1. T3 Referral, Notification & Reporting1 ARIZONA T 3 HOW TO TRAIN HEARING SCREENERS RENEWAL CURRICULUM: REFERRAL/NOTIFICATION AND REPORTING

2. T3 Referral, Notification & Reporting2 Referral/Notification and Reporting Learning Objectives Understand the results of hearing screening methods. Know appropriate responses to screening outcomes. Demonstrate principles of effectively communicating with parents. Understand documentation and tracking procedures. Know how to report screening results to ADHS. Understand the role of community resources.

3. T3 Referral, Notification & Reporting3 Pure Tone Screening To pass a pure tone screening, a child must respond to each of these four frequencies at the screening level in both ears: 25 dB HL 500 Hz 20 dB HL1000 Hz 20 dB HL2000 Hz 20 dB HL4000 Hz

4. T3 Referral, Notification & Reporting4 Tympanometry To pass a three-frequency, pure tone hearing screening with tympanometry, the child: Responds to the pure tone screen at 1000 Hz, 2000 Hz and 4000 Hz at 20 dB in each ear, and Reaches a point of maximum immittance in each ear within the range of +100 mm H 2 O to -200 mm H 2 O in each ear.

5. T3 Referral, Notification & Reporting5 Otoacoustic Emissions (OAE) To pass the otoacoustic emissions screening: Reproducibility must be greater than 50% in each ear; and The response must present no less than 3 dB above the noise floor at a minimum of three frequencies.

6. T3 Referral, Notification & Reporting6 Documentation Requirements The Arizona DHS Hearing Screening Rules contain requirements for: referring children who do not pass the second hearing screening test, notifying parents, and making reports to the agency.

7. T3 Referral, Notification & Reporting7 Referrals All referrals are made to the parent/guardian for follow-up with one or more of the following: Audiologist Physician Primary care practitioner

8. T3 Referral, Notification & Reporting8 Referral Conditions If a child fails 2 nd pure tone and school has an audiologist, screener may consult with the audiologist. If one of “Four Reasons NOT to Screen” is present, refer to primary care practitioner or physician. If a child fails 2 nd pure tone and school has no audiologist and parents have insurance, refer to parent who will refer to physician and/or an audiologist for further evaluation. If a child fails the 2 nd pure tone and no school audiologist and no insurance, parents may need assistance in finding care; discussed further in Resources section. If a child passes pure tone and fails tympanometry, refer to primary care physician/may be middle ear problem. If a child passes tympanometry and fails pure tone, refer to an audiologist/may be hearing loss. If only pure tone or OAE are used without tympanometry, refer to either an audiologist or health care provider.

9. T3 Referral, Notification & Reporting9 Good Listening Skills Assure privacy. Show interest in their concerns. Be attentive. Minimize distractions. Welcome their questions. Try to imagine what the parent is feeling. Resist the temptation to quickly give advice or make judgments beyond your expertise. Allow parents to clarify the meaning of the screening results, and facilitate their efforts in taking the next steps required to evaluate the child’s hearing.

10. T3 Referral, Notification & Reporting10 “How Do You Say It?” Activity Parents want you to appreciate their concern for their child’s health. Parents want clear and accurate information. Parents want you to recognize that they want the best for their child.

11. T3 Referral, Notification & Reporting11 Notifications Each of the child’s teachers Person responsible for school’s special education services

12. T3 Referral, Notification & Reporting12 Specific Program Documentation Class Screening Results Hearing Re-screening List Individual Hearing Screening Results

13. T3 Referral, Notification & Reporting13 Diagnostic and Support Services Private health insurance plan or HMO Local health department School nurse Audiologist contracted with school district Audiologist in private practice or on staff of hospital or clinic AHCCCS KidsCare ASDB Regional Cooperative Programs CCRS

14. T3 Referral, Notification & Reporting14 Early Childhood Resources Parent Outreach Program Arizona Early Intervention Program Arizona Council for the Hearing Impaired ADHS Sensory Program

15. T3 Referral, Notification & Reporting15 Hearing Screening Program Report Enrolled at the time of the first screening Did not have a first screening Had a first screening Did not pass a first screening Had a second screening Did not pass the second screening Were evaluated by an audiologist Were evaluated by a physician or primary care practitioner Were first diagnosed as deaf or hard of hearing during the current school year Were diagnosed as deaf or hard of hearing during a prior school year

16. T3 Referral, Notification & Reporting16 ADHS Sensory Program Reported results help the Sensory Program evaluate how successful our state is in identifying children with hearing loss and in providing timely and appropriate educational and medical follow-up and management.