11:44.100 --> 00:11:47.480 just getting the screenings done, but making sure the follow up 195 00:11:47.500 --> 00:11:51.880 and reporting steps are also occurring in a, quality fashion. 196 00:11:51.900 --> 00:11:56.446 But that is the ultimate goal identifying and serving children with hearing loss. 197 00:11:56.466 --> 00:11:58.780 So that's where we're headed. 198 00:11:58.800 --> 00:12:00.580 So throughout today's 199 00:12:00.600 --> 00:12:05.080 presentation we hope you'll take some notes. 200 00:12:05.100 --> 00:12:07.880 And particularly we've created a handout 201 00:12:07.900 --> 00:12:12.380 which you see on the screen right here and in the chat as well. 202 00:12:12.400 --> 00:12:14.146 There's a link. 203 00:12:14.166 --> 00:12:17.946 You can download it, but you could also capture 204 00:12:17.966 --> 00:12:22.113 that QR code there that you see on your screen, 205 00:12:22.133 --> 00:12:28.180 on which to take notes either during or after today's presentation. 206 00:12:28.200 --> 00:12:33.480 Our goal is to help you identify specific steps 207 00:12:33.500 --> 00:12:37.913 you can take to improve your hearing screening practices 208 00:12:37.933 --> 00:12:40.646 based on wherever you are right now 209 00:12:40.666 --> 00:12:43.613 in your current practices and needs. 210 00:12:43.633 --> 00:12:47.880 And we know that given all of the responsibility things 211 00:12:47.900 --> 00:12:50.980 that you do, like most of us, 212 00:12:51.000 --> 00:12:56.413 there's probably room for improvement in your track toward 213 00:12:56.433 --> 00:13:00.646 really implementing quality evidence based practices, 214 00:13:00.666 --> 00:13:06.380 and we hope this will help you identify some, future steps you can take. 215 00:13:06.400 --> 00:13:11.380 So we'll be going through all of this today as a part of our discussion. 216 00:13:11.400 --> 00:13:15.680 Now, all of the information that we're covering today draws upon 217 00:13:15.700 --> 00:13:21.013 resources you can explore on our website after today's presentation. 218 00:13:21.033 --> 00:13:25.880 And so if you don't remember anything else today, remember our website, 219 00:13:25.900 --> 00:13:29.213 which is Kids hearing or where you'll find 220 00:13:29.233 --> 00:13:32.313 information about, overall 221 00:13:32.333 --> 00:13:36.746 planning about big picture information, 222 00:13:36.766 --> 00:13:39.946 how to find a local audiologist 223 00:13:39.966 --> 00:13:44.180 to support your screening efforts or for referral purposes. 224 00:13:44.200 --> 00:13:47.213 Information about screening equipment 225 00:13:47.233 --> 00:13:52.280 Terry talked about always a moment ago, which we'll spend some time on today. 226 00:13:52.300 --> 00:13:57.013 If that's new to you and you're interested in learning about that equipment, 227 00:13:57.033 --> 00:13:59.613 you'll find information here 228 00:13:59.633 --> 00:14:03.546 as well as about audio audiometry equipment. 229 00:14:03.566 --> 00:14:07.846 You'll also find resources related to accessing training, 230 00:14:07.866 --> 00:14:12.880 which is a key component to making sure that not only do 231 00:14:12.900 --> 00:14:17.580 we start off with evidence based practices, but that we maintain 232 00:14:17.600 --> 00:14:21.746 and monitor and check in over time that that's what we're doing. 233 00:14:21.766 --> 00:14:26.580 You'll find a lot of practical resources in the next section of our website 234 00:14:26.600 --> 00:14:30.080 for getting ready to screen protocol guides 235 00:14:30.100 --> 00:14:33.546 and forms for documenting results, 236 00:14:33.566 --> 00:14:36.513 as well as letters that you can send out to people, 237 00:14:36.533 --> 00:14:38.680 letting them know about your screening efforts, 238 00:14:38.700 --> 00:14:42.813 or making referrals or reporting to parents, or help 239 00:14:42.833 --> 00:14:47.713 other health care providers or audiologists about your screening. 240 00:14:47.733 --> 00:14:50.380 And then some tools for tracking 241 00:14:50.400 --> 00:14:53.680 a group of children through the screening and follow up process. 242 00:14:53.700 --> 00:14:58.313 So be sure to get acquainted with what we've got there, 243 00:14:58.333 --> 00:15:02.113 especially if you're thinking about creating something new. 244 00:15:02.133 --> 00:15:05.013 Regarding your hearing screening efforts. 245 00:15:05.033 --> 00:15:07.980 You know, don't recreate the wheel if there is something there 246 00:15:08.000 --> 00:15:09.046 that you can download. 247 00:15:09.066 --> 00:15:12.280 We've got lots of free resources there that you're 248 00:15:12.300 --> 00:15:16.213 welcome to download, adapt, do whatever is useful with. 249 00:15:16.233 --> 00:15:20.680 So, we encourage you to go to kids hearing.org. 250 00:15:20.700 --> 00:15:23.346 So let's get started to make sure 251 00:15:23.366 --> 00:15:26.646 we're all on the same page about, 252 00:15:26.666 --> 00:15:30.413 what hearing screening is all about 253 00:15:30.433 --> 00:15:35.480 by getting a quick review of the auditory or hearing system. 254 00:15:35.500 --> 00:15:40.513 And this is a little excerpt from one of our online trainings, 255 00:15:40.533 --> 00:15:43.646 that, or courses that, 256 00:15:43.666 --> 00:15:46.813 that cover evidence based practices. 257 00:15:46.833 --> 00:15:50.280 There are three main parts to the auditory system 258 00:15:50.300 --> 00:15:56.213 the outer ear, the middle ear and the inner ear or cochlear. 259 00:15:56.233 --> 00:15:57.180 As this mother's 260 00:15:57.200 --> 00:16:00.313 voice reaches her child's ear, 261 00:16:00.333 --> 00:16:03.746 the incoming sound causes the eardrum to vibrate, 262 00:16:03.766 --> 00:16:07.346 which then moves through small bones in the middle ear. 263 00:16:07.366 --> 00:16:11.380 This movement stimulates thousands of tiny, sensitive hair 264 00:16:11.400 --> 00:16:14.580 cells in the inner ear. 265 00:16:14.600 --> 00:16:17.980 From the inner ear, the sound signal is carried along 266 00:16:18.000 --> 00:16:22.046 special nerves to the hearing centers of the brain, 267 00:16:22.066 --> 00:16:27.813 and the child experiences the sensation we call sound 268 00:16:27.833 --> 00:16:34.013 is something you. 269 00:16:34.033 --> 00:16:34.646 So well, 270 00:16:34.666 --> 00:16:38.013 this is how the auditory system, typically functions. 271 00:16:38.033 --> 00:16:40.513 There can be some exceptions. 272 00:16:40.533 --> 00:16:42.980 So for example, there can be 273 00:16:43.000 --> 00:16:47.180 temporary issues like a wax blockage. 274 00:16:47.200 --> 00:16:51.280 Or we can have fluid in the middle ear that's caused by ear infections 275 00:16:51.300 --> 00:16:56.480 that we may discover and get addressed during the hearing screening process. 276 00:16:56.500 --> 00:16:59.313 But the primary target condition of 277 00:16:59.333 --> 00:17:02.380 the hearing screening is the functioning of that inner ear, 278 00:17:02.400 --> 00:17:06.446 the cochlea, that snail shaped portion of the ear. 279 00:17:06.466 --> 00:17:07.913 In some instances, 280 00:17:07.933 --> 00:17:11.713 the sound will travel normally right through the outer and the middle ear, but 281 00:17:11.733 --> 00:17:16.413 when it reaches the cochlea, the system is not transmit it to the brain, 282 00:17:16.433 --> 00:17:19.613 resulting in what we would call, 283 00:17:19.633 --> 00:17:23.613 a sensory neural hearing loss. 284 00:17:23.633 --> 00:17:26.013 And this condition is usually permanent. 285 00:17:26.033 --> 00:17:30.280 And this is the primary target condition for which we are screening 286 00:17:30.300 --> 00:17:34.480 in our mass screening efforts. 287 00:17:34.500 --> 00:17:35.080 Now we need 288 00:17:35.100 --> 00:17:38.246 to, we need to screen through childhood 289 00:17:38.266 --> 00:17:41.246 because hearing loss can occur at any time. 290 00:17:41.266 --> 00:17:44.113 It can occur as the result of illness, 291 00:17:44.133 --> 00:17:48.380 physical trauma or environmental or genetic factors. 292 00:17:48.400 --> 00:17:51.880 And this is often referred to as late onset hearing loss, 293 00:17:51.900 --> 00:17:57.180 just simply meaning that it's acquired after the newborn period. 294 00:17:57.200 --> 00:17:58.413 Thanks, Terry. 295 00:17:58.433 --> 00:18:00.013 So, you know, 296 00:18:00.033 --> 00:18:04.180 this is really important information for you to think about 297 00:18:04.200 --> 00:18:10.146 as you share your efforts, which sometimes are viewed by teachers 298 00:18:10.166 --> 00:18:16.146 or parents as disruptive, maybe not even important. 299 00:18:16.166 --> 00:18:18.846 Permanent hearing loss is 300 00:18:18.866 --> 00:18:22.446 often called the invisible condition. 301 00:18:22.466 --> 00:18:23.780 And the. 302 00:18:23.800 --> 00:18:26.846 And yet it is the most common birth 303 00:18:26.866 --> 00:18:29.980 defect in the United States. 304 00:18:30.000 --> 00:18:32.680 It affects approximately three children 305 00:18:32.700 --> 00:18:35.913 in a thousand at birth, 306 00:18:35.933 --> 00:18:39.446 and that doubles to about 6 in 1000. 307 00:18:39.466 --> 00:18:43.780 By the time children in our school. 308 00:18:43.800 --> 00:18:46.046 And then 309 00:18:46.066 --> 00:18:48.846 permanent hearing loss increases 310 00:18:48.866 --> 00:18:52.780 dramatically during the school age year to 50. 311 00:18:52.800 --> 00:18:55.046 In a thousand. 312 00:18:55.066 --> 00:18:56.713 Well, you know, I have to interrupt here. 313 00:18:56.733 --> 00:19:00.346 Well, because, you know, you do. 314 00:19:00.366 --> 00:19:03.213 This statistic just blows my mind. 315 00:19:03.233 --> 00:19:05.580 And I thought I was pretty up on things. 316 00:19:05.600 --> 00:19:11.380 And when we started working, you and Terry and I started doing these, webinars. 317 00:19:11.400 --> 00:19:15.846 It just drove home this, this idea 318 00:19:15.866 --> 00:19:19.946 that, no, it's not just at birth, that this hearing, hearing loss 319 00:19:19.966 --> 00:19:21.113 is occurring in children 320 00:19:21.133 --> 00:19:24.380 while it occurs through it, through it can occur throughout your life. 321 00:19:24.400 --> 00:19:28.713 These school age years is the real prime a prime target area 322 00:19:28.733 --> 00:19:33.180 to really try and help and identify that kids are having difficulty hearing. 323 00:19:33.200 --> 00:19:38.813 So I just had to stop and say it again, because it's just and I'm glad you do. 324 00:19:38.833 --> 00:19:41.946 And each time, because, you know, hearing loss 325 00:19:41.966 --> 00:19:46.513 may be in fact invisible, not noticed. 326 00:19:46.533 --> 00:19:52.113 We need to see these children and make sure that they get the support 327 00:19:52.133 --> 00:19:57.946 and services that they need. So 328 00:19:57.966 --> 00:20:00.413 why is hearing loss 329 00:20:00.433 --> 00:20:04.080 called the invisible conditions now condition now? 330 00:20:04.100 --> 00:20:08.413 One of the reasons is because it isn't easily observed 331 00:20:08.433 --> 00:20:12.213 and can be easily disguised by the children themselves. 332 00:20:12.233 --> 00:20:16.113 This is especially true when children who are identified 333 00:20:16.133 --> 00:20:19.780 with permanent hearing loss during the school age years. 334 00:20:19.800 --> 00:20:22.480 They're not likely to be the children 335 00:20:22.500 --> 00:20:25.480 with severe, profound hearing loss. 336 00:20:25.500 --> 00:20:26.113 Children. 337 00:20:26.133 --> 00:20:29.513 Who by that age would. 338 00:20:29.533 --> 00:20:31.513 It would be pretty obvious. 339 00:20:31.533 --> 00:20:36.080 Rather, children identified at this point 340 00:20:36.100 --> 00:20:40.813 are more likely to have mild or moderate hearing loss. 341 00:20:40.833 --> 00:20:46.580 Maybe a progressive hearing loss, one that's getting worse over time. 342 00:20:46.600 --> 00:20:48.646 Children identified at this 343 00:20:48.666 --> 00:20:52.180 point, are often 344 00:20:52.200 --> 00:20:56.046 used to following visual cues 345 00:20:56.066 --> 00:21:00.446 that accompany a sound and may 346 00:21:00.466 --> 00:21:04.913 in fact disguise the fact that they are using vision 347 00:21:04.933 --> 00:21:10.413 to accommodate for a compromised hearing ability. 348 00:21:10.433 --> 00:21:14.513 They may be following their peers. 349 00:21:14.533 --> 00:21:18.180 They, may simply be copying 350 00:21:18.200 --> 00:21:22.713 the behaviors of their children, which give us the idea that they're fault, 351 00:21:22.733 --> 00:21:27.913 that they're hearing our instruct, and when in fact, that isn't the case. 352 00:21:27.933 --> 00:21:30.513 So they may be challenged in 353 00:21:30.533 --> 00:21:33.513 some ways we may not immediately recognize. 354 00:21:33.533 --> 00:21:39.446 And so their hearing loss does, in fact, remain invisible to us, 355 00:21:39.466 --> 00:21:43.313 and they may not appear on our radar, 356 00:21:43.333 --> 00:21:47.713 as kids to be particularly concerned about 357 00:21:47.733 --> 00:21:50.080 that is until 358 00:21:50.100 --> 00:21:53.713 they fall further and further behind. 359 00:21:53.733 --> 00:21:56.146 And even then, as they start 360 00:21:56.166 --> 00:21:59.680 to appear on some of our radars, 361 00:21:59.700 --> 00:22:03.246 if they haven't had appropriate hearing 362 00:22:03.266 --> 00:22:06.113 and hearing screening and follow up, 363 00:22:06.133 --> 00:22:10.246 they're at risk for being misdiagnosed 364 00:22:10.266 --> 00:22:13.646 and described as maybe having a learning disability 365 00:22:13.666 --> 00:22:19.636 or a mental health need, or even being on the autism spectrum. 366 00:22:19.656 --> 00:22:20.913 367 00:22:20.933 --> 00:22:22.846 We can't tell you 368 00:22:22.866 --> 00:22:26.813 how this happens all too often 369 00:22:26.833 --> 00:22:30.513 in fact, you know, one of our earliest findings in the Echo 370 00:22:30.533 --> 00:22:35.846 initiative demonstrated this among the children in our earliest studies, 371 00:22:35.866 --> 00:22:40.613 who were identified with late onset permanent hearing loss, 372 00:22:40.633 --> 00:22:43.513 many of them were already enrolled 373 00:22:43.533 --> 00:22:48.646 in some kind of special education service is usually speech 374 00:22:48.666 --> 00:22:54.646 therapy services, and no one had evaluated or even considered hearing. 375 00:22:54.666 --> 00:23:00.113 And this is a problem we continue to see to this day. 376 00:23:00.133 --> 00:23:03.446 I mean, obviously, we hope it's obvious that all of the speech 377 00:23:03.466 --> 00:23:08.213 therapy in the world is unlikely to be very effective 378 00:23:08.233 --> 00:23:12.046 if there is an underlying or unidentified hearing loss. 379 00:23:12.066 --> 00:23:16.146 So we absolutely do not want to wait 380 00:23:16.166 --> 00:23:19.446 until a child's hearing loss manifests 381 00:23:19.466 --> 00:23:23.180 in visible ways to then identify it. 382 00:23:23.200 --> 00:23:28.413 And that underscores the value of quality hearing, screening and follow up 383 00:23:28.433 --> 00:23:32.980 practices, and the role that you can play in advocating 384 00:23:33.000 --> 00:23:37.413 for quality hearing, screening and follow up for all children, 385 00:23:37.433 --> 00:23:41.613 especially those receiving special education services. 386 00:23:41.633 --> 00:23:45.513 Keep in mind, all too often, 387 00:23:45.533 --> 00:23:51.346 no one else in the life of these kids is doing this 388 00:23:51.366 --> 00:23:54.446 other than new and well, I'm going to interrupt 389 00:23:54.466 --> 00:23:58.346 for just a moment here and just highlight, you know, you shared 390 00:23:58.366 --> 00:24:02.313 absolutely anyone receiving special education services, but I think 391 00:24:02.333 --> 00:24:06.480 a good, best practice is when children are being evaluated 392 00:24:06.500 --> 00:24:09.846 to determine if they need special education services. 393 00:24:09.866 --> 00:24:13.580 The two things that, when I was practicing that we always took 394 00:24:13.600 --> 00:24:19.246 care of before, anything else was a hearing screening and a vision screening. 395 00:24:19.266 --> 00:24:23.613 The kids have to be able to see and hear to learn, and we need to rule those out 396 00:24:23.633 --> 00:24:25.946 before we start determining if they need special education. 397 00:24:25.966 --> 00:24:29.213 Absolutely. Thank you for waving that flag. 398 00:24:29.233 --> 00:24:34.713 And it is amazing that for various reasons that can be understandable. 399 00:24:34.733 --> 00:24:38.113 That is not always the case. 400 00:24:38.133 --> 00:24:39.380 So, Terry. 401 00:24:39.400 --> 00:24:42.780 Oh, I've just in agreement with with both of the things 402 00:24:42.800 --> 00:24:46.946 both of you have said and really just, take it a bit further. 403 00:24:46.966 --> 00:24:52.346 You know, hearing screenings are central to the overall mission of schools because 404 00:24:52.366 --> 00:24:57.213 and I unidentified, hearing loss of any degree can have an impact on these things. 405 00:24:57.233 --> 00:25:02.180 You see here on your screen on, language and speech development, 406 00:25:02.200 --> 00:25:05.280 academic achievement, grade retention, social 407 00:25:05.300 --> 00:25:08.680 anxiety, isolation and anxiety. 408 00:25:08.700 --> 00:25:12.180 And so, very important point. 409 00:25:12.200 --> 00:25:16.480 We also, realized right off the bat that one of your challenges 410 00:25:16.500 --> 00:25:21.246 may be some pushback or resistance to you pulling children out 411 00:25:21.266 --> 00:25:25.180 for the various screenings that you need to do 412 00:25:25.200 --> 00:25:27.546 to help you address this, 413 00:25:27.566 --> 00:25:32.146 we have a couple of resources that you can find on our website, kids.org. 414 00:25:32.166 --> 00:25:37.780 And this particular handout that you see here that's in English and in Spanish 415 00:25:37.800 --> 00:25:43.813 would actually, we think, be great to share with teachers and others. 416 00:25:43.833 --> 00:25:44.180 Excuse 417 00:25:44.200 --> 00:25:48.513 me in your screening setting whose help and support that you need 418 00:25:48.533 --> 00:25:51.880 and helps them understand what we're talking about here. 419 00:25:51.900 --> 00:25:56.080 That hearing screening is very much aligned 420 00:25:56.100 --> 00:26:01.946 with the goals they are aiming to achieve achieve with all of their students. 421 00:26:01.966 --> 00:26:04.780 So I mentioned the handout a minute ago, 422 00:26:04.800 --> 00:26:08.346 and so we'd like you to, download 423 00:26:08.366 --> 00:26:11.446 that if you see it in the chat box, 424 00:26:11.466 --> 00:26:15.080 this is a good time or on your own paper as well, 425 00:26:15.100 --> 00:26:20.980 to jot down a note or two about how that handout we just showed 426 00:26:21.000 --> 00:26:26.513 or other things could help garner some support 427 00:26:26.533 --> 00:26:31.246 for the screening and follow up efforts that you need to engage with. 428 00:26:31.266 --> 00:26:36.913 Can you other people to see the importance of this? 429 00:26:36.933 --> 00:26:41.013 So again, look at our website for some of that information 430 00:26:41.033 --> 00:26:44.380 and other information that can be useful to you. 431 00:26:44.400 --> 00:26:48.413 Okay, Terry, let's talk about the first component of evidence 432 00:26:48.433 --> 00:26:52.446 based screening practices using the recommended methods 433 00:26:52.466 --> 00:26:57.913 that are appropriate for the age and developmental level of the child. 434 00:26:57.933 --> 00:27:00.280 Yes. So as we mentioned a moment ago, 435 00:27:00.300 --> 00:27:04.180 pure tone audiometry and OSA screening, they're the recommended 436 00:27:04.200 --> 00:27:07.246 methods that we're going to be talking about this afternoon. 437 00:27:07.266 --> 00:27:11.146 The availability of pure tone and zero screening 438 00:27:11.166 --> 00:27:14.446 really means that it's no longer appropriate to rely solely 439 00:27:14.466 --> 00:27:18.580 on subjective methods that may have been used in the past. 440 00:27:18.600 --> 00:27:22.846 These are methods such as ringing a bell behind a child's head 441 00:27:22.866 --> 00:27:27.646 or, depending solely on caregivers perceptions of a child's hearing. 442 00:27:27.666 --> 00:27:31.780 Now, don't get me wrong, the observations of a child's response to sound, 443 00:27:31.800 --> 00:27:36.580 especially the lack of a response, can be helpful and we should pay attention 444 00:27:36.600 --> 00:27:40.513 to how children do or do not respond, to their environment. 445 00:27:40.533 --> 00:27:45.880 But these sorts of blobs of observations, they don't constitute a hearing 446 00:27:45.900 --> 00:27:49.246 screening because they're far too crude and unreliable. 447 00:27:49.266 --> 00:27:50.580 And, you know, frankly, 448 00:27:50.600 --> 00:27:54.446 we can do so much better than that because of our current technology. 449 00:27:54.466 --> 00:27:58.780 You probably recognize the pure tone method because you already use it. 450 00:27:58.800 --> 00:28:03.646 Or maybe you've had your own hearing screen this way in this procedure, 451 00:28:03.666 --> 00:28:07.980 musical note like tones are presented to children through headphones, 452 00:28:08.000 --> 00:28:11.980 and children respond, providing a behavioral response 453 00:28:12.000 --> 00:28:16.780 like raising a hand to indicate that they've heard these tones. 454 00:28:16.800 --> 00:28:17.113 Cure. 455 00:28:17.133 --> 00:28:17.980 Tone screening 456 00:28:18.000 --> 00:28:22.813 gives us a good idea of the functioning of the entire auditory system. 457 00:28:22.833 --> 00:28:26.380 Actually all the way to the brain, with the child showing a physical 458 00:28:26.400 --> 00:28:30.180 or behavioral indication that they perceive the sound. 459 00:28:30.200 --> 00:28:33.013 It's a relatively affordable method with the screening 460 00:28:33.033 --> 00:28:36.213 equipment costing like everything, and it's always going up. 461 00:28:36.233 --> 00:28:39.013 I think they're about $1,000 now. 462 00:28:39.033 --> 00:28:42.146 The equipment is durable and portable, enabling us 463 00:28:42.166 --> 00:28:46.413 to easily transport it and use it in a variety of locations, 464 00:28:46.433 --> 00:28:49.646 maybe taking it from one school to the next. 465 00:28:49.666 --> 00:28:53.480 And a wide range of individuals can learn 466 00:28:53.500 --> 00:28:58.113 and be trained to perform the pure tone screening procedure. 467 00:28:58.133 --> 00:28:59.980 Now, here's an excerpt. 468 00:29:00.000 --> 00:29:02.646 We want to give you a sense of what at least 469 00:29:02.666 --> 00:29:05.746 we have available for training purposes on our website. 470 00:29:05.766 --> 00:29:11.880 This is an excerpt, from our our training on pure tone audiometry screening. 471 00:29:11.900 --> 00:29:16.813 So let's just listen very briefly to conduct pure tone screening, 472 00:29:16.833 --> 00:29:19.713 we first take a look at the ear to make sure 473 00:29:19.733 --> 00:29:24.513 there is no visible sign of infection with blockage. 474 00:29:24.533 --> 00:29:26.680 If the ear appears normal, 475 00:29:26.700 --> 00:29:32.246 the screener then instructs or conditions the child how to listen for a tone, 476 00:29:32.266 --> 00:29:35.246 and then respond by raising a hand 477 00:29:35.266 --> 00:29:38.813 or placing a toy in a bucket. 478 00:29:38.833 --> 00:29:43.013 Once the screener has observed that the child reliably responds to 479 00:29:43.033 --> 00:29:47.380 sounds that are presented just as the screener instructed, 480 00:29:47.400 --> 00:29:51.280 the actual screening is started 481 00:29:51.300 --> 00:29:52.946 during the screening process. 482 00:29:52.966 --> 00:29:58.913 This listen and respond game is repeated at least twice at three different pitches 483 00:29:58.933 --> 00:30:02.113 on each ear, noting the child's response 484 00:30:02.133 --> 00:30:06.580 or lack of response after each tone is presented. 485 00:30:06.600 --> 00:30:10.246 If the child responds appropriately and consistently 486 00:30:10.266 --> 00:30:13.180 to the range of tones presented to each ear. 487 00:30:13.200 --> 00:30:16.580 The child passes the screening. 488 00:30:16.600 --> 00:30:18.880 So our website again kids 489 00:30:18.900 --> 00:30:22.113 hearing.org provides 490 00:30:22.133 --> 00:30:24.380 comprehensive training on pure tone 491 00:30:24.400 --> 00:30:27.513 screening if you or others need that. 492 00:30:27.533 --> 00:30:32.413 And as the screening process itself, pure tone 493 00:30:32.433 --> 00:30:38.746 screeners, need to actually learn how to step through 494 00:30:38.766 --> 00:30:40.813 the process manually with 495 00:30:40.833 --> 00:30:44.880 each child, including multiple specific steps 496 00:30:44.900 --> 00:30:50.013 that have to be followed in a sequence in order to be valid. 497 00:30:50.033 --> 00:30:51.380 Valid. 498 00:30:51.400 --> 00:30:57.280 And it's trickier to do correctly than one might assume. 499 00:30:57.300 --> 00:31:00.413 And easy to drift away 500 00:31:00.433 --> 00:31:04.513 from the actual required process. 501 00:31:04.533 --> 00:31:10.480 Now, anyone who is good at working with kids and can certainly learn to do 502 00:31:10.500 --> 00:31:13.946 pure tone screening, but we really can't 503 00:31:13.966 --> 00:31:18.413 emphasize enough that it is imperative that anyone doing 504 00:31:18.433 --> 00:31:22.613 pure tone screening receive formal, comprehensive training. 505 00:31:22.633 --> 00:31:25.546 That if there are a group of you in a school that are doing this, that 506 00:31:25.566 --> 00:31:32.046 you're doing it all the same way, and to get a refresher on an annual basis 507 00:31:32.066 --> 00:31:34.646 to make sure your screening habits 508 00:31:34.666 --> 00:31:38.046 have somehow drifted over time, 509 00:31:38.066 --> 00:31:40.813 which we can all have happened 510 00:31:40.833 --> 00:31:44.513 if we aren't extremely careful. 511 00:31:44.533 --> 00:31:49.313 Though like many tasks that look simple enough from an observer's 512 00:31:49.333 --> 00:31:56.013 perspective, conducting pure tone screening is actually quite complicated, 513 00:31:56.033 --> 00:31:56.980 partly because of the 514 00:31:57.000 --> 00:32:00.380 manual aspect of it, and there are many ways 515 00:32:00.400 --> 00:32:05.013 that one can make mistakes that can invalidate screening. 516 00:32:05.033 --> 00:32:09.446 Our trainings and some of the resources that go with it 517 00:32:09.466 --> 00:32:15.213 are really aimed at giving you positive criteria to follow 518 00:32:15.233 --> 00:32:18.780 so that you don't end up making some of the common 519 00:32:18.800 --> 00:32:23.046 critical mistakes that we've often observed. 520 00:32:23.066 --> 00:32:24.113 Yes, exactly. 521 00:32:24.133 --> 00:32:28.946 In fact, reviewing this common mistake list that we're, we've got, 522 00:32:28.966 --> 00:32:34.180 on your screen now is is good for even me who's been, screened for years 523 00:32:34.200 --> 00:32:38.846 to remember because of that drift that that can happen with the best of us. 524 00:32:38.866 --> 00:32:43.246 So just to sensitize you as to why training and regular monitoring 525 00:32:43.266 --> 00:32:45.813 of your screening practices are so important, 526 00:32:45.833 --> 00:32:49.980 I just want to just take a moment and look at some of these here, 527 00:32:50.000 --> 00:32:51.646 these common mistakes. 528 00:32:51.666 --> 00:32:54.880 So one of them is not following a standard screening protocol 529 00:32:54.900 --> 00:32:57.713 that includes appropriate screening frequencies 530 00:32:57.733 --> 00:33:00.746 and the numbers of screening attempts on each ear. 531 00:33:00.766 --> 00:33:04.880 We can present tones and patterns that the child starts to predict 532 00:33:04.900 --> 00:33:09.013 rather than responding to the actual sounds as they're presented. 533 00:33:09.033 --> 00:33:12.280 We got to be sure that that placement of the earphones is correct. 534 00:33:12.300 --> 00:33:15.780 Like it can be, incorrect. 535 00:33:15.800 --> 00:33:19.080 It could be over their hair or too far forward or backwards. 536 00:33:19.100 --> 00:33:23.580 Sometimes we provide visual cues, or we may even have a reflective surface 537 00:33:23.600 --> 00:33:26.446 that the child is looking at where they can be cued, 538 00:33:26.466 --> 00:33:30.846 that we're pressing a button even without you realizing that they're seeing that, 539 00:33:30.866 --> 00:33:35.380 sometimes we forget to switch ears and we test the same ear twice. 540 00:33:35.400 --> 00:33:37.813 We, may not do an equipment check, 541 00:33:37.833 --> 00:33:40.846 make sure it's working before we start screening. 542 00:33:40.866 --> 00:33:44.680 We need to be aware of noisy rooms and not sometimes 543 00:33:44.700 --> 00:33:47.880 we don't test the sound levels of the room in advance, 544 00:33:47.900 --> 00:33:51.280 increasing the volume to accommodate for a noisy environment. 545 00:33:51.300 --> 00:33:54.080 As silly as that may sound, that that happens. 546 00:33:54.100 --> 00:33:57.013 And we've we've seen that, 547 00:33:57.033 --> 00:33:58.180 going right along with that. 548 00:33:58.200 --> 00:34:01.380 We've seen people help a child pass by raising the volume 549 00:34:01.400 --> 00:34:04.946 or giving them the benefit of the doubt. 550 00:34:04.966 --> 00:34:08.646 We need to recognize whether our equipment is failed during the screening. 551 00:34:08.666 --> 00:34:11.513 And sometimes we talk or provide other subtle cues, 552 00:34:11.533 --> 00:34:14.546 that prompt the child during the screening. 553 00:34:14.566 --> 00:34:16.813 And then just really, 554 00:34:16.833 --> 00:34:20.846 one to emphasize is that sometimes we assume children who do not 555 00:34:20.866 --> 00:34:25.380 pass are receiving the follow up screening and diagnostic services 556 00:34:25.400 --> 00:34:28.613 without actually having the evidence to support that. 557 00:34:28.633 --> 00:34:32.013 Now, Terry, that's where I want to do 558 00:34:32.033 --> 00:34:35.880 like a quick timeout on that number 12 there. 559 00:34:35.900 --> 00:34:38.480 That's the thing that we see 560 00:34:38.500 --> 00:34:41.380 all too often is that, 561 00:34:41.400 --> 00:34:44.580 those that do the screening 562 00:34:44.600 --> 00:34:48.313 may be just passing on those results 563 00:34:48.333 --> 00:34:53.013 without really knowing, with any confidence that there's a system 564 00:34:53.033 --> 00:34:57.880 in place where the parents and the providers involved 565 00:34:57.900 --> 00:35:02.880 are actually doing that next critical mistake. 566 00:35:02.900 --> 00:35:05.246 As we said earlier on, 567 00:35:05.266 --> 00:35:08.213 all of the effort we can go into that 568 00:35:08.233 --> 00:35:13.780 can go into screening is worthless if we don't have 569 00:35:13.800 --> 00:35:19.770 really a solid system to support children in getting that follow up piece. 570 00:35:19.790 --> 00:35:21.046 571 00:35:21.066 --> 00:35:24.346 So that's pure tone screening. 572 00:35:24.366 --> 00:35:30.880 Now, it's important to note that when using pure tone screening, 573 00:35:30.900 --> 00:35:33.280 there is going to be a percentage of children, 574 00:35:33.300 --> 00:35:36.280 depending on the age group that you're working with 575 00:35:36.300 --> 00:35:40.746 and whether they're developing typically or not. 576 00:35:40.766 --> 00:35:45.046 There is going to be a group of children who won't be able to be conditioned 577 00:35:45.066 --> 00:35:49.446 that first thing you do before you even start screaming, 578 00:35:49.466 --> 00:35:54.580 and who then won't be able to actually be screened. 579 00:35:54.600 --> 00:35:57.680 And it's never acceptable 580 00:35:57.700 --> 00:36:02.280 to simply delay the screening to a later time. 581 00:36:02.300 --> 00:36:05.246 For children who might be difficult to screening. 582 00:36:05.266 --> 00:36:09.680 I mean, that that really I mean, if you pause and think about that for a minute, 583 00:36:09.700 --> 00:36:15.146 that really doesn't make sense, because those are the very children 584 00:36:15.166 --> 00:36:18.046 that may actually have a hearing loss. 585 00:36:18.066 --> 00:36:21.380 So in younger populations, 586 00:36:21.400 --> 00:36:26.313 you know, 5 or 6 year olds, or younger, 587 00:36:26.333 --> 00:36:27.146 we wouldn't be 588 00:36:27.166 --> 00:36:31.513 surprised if 20 to 25% of those children 589 00:36:31.533 --> 00:36:35.580 won't be able to be screened with pure tone audiometry. 590 00:36:35.600 --> 00:36:37.780 And and then there's 591 00:36:37.800 --> 00:36:41.646 additional children who maybe whose primary language 592 00:36:41.666 --> 00:36:45.613 is different from your own, or children with certain disability 593 00:36:45.633 --> 00:36:50.680 parties for whom the screening process may not be achievable. 594 00:36:50.700 --> 00:36:54.846 Yet we want all of those children to be screened, 595 00:36:54.866 --> 00:36:59.680 not just the ones that are easier to get done. 596 00:36:59.700 --> 00:37:06.446 So, we need to have a backup plan. 597 00:37:06.466 --> 00:37:09.580 Fortunately, we have an alternative. 598 00:37:09.600 --> 00:37:13.113 And that's where your odo acoustic emission 599 00:37:13.133 --> 00:37:17.013 screening comes in, which you see on the photo here. 600 00:37:17.033 --> 00:37:20.246 This is the recommended hearing screening method 601 00:37:20.266 --> 00:37:23.680 universally for children birth to three years of age. 602 00:37:23.700 --> 00:37:28.346 As you'll see in a moment, the ease and speed of this screening is causing 603 00:37:28.366 --> 00:37:32.913 many people to reconsider the use of pure tone audiometry. 604 00:37:32.933 --> 00:37:37.680 With older children, some schools and health care providers are switching 605 00:37:37.700 --> 00:37:42.546 to OAC screening for all children, so that they have just one method, 606 00:37:42.566 --> 00:37:46.113 one type of equipment that they can use with all children, 607 00:37:46.133 --> 00:37:51.146 regardless of age, developmental level, or primary language. 608 00:37:51.166 --> 00:37:54.713 So we have a very useful document on our website 609 00:37:54.733 --> 00:37:59.680 that can help you and your team think through the use of Oasys versus 610 00:37:59.700 --> 00:38:02.846 pure tones, which we'll show you a little later, 611 00:38:02.866 --> 00:38:09.146 but what you should be sure to check out if you face a decision now or at any point 612 00:38:09.166 --> 00:38:14.646 about what you're going to do with children or who are difficult to screen 613 00:38:14.666 --> 00:38:17.413 if pure tone is, in fact, what you're doing right now. 614 00:38:17.433 --> 00:38:23.246 But, you know, at a minimum, you'll have to have some kind of a plan 615 00:38:23.266 --> 00:38:26.580 for screening children who are unable to be screened 616 00:38:26.600 --> 00:38:31.046 with pure tone, and that will either be to do 617 00:38:31.066 --> 00:38:34.813 if you're following evidence based practice, that will even either 618 00:38:34.833 --> 00:38:38.146 be to do away is or 619 00:38:38.166 --> 00:38:42.380 to have an audiologist who can be sure to come and screen 620 00:38:42.400 --> 00:38:47.080 all of the children that you can't screen and do it in a timely way, 621 00:38:47.100 --> 00:38:51.780 never delaying them just because they're difficult to screen. 622 00:38:51.800 --> 00:38:55.813 Because, as we said, the difficult to screen 623 00:38:55.833 --> 00:39:01.780 children may be the very ones we're needing to identify 624 00:39:01.800 --> 00:39:05.413 who have some type or degree of hearing loss. 625 00:39:05.433 --> 00:39:08.446 And we'll I'm just going to pipe in here and say, 626 00:39:08.466 --> 00:39:12.346 one of the things that also falls into the consideration is what the rules 627 00:39:12.366 --> 00:39:15.780 and regulations are in your own state in terms of being able to screen 628 00:39:15.800 --> 00:39:19.580 and the devices you can use to screen and we'll talk about that in a little bit. 629 00:39:19.600 --> 00:39:23.946 But, that kind of adds to and complicates sometimes the decisions 630 00:39:23.966 --> 00:39:25.446 on how to make this happen. 631 00:39:25.466 --> 00:39:30.480 But your point that doesn't change the point that if a child fails, it fails 632 00:39:30.500 --> 00:39:34.713 a, screening or we cannot screen them, we have to make sure 633 00:39:34.733 --> 00:39:36.080 that there's follow up. 634 00:39:36.100 --> 00:39:40.180 Like so many fields that are constantly evolving, 635 00:39:40.200 --> 00:39:44.313 evolving in part because of the development of technology. 636 00:39:44.333 --> 00:39:46.946 Hearing screening is just like that. 637 00:39:46.966 --> 00:39:50.880 And a lot of the regulations that are in place at state 638 00:39:50.900 --> 00:39:55.213 and local levels are based on, frankly, old science. 639 00:39:55.233 --> 00:40:01.480 And so, you do want to be aware of that before you make a radical shift. 640 00:40:01.500 --> 00:40:06.613 The one thing I can encourage you about is, even if your state does require 641 00:40:06.633 --> 00:40:10.813 pure tone audiometry, if you're unable to do it, there's 642 00:40:10.833 --> 00:40:14.713 probably a window that permit you to do 643 00:40:14.733 --> 00:40:18.246 oh is as the second dairy level screening. 644 00:40:18.266 --> 00:40:23.380 But again, find out what your state and local regulations are. 645 00:40:23.400 --> 00:40:25.380 This is a quick look at that. 646 00:40:25.400 --> 00:40:29.246 That document, that we have on our website 647 00:40:29.266 --> 00:40:32.446 that we encourage you to have a look at that shows 648 00:40:32.466 --> 00:40:36.846 the considerations between pure tone and and audiometry. 649 00:40:36.866 --> 00:40:42.580 Now, one of the things that we love about screening, especially for younger 650 00:40:42.600 --> 00:40:47.080 children, is that we can screen children in a wide range of environments. 651 00:40:47.100 --> 00:40:50.513 And you notice that on this screen right here, these children aren't 652 00:40:50.533 --> 00:40:55.413 being pulled out into, an environment that's foreign or strange to them. 653 00:40:55.433 --> 00:41:01.180 They are being screened at every day educational and, care environments 654 00:41:01.200 --> 00:41:05.680 where the children are already happily spending their time. 655 00:41:05.700 --> 00:41:08.113 And so, 656 00:41:08.133 --> 00:41:09.213 Terry, you know, what have 657 00:41:09.233 --> 00:41:13.546 you found about the the people that can do these screenings? 658 00:41:13.566 --> 00:41:14.646 Yeah. 659 00:41:14.666 --> 00:41:18.880 You know, really in fact, the screening works best when the children 660 00:41:18.900 --> 00:41:22.580 are familiar and comfortable with the adult that's doing the screening. 661 00:41:22.600 --> 00:41:25.613 And where they can play with the toy, they can be held, 662 00:41:25.633 --> 00:41:29.846 they can look at a book or even sleep of the screening is being conducted. 663 00:41:29.866 --> 00:41:32.546 Being able to go to the children can actually really 664 00:41:32.566 --> 00:41:35.946 speed up the amount of time it takes to screen a group of children 665 00:41:35.966 --> 00:41:40.880 and frankly, screening to, you know, school age children with ease. 666 00:41:40.900 --> 00:41:43.580 The older they are, the, the easier it goes. 667 00:41:43.600 --> 00:41:47.746 It's usually a breeze only taking a few minutes per child. 668 00:41:47.766 --> 00:41:50.946 Now, here are some examples of the handheld 669 00:41:50.966 --> 00:41:53.813 equipment that we that we're talking about here. 670 00:41:53.833 --> 00:41:58.980 Now, incidentally, the two devices on either end on the far right or the far 671 00:41:59.000 --> 00:42:04.046 left of this photo, they're unique in that they offer a model that has both. 672 00:42:04.066 --> 00:42:08.080 So it has both OAG and audiometry. 673 00:42:08.100 --> 00:42:11.246 So a pair of headphones can plug into those. 674 00:42:11.266 --> 00:42:14.980 So if you use pure tone with older children you can have your alternative 675 00:42:15.000 --> 00:42:15.946 method literally. 676 00:42:15.966 --> 00:42:18.713 Right there in the same machine in your hand. 677 00:42:18.733 --> 00:42:22.080 For when you can't screen a child with pure tones. 678 00:42:22.100 --> 00:42:28.246 That dual use, is a feature worth noting for sure. 679 00:42:28.266 --> 00:42:28.946 Now, unlike 680 00:42:28.966 --> 00:42:32.846 pure tone audiometry, OE screening is fully automated, 681 00:42:32.866 --> 00:42:37.346 so once you start that screening, then the equipment will independently, 682 00:42:37.366 --> 00:42:40.346 compete, complete the process. 683 00:42:40.366 --> 00:42:43.546 Your job then is going to be to set up the environment, 684 00:42:43.566 --> 00:42:46.713 to, insert a probe into the child's ear 685 00:42:46.733 --> 00:42:50.780 and then manage their behavior while the screening is being completed. 686 00:42:50.800 --> 00:42:52.646 Just like with pure tone screening. 687 00:42:52.666 --> 00:42:54.746 To conduct an OAC screening, 688 00:42:54.766 --> 00:42:57.913 we're going to first take a thorough look at that outer part of the ear 689 00:42:57.933 --> 00:43:02.113 to make sure that there is no visible sign of infection or blockage. 690 00:43:02.133 --> 00:43:06.380 And here's a quick excerpt from one of from our training on zero eight 691 00:43:06.400 --> 00:43:11.213 screening that will give you an idea of how it works. 692 00:43:11.233 --> 00:43:13.913 A small probe is placed in the ear canal 693 00:43:13.933 --> 00:43:18.646 that delivers a low volume sound stimulus into the ear. 694 00:43:18.666 --> 00:43:19.546 A cochlea that is 695 00:43:19.566 --> 00:43:22.580 functioning normally will respond to this sound 696 00:43:22.600 --> 00:43:26.746 by sending the signal to the brain, while also producing 697 00:43:26.766 --> 00:43:30.080 an acoustic emission. 698 00:43:30.100 --> 00:43:32.380 This emission is analyzed 699 00:43:32.400 --> 00:43:36.280 by the screening unit and in approximately 30s. 700 00:43:36.300 --> 00:43:40.613 The result is displayed in the computer screen as a pass 701 00:43:40.633 --> 00:43:46.946 or refer. 702 00:43:46.966 --> 00:43:49.513 Yeah, in every normal, healthy inner 703 00:43:49.533 --> 00:43:53.313 ear should produce an emission that can be recorded in this way. 704 00:43:53.333 --> 00:43:56.980 So unlike what we saw with pure tone screening, or the person 705 00:43:57.000 --> 00:44:00.613 doing the screening here doesn't have to manually step 706 00:44:00.633 --> 00:44:04.480 through the various frequencies and the tones being tested. 707 00:44:04.500 --> 00:44:10.180 Once that probe is in the ear and stable, the screener then would push a button 708 00:44:10.200 --> 00:44:14.680 and the entire screening process is then completed automatically. 709 00:44:14.700 --> 00:44:19.780 The nice thing about this is it eliminates all sorts of possibilities for, error. 710 00:44:19.800 --> 00:44:21.280 The same kinds of things were, 711 00:44:21.300 --> 00:44:24.380 you know, that we're so concerned about with pure tone screening. 712 00:44:24.400 --> 00:44:27.280 Regardless, though, it's still requires thorough training, 713 00:44:27.300 --> 00:44:31.146 which can be accomplished online, just like you saw, here. 714 00:44:31.166 --> 00:44:35.313 And and just like you can complete the Pure Tone screening online. 715 00:44:35.333 --> 00:44:40.080 So let's just take a quick look at an actual real time screening. 716 00:44:40.100 --> 00:44:41.180 This is unedited. 717 00:44:41.200 --> 00:44:44.546 So this woman on the right is putting a probe 718 00:44:44.566 --> 00:44:48.246 in this little guy's here and she's going to push a button. 719 00:44:48.266 --> 00:44:50.746 You'll see the device here in a moment. 720 00:44:50.766 --> 00:44:56.813 And that screening has started. 721 00:44:56.833 --> 00:44:57.980 Yeah. 722 00:44:58.000 --> 00:45:00.613 And that means they got that result 723 00:45:00.633 --> 00:45:04.746 of either a pass or refer that quick. 724 00:45:04.766 --> 00:45:06.313 You can see how much quicker that is. 725 00:45:06.333 --> 00:45:09.013 There's curtains. 726 00:45:09.033 --> 00:45:13.946 And now the helper is putting the probe in the other ear 727 00:45:13.966 --> 00:45:15.646 and you'll see the handheld device here. 728 00:45:15.666 --> 00:45:17.613 There it is. 729 00:45:17.633 --> 00:45:22.280 They've started it. 730 00:45:22.300 --> 00:45:23.646 He's already done it. 731 00:45:23.666 --> 00:45:28.180 So ideally that's how quickly that can go. 732 00:45:28.200 --> 00:45:31.913 So using the recommended methods 733 00:45:31.933 --> 00:45:36.513 is one of the key components of evidence based practices. 734 00:45:36.533 --> 00:45:41.413 And again you know to to compare the two you'll 735 00:45:41.433 --> 00:45:45.846 you've got a handout on our website to, to help you look at this. 736 00:45:45.866 --> 00:45:51.813 Now I want to encourage you to think about using your handout again. 737 00:45:51.833 --> 00:45:54.046 Where are we right now? 738 00:45:54.066 --> 00:45:56.980 In terms of this 739 00:45:57.000 --> 00:46:00.880 consideration of equipment, have we reevaluated this? 740 00:46:00.900 --> 00:46:04.046 Do we have a practice for when we can't 741 00:46:04.066 --> 00:46:07.780 successfully screen a child with one method? 742 00:46:07.800 --> 00:46:10.146 What else do we do? 743 00:46:10.166 --> 00:46:14.446 And have we had standardized training that we can document, 744 00:46:14.466 --> 00:46:19.246 by the way, our training opportunities that are available on our website 745 00:46:19.266 --> 00:46:23.246 now offer continuing education, credits 746 00:46:23.266 --> 00:46:26.480 through Nap that the National Association 747 00:46:26.500 --> 00:46:29.846 of Pediatric nurses. 748 00:46:29.866 --> 00:46:34.046 So that's available through our our website. 749 00:46:34.066 --> 00:46:38.580 So remember that now in addition, 750 00:46:38.600 --> 00:46:42.680 we want to make sure that we're implementing follow up. 751 00:46:42.700 --> 00:46:46.313 And so it's a very important thing to think about. 752 00:46:46.333 --> 00:46:48.546 And something that we include in the training 753 00:46:48.566 --> 00:46:53.380 is what that follow up protocol needs to look like. 754 00:46:53.400 --> 00:46:57.113 We don't want to over refer children and burden health 755 00:46:57.133 --> 00:47:02.613 care providers like who could do middle ER evaluations. 756 00:47:02.633 --> 00:47:07.113 But we also don't want to just make aimless 757 00:47:07.133 --> 00:47:11.613 as assumption is that a child will get the follow up that they need. 758 00:47:11.633 --> 00:47:15.213 And so in the training that we offer, and 759 00:47:15.233 --> 00:47:19.613 I don't want to say that's the only way you can implement evidence based practice. 760 00:47:19.633 --> 00:47:20.780 It isn't. 761 00:47:20.800 --> 00:47:23.713 There are local audiologists can help 762 00:47:23.733 --> 00:47:27.146 you establish your product, your protocol, as well. 763 00:47:27.166 --> 00:47:30.980 But know that in our resources 764 00:47:31.000 --> 00:47:33.880 you'll see the recommended protocol 765 00:47:33.900 --> 00:47:40.013 that is used and based on evidence, throughout the country 766 00:47:40.033 --> 00:47:43.280 of all children of different ages, 767 00:47:43.300 --> 00:47:47.413 using either the OAC or the pure tone method. 768 00:47:47.433 --> 00:47:50.480 So we're not going to go into it in detail. 769 00:47:50.500 --> 00:47:53.380 But you'll notice that there's an initial screen. 770 00:47:53.400 --> 00:47:57.446 And if the child passes, on both ears, 771 00:47:57.466 --> 00:48:00.580 then you can assume the process is complete. 772 00:48:00.600 --> 00:48:03.346 But if they don't, then we recommend 773 00:48:03.366 --> 00:48:07.213 a screening again in about two weeks. 774 00:48:07.233 --> 00:48:09.613 That would be though, only for 775 00:48:09.633 --> 00:48:13.413 about 20 to 25% of the children. 776 00:48:13.433 --> 00:48:16.513 Most will pass right off the bat, 777 00:48:16.533 --> 00:48:21.613 and then after two weeks, we expect that it would go down to about 8%. 778 00:48:21.633 --> 00:48:25.313 That still haven't passed on both years, 779 00:48:25.333 --> 00:48:30.546 and that 8% would be referred for a middle ear consultation 780 00:48:30.566 --> 00:48:35.213 and potentially treatment for a middle ear condition. 781 00:48:35.233 --> 00:48:37.446 That 8% is very screened 782 00:48:37.466 --> 00:48:40.446 and if they pass, they're done. 783 00:48:40.466 --> 00:48:44.080 And if they don't, then that small group of children, 784 00:48:44.100 --> 00:48:49.246 usually about 1%, are referred to a health care provider 785 00:48:49.266 --> 00:48:53.680 for in evaluate to an audiologist 786 00:48:53.700 --> 00:48:57.046 for a complete ideological evaluation. 787 00:48:57.066 --> 00:48:58.480 From whom? 788 00:48:58.500 --> 00:49:03.213 You would want to get those results and to make sure that the child is 789 00:49:03.233 --> 00:49:08.613 is accessing the intervention and supports from the school that they need. 790 00:49:08.633 --> 00:49:11.480 So the overall rule 791 00:49:11.500 --> 00:49:15.546 of establishing evidence based screening 792 00:49:15.566 --> 00:49:19.480 is that you're done with your screening process. 793 00:49:19.500 --> 00:49:20.213 Sure. 794 00:49:20.233 --> 00:49:23.646 Not just when you've done an initial screening, 795 00:49:23.666 --> 00:49:25.746 but really only after you've 796 00:49:25.766 --> 00:49:30.880 got a passing result on both ears at some point along the way. 797 00:49:30.900 --> 00:49:35.346 Or the child has been to an audiologist and you've got the results. 798 00:49:35.366 --> 00:49:38.413 Yeah. Well, just let me interject that. 799 00:49:38.433 --> 00:49:39.780 That's exactly right. 800 00:49:39.800 --> 00:49:44.380 We really want to caution everyone that a screening process is not complete 801 00:49:44.400 --> 00:49:48.680 just because a referral has been made or a letter has been sent home. 802 00:49:48.700 --> 00:49:53.513 These, are the only conditions under which we can really say that 803 00:49:53.533 --> 00:49:56.513 a screening is done for a given child, and that's that. 804 00:49:56.533 --> 00:49:58.880 They've passed the screening on both ears, 805 00:49:58.900 --> 00:50:03.080 or they've received an evaluation, and we've obtained those results. 806 00:50:03.100 --> 00:50:05.380 And there's one exception, isn't there, Terry? 807 00:50:05.400 --> 00:50:09.813 There's an exception about this protocol. 808 00:50:09.833 --> 00:50:11.180 Yeah, exactly. 809 00:50:11.200 --> 00:50:15.646 You know, whenever we hear a parent or a caregiver, 810 00:50:15.666 --> 00:50:18.880 complaint about hearing or language development, 811 00:50:18.900 --> 00:50:23.680 we want to take that seriously and we go ahead and refer them for, 812 00:50:23.700 --> 00:50:29.346 further evaluation, even if they've passed on the hearing, screening. 813 00:50:29.366 --> 00:50:33.413 So that's a lot, right, that it's a lottery. 814 00:50:33.433 --> 00:50:35.980 Who is supposed to do all of this? 815 00:50:36.000 --> 00:50:40.780 Is it the school nurse that has to do every one of these steps? 816 00:50:40.800 --> 00:50:45.513 Or are there people that school nurses and others in the school, 817 00:50:45.533 --> 00:50:50.380 context can also be involved to make sure 818 00:50:50.400 --> 00:50:56.846 that that complete process is built and. 819 00:50:56.866 --> 00:50:57.813 Yeah, exactly. 820 00:50:57.833 --> 00:50:59.480 Who's responsible for all of this? 821 00:50:59.500 --> 00:51:03.213 You know, let's, look at these 822 00:51:03.233 --> 00:51:07.513 these questions here, William, that can help us address that. 823 00:51:07.533 --> 00:51:07.813 Yeah. 824 00:51:07.833 --> 00:51:13.780 We want to make sure that we think about who can help you with this process. 825 00:51:13.800 --> 00:51:17.380 Are there helpers like administrative supports 826 00:51:17.400 --> 00:51:21.380 or volunteers who can help following up with parents 827 00:51:21.400 --> 00:51:26.546 and make sure that they understand that their child didn't refer that 828 00:51:26.566 --> 00:51:29.013 they're helping guide the parents 829 00:51:29.033 --> 00:51:32.513 through seeking that follow up point. 830 00:51:32.533 --> 00:51:35.080 Whether it's the middle ear evaluation 831 00:51:35.100 --> 00:51:39.380 or getting the audiology appointment made, 832 00:51:39.400 --> 00:51:40.546 who's help? 833 00:51:40.566 --> 00:51:43.713 Whose help can you get to help 834 00:51:43.733 --> 00:51:47.013 document and oversee the children 835 00:51:47.033 --> 00:51:49.780 that do need more than just 836 00:51:49.800 --> 00:51:53.080 the initial screening? 837 00:51:53.100 --> 00:51:56.780 Kathy, do you have insights about how, 838 00:51:56.800 --> 00:52:03.046 school nurses can look to others in the school context 839 00:52:03.066 --> 00:52:07.246 to help implement these evidence based practices? 840 00:52:07.266 --> 00:52:07.980 Well, thanks. 841 00:52:08.000 --> 00:52:13.880 Well, there's lots of opportunity and there's lots of different situations. 842 00:52:13.900 --> 00:52:17.146 Some of it might be pooling together with other school nurses 843 00:52:17.166 --> 00:52:18.846 to do mass screenings. 844 00:52:18.866 --> 00:52:20.680 Quickly and efficiently. 845 00:52:20.700 --> 00:52:23.480 Others might be using volunteers or, as you said, maybe 846 00:52:23.500 --> 00:52:26.546 if there's a community liaison type individual, 847 00:52:26.566 --> 00:52:30.080 built into your school and having volunteers just help, 848 00:52:30.100 --> 00:52:35.513 helping with that more community, liaisons to connect with parents. 849 00:52:35.533 --> 00:52:37.446 But one of the things that I think I know 850 00:52:37.466 --> 00:52:41.613 from my own practice that I kind of reflect back and am, 851 00:52:41.633 --> 00:52:44.813 disappointed in myself in is I just used to send our state 852 00:52:44.833 --> 00:52:47.980 referral form home, and really looking back at that, 853 00:52:48.000 --> 00:52:52.046 I realize it was a form that only I understood. 854 00:52:52.066 --> 00:52:54.646 The parents certainly probably didn't understand. 855 00:52:54.666 --> 00:52:59.346 And, I didn't think about, health literacy or the language 856 00:52:59.366 --> 00:53:03.580 barriers that the parents receiving this morning might be facing. 857 00:53:03.600 --> 00:53:09.213 So I know that you have different resources available on your website, and 858 00:53:09.233 --> 00:53:14.913 I just encourage people to think about, why are they getting those referrals back? 859 00:53:14.933 --> 00:53:19.313 Is it because the parents or the caregiver doesn't understand what I'm asking? 860 00:53:19.333 --> 00:53:23.046 And so attaching a cover letter or making a phone call to follow up, 861 00:53:23.066 --> 00:53:27.246 where I know those things are difficult to do, certainly in a busy schedule, 862 00:53:27.266 --> 00:53:31.413 but those are some of the things that, might be helpful in trying to really get 863 00:53:31.433 --> 00:53:36.946 to the final to the to the finish line, which is having the referral form 864 00:53:36.966 --> 00:53:40.880 or having the results from the referral brought back to the school. 865 00:53:40.900 --> 00:53:46.480 I was so surprised during a meeting that we had with a group of 866 00:53:46.500 --> 00:53:50.546 of school nurses last spring asking them, 867 00:53:50.566 --> 00:53:54.513 I mean, they were all really engaged in doing, hearing, screaming, 868 00:53:54.533 --> 00:53:58.713 and I said, how many children were ultimately identified? 869 00:53:58.733 --> 00:54:01.046 This past year? 870 00:54:01.066 --> 00:54:02.313 And there were 871 00:54:02.333 --> 00:54:06.380 very few that could answer that question 872 00:54:06.400 --> 00:54:08.646 that they didn't know. 873 00:54:08.666 --> 00:54:11.146 And and so 874 00:54:11.166 --> 00:54:13.346 it begs the larger question. 875 00:54:13.366 --> 00:54:17.446 Well, it's hard to expect people to support your screening efforts 876 00:54:17.466 --> 00:54:23.413 if you can't talk about the benefits of it that were finally rendered to children 877 00:54:23.433 --> 00:54:27.780 who are ultimately identified, who ended up getting hearing aids 878 00:54:27.800 --> 00:54:31.546 or other kinds of intervention, and support, 879 00:54:31.566 --> 00:54:35.513 and so having a complete process is essential. 880 00:54:35.533 --> 00:54:40.480 And so we encourage you to check out some of the letters, referral letters, 881 00:54:40.500 --> 00:54:44.146 forms and general information that we have 882 00:54:44.166 --> 00:54:49.846 on our website that will help you convey the importance of all of this 883 00:54:49.866 --> 00:54:53.446 to those that you might be seeking help from. 884 00:54:53.466 --> 00:54:57.580 And I would I would suggest that even even if a child doesn't end up having to go 885 00:54:57.600 --> 00:55:01.213 to the audiologist, even identifying a child who is having difficulty hearing 886 00:55:01.233 --> 00:55:04.346 because of, of, just an inner ear infection 887 00:55:04.366 --> 00:55:07.680 or those kinds of things, not hearing is not hearing. 888 00:55:07.700 --> 00:55:11.680 So by identifying these children and getting them whatever level of support 889 00:55:11.700 --> 00:55:16.013 they need to improve their hearing, it's a win and we should be recording 890 00:55:16.033 --> 00:55:17.013 those kinds of things. 891 00:55:17.033 --> 00:55:20.646 And those are things you share when you go and see the Board of Education 892 00:55:20.666 --> 00:55:24.846 and give a report and those kinds of things to get again, garner that support 893 00:55:24.866 --> 00:55:28.013 using the form that you showed, the flier that you showed earlier, 894 00:55:28.033 --> 00:55:33.080 describing what the process is and why, all of those things can really help, 895 00:55:33.100 --> 00:55:36.513 you know, kind of build a little bit of a groundswell beneath you, 896 00:55:36.533 --> 00:55:40.513 to show, the importance of the hearing screening. 897 00:55:40.533 --> 00:55:42.080 Thank you. 898 00:55:42.100 --> 00:55:46.480 So we're almost at the top of the hour, but we can hang on for a little bit here 899 00:55:46.500 --> 00:55:51.446 and answer some questions I want before anybody runs off. 900 00:55:51.466 --> 00:55:52.413 There's a 901 00:55:52.433 --> 00:55:58.403 a link in the chat for a quick evaluation of how we did today, along with what? 902 00:55:58.423 --> 00:55:59.413 903 00:55:59.433 --> 00:56:01.613 We'll give you a certificate of attendance. 904 00:56:01.633 --> 00:56:07.713 So, we'd love it if you would complete that before you run off. 905 00:56:07.733 --> 00:56:10.113 But in the Q and A, you'll see, 906 00:56:10.133 --> 00:56:14.680 some, an opportunity to ask us some questions. 907 00:56:14.700 --> 00:56:20.546 The first question is about whether this has been recorded, and it has 908 00:56:20.566 --> 00:56:24.313 so if you missed anything today or if you think of people 909 00:56:24.333 --> 00:56:28.113 who could benefit from today's webinar, 910 00:56:28.133 --> 00:56:30.946 it's available on kids 911 00:56:30.966 --> 00:56:35.113 hearing.org, and it will be there in a couple of days. 912 00:56:35.133 --> 00:56:38.080 And then you can review it again, share it, 913 00:56:38.100 --> 00:56:42.846 have a meeting with some of your people and watch it together and, and discuss 914 00:56:42.866 --> 00:56:49.080 the process that you are in and improving your services. 915 00:56:49.100 --> 00:56:54.613 So, know that the recording is there. 916 00:56:54.633 --> 00:56:58.846 Teri, we have a question here 917 00:56:58.866 --> 00:57:02.980 about, 918 00:57:03.000 --> 00:57:04.880 Did you mention threshold 919 00:57:04.900 --> 00:57:08.813 screens in New York State? 920 00:57:08.833 --> 00:57:12.313 Do we have we have to do threshold screens 921 00:57:12.333 --> 00:57:16.080 after a failed pure attempt. 922 00:57:16.100 --> 00:57:19.513 Yes. We have not talked about, threshold screens. 923 00:57:19.533 --> 00:57:24.013 And in this context, what that means is if they do not pass 924 00:57:24.033 --> 00:57:27.013 the hearing screening, in the case of pure tone 925 00:57:27.033 --> 00:57:31.013 at the screening levels, then, 926 00:57:31.033 --> 00:57:34.180 they find the threshold or the quietest level 927 00:57:34.200 --> 00:57:36.746 that they can get the child to respond. 928 00:57:36.766 --> 00:57:39.846 And that is not part of our protocol. 929 00:57:39.866 --> 00:57:44.080 And it, we leave that 930 00:57:44.100 --> 00:57:47.813 for the full diagnostic evaluation because, 931 00:57:47.833 --> 00:57:52.946 if they don't pass the screen, we don't none of us need define threshold. 932 00:57:52.966 --> 00:57:55.513 We can appropriately refer that on. 933 00:57:55.533 --> 00:57:59.180 Now the second part of the question is, in New York State, 934 00:57:59.200 --> 00:58:02.413 do we have to do threshold screenings after a failed pure tone? 935 00:58:02.433 --> 00:58:07.580 And unfortunately, I don't know, the, state, regulations on that. 936 00:58:07.600 --> 00:58:13.413 I find it very rare, though, that a, finding threshold would be required. 937 00:58:13.433 --> 00:58:18.746 The next question, is it recommended to test a child who already has hearing aids? 938 00:58:18.766 --> 00:58:20.513 Great question, and absolutely not. 939 00:58:20.533 --> 00:58:21.780 You don't need to do that. 940 00:58:21.800 --> 00:58:24.413 When they, have been fit with hearing aids, 941 00:58:24.433 --> 00:58:29.013 their hearing loss has already been diagnosed and they've, entered treatment, 942 00:58:29.033 --> 00:58:32.080 of which the hearing aids are part of that treatment plan, 943 00:58:32.100 --> 00:58:37.446 and they should be under the care of an audiologist to help maintain, the, 944 00:58:37.466 --> 00:58:42.313 programing the adjustments and the working ability of those hearing aids. 945 00:58:42.333 --> 00:58:45.280 So what you do want to do. 946 00:58:45.300 --> 00:58:47.080 Okay. Because I was going to say I'm going to type in. 947 00:58:47.100 --> 00:58:50.180 Go ahead. Well, as you know, Kathy 948 00:58:50.200 --> 00:58:51.080 well but I was just 949 00:58:51.100 --> 00:58:54.313 going to say is that what we are responsible for 950 00:58:54.333 --> 00:58:58.180 doing is ensuring that the student is continuing to have that follow up care. 951 00:58:58.200 --> 00:59:02.046 So because they show up with the hearing aids, 952 00:59:02.066 --> 00:59:05.846 you can also inspect the outer ear to make sure you don't see any, any issues 953 00:59:05.866 --> 00:59:06.713 going on with that. 954 00:59:06.733 --> 00:59:08.446 Make sure the hearing aids are in working order. 955 00:59:08.466 --> 00:59:09.346 Those kinds of things 956 00:59:09.366 --> 00:59:13.580 is certainly a reasonable thing to do, but you don't need to screen their hearing, 957 00:59:13.600 --> 00:59:17.680 but you do need to document when they were last seen by the audiologist, 958 00:59:17.700 --> 00:59:22.646 or that they're still under the care of of someone, for their hearing. 959 00:59:22.666 --> 00:59:23.613 Well, that's what you were going to say. 960 00:59:23.633 --> 00:59:24.680 Well, yes. 961 00:59:24.700 --> 00:59:27.013 And what things I always want to say. 962 00:59:27.033 --> 00:59:30.180 And we'll leave everybody with this thought. 963 00:59:30.200 --> 00:59:34.580 It it has to do with don't make assumptions. 964 00:59:34.600 --> 00:59:38.413 We don't want to, first of all, make an assumption 965 00:59:38.433 --> 00:59:42.280 that a child can hear appropriate, 966 00:59:42.300 --> 00:59:47.980 even if they're following along with some degree of success. 967 00:59:48.000 --> 00:59:53.380 We never want to assume it, because hearing loss can be invisible to us. 968 00:59:53.400 --> 00:59:55.113 It can be disguised. 969 00:59:55.133 --> 00:59:59.980 We don't want to assume that if a child doesn't pass the screening 970 01:00:00.000 --> 01:00:05.680 and we send home a letter, that anything happens after that point, 971 01:00:05.700 --> 01:00:10.246 we don't want to assume that a health care provider is following up, 972 01:00:10.266 --> 01:00:13.746 or that the family has found an audiologist. 973 01:00:13.766 --> 01:00:19.280 We have to have a system in place that establishes 974 01:00:19.300 --> 01:00:24.746 when we know the child is either passed on both ears 975 01:00:24.766 --> 01:00:28.946 or has been to an audiologist, and we have a result. 976 01:00:28.966 --> 01:00:31.746 We don't want to make any assumptions. 977 01:00:31.766 --> 01:00:35.746 And then lastly, we don't want to assume that just because a child 978 01:00:35.766 --> 01:00:39.446 had a, has a hearing aid 979 01:00:39.466 --> 01:00:44.113 that that that has been checked in on recently, 980 01:00:44.133 --> 01:00:47.646 hearing loss can be progressive. 981 01:00:47.666 --> 01:00:52.746 Children are growing and hearing aids will not necessarily fit, 982 01:00:52.766 --> 01:00:58.246 the way they did six months ago and function the same. 983 01:00:58.266 --> 01:01:02.513 So we want to make sure that that assumption isn't made. 984 01:01:02.533 --> 01:01:07.146 And we don't want to assume that just because a child may be getting 985 01:01:07.166 --> 01:01:12.413 speech and language therapy or other types of intervention, 986 01:01:12.433 --> 01:01:16.280 that hearing has been also incorporated 987 01:01:16.300 --> 01:01:19.680 in the evaluation and assessment process, 988 01:01:19.700 --> 01:01:23.113 because sometimes it is overlooked. 989 01:01:23.133 --> 01:01:26.813 So Kathy and Terri, thank you so much. 990 01:01:26.833 --> 01:01:31.413 And to all of you, thank you for your attention to all of this 991 01:01:31.433 --> 01:01:34.146 and for what you can do as you go through 992 01:01:34.166 --> 01:01:37.246 that list that you have on your handout there. 993 01:01:37.266 --> 01:01:39.580 I'm going to put that QR code back up 994 01:01:39.600 --> 01:01:44.480 so that if you didn't get it, you can look at it again, 995 01:01:44.500 --> 01:01:47.613 and think about 996 01:01:47.633 --> 01:01:52.313 what you can do to continue the progress 997 01:01:52.333 --> 01:01:57.680 of improving your practices so that they are fully in line 998 01:01:57.700 --> 01:02:04.080 with evidence based recommendation and. 999 01:02:04.100 --> 01:02:05.913 Thanks, everyone. 1000 01:02:05.933 --> 01:02:10.180 Know that you can contact us through our website, kids hearing.org 1001 01:02:10.200 --> 01:02:15.013 if there are any other questions or guidance that we can offer to you, 1002 01:02:15.033 --> 01:02:18.246 we're happy to do that. 1003 01:02:18.266 --> 01:02:21.146 And thanks to the National Association 1004 01:02:21.166 --> 01:02:27.714 of School Nurses for helping us reach out to this audience.