By Cheryl DeConde Johnson, Susan Dillmuth-Miller, Sarah Florence, Kym Meyer, and Rachel Parkington
Most d/Deaf or hard-of-hearing students need audiological support as part of their school special-education services. To meet this need, audiologists in clinical practice are encouraged to support their student patients. To assist, this article offers guidance regarding the audiologist’s potential contributions to the individualized education program (IEP) and the experiences of non-school-based audiologists.
Overview of IEP Requirements for Audiology Services
The Individuals with Disabilities Education Act (IDEA, 2004) contains procedural requirements for assessment, eligibility determination, and the development of services and supports for student IEPs.
These services, including audiological assessment, are provided to children at no charge under the IDEA requirement for a free and appropriate public education (FAPE). However, non-school-based audiologists frequently perform audiological assessments that are billed to insurance or Medicaid. Participation in the remaining steps of the IEP process can be challenging unless audiologists understand special-education eligiblity procedures and the way they contribute to supporting their patients’ needs.
|PART 1. DEVELOPMENT, REVIEW, AND REVISION OF THE INDIVIDUALIZED EDUCATION PLAN (IEP) [34 CFR §300.324]|
|REQUIRED INFORMATION||AUDIOLOGIST’S CONTRIBUTION|
|Strengths of the child||Describe communication skills and ability to accommodate the hearing condition, self-advocacy skills, etc.|
|Parental concerns for enhancing their child’s education||Describe concerns parents shared through the assessment process.|
|Results of the initial or most recent evaluation||Describe audiological and functional assessment data regarding hearing condition, listening performance, use of hearing and/or other technology, and classroom acoustics.|
|Academic, developmental, and functional needs||Describe services and accommodations needed to address impact of the hearing condition or auditory-processing deficit (APD) on academic performance, communication skills, social/emotional wellness, hearing condition acceptance, self-advocacy, management of personal/assistive amplification, knowledge of hearing condition/APD, and use of accommodations.|
|Consider special factors:
||Address language and communication needs relative to communication and learning abilities in various classroom situations, and the need for accommodations and services specifically addressing hearing and other assistive technology devices and accompanying services.|
|PART 2. COMPONENTS OF THE IEP [34 CFR §300.320]|
|REQUIRED INFORMATION||AUDIOLOGIST’S CONTRIBUTION|
|Statement of present levels of academic achievement and functional performance||Provide audiological and functional assessment data regarding the hearing condition, listening performance, use of hearing and/or other technology, and classroom acoustics.|
|Statement of measurable annual goals, including academic and functional goals||Assist in writing annual goals for auditory and listening skills, use and independence with hearing technology, and self-advocacy for appropriate accommodations, etc.|
|Description of measurements to document annual goal progress and frequency of progress reports||Describe frequency of delivery of progress for parents, which can be combined with other special-education reporting.|
|Statement of special education and related services and supplementary aides and services to be provided to child||Describe necessary audiology services: annual/more frequent hearing evaluations, classroom acoustic modifications, personal hearing technology/hearing assistance technology (HAT), and services including orientation and monitoring, auditory- and listening-skill development, and self-advocacy development.|
|Statement of program modifications or supports for school personnel to enable child to attain annual goals, make progress in the general education curriculum, and be educated and participate with other children with/without disabilities||Recommend accommodations based on assessment results and classroom listening needs; describe necessary teacher/staff support and training needed to ensure accommodations implemented.|
|Statement of individual accommodations necessary to measure the academic achievement and functional performance on state and districtwide assessments||Report accommodations needed to enable student to participate in assessments (e.g., accommodations, hearing technology).|
|Projected date to begin services and modifications and anticipated frequency, location, and duration of services and modifications||Report service-delivery data; consider short-term and long-term services based on student needs.|
|For transition students (16+ yrs), appropriate measurable post-secondary goals related to training, education, employment, independent-living skills, and the transition services needed to assist in reaching those goals||Report information to assist student in developing goals based on access needs, knowledge of rights, and services through Americans with Disabilities Act and other agencies; provide community linkages necessary to continue hearing- or processing-related services once the student graduates.|
TABLE 1 describes the required information that pertains to IEP development and suggested contributions of audiologists.
Non-school-based audiologists often seek ways to ensure that their patients are receiving the school support they need, especially for monitoring their personal hearing instruments and the use of remote microphone (RM) hearing assistive technology (HAT). Adequate support is more difficult to achieve when an educational audiologist is not working in the schools.
Non-school-based audiologists may consider contracting with schools to provide these services. The Educational Audiology Association’s Guidelines for Developing Contracts for School-Based Audiology Services (EAA, 2018) is useful for this purpose.
In the discussion that follows, four audiologists from private and public non-school-based practice settings describe their experiences supporting students in their education settings, including participating and providing IEP services to ensure audiological, communication access, and educational needs are met.
Hear to Learn, NH
The IEP team looks to me, as a privately contracted provider providing in-person services, to provide information and guide decisions that may be related to eligibility, services, and accommodations.
When asked to provide input regarding assessments for students, it is my responsibility to recommend tests that will provide insight into the student’s hearing or auditory-processing deficit (APD) and functional or self-advocacy assessments that affect the student’s school performance and service needs.
To do this effectively, I must keep current on available assessments that would be best for each individual student. When invited to an eligibility-determination meeting, I interpret my assessments and those completed by the clinical audiologist.
Tips for Supporting Student IEPs
- Be familiar with pertinent federal and state IDEA regulations.
- Review the school district’s website for information about audiology and special-education services for students who are d/Deaf or hard of hearing.
- Review the student’s IEP services with the parents.
- Determine if there are gaps in audiology and other education-related services for students who are d/Deaf or hard of hearing.
- If appropriate, inform parents of their right to appropriate assessments and services for their child under IDEA.
- Be familiar with local and state parent-advocacy resources and organizations (e.g., Hands & Voices, AGBell, and the federally funded state special-education Parent Information Centers).
The school staff often ask questions such as “how would you describe this hearing loss,” “how does this hearing loss impact the student’s education,” “should we categorize this student as d/Deaf, hearing impaired, or d/Deaf/blind?”
I assist summarizing the hearing loss/APD, educational impact, evaluations, accommodations, and develop self-advocacy goals. Many meetings during the 2020–2021 school year are being held remotely. This allows me to schedule and attend meetings that I may not have been able to attend if held in person. I have seen the benefit of having all team members present, whether face-to-face or on Zoom, as we each bring specific expertise regarding student-access supports.
As a contract provider, the biggest challenge for me is inclusion in the planning and meetings. This occurs even when the student’s primary diagnosis is hearing impairment and I am an established member of the team. I often hear “we forgot” or “we did not think it was necessary.” When you are not an employee of the school district, or if the team is large, it is common to be overlooked.
If I am not able to give input to the team, the hearing evaluations may be summarized incorrectly or may not be mentioned in the student’s eligibility forms and IEP document. Without my guidance, educational audiology service hours often are not written into the service grid.
Occasionally, I am told by staff members that, if they add my services, they are not sure how the district will respond. I have also been told that my services are unnecessary in the IEP and the schools do not want to spend additional funds. In these cases, it is always helpful to have information about the role of the educational audiologist (EAA, 2018; 2019), the National Association of State Directors of Special Education Guidelines (2018), pertinent IDEA regulations, and any other materials to advocate for your position.
Typically, the more I can participate in IEP or other team meetings, the more the teachers and school administrators understand and value my services, which generally leads to a contract for my time.
DotCom Therapy, CO
As an audiologist contracted to provide services remotely, I am involved in all functions of the IEP team including evaluation, eligibility determination, and the development of the IEP. Because excellent communication between on-site school personnel and a remote audiologist is critical, my participation in the IEP meeting and development process is generally smooth.
When services are provided in a fully remote state, I coordinate and schedule audiological evaluations at a local clinic or obtain copies of results from the student’s personal audiologist. Additional information may be obtained from the student’s classroom teachers via questionnaires or inventories.
Upon receipt of records, and through collaboration with a teacher of d/Deaf or hard of hearing students, eligibility can be determined and recommendations can be made for appropriate accommodations. Depending on the individual school district,
I may have direct access to edit the IEP draft but, commonly, I work with the case manager to insert my contributions.
Many districts that are using fully remote educational audiology services are either rural or districts with few students with reduced hearing. In these cases, the biggest challenge with the IEP team stems from their unfamiliarity with special-education eligibility for students who are d/Deaf or hard of hearing.
In these circumstances, my role may be more like that of an advocate. It is important to recognize the balance between representing the needs of the student while also helping school personnel understand your role on their team.
Historically, attending IEP meetings remotely was challenging, often because the meeting participants would forget to include my input. However, under COVID-19 restrictions, remote-meeting attendance has become expected and increasingly welcomed. As a result of increased participation, providers are present to discuss their findings and recommendations in a more collaborative manner.
The Learning Center for the Deaf
Prior to the development of Public School Partnerships (PSP) at The Learning Center for the Deaf in 2002, educational audiology did not systematically exist in our state outside of two major cities, each of which had one educational audiologist.
Previously, hospitals did hearing tests and the school-based speech-language pathologist interpreted them. Audiologists were not involved in the IEP process. Once PSP offered contract educational audiology services, our increasingly growing team of educational audiologists provided in-district support to students who are d/Deaf or hard of hearing and who are educated within their home school districts.
Hospital settings still provide clinical hearing and auditory-processing diagnoses to the school district. Our contracted educational audiologist interprets for the IEP team how this information relates to auditory access to the curriculum. In addition, the contracted educational audiologist observes the student in the classroom and identifies other tools to evaluate the child’s access to the curriculum and inform IEP goals and services (e.g., teacher and student questionnaires).
These tools can help inform the IEP goal development, accommodations needed, and service delivery. The educational audiologist may be “put on the grid” (special-education “speak” for adding the audiologist to the service-delivery team) to provide ongoing consultation to the IEP team or even regular observations of the student in classes to help teachers implement classroom accommodations.
Educational audiologists partner with teachers of students who are d/Deaf or hard of hearing and the school’s speech-language pathologist. The educational audiologist’s training, expertise, and scope of practice cover a gap that these other professionals cannot fill.
A contract-consultation model can be challenging because you are not physically present and, as a result, may not be invited to IEP meetings or consulted when new students who are d/Deaf or hard of hearing move to the district. Our educational audiologists check in with the administrators and their school-based contacts to ensure we are meeting student needs and preventing students from falling through the cracks.
East Stroudsburg University, PA
As a clinical audiologist in a rural communication and sciences disorders (CSD) program, my role in IEP development varies across school districts and has changed over time. At first, not all districts had access to an educational audiologist, so I was contracted directly by the districts.
As school districts gained access to educational audiologists, I continued consultation for children in unique circumstances, including children needing access to transportation to the school-based educational audiologist, those enrolled in private schools, students from other counties without an educational audiologist, and those needing assessment for APD and/or treatment. The parents typically determine my level of involvement with the IEP.
Many of my consultations involve children with APD. Parents seek my services for evaluation and treatment. I see children who have APD, but are not necessarily eligible for speech and language services through the school. I assess for eligibility determinations, functional assessments, and explanations of how the APD interacts with listening in the classroom, academics, and auditory comprehension.
The graduate speech-language pathology students under my supervision play a role in relating functional performance to their assessments and provide in-service training to school staff. Students are seen in our clinic for auditory-skills treatment, often a service not provided in the schools.
This intervention is provided by supervised university graduate students. Parents share my reports and progress reports with the school case manager, give me permission to discuss them with the school team, or invite me to the IEP meetings.
As a consultant, I am an outsider to the school and my involvement is overlooked, unless parents advocate for my presence. Another challenge is a heavy teaching schedule during school hours, limiting my availability for IEP meetings. Our evaluations provide important information to the IEP and often prompt the team to agree to a consultation with the school-based educational audiologist.
This article is a part of the January/February 2021 Audiology Today issue.
Educational Audiology Association. (2012) Guidelines for Developing Contracts for School-Based Audiology Services. www.edaud.org/position-stat/8-position-06-12.pdf (accessed November 20, 2020).
Educational Audiology Association. (2018) Supporting Students who are Deaf and Hard of Hearing; Shared and Suggested Roles of Educational Audiologists, Teachers of the Deaf and Hard of Hearing, and Speech-Language Pathologists. www.edaud.org/position-stat/15-position-02-18.pdf (accessed November 20, 2020).
Educational Audiology Association. (2019) Educational Audiology Scope of Practice. http://edaud.org/pdf/scope-of-practice.pdf (accessed November 20, 2020).
Individuals with Disabilities Education Improvement Act of 2004. (IDEA 2004) Public Law 108-466, 20 U.S.C. Section 1400 et seq. https://sites.ed.gov/idea/statuteregulations/ (accessed November 20, 2020).
Johnson CD, Seaton JB. (2021) Educational Audiology Handbook. 3rd ed. San Diego: Plural Publishing, Inc.
National Association of State Directors of Special Education (NASDSE). (2018) Optimizing Outcomes for Students who are Deaf or Hard of Hearing: Educational Service Guidelines. 3rd ed. Alexandria, Va.: NASDSE. www.nasdse.org/docs/nasdse-3rd-ed-7-11-2019-final.pdf (accessed November 20, 2020).