1. Field Experiences with Mobile Screening Technologies
Carmen Strigel, RTI International

2. Context Ethiopia 2016/2017 USAID-funded READ TA activity
3,725 grade 2 students from 63 schools in 5 regions
Baseline activity for 3-months intervention on teacher adoption of inclusive instructional practices in mainstream reading classrooms
Philippines
2018
USAID-funded ACR Asia Task Order
1,232 grades 1–3 students from 8 schools in 2 regions
Pilot study on teachers’ effective use of screening tools in school context; also compared to medical screeners and government-employed data collectors

3. Screening approaches, by definition, are rapid and simplified measures
What is Screening?
Process conducted by a non-medical person to determine whether a student might have a potential disability.
Does not result in, or replace, a medical diagnosis by a trained professional
Screen only for some aspects of a potential disability
Used to determine the need for referral and further evaluation
Screening approaches, by definition, are rapid and simplified measures
Measuring visual acuity when screening for a potential vision impairment, e.g., will not detect potential challenges with a child’s depth perception.
Screening tools may be less sensitive (not detecting a possibly disability) or more sensitive (e.g., indicating a potential hearing impairment due to confounding ambient noise) than formal medical evaluation tools.

4. Screening Devices Ethiopia – local TENCO Android phones
Philippines – local Iconia Talk Android tablets

5. Hearing Screening – hearScreen, SA
Pure tone audiometric screening 
Screener-administered
Default protocol – sounds at 3 frequencies both right and left ear
Clinically validated (Faheema et al., 2016)
Proprietary tool
Headset calibration to specific hardware
HearScreen is a mobile-phone/tablet-based hearing screening tool with increasing application in low and middle-income contexts, originally developed in South Africa. HearScreen requires the use of a professionally calibrated noise-cancelling headset, in addition to the app on the mobile device. It allows for screening with a range of protocols, but by default entails a pure noise audiometric assessment at three different frequencies for both ears. During screening, the child wears the headset and is asked to indicate when and in which ear she hears a sound by raising the respective arm.
The application automatically re-tests any child with a potential hearing impairment to confirm results given the sensitivity of pure tone audiometry to ambient noise. In a validation study with 1,070 school-aged children in South Africa, hearScreen obtained a sensitivity of 75.0% and specificity of 98.5% compared to conventional screening audiometry (Faheema, Swanepool, Eikelboom, Myburgh, & Hall, 2016).

6. Vision Screening – PeekVision, UK
Peek Acuity is a vision screening tool that utilizes the tumbling E optotype standardized vision screening charts described under 2.2.1, but on a mobile phone. In addition to facilitating scoring and data management using the mobile device, the tool also contains a simulation to simulate the degree of potential vision acuity of a person with vision impairment to persons without a vision impairment. A recent validation study conducted with 393 children aged 6-16 in Paraguay obtained a sensitivity of 48% and 83% specificity compared to a medical evaluation by a pediatric ophthalmologist.
While sensitivity was relatively low, two alternative approaches for vision screening by non-medical professionals, a single line of tumbling E optotypes set at 20/40 and the Spot Vision Screener, yielded similar scores to Peek Acuity (De Venecia, Bradfield, Møller Trane, Bareiro, & Scalamogna, 2018). In the Asia region, Peek Acuity has been empirically studied in India, with additional screening programs planned in Indonesia, Pakistan, and the Philippines.
Vision acuity screening
Screener-administered
Already piloted in Ethiopia and several other countries in Africa and Asia
Clinically validated (De Venecia et al., 2018)
Proprietary tool

7. Field Experience Findings
Significantly more children - already in school - were referred for having potential vision or hearing impairment than teachers, DPO, and MOE staff anticipated (Ethiopia)
Technology-mediated tools were appropriate for both contexts and target groups
Ethiopia endline: 70% of teachers reported having become very comfortable, 25% somewhat comfortable, with the screening tools
Strong and easy adoption of vision screening tool among all types of screeners in both contexts
Strong feasibility using the vision screening tool at schools in both contexts
Good adoption of hearing screening tool among all types of screeners
Requires more intensive training effort on software and logistics
Ethiopia:
4.86% of children flagged for HI: 2.1%mild; 0.7% moderate; 0.7% moderate-severe; 1.3% severe
5.37% of children flagged for VI: 1.9% mild; 2.8% moderate; 0.7% severe

8. Field Experience Findings
Challenges with background noise for reliable hearing screening (context differences)
Requires in-depth pre-testing of screening protocols and logistics
Careful, context-specific consideration of socio-cultural aspects of screening activity
Risks of labeling and stigmatization as a result of screening activity
Parental consent and concerns
Pathways for effective referral and concrete intervention
Careful consideration of school-based screening activities to be purposeful and coupled with disability awareness initiatives
Selection of screening tools
type of disability to screen for
purpose of the screening activity
age of the child
screening context
resources available
False positives