Review of DETA Criteria for Hearing Impairment

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Key issues for the Review in HI• Aligning DETA definitions and criteria with national and

international standards

• Examining the links between the hearing impairment and the activity limitations/ participation restrictions for different degrees of hearing loss

• Evaluating the effectiveness of the verification form introduced in July 2006

• Identifying when a review of verification is appropriate

• Investigating ways to better identify and support students in schools with high incidence of Otitis Media

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Definitions of HI: International and National Criteria

• The range of normal hearing is 0-20dB (WHO, AH)

• Research - effects of mild hearing loss

• Research – effects of classroom acoustics

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New Criteria (from November 12 2007)Criterion 1

• Evidence of a hearing loss greater than 20dB at any one frequency in either ear

• Audiogram and written report from an audiologist or otolaryngologist

• The most current audiogram accepted for permanent Hearing Loss

• Fluctuating conductive (‘temporary’) hearing loss – audiogram within previous 12 months and history of persistent hearing loss

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New Criteria (from November 12 2007)

Criterion 2

• The hearing loss must be shown to manifest itself in activity limitation and participation restriction in the school context

Hearing Impairment -

Activity Limitation / Participation

Restriction in the school context

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ICF Activity (Limitation) and Participation (Restriction) Domains:

1. Learning and applying knowledge

2. General tasks and demands

3. Communication

4. Mobility

5. Self care

6. Domestic life

7. Interpersonal interactions and relationships

8. Major life areas

9. Community, social and civic life

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Possible Activity Limitation and Participation Restriction due to HI: Some ICF Examples

Difficulty with:• Learning through listening (d115)• Receiving spoken messages (d310)• Engaging effectively in conversation (d350)

• With one person (d3503)• With many people(d3504)

• Engaging in discussion (d355)• Remunerative employment (d850)• Engaging in some forms of recreation and leisure

(d920)

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GREAT INDIVIDUAL VARIATION: hearing impairment, environmental and personal factors

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Hearing Impairment, Activity Limitation and Participation Restriction: Classroom examples

Difficulty with:• Attending/ tuning in to what is going on• Accessing spoken information - teachers & other

students• Taking part in discussions• Accessing audio, TV, videos etc• Listening for long periods – fatigue factors• Learning information incidentally• Responding quickly to questions or commands• Making sense of new information• Learning new vocabulary and using words

appropriatelyNational Deaf Children’s Society – Deaf Friendly Classrooms Project

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Hearing Impairment, Activity Limitation and Participation Restriction: Social examples

Difficulty with:• Learning social behaviour incidentally• Communicating effectively with others• Initiating conversations• Using appropriate language when interacting

with others• Being fully included in large groups• Expressing feelings and emotions verbally• Developing confidence and a positive self image

National Deaf Children’s Society – Deaf Friendly Classrooms Project10

education adjustment program Department of Education, Training and the Artseducation adjustment program Department of Education, Training and the Arts Activity Limitation and Participation Restriction:

Degrees of Hearing Impairment

The review focused on current evidence relating to:

– Mild hearing loss, including CHL due to otitis media– Unilateral hearing loss

• Variable impact of mild and unilateral hearing loss:physical environment (eg noise, distance, reverberation,

lighting)communication factors (eg size of group, demands of the

activity)personal factors (eg coping strategies, fatigue levels)

• Inside a classroom a mild hearing loss can be disabling• Outside school context mild or moderate hearing loss may be

an impairment but not a disability11

The Verification Form:

Hearing Impairment

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Verification Form:

The HI verification form trialled in July 2006 has been accepted with only a few modifications

Scaffolds best practiceEncourages communication between

schools and the AVT: HIEnhances links between the impairment,

effects and appropriate educational adjustments

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Information about the hearing impairment

Specialist teacher report: • Degree and type of hearing loss• Age of onset – pre or post-lingual • Age of diagnosis and history• Associated medical conditions• Other impairments• Consistent use of amplification or cochlear implant• Auditory skills • Communication mode and competence

• Speech and language development completed by a teacher with recognised qualifications in the area of

hearing impairment 14

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Reporting on activity limitation and participation restriction for HI verification

Describe how the student’s hearing impairment affects their ability to access, participate and demonstrate what they know and can do to achieve positive outcomes

Focus areas of the EAP are used:• Curriculum (including disability specific curriculum)• Communication• Social participation/ emotional well being (including

behaviour)• Health and personal care• Safety• Learning access and the environment

The school team comments on the activity limitations and participation restrictions resulting from the hearing loss

using information obtained from discussions with the parent and teacher of the deaf

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Reporting on activity limitation and participation restriction

Consider the primary impairment:• Direct impact of hearing impairment – participation in

classroom activities, access to the spoken language and the curriculum, communication restrictions

Consider any secondary impairment:• Speech and language impairment occurring as a result of

hearing impairment • Associated learning and other difficulties• Social or emotional difficulties

‘Impairments may result in other impairments' - ICF16

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Hearing in the classroom

• Detection *Noise and• Discrimination

Reverberation• Identification• Comprehension

*Distance • Attention

*Direction

• Effort/ fatigue *Group size

•Speaker variables• Technology, media

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sounds syllables words phrases messages

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The (hearing impaired) student may not know that s/he has not heard or misheard:

• may not be able to hear enough to make sense of what is said

• may think they have understood fully and not realise that they have missed out on important information

• may misunderstand what is said or written

You don’t always know what you don’t know18

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It is not always possible to observe when a student has not heard or has misheard in the classroom

Verification Reviews and Removal from Category

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Review of HI Verification

• No mandatory review for permanent hearing losses

• Review required for:• mild hearing loss • fluctuating conductive hearing loss• permanent conductive hearing loss

where medical intervention occurs• Review and date of review determined by the

verifier

Removal from HI category 21

Identification of students with hearing impairment in school

communities with a high incidence of CHL: OM

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Click to edit Master title style

• Click to edit Master text styles– Second level

• Third level– Fourth level

» Fifth level

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Identification and Support for students in schools with High Incidence of Otitis Media

Current external verification process not appropriate for identifying high incidences of CHL:OM in

indigenous populations – Problems collecting information to fit verification

criteria– Under-reporting of CHL:OM through verification process compared

with prevalence (1.46% of indigenous students verified HI)

– Verification is suited to low incidence disability– Resource intensive– Match identification and support: The Whole School

Approach23

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Verification Review Recommendations:Conductive Hearing Loss: Otitis Media

Students in school communities with a high incidence of CHL: OM:

That DETA investigate methods of identification for whole schools with high incidences of CHL: OM, rather than individually identifying and supporting students through the EAP process. This process would be developed in consultation with local communities with the aim of becoming an integrated identification and service delivery model, to be implemented within a cost-neutral framework.

Students with CHL: OM experiencing educational impact requiring individual support and intervention greater than the general school population to be submitted for verification on an individual basis.

Students with a hearing impairment not identified as CHL: OM to be submitted to verification on an individual basis even though they are attending an identified school with a high incidence of CHL: OM24

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Contact Details

Joy.MacDougall@deta.qld.gov.au

• For HI specific verification questions– Ph: 3240 9312 (Monday, Tuesday, Friday)

• For general verification questions – Ph: 3240 9348 (Jeannie Grace)– Fax: 3240 9300

• EAP Verification Team141 Merton RdWOOLLOONGABBA Q 4102