Advocacy Notes: Documenting Daily Amplification Use is Legally REQUIRED in the U.S.

TOPIC: I’ve asked the school to check a student’s hearing aids and FM/RM system daily and they refuse. 

Documenting Daily Amplification Use is Legally REQUIRED in the U.S.

Per IDEA Sec. 300.113. (a) Each public agency must ensure that hearing aids worn in school by children with hearing impairments, including deafness, are functioning properly. (b) (1) Each public agency must ensure that the external components of surgically implanted medical devices are functioning properly.

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Get Free Tools to Work with Children with Hearing Loss

Get Free Tools to Work with Children with Hearing Loss

The Ida Institute, a nonprofit working to advance person-centered hearing care, offers free pediatric tools and resources to support educators and hearing care professionals in understanding the perspectives of children with hearing loss and give the them stronger voices as they advocate for their own needs.

The World Healthcare Organization reports that while the most obvious effect of childhood hearing loss is on language development, it also impacts literacy, self-esteem, social skills, academic achievements, employment opportunities, emotional and psychological well-being, and can bring on feelings of isolation, loneliness and depression[1].

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Advocacy Notes: Documenting Daily Amplification Use is Legally REQUIRED in the U.S.

TOPIC: I’ve asked the school to check a student’s hearing aids and FM/RM system daily and they refuse. 

Documenting Daily Amplification Use is Legally REQUIRED in the U.S.

Per IDEA Sec. 300.113. (a) Each public agency must ensure that hearing aids worn in school by children with hearing impairments, including deafness, are functioning properly. (b) (1) Each public agency must ensure that the external components of surgically implanted medical devices are functioning properly.

A court case from June 2015 has raised the bar for what educators who specialize in DHH must know and do. In this case, the school district team had included use of an FM system on a student’s IEP. The educational audiologist fitted and verified the FM for the specific student’s use and trained the teacher in its use. The FM system was then made available to the student. The court found the school district negligent in providing FAPE because there was no record that the FM/HAT devices was provided to the student daily. Read more. This finding strengthens the need for daily hearing aid monitoring and data collection.

Access is so important that the IDEA statute (20 USC 1400(c)(5)(H)) specifies “supporting the development and use of technology, including assistive technology devices and assistive technology services, to maximize accessibility for children with disabilities.”
The special considerations portion of IDEA specific to students with hearing loss requires that the IEP team must… iv) Consider the communication needs of the child, and in the case of the child who is deaf or hard of hearing, consider the language and communication needs, opportunities for direct communication with peers and professional personnel in the child’s language and communication mode, academic level, and full range of needs, including opportunities for direct instruction in the child’s language and communication mode, and (v) Consider whether the child requires assistive communication devices and services. 34 CFR 303.324(2).  Typically, students who with amplification systems must use them as part of receiving a free and appropriate public education (FAPE). Without amplification, students who are hard of hearing will not have an equal or appropriate opportunity for direct communication with peers or professional personnel. Thus the requirement that assistive devices be considered as a part of FAPE.

We know that not all families want their child to gain the attention needed to perform hearing device monitoring. We also know that in the US, there needs to be documentation that the student’s hearing devices are functioning properly. Thus, we truly need to inform families of these requirements. An example of Amplification Monitoring Consent Form has been included in the Hearing Aids and FM/DM pages of the Supporting Success website.

Since hearing devices can malfunction at any time, to truly ensure that they are functioning properly we ultimately need to teach the student how to be responsible for their own hearing aid monitoring. See Building Skills for Independence and Advocacy in Action for instructional materials to strengthen hearing device independence skills for students.

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Get Free Tools to Work with Children with Hearing Loss

Get Free Tools to Work with Children with Hearing Loss

The Ida Institute, a nonprofit working to advance person-centered hearing care, offers free pediatric tools and resources to support educators and hearing care professionals in understanding the perspectives of children with hearing loss and give the them stronger voices as they advocate for their own needs.

The World Healthcare Organization reports that while the most obvious effect of childhood hearing loss is on language development, it also impacts literacy, self-esteem, social skills, academic achievements, employment opportunities, emotional and psychological well-being, and can bring on feelings of isolation, loneliness and depression[1].

Growing Up with Hearing Loss

Growing Up with Hearing Loss uses videos, questions, and suggestions to inform and inspire children and their parents and to prompt them to think about communication needs and skills development.

To help manage the key transitions in a child’s life, the institute developed Growing Up with Hearing Loss. The resource offers easy-to-follow strategies for developing independence, good decision-making, and self-awareness during each developmental stage.

Lisa Kovacs, Director of Programs at Hands & Voices, an advocacy group for parents of children with hearing loss, has used Growing Up with Hearing Loss in an online module for teens. She said some of the benefits are that the resourcetargets self-determination skills in different ages and stages of a child’s journey starting at age three until the time the child becomes a young adult. Strong self-determination leads to competent self-advocacy skills, which will support students as they transition into either the workforce or post-secondary education.”

My World Tool

Use My World to recreate their day in a home, playground, or classroom setting by populating the spaces with friends, family, and the things they enjoy. Then, they can use the environments to help articulate their challenges, thoughts, and feelings about living with hearing loss.

Ida’s popular My World tool resembles a game in both its digital and physical versions, making sessions more relaxed and enjoyable for kids. The free My World app is downloadable from iTunes and the Play Store. Research has shown that working with children in a play setting can ease anxiety and improve their sense of self, adaptive functioning, and family functioning.

Jacqueline Dahlen, a teacher consultant for the deaf and hard of hearing in Alberta, Canada, uses Ida’s My World app with her students. I like the interactive nature of the app which allows the student to place or move objects in space to represent their listening environments,” she says. “The students enjoy selecting their avatar and I like the different listening environments to choose from. It sparks discussions with students from the visuals created.”

Telecare for Teens and Tweens

Ida Telecare for Teens and Tweens tools encourage students to reflect on their needs and help them to take greater control of their hearing health and become better advocates for themselves.
The Ida Institute has also developed a suite of telehealth tools which includes Ida Telecare for Teens and Tweens. A study2 on the Telecare for Teens and Tweens tools by the Ear Foundation showed the tools encourage young people (study participants were ages 11-17) to participate in their hearing care and that sharing their experiences promotes social participation and discussions of hopes and concerns in an empowering way. The study concludes, This approach fosters self-determination, self-management, and self-advocacy thereby increasing the potential for positive long-term outcomes.  

The Ida Institute

“Our tools and resources help children and young people think about and express their needs,” says Ida’s Associate Director, Ena Nielsen. “This helps professionals learn what is most important to the child and their family so they can focus on what matters most.” You can learn more about these and other Ida tools and resources on their website at idainstitute.com/tools  

References

[1]. WHO, Childhood Hearing Loss: Strategies for prevention and care https://www.who.int/docs/default-source/imported2/childhood-hearing-loss–strategies-for-prevention-and-care.pdf?sfvrsn=cbbbb3cc_0

  1. [2] Ear Foundation study https://www.earfoundation.org.uk/research/research-categories/current-research/transitioning-for-european-young-people-using-telecare-tools

 

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Self-Advocacy as a Stand-Alone Service?

IEP Individualized Education Program Teaching Words 3d Render Illustration
Too often we hear, “He has good grades, so he won’t qualify for special education.” It is true that there must be a relationship between a child’s disability and school performance to qualify for services, however, IDEA specifies educational performance, not grades. There are characteristics associated with having a hearing loss that impact school performance, like missing or misunderstanding more communication than their peers. This is the basis for ongoing language and vocabulary issues and underlies the need for self-advocacy. Accommodations cannot close all ongoing communication gaps. It truly is necessary to teach self-advocacy skills to enable students to fully participate in the classroom and act appropriately when they know they have not fully received or understood information.

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Advocacy Notes: Reading Progress for DHH Plus

Progress in Light of Circumstances – A Right for Every Student

I don’t think my child is making progress in reading…

Our question from the field: At a recent IEP meeting it seemed as though my child who has both hearing loss and other learning issues hasn’t made any progress in learning to read in the last year. I KNOW he can learn. The school didn’t seem surprised nor did they suggest any changes in the program….  

The special education pendulum has swung away from segregated settings where students with special needs minimally mixed with ‘regular’ students in the 1980s to the current full inclusion model, where direct 1:1 instructional services are becoming increasingly rare. Students with hearing loss are already at high risk for ‘academic slippage’ due to their inability to completely access classroom communication without appropriate accommodations and supports. The move from pull-out services to provide intensive teaching in reading, language, and self-advocacy, places our students at even higher risk for developing increasing academic delays over time.

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Advocacy Notes: Reading Progress for DHH Plus

Progress in Light of Circumstances – A Right for Every Student

I don’t think my child is making progress in reading…

Our question from the field: At a recent IEP meeting it seemed as though my child who has both hearing loss and other learning issues hasn’t made any progress in learning to read in the last year. I KNOW he can learn. The school didn’t seem surprised nor did they suggest any changes in the program….  

The special education pendulum has swung away from segregated settings where students with special needs minimally mixed with ‘regular’ students in the 1980s to the current full inclusion model, where direct 1:1 instructional services are becoming increasingly rare. Students with hearing loss are already at high risk for ‘academic slippage’ due to their inability to completely access classroom communication without appropriate accommodations and supports. The move from pull-out services to provide intensive teaching in reading, language, and self-advocacy, places our students at even higher risk for developing increasing academic delays over time.  

In light of this, I found a court case from 2002 that gave me pause, and hope. In Kevin T. V. Elmhurst Comm. School District No. 205, Kevin, who had a learning disability and ADHD, had received twelve years of special education (age 6-18). Kevin had average intellectual potential but his reading, math and writing skills were at the 3rd to 5th grade levels despite receiving special education services. Triennial assessments over 9 years showed that his IQ dropped nearly 20 points. Scores on academic achievement tests also decreased significantly over a 6-year period. The school was aware of his poor reading scores but did not make IEP changes to address his reading difficulties. It was stated multiple times that he should have been assessed for, and given, assistive technology (AT), but the district did not consider, let alone provide Kevin, with AT. Modifications or accommodations during state testing procedures were not included on his IEP. Although Kevin’s skills were deficient, at the end of his 12th grade year while receiving all Fs, he graduated with a high school diploma. Per this court decision, “Automatic grade promotion does not necessarily mean that the disabled child received a FAPE or is required to be graduated.”  

At the urging of the parents, the district transferred Kevin to a specialized day school where he received intensive instruction. In one year, Kevin made about 3 years of progress in reading, math, and writing. His parents then decided to bring the case to court. The court ruled that Kevin receive compensatory education. The school district was required to reimburse the parents for tuition paid to the specialized school and for his continued education at the school.

Where is the silver lining in this case?

The IEP should be reasonably calculated to enable a child to make progress appropriate in light of the child’s circumstances.
Schools can and should be held accountable when students with disabilities are not making sufficient progress. Indeed, the March 22, 2017 US Supreme Court decision rejected the standard of minimal progress. For children fully integrated in the regular classroom, the IEP should be reasonably calculated to enable a child to make progress appropriate in light of the child’s circumstances.  

A free and appropriate public education (FAPE) for students with disabilities includes specially designed instruction to meet the unique needs of the child. Present levels of performance and continuous performance monitoring are critical elements for determining student needs, and also identifying if the specially designed instruction is truly meeting the needs of the child. Children who display hearing loss as their only disability do not have a disordered learning. Issues in education are related directly to the access barriers caused by the hearing loss. These barriers must be accommodated per ADA and an IEP be suitably designed to close the existing gaps in learning and support the student’s ability to keep pace in the classroom.  

A recent research study* focused on the reading performance of students who were deaf/hard of hearing and had additional learning issues. The majority of the 214 students in this study had either intellectual or multiple disabilities as their primary disability while about 10% had DHH as their primary.  Over the 6-year period the 314 students took an alternate reading assessment an average of 3.72 times between grades 3-11. When comparing the performance of the 214 DHH+ students with the performance of other students with significant disabilities taking the same alternate reading assessment, the DHH+ students had overall poorer performance and growth rates. Most of these students increased their performance on the alternate state reading standards as they progressed in grade level. The percentage of ‘proficient’ increased, while the percentage of ‘emerging’ decreased during the 6-year period. The fact that the study found students who are DHH+ had lower proficiency scores than other students with significant disabilities on their state alternate assessment underscores how the addition of hearing loss to a child with complex needs is multiplicative, not additive. The need for interdisciplinary teaming to untangle and respond to the unique and complex needs of students who are DHH+ is essential. Like all students, those who are DHH+ CAN LEARN!  

Intensive instruction by persons who truly understand the unique learning needs of the specific disability is likely to result in substantial progress to close achievement gaps. If our students are 1+ years delayed in their achievement, it is unlikely that they will close this gap nor keep up with the current pace of learning UNLESS an appropriately intense program of specialized instruction – by a teacher of the deaf/hard of hearing – supports this progress.

Services need to be appropriate if a child with hearing loss is to receive FAPE.

Appropriate:

Accommodations to optimize access to school communication

Assessment to identify the learning needs unique to students with hearing loss

Intensity of specialized instruction tailored to meet these unique needs by a knowledgeable teacher with specialty in working with students with hearing loss

Continuous progress monitoring to measure progress in closing learning gaps

Revising IEP services and accommodations/supports to support GROWTH.

* Donne, V, Hansen, M.A.,  & Zigmond, N. (2019). Statewide alternate reading assessment of students who are deaf/hard of hearing with additional disabilities. Communication Disorders Quarterly, 40(2), 67-76.

For a review of this study, refer to the January 2020 Teacher Tools e-magazine Knowledge is Power article by Holly Pedersen.  

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Self-Advocacy as a Stand-Alone Service?

IEP Individualized Education Program Teaching Words 3d Render Illustration
Too often we hear, “He has good grades, so he won’t qualify for special education.” It is true that there must be a relationship between a child’s disability and school performance to qualify for services, however, IDEA specifies educational performance, not grades. There are characteristics associated with having a hearing loss that impact school performance, like missing or misunderstanding more communication than their peers. This is the basis for ongoing language and vocabulary issues and underlies the need for self-advocacy. Accommodations cannot close all ongoing communication gaps. It truly is necessary to teach self-advocacy skills to enable students to fully participate in the classroom and act appropriately when they know they have not fully received or understood information.

The ‘bread and butter’ of itinerant support to students with hearing loss is often considered to be ensuring communication access, supporting language development to allow expected academic progress, and self-advocacy skills training. While access relates to ADA requirements, and supporting language is linked to academics, training in self-advocacy is too often considered to be non-academic and therefore not necessary.

Students do not know what they didn’t hear because they didn’t hear it – yet they are held accountable for receiving and fully understanding this information.

If a student who was low vision was continually knocking into people, desks, and classroom walls due to the inability to clearly see everything, a vision specialist would likely be called in to assist the student in developing appropriate orientation and mobility skills. A student with hearing loss often incompletely hears, misses spoken information, or misunderstands what is said. Self-Advocacy training is to a student with hearing loss what orientation and mobility training is to a student with visual impairment.
Full participation in the classroom requires that a student recognize when a communication breakdown occurs, and self-advocate for their listening and learning needs. Students who are deaf or hard of hearing must have the knowledge and skills to access accommodations and support in any setting and as an integral part of an independent adulthood. Ideally, students would have instruction in self-advocacy from preschool through grade 4 (about age 10). As they reach the tween and teen years, focus should change on supporting the student’s ability to problem-solve communication issues as part of their self-determination of future goals.

The Iowa Core Curriculum states, “students who are deaf or hard of hearing have specialized needs not covered in the general education curriculum. Hearing loss adds a dimension to learning that often requires explicit teaching, such as information gained through incidental learning. It has been estimated that for persons without hearing loss, 80% of information learned is acquired incidentally. No effort is required. Any type of hearing loss interrupts this automatic path to gain information. This incidental information must be delivered directly to students who are deaf or hard of hearing.

Most teachers without specialized training related to hearing loss do not have the expertise to address the unique needs of students who are deaf or hard of hearing. Therefore, IFSP & IEP team collaboration with educational audiologists and teachers of students who are deaf or hard of hearing is necessary in addressing academic and social instruction and the assessment of these areas. In order to close this information gap, the Expanded Core Curriculum for Students who are Deaf or Hard of Hearing was developed.”

Legal Considerations

In determining whether a child has educational performance needs that require specialized support IDEA specifies that team must: iv) Consider the communication needs of the child, and in the case of the child who is deaf or hard of hearing, consider the language and communication needs, opportunities for direct communication with peers and professional personnel in the child’s language and communication mode, academic level, and full range of needs, including opportunities for direct instruction in the child’s language and communication mode… 34 CFR 303.324(2). Hearing loss of any degree impacts and reduces the amount of communication students fully receive.

The American’s with Disabilities Act is a discrimination law that, in summary, requires schools to ensure that students with hearing loss have communication that is as effective as it is for others. If not, auxiliary aids and services must be provided to “level the playing field” or allow equal access. Since we KNOW that there is no amplification that fully closes the ‘listening gap’ for students in a classroom and we KNOW that incidental language will be missed, and we KNOW that classroom or group discussions are especially challenged then the FACT that students with hearing loss will not perceive information as fully as hearing peers will be one of their (full range of) needs.

Not hearing everything in the classroom does have an adverse educational effect on the ability to fully comprehend, learn at the same pace as others, and fully participate in all school activities.
IDEA has indicated that a child’s disability condition must have an adverse educational effect to be considered eligible for specialized services. Note – IDEA did not say the child must have poor grades. Self-advocacy skills, if the student knows how and when to appropriately use them, facilitate full participation and greater levels of comprehension, thereby allowing full access to the general education curriculum.

Components of Self-Advocacy: Following are basic questions that students with hearing loss typically require instruction in so that they can understand their hearing needs and respond appropriately.

Self-Advocacy

  1. 1. What does it mean to have a hearing loss?
  2. 2. Why do I have problems understanding (relate to hearing loss and language issues)?
  3. 3.  How does my hearing loss affect me (school, socially)?
  4. 4. When do I have problems understanding what people say?
  5. 5. How important are my hearing devices?
  6. 6. How do I know when my hearing devices are not working?
  7. 7. What should I do when they are not working?
  8. 8. What can I do when I know I have not heard what was said (specific self-advocacy & communication repair strategies)?

Self-Determination

  1. 1. How much am I willing to have the hearing loss impact how well I do in school (planning/future goals)?
  2. 2. When is it critical for me to disclose my hearing loss (problem solving)?
  3. 3. What are my legal rights to access, supports, and services?

From the US Office of Civil Rights:

We need to encourage students to understand their disability.
  • They need to know the functional limitations that result from their disability.
  • Understand their strengths and weaknesses. Be able to explain their disability to others.
  • Be able to their difficulties in the past, and what has helped them overcome such problems.
  • This should include specific adjustments or strategies that might work in specific situation.
  • They must practice explaining their disability, as well as why they need certain accommodations, supports, or services.
U.S. Department of Education, Office for Civil Rights, Transition of Students With Disabilities to Postsecondary Education: A Guide for High School Educators, Washington, D.C., 2007

He does not know what he did not hear.

This reality underlies the requirement to teach self-advocacy, specifically teaching the student about what he does hear, does not hear and under what conditions, and how to use situational awareness to recognize when he likely missed information. Some knowledge of hearing loss teaching and assessment resources:
  1. 1. Advocacy in Action Self-Advocacy Curriculum
  2. 2. Audiology Self-Advocacy Checklist – Elementary School  Middle School  High School
  3. 3. Building Skills for Success in the Fast-Paced Classroom
  4. 4. ELFLing
  5. 5. Monkey Talk Self-Advocacy Game
  6. 6. Phonak Guide to Access Planning
  7. 7. Recorded Functional Listening Evaluation Using Sentences (FLE)
  8. 8. Rule the School Self-Advocacy Game
  9. 9. Steps to Success Sequence of Skills for Students who are Deaf/Hard of Hearing

Teaching Hearing Device Use and Troubleshooting

Some knowledge of hearing device use teaching and assessment resources:
  1. 1. Race to the Brain Game
  2. 2. Advocacy in Action Self-Advocacy Curriculum
  3. 3. Building Skills for Independence in the Mainstream
  4. 4. SEAM – Student Expectations for Advocacy & Monitoring Listening and Hearing Technology (PDF)
  5. 5. Steps to Success Scope and Sequence of Skills for Students who are Deaf/Hard of Hearing

Teaching Self-Advocacy Strategies

Some knowledge of self-advocacy skills teaching and assessment resources:
  1. 1. Advocacy in Action Self-Advocacy Curriculum
  2. 2. Building Skills for Independence in the Mainstream
  3. 3. Building Skills for Success in the Fast-Paced Classroom
  4. 4. COACH: Self-Advocacy & Transition Skills for Secondary Students who are Deaf/Hard of Hearing
  5. 5. Guide to Self-Advocacy Skill Development: Suggestions for Sequence of Skill Attainment (PDF)
  6. 6. Monkey Talk Self-Advocacy Game
  7. 7. Phonak Guide to Access Planning
  8. 8. SCRIPT 2nd Ed: Student Communication Repair Inventory & Practical Training
  9. 9. Steps to Success Scope and Sequence of Skills for Students who are Deaf/Hard of Hearing
  10. 10. What’s the Problem Game

Success in the general education setting requires ongoing instruction in self-advocacy skills needs, including hearing device independence for students who are hard of hearing, as part of the IEP or 504 Plan.

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White Paper: Estimating the Level of Communication Effectiveness / Access

White Paper: Estimating the Level of Communication Effectiveness / Access reviews the requirements for schools to ensure that students with hearing loss have communication that is as effective as peers. It provides specific recommendations for ways in which the level of access, can be assessed for students who are auditory learners and those who are visual learners, along with students who have expressive communication issues. July 2017
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White Paper: Estimating the Level of Communication Effectiveness / Access

White Paper: Estimating the Level of Communication Effectiveness / Access reviews the requirements for schools to ensure that students with hearing loss have communication that is as effective as peers. It provides specific recommendations for ways in which the level of access, can be assessed for students who are auditory learners and those who are visual learners, along with students who have expressive communication issues. July 2017
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