Interprofessional School-based Team Helps Child Access Auditory Information and Improve Literacy
Work Setting: Schools
Summary
Neel is a third-grade student with bilateral mild-to-moderate sensorineural hearing loss. He uses behind-the-ear (BTE) hearing aids in both ears and receives accommodations in the classroom setting, including the use of a remote microphone system, through a Section 504 plan. A team of professionals at Neel’s school created a plan focused on helping him better access auditory information and improve literacy skills over the course of the school year.
Meet the Team
Background
Nine-year-old Neel was diagnosed with bilateral, mild-to-moderate sensorineural hearing loss at 6 months old. Records indicate that Neel did not pass a newborn hearing screening in both ears. Neel’s family reported that there is no family history of childhood hearing loss. Neel has been using BTE hearing aids in both ears since he was an infant. The family uses listening and spoken language to communicate.
When the interprofessional practice (IPP) team was assembled, Neel was enrolled in third grade in his local public school. He participated in the general education environment—with academic accommodations provided through a Section 504 plan. Family members reported that Neel had no issues with oral expression or social language. They did report some concerns with (a) his grades in reading skills and (b) teacher comments on his most recent report card. His parents were concerned that Neel may need more direct support with reading skills and wanted to make sure that his hearing loss wasn’t impacting his academic skills.
The IPP team recognized that Neel’s case required joint communication and collaboration with the individualized education program (IEP) team, since Neel and his family are part of this team in addition to being part of the IPP team. Both teams needed to adequately share relevant information in a timely way. Team members concurred about the importance of mutual trust, respect, and support—both within teams and across teams.
How They Collaborated
The IPP team met to discuss and finalize the areas of assessment and mutually agreed on their roles in assessment. Each member of the IPP team met with Neel so they could assess his hearing, language, and literacy skills. Afterwards, the team met with one another to share their findings.
The educational audiologist reviewed the results of the most recent comprehensive audiologic evaluation performed by Neel’s clinical audiologist. Findings suggested a stable mild-to-moderate hearing loss with good word recognition bilaterally. A check of Neel’s hearing aids and remote microphone technology revealed that all devices were in proper working order. The educational audiologist performed an informal assessment of the school environment (e.g., classrooms, gymnasium, and cafeteria) to identify potential barriers to visual, auditory, and educational access. Finally, the educational audiologist conducted an observation of Neel’s functional listening skills in each of his classroom environments. These observations revealed that the remote microphone system was not functioning properly in math class (e.g., the transmitter was not getting powered on). Neel indicated that this had been going on for quite some time but that he hadn’t wanted to call attention to himself by speaking to his teacher.
The school-based SLP conducted comprehensive speech, language, and auditory skill assessments—including phonological awareness skills, understanding and use of vocabulary and grammar skills, auditory comprehension, and reading comprehension—which showed that some of Neel’s language skills were within the average range, and others were below average. He demonstrated age-appropriate vocabulary and grammar skills on assessment measures and in language sample analysis. On tasks of auditory comprehension and reading comprehension, Neel had difficulty recalling specific parts of multi-step directions, remembering details from orally presented stories, and answering comprehension questions for a short passage that he had read out loud. Based on the results of the evaluation and school district eligibility for special education guidelines, Neel qualified for direct speech-language services.
The SLP let the school reading specialist / literacy teacher know that when Neel read a passage out loud, he made errors decoding words, using consistent reading rate, and attending to punctuation.
Neel’s parents reported that when Neel read aloud with them, he seemed to read quickly, guessed at words, and sometimes didn’t pay attention to punctuation. They also said that he would restart or stop in the middle of sentences. They noted that Neel didn’t like to read aloud and needed reminders to slow down and pace himself.
After reviewing the evaluation results, the IPP team recommended that Neel receive direct reading, speech-language, and audiology services through an individualized education program (IEP). Once the IEP was finalized, Neel began meeting with
- the school reading specialist / literacy teacher to address decoding and fluency needs;
- the school-based SLP to identify and implement strategies for oral language comprehension; and
the audiologist to work on goals related to using his hearing technology, developing his auditory skills, understanding his hearing loss and factors that affect communication access, and proactively engaging in self-advocacy.
Treatment Outcome
The school-based SLP and the school reading specialist / literacy teacher work closely together to identify and use the same or similar reading materials in their sessions—to target Neel’s reading fluency and comprehension needs. They regularly share Neel’s progress toward IEP goals with each other and with the larger team. Data show that Neel is making steady progress toward literacy and language comprehension goals and is beginning to apply skills in the classroom and at home.
The educational audiologist provided an in-service training for Neel’s teachers and support staff to ensure that they know how to use his remote microphone technology properly. The educational audiologist and Neel’s teachers came up with a plan for Neel to leave classrooms 1–2 minutes before his peers—this gives him time to check the functioning of his hearing technology with the teacher of his next class before instruction begins. He also practices restating key pieces of directions and asking for repetition when unsure of what he heard.
Ongoing Collaboration
The IPP team sends monthly emails among team members and Neel’s family to coordinate ongoing services. In these emails, the team and the family share what is working and what needs adjustment to meet Neel’s academic needs. In addition, the IPP team checks in regularly with Neel’s IEP case manager to ensure that he is making progress toward meeting goals and objectives.
