Educational Audiology Awareness Week: Hearing Screening In Schools

In this episode of the empowEAR Audiology Podcast, we explore the importance of Educational Audiology Awareness Week with guests Dr. Kristin Jolkowski and Dr. Tori Ashton of the Educational Audiology Association, who highlights the essential role of school hearing screenings. They discuss how early identification of hearing loss impacts students' academic success and the importance of collaboration between educational audiologists, nurses, school staff, and families. The episode also provides valuable resources and advocacy tips to raise awareness and improve hearing support in schools.  #EdAudWeek  #EdAudAdvocacy

For more information:  https://edaud.org/edaudawarenessweek/

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For transcripts of this episode- visit the podcast website at: https://empowearaudiology.buzzsprout.com

Transcript

Announcer: [00:00:00] Welcome to episode 71 of empowEAR Audiology with Dr. Carrie Spangler.

Carrie: [00:00:14] Welcome to the empowEAR Audiology podcast, a production of the 3C Digital Media Network. I am your host, Dr Carrie Spangler, a passionate, deaf and hard of hearing audiologist. Each episode will bring an empowering message surrounding audiology and beyond. Thank you for spending time with me today, and let's get started with today's episode. All right. Welcome to the EmpowEAR Audiology podcast. I am so excited. I have two wonderful guests with me today as we kick off Educational Audiology Awareness Week for 2024. So first I have the president for the Educational Audiology Association Dr. Tori Ashton, and a little bit about Tori. She's in her 10th year as an educational audiologist with the Cooperative Educational Service Agency #4  in Wisconsin. She received a Bachelor of Science from the University of Wisconsin River falls and her Doctor of Audiology from the University of Wisconsin, Madison. She provided the educational audiology services to 12 school districts within a 60 mile radius. Tori is currently the president of EAA. As I've said before, and in addition to her role as president, she serves on many of the subcommittees within the Association, and in her free time, she enjoys her DIY projects, baking and reading. And I also have another wonderful EAA member with me today too, Dr Kristin Jolkowski, and she is an educational audiologist geologist serving southeast Nebraska. She received a Bachelor of Science degree in communication disorders from the University of Nebraska, Lincoln in 2004, and she received a Doctor of Audiology degree from the University of Nebraska, Lincoln in 2009. During her education, she was a research assistant at Boys Town National Research Hospital in Omaha, Nebraska, and then upon graduation, she worked at a busy otolaryngology clinic in Lincoln, Nebraska, serving patients of all ages. She found her passion for working with pediatric population and changed career setting to an educational audiologist in 2015. Kristin has a strong passion for interprofessional collaboration to improve outcomes for children who are deaf and hard of hearing. So Kristin and Tori, welcome to the podcast. I'm so excited to have you.

Kristin: [00:02:54] Thank you Carrie.

Carrie: [00:02:56] Yay! And as we kick off Educational Audiology Awareness Week, I would love, um, if one of you would just tell me if you want to just share a little bit about the Educational Audiology Association and why we are doing this.

Tori: [00:03:13] Yeah. So last year was actually our first year of celebrating, um, the Educational Audiology Association or not Association Awareness Week. Um, our goal with celebrating this week is to raise awareness about our services, hearing loss and students in the schools. Um, as well as just celebrating Ed AuDs in the work that we do.

Carrie: [00:03:38] Yeah. So I'm excited that we have this second year that we're, um, keep on doing this and raise that awareness. And I know that this year, um, we as an association really decided to focus in on, um, a couple of topics. One, just, you know, the general public and what educational audiologists do and how they impact in the schools. But we also took a deeper dive into hearing screenings. And I know most of our listeners will be familiar with this topic. But as we were talking a little before coming on the air, we all are from different states. And so how hearing screenings are done and impacted in different states is really diverse. So I guess one of my first questions for all of us, so we're kind of all on the same page is why would hearing screenings really be important for our school age kids?

Tori: [00:04:42] Um, I can kind of give like a broad.

Carrie: [00:04:44] That would be great.

Tori: [00:04:45] Answer to that one. Um, I think hearing screenings are essential for obviously identifying students with hearing loss, but I think especially those students who have been like, lost to follow up from newborn hearing screenings, or students who might have late onset hearing loss, as well as students who might experience fluctuating hearing due to middle ear, um, pathology. Um, I think hearing loss definitely can hinder academic performance. Um, and it can affect a student's ability to engage, comprehend and participate in the classroom.

Carrie: [00:05:21] Yeah. All very important reasons to, uh, screen for hearing and kind of like what you said. Um, you know, it can happen at any time. So just because they had a universal newborn hearing screening doesn't mean that later on they're not going to have difficulties with hearing, too. So, um, I guess just kind of thinking about it from a United States State perspective too. What is the current state of school based hearing screenings in the United States?

Kristin: [00:06:01] So I was looking at the American Speech and Hearing Association. They've got, um, some documents that talk about how the different states do things, and not every state actually mandates school hearing screenings yet. Um, they're still 7 or 8 states that have no requirement for hearing screenings in the schools at all. So we've got 37 states mandating it, about five that suggest it. But we still have, in my opinion, maybe too many states that just kind of let it be whatever people want it to be. And we all know that, you know, these students need to have that access to instruction to be able to make that growth in school. And so it's not something you can just observe and determine that hearing is impacting you. Really, the screening is vital to figuring that out.

Carrie: [00:06:52] Yeah, and I'm glad you brought that up, because I was just looking at our EIA awareness page online. And that is a link on the educational audiology awareness page. Is that map of the hearings? You know, the states that are actually have protocols in place and some that just suggest it and some of them that like you said, Kristin, are not doing it at all. So very interesting. But if I guess that takes me to the next question, would be those states that maybe are just suggesting doing it or not doing it and don't have any kind of hearing screening protocol in place, what would be that next step or what action steps need to take place?

Kristin: [00:07:52] So I think you have to find. Yeah, you have to find somebody who's got the gumption to kind of take on a project. And so, um, I think on the EAA page, I know the name. I can't remember what Ncam stands for. Can someone help me out?

Carrie: [00:08:09] Yes.

Carrie: [00:08:10] National Center for Hearing Care and Assessment, I think.

Tori: [00:08:14] Assessment and management.

Carrie: [00:08:16] Okay.

Carrie: [00:08:17] I was close.

Kristin: [00:08:17] So they're based in Utah, and I know that they do a lot to support with newborn hearing screenings and maybe like early childhood. And they've got some webinars, but I feel like they've got some good things to get like preschool kind of screenings in place that if you really need, I guess, a starting point, it has some training options to kind of figure out what equipment you might need, um, maybe even paperwork options on how to track it and that sort of thing. Um, school age wise, I think that's a bigger beast, because then you're dealing with the complexities of school districts and how to initiate that. But EAA, I think, has some information that can help support a why, if you need to bring that to the powers that be within your school district.

Carrie: [00:09:09] Yeah.

Carrie: [00:09:10] And it might be something too just from a legislative process to I can just speak for I live in Ohio and that was definitely it's a law. And, you know, there's laws and rules that indicate that, you know, different age levels and grade levels need to be screened in the state. So maybe another resource would be, um, again, with that ASHA link that it talks about the state hearing screening requirements and um, gives a whole list of all 50 states and what they're currently doing the as whatever state you happen to live in, you could look at that list and see exactly who you know, the ages and who can screen and all of those types of protocols, too. But I guess to kind of talking to both of you, what has been, I think, Tori, you said you live in a state that, um, doesn't have. It's just optional if they decide they want to do it or not. So what have been some of the barriers, do you think, for implementing a protocol?

Tori: [00:10:25] Um, I definitely think it's one of the major ones is we don't mandate it here in Wisconsin, so schools don't have to do them. Um, but in my experience, I found that other barriers have just been, um, resources. Some of my rural schools don't have the appropriate equipment to be able to even screen a student. Um, also, having trained people who are able to, um, complete a hearing, screening time has been a big one. Time, some of our schools have just one nurse or a health aide, and they can't get through all the students that would need to be screened. Um, so those are, I would say the major ones that I've seen is just resources, train people and then time overall to get them done. Um.

Kristin: [00:11:13] I would agree even Nebraska does mandate, but I think some of those barriers still exist that it is mandated. But it's very stressful because it's mandated because you don't always it's hard to find the time, and it's hard to find a spot in a building to actually do the screening and training. Um, all of that still becomes a, a burden that sometimes is hard to meet. We have to meet it because it's mandated, but it's still difficult.

Carrie: [00:11:50] Yeah.

Carrie: [00:11:51] And I guess, um. What could we, I guess, what is the why? I mean, like, I mean, do we go back to the why of why it's important to to do the, the hearing screening? Do you think that would make a difference if administrators or special ed coordinators or teachers understood from a crucial point of view why a kid sitting in a classroom who has unidentified hearing loss would be struggling?

Tori: [00:12:31] I definitely think so. I think I mean, hearing loss, not teachers don't always know as much or what to be looking for for a student who might have a hearing loss or are having trouble focusing in class. I think sometimes it just gets put onto being like an attention issue, when really it it might not be. So I think there's kids who have maybe been misdiagnosed or mismanaged, even in the school setting where, you know, had we done a hearing screening and identified that there was a hearing loss, their accommodations in the classroom and supports would probably look very different.

Carrie: [00:13:08] Mhm.

Kristin: [00:13:09] And I think the piece, just like with newborn hearing screenings, the I don't know if we say selling point, but the why and how you can help convince is the sooner you identify these hearing needs, the sooner you can put those accommodations and supports into place. And then the less impact that hearing loss has over time, which tends to save districts money because you don't have to put as big and as expensive as supports in and so trying to have that be a leading point if you're talking to. Um, administration or superintendents or legislatures about maybe a cost. Savings as a benefit can be a way to get the wheel moving a little bit faster.

Carrie: [00:13:59] Yeah. And I'm just looking at our infographic on the EAA website about. Hearing screenings. And it talks about the unaddressed hearing loss is expensive and like due to so due to the potential for academic underperformance and subsequent lost wages as adults. Unaddressed hearing loss can cost about $750 billion annually. So I mean, I know that's not per person, but still, if you look at it from that big like dollars and cents perspective, um, doing a what? Three minute hearing screening at a school can really save a lot of money in the long run.

Carrie: [00:14:43] Yeah.

Carrie: [00:14:45] And, eh, I guess if we kind of step back again in a perfect world. Um, let's just maybe talk about what hearing screening could or should look like within within the school type setting. Who would really be the ones doing the screenings, and what grades might you want to make sure that you're capturing?

Tori: [00:15:17] I think I most common ones that I've seen, if a school is doing a hearing screening, it's been the school nurse. Um, sometimes it's the SLPs. Um, I definitely think us as educational audiologists are the ones who can be completing hearing screenings, whether it's you partner up with your school nurse And SLP to get through students, or if that's a role that the educational takes on educational audiologist takes on themselves. Um, I also think that um, or like what grade levels the EAA or the Educational Audiology Handbook has a whole chapter on hearing screens as well. So that's another good resource to look into. But um, they've talked about, you know, like the early childhood age groups or like at Child Find. Some schools do those child find days before the kids come into school. Um, having hearing screenings done then um, at kindergarten, some of the other grades that were mentioned were first grade, third grade, fifth grade, seventh grade, or ninth grade as all options of populations that could be tested. Um.

Kristin: [00:16:31] I think that getting that early childhood, the preschoolers and the early elementary schoolers, because that's really where you want to there in those vital years of of learning to read and learning that language. And, um, you want to identify any hearing needs quickly in Nebraska mandates preschool for fourth grade every year they have to be screened, and then it becomes seventh grade and 10th grade. So it's a lot of that preschool elementary time. And then once in middle school, once in high school. But I think that that preschool early elementary, that's that's the the time you want to find this, you can put those supports in so that you can keep kids developing on track.

Carrie: [00:17:19] Yeah.

Tori: [00:17:19] I also think, um, another population to include a screening on is any student who is being evaluated for speech and language services. I definitely don't feel they should go through an evaluation without a hearing screening haven't been completed.

Kristin: [00:17:36] I would second that wholeheartedly. I even sometimes yeah, I sometimes even think, um, some of our kids that might have some behaviors in the school setting that I want them screened because I don't know if. Are they, are they having behaviors because they're not able to access and hear as well as they could? Attention, focus, all of that stuff. Speech, language, attention, focus, behavior, all of that.

Carrie: [00:18:07] Right.

Carrie: [00:18:09] Yeah. So essentially, any child that is being referred for any kind of specially designed instruction, um, would be good to do a hearing screening for.

Kristin: [00:18:24] Agreed. Yeah.

Carrie: [00:18:26] And then in Ohio, um, just a few years ago, we added 11th grade on. And it is interesting since we've added that on how many kids are being referred because of noise induced. So they're getting a little, you know, they're not passing at like 4000Hz. So it's interesting that we have this group of, uh, students who and the other end of the school age years who are not passing hearing screenings, too.

Kristin: [00:19:00] That is true. I kind of forget that they all hang out with their AirPods in and yeah, music cranked and loud music. Yes. Yeah.

Carrie: [00:19:11] So another awareness of uh, for educational audiologist is the impact of noise on hearing too.  You kind of mentioned a couple of these things. Kristin, you mentioned like some of those kids who may, you know, have some behaviors within the classroom that may be kind of a red flag of, hey, have you checked out their hearing yet? Are there any other red flags for either parents or teachers that we should be thinking about? For kids who definitely should be screened for hearing?

Tori: [00:19:49] I think the probably the easiest and most common would be for those students who seem like they're daydreaming or not following along. Mhm. Um, articulate.

Carrie: [00:20:01] Yeah.

Kristin: [00:20:01] Articulation concerns. So if you are having trouble understanding a child's speech, sometimes the speech that's produced is related to the sound that they hear. So you want to rule out or rule in any hearing needs that could be impacting that. I'm going to throw out there. Um, and I don't know if this is sort of a tangent, but, um, our neurodiverse population,  kids on the autism spectrum, I think, and I don't know the research that's there, but I think that they're later identified just because of the confounding nature, um, of just their development with the ASD diagnosis, that finding a way to have those kids screened for hearing.

Carrie: [00:20:51] Um, would.

Kristin: [00:20:52] Be good, too.

Carrie: [00:20:53] Yeah.

Carrie: [00:20:54] Because I think there's research that shows what, like 40% of kids who have additional needs have some sort of hearing loss. So whether it's conductive or sensorineural loss, um, that's probably a population that doesn't always get screened because they're more difficult to test. But it could definitely be impacting the bottom line of why communication is difficult or learning is difficult as well. I always think about our kids who are struggling to read and have any kind of phonological awareness like, well, are they hearing the sounds or are they not? So making sure that we're screening that population as well?

Carrie: [00:21:45] Definitely.

Carrie: [00:21:48] Well, let's just say that a student goes through a hearing screening process and they are a non-pass or they fail their hearing screening. What would be the next step of what would happen next? In a perfect world.

Tori: [00:22:10] Kristin, I want to turn to you since your state does mandate and mine doesn't.

Kristin: [00:22:14] So in in the utopia that I want, I guess that family would be notified that their child did not pass their hearing screening and given an array of contact information for an audiologist that they could contact and have a diagnostic hearing evaluation completed. And then whoever that audiologist was that completed the diagnostic would, you know, provide the resources for if they needed. Ent physician consultation, um, kind of what the next steps would be from there in regards to whatever the hearing findings were, that would be idealistic and they would do it in like two weeks and.

Carrie: [00:23:02] They'd.

Kristin: [00:23:02] Magically get into the ENT in a month. It would be great.

Carrie: [00:23:07] Yeah.

Carrie: [00:23:07] And then they would share the results back with the school.

Carrie: [00:23:11] Exactly.

Kristin: [00:23:12] Yes. They would. They would sign some releases of information where we could all collaborate together to support the student. Right. That would. That would be my utopia.

Carrie: [00:23:24] Yeah. I would.

Tori: [00:23:25] Even include, um, I have done it for some of my districts that are screening is they'll pull me in to do re screens. So any of the students who did not pass a few weeks later, they have me come in and re screen them. But then they also sometimes include like those difficult to test. So the students that they couldn't get tested, they'll ask me to test them as well. Um, so I even think, you know, waiting a few weeks and doing a re screen. And if they still are not passing, you know, you're notifying family again. I would notify them both times, but again that your child did not pass. And you know, here's what you need to do for follow up.

Kristin: [00:24:03] I would agree with that to our state. Um, at least with the districts I work with do like a two tiered screening. So they screen, wait a couple of weeks, screen again, and then would refer on after that. So yeah, because I think if you, I think having that two tiered kind of thing is important to keep the screening protocol and process from kind of going overboard and having a lot of kids that may pass the second time. Um, bogging down some of the community audiology availability.

Carrie: [00:24:43] Do either of you are you the next step sometimes in the process for more of an assessment if they don't pass a screen?

Tori: [00:24:56] I am. Um, sometimes it kind of depends. Sometimes they'll if they're in eval, they will add me on to the eval to do a full hearing assessment. Other times the districts with parent consent just ask me to come in and do more of an eval versus just a screen to get more information. And we go then then we go from there to see what we need to do. But now I would also say not in all cases.

Carrie: [00:25:25] Yeah.

Tori: [00:25:26] So I would kind of depends. Yeah.

Kristin: [00:25:28] I would kind of second what Tori said. So for students that didn't pass, but there's definite educational concerns and they're either doing like a mtss multi-tiered systems of support kind of intervention process, or they're moving into evaluation to look at that specialized special education situation. They'll bring me in most of the time. Um, for students where it doesn't seem to be impacting school yet, then it depends. Sometimes I get brought in and I become I've gone out and done rescreens or I've, um, contacted family to be kind of a more of a support of why it's important to follow up.

Carrie: [00:26:16] Yeah.

Carrie: [00:26:17] Yeah. Sometimes having that, I don't know more in in-depth testing at the school. And then if you have community connection with the clinical pediatric cardiologist at a hospital or clinic, we can help facilitate that conversation. And the importance, like what you just said with the parents of following up and why that next step is really critical in that hearing screening process. I was just trying to think, is there anything I missed with the hearing screening that we wanted to promote for Educational Audiology Awareness Week? I mean, I think we covered like the ages and why it's so crucial to have hearing screenings. And if you don't have it in your state, we have those resources on the website that really can help with advocacy and maybe getting moving the needle to more, um, screenings within within your state too. But yeah, just that foundation for literacy and phonemic awareness and academics. If they're missing auditory information within our classroom. Um, and then really involving us as educational audiologist to in that hearing screening process. Did I miss anything?

Kristin: [00:27:44] I can't think of anything. I feel like we kind of touched. We I think of the importance.

Carrie: [00:27:50] And.

Carrie: [00:27:51] I think it would be a great way to kind of plug into why educational audiologists are important for your school districts. To one of you guys want to give a little spiel about getting an educational audiologist or why you should have one on your team?

Carrie: [00:28:17] I mean.

Kristin: [00:28:18] That. Yeah. I'm going to defer to Tori.

Tori: [00:28:21] I will say Wisconsin does do a really good job at I mean, we have a number of educational audiologists throughout our state covering a lot of our, a lot of our state that most districts have access to an educational audiologist in some way, whether it's they're going through, you know, our state agencies that we have, um, we have some who have private practices that go into schools. Um, but I think sometimes for schools, it's we really need to advocate for our services and what we can do for them. Because I in my experience, most of the times, the schools don't really know all that we could provide for the students and not just students on IEPs, but students, you know, all of their students with like hearing screenings, but or, you know, classroom amplification systems or all things that we can cover and help districts with. But I think really just communicating with your administration on the different, different roles that we have in, in the schools and why, you know, yes, students might have clinical audiologists, but why do they also need a school audiologist? Is our roles differ a little bit but are also very similar?

Kristin: [00:29:41] I would agree Nebraska is pretty good with educational audiology in the more urban eastern side of the state because we're just a denser population. But, um, it's a little more sparse as we get to the more sparse rural part of our state. And I think, like you said, it's building that relationship with your school teams. I've even noticed that in my job, when I start to have more students in a building, then I also start to get like school psychologists reaching out to me like, oh, hey, I've got a question. And so it's that, um, when you're seen and your, your skills are seen, then people start using you more. And so it's hard for how do you, how do you build that in a place that doesn't have an educational ideology yet? Because I think if they did, then they see the value that we have and they start utilizing our services more, but it's building that capacity in the areas that don't have our profession as of yet.

Carrie: [00:30:46] Mhm. Yeah.

Carrie: [00:30:48] And I think in our state, um, I've really tried to network a lot with our partners, our speech language pathologist in the state, and they're in every school, uh, no matter what. And just really marketing and sharing like this is an IDEA related service and this is what I can do for you, to help you. And this is how you can help advocate for having an educational audiologist and within your district, or compact or whatever your school district is to. So yeah, I agree. Just getting out there, marketing and sharing all of the, um, different things that we can do for students, whether they are, um,  for specially designed instruction or just students sitting in the classroom that need to be able to to listen every day and communicate.

Kristin: [00:31:52] And I think we have a nice role in supporting families, because clinical audiology, in my experience, has a much, uh, there are just time crunched. It's it's a time crunch kind of setting where I've spent time trying to really help parents understand all of the jargon that they got fed at the clinical audiology side. Um, while I think clinical audiology tries very hard to to help that be clear and understood, there's just that time crunch that changes where I can take a little bit more time to help parents have a better understanding of how their child's impacted and what the supports that could benefit them in that sort of thing.

Carrie: [00:32:37] Yeah, which is another great point, like our connections with our pediatric and clinical audiologist and how we can help bridge that gap together so that our students succeed. And how do you. Right. You know, they can help empower parents to to advocate for having that service within the school. So if we kind of close up today with our podcast, I thought I would ask, Tori. What do you what what can people find on the educational audiology web page to really celebrate Educational Audiology Awareness Week?

Tori: [00:33:24] Um, we have some different links to documents specifically about hearing screenings. I know we mentioned the one from ASHA. We linked to that. We have a few that EAA has created. Um, there's like fun coloring pages you can print off for your students. So if any Ed AuDs are, you know, seeing their students within that week, they have some, you know, fun activity that they could do with them. Um, different social media posts that, you know, you guys can put on your own pages to help promote educational audiology, um, awareness as well as hearing screenings. Um, I think too on our website, if a good document and I have used it, you know, in talking with school districts is our scope of practice. Um, again, every state is different. How it looks in every state might be slightly different, but that's a really nice overview of all of the things that we can do as educational audiologists. Um, another thing I was going to mention is that this week, um, and so the National Center for Hearing Assessment and Management, along with ASHA and EAA, we're kind of co-hosting a webinar, um, that's entitled In Identifying Children with Hearing Loss the Key Roles of an SLP and Educational audiologist, and evidence based screenings and follow ups. So if you can't catch that one live, um, it will be on NcHAM's website to view too. So I would definitely encourage anyone to do that resource or webinar.

Carrie: [00:35:05] Yay!

Carrie: [00:35:06] Well, yeah. So definitely visit the EdAuD.org website and I'll link that in the show notes as well. And if you are out there on social media, make sure you use the hashtag #edaudweek or hashtag #edaudadvocacy so that our resources can get shared by many, many others. So as we wrap up again, um, I just want to say thank you, Kristin and Tori for joining me and the empowEAR Audiology podcast. And as we kick off Educational Audiology Awareness Week. So thank you for joining.

Tori: [00:35:48] Thanks for having us.

Kristin: [00:35:50] Yes. Thank you.

Announcer: [00:35:51] Thank you for listening. This has been a production of the 3C Digital Media Network.