Hearing Conservation Program (HCP)
The primary purpose of the Hearing Conservation Program is the ongoing identification and habilitation of hearing impairment for ages birth through 21 years of age. Children who are identified with hearing loss of either a permanent or medically remediable nature receive appropriate referral, aural (re)habilitation, case management, and other pertinent services that will allow them to participate fully in communicative aspects of their lives.
The Hearing Conservation Program (HCP) is a state wide
program serving Montana's preschool and school age children. The state
is broken into fourteen service areas. The Montana Rural Institute on Disabilities
(RID) has administered Area 11 (five counties in Western Montana) of the
Hearing Conservation Program since 1987.
The HCP audiologist provides training for school personnel to conduct initial screenings of school-age children, assists in follow-up screenings and on-site mini-diagnostics, issues appropriate referrals following careful review of screening data, and serves as the primary consultant for schools concerning hearing impaired children. The audiologist serves as a member of child study teams, individual education planning teams and individual family service planning teams. In addition, the audiologist screens and provides follow-up for the preschool population. Services also include conducting periodic evaluation of amplification, fitting and evaluation of personal and sound field assistive listening devices, coordinating calibration of equipment, scheduling use of screening equipment, and maintaining records.
As a result of the HCP, approximately 12,500 children are screened/re-screened each year, with approximately 150 referred for in-depth hearing testing and another 380 referred for medical evaluation (typically for middle-ear pathology, such as ear infections).
Goals and Objectives
Training Local School Screening Personnel:
Preferably, individuals familiar with hearing disorders, (that is, school speech pathologists and nurses), will be trained to oversee routine hearing screening. Training will include, but not be limited to: organization of screening, screening procedures, data collection, simple trouble-shooting for equipment difficulties or failure, and the potential for background noise interference during screening. Training sessions will be provided for personnel new to the screening program prior to the screening, with updates to returning personnel as deemed appropriate and necessary by the audiologist.
Advising and Consulting:
The area advisor shall be available to answer any questions related to hearing loss, its effects, diagnosis and treatment. The area advisor will serve as a referral source for school personnel and connected agencies and will refer to more appropriate sources when necessary.
Hearing screening will consist of an individually administered pure tone air-conduction screening. Immittance screening may be provided where equipment and trained personnel are available. Grades screened and failure/referral criterion for these procedures are in accordance with state guidelines. Initial screening will be conducted by trained personnel. Screening shall be conducted throughout the school year, with initial school screening typically conducted in the fall and early winter. Follow-up screening occurs approximately 4-8 weeks after the initial screening, and may be performed either by the audiologist or by school personnel.
The area advisor shall, when possible, be available by telephone for questions and advising for school personnel during screening. For difficult-to-test children (i.e. severely handicapped children), the area advisor shall, when possible, perform the screening for these children.
Preschool screening shall be conducted by the area advisor (audiologist) with the help of a volunteer when necessary. Preschool hearing screening will be held in conjunction with existing child-find programs. Pure tone and immittance screening will be provided. In addition, a high risk questionnaire may be used for children under two and one-half years of age who do not condition to play audiometry. When possible, portable Visual Reinforcement Audiometry (VRA) equipment will be utilized to test children under two and one-half years of age; use of this equipment is dependent upon a quiet, non-distracting environment.
The area advisor will review all screening/re-screening results and make appropriate referrals (re-screen, medical referral, audiologic referral, etc.) within one week of receiving results or within one week of completion of re-screening. Factors considered prior to referral may include, but not be limited to, screening results (pure tone and possibly immittance results), prior results, severity of loss, configuration of loss, academic performance, contact with parents, available resources, and geographic limitations. Every attempt will be made to accomplish audiologic evaluation within two to three weeks of referral.
Each medical referral form will include a reply portion to be completed by the doctor performing the evaluation. The area advisor (audiologist) will determine the need for full audiological evaluation and make referral to the area program center for that evaluation. The area advisor will work with school personnel and local agencies in order to complete referral objectives. Results of all referral replies returned will be noted in the school file and/or child's file. New files will be initiated for any child diagnosed as hearing impaired.
Amplification and Known Loss Follow-up:
Periodic follow-up of children using amplification will be performed. This may be accomplished either by phone contact or in person. Evaluation of amplification could include biological listening checks and examination of the ear mold and hearing aid. Ear impressions may be taken should the child require new ear molds. Evaluation may include electroacoustic monitoring. For children who use an assistive listening device (ALD), listening checks and electroacoustic evaluation may be performed; also, the area advisor may train appropriate personnel and/or parents in the use of (and listening checks for) the ALD. Each child with a known hearing loss will receive pure tone threshold testing periodically (typically on an annual basis); when significant shifts in threshold occur, parents will be notified and the child may receive an audiological referral. All students with hearing aids will receive annual hearing evaluation referrals in order to closely monitor aided and unaided performance.
Aural rehabilitation shall be viewed as an ongoing process. Previously identified hearing-impaired children will be followed through the school screening process. Consultation with teachers regarding students with potentially educationally significant hearing losses may take place on the day the audiologist is testing at the school; or, this consultation may be conducted by letter, handouts, or phone contact. If significant changes in hearing status occur, the need for program modifications will be discussed as soon as possible with parents and school personnel. Referrals for additional services or changes in services will be accomplished as needs arise.
Child Study Team/Individual Education Plan Participation:
When appropriate, the area advisor (audiologist) will participate in the child study team and/or individual education planning process for hearing-impaired students. This may be through written report, phone consultation, or actual attendance. Participation in this process may be organized to correspond with possible inservice or informational forums.
Inservice and Consultation:
Each school shall receive a list of children with known hearing loss attending that school. The school speech pathologist shall be responsible for distributing this information to the appropriate teachers. The area advisor would be available upon request to discuss the impact of the hearing loss on education and class participation; counseling and education will be available to educators and administrators. Inservice presentations shall be available to schools upon request or may be initiated by the audiologist.