Specialist Teaching Service

Introduction

The LEA adopts the philosophy of Natural Auralism for the majority of hearing-impaired children in Leicestershire. The Natural Aural philosophy is an approach to the education of hearing-impaired children which uses children's residual hearing as the medium of learning through which they are enabled to acquire speech and language in a similar manner to hearing children, albeit often at a slower rate.

Underpinning this approach is the constant monitoring and assessment of hearing-impaired children's hearing in order to ensure maximum use of residual hearing. Naturally, only when best use is made of residual hearing is the hearing-impaired child ensured high quality access to the curriculum and the best possible learning environment. For the small number of pupils who are not following a natural aural approach, the importance of effective and appropriate audiological management still cannot be overstated if the goal of the highest level of fluency in English and of maximum participation in mainstream environments is to be achieved.

Hearing Assessments:

The Hearing Impairment Team is routinely involved in the assessment and monitoring of hearing in seven main areas:

1. Diagnosis of hearing loss in pre-school children.
2. Diagnosis of hearing loss in school aged children.
3. Monitoring the hearing levels of known pre-school hearing-impaired children.
4. Monitoring the hearing levels of known hearing-impaired school aged children.
5. Monitoring of those children held in the Hearing Impairment Team's 'holding bank.'
6. Assessments of the hearing thresholds of children attending schools for the severely learning disabled.
7. Assessment of school leavers and those in the further education sector.

Assessment of this nature is generally undertaken by Educational Audiologists (often in conjunction with Staff Grade Practitioners or Senior Medical Officers from the Fosse Health Trust) and Medical Technical Officers in community clinics. Referrals are generally made by Health Visitors, GPs, Speech Therapists or ENT Consultants.

There are two types of community clinics involving pre-school children;

• Paediatric Audiology Clinics staffed by an Educational Audiologist (EA), Medical Technical Officer (MTO) for children aged around 8 months to around 3 years.
• Special Audiology Clinics again staffed by the EA and MTO but also in conjunction with Staff Grade Practitioner for young and very young children who have special educational needs.

There are usually one of five likely outcomes of these assessments:

The assessment takes place in hospitals and/or health centres. For further details of these clinics and their related policy document please see the document entitled Children's Audiology Strategy (Fosse Health Trust).

School aged children are sometimes referred to the Specialist Teaching Service by ENT staff who feel they can offer no further treatment or who have been diagnosed as having a permanent hearing loss. However, more often referrals are received from the Fosse Health Trust where hearing tests carried out by MTO have been vetted by an Educational Audiologist and it has been decided that such children's hearing difficulties may have educational implications.

These 'new cases' are then investigated by a Teacher of the Deaf (TOD) and a battery of educational tests, including full audiometric analysis and speech discrimination are carried out. The aim of this testing procedure is to establish if there is any immediate or long term educational difficulty resulting from the child's hearing loss.

If there are positive findings the child forms part of the Hearing Impairment Team's caseload immediately and is usually fitted with hearing aids. If the issues are less clear, then the child is monitored by the TOD who reports to a New Cases conference held on a twice termly basis. On occasions some children will not need the intervention of the Team and can be discharged. Further details of the New Case referrals can be found elsewhere.

The monitoring of known pre-school children's hearing thresholds is undertaken by the Educational Audiologist and organised by the Early Years Co-Ordinator. Young children fitted with hearing aids have their aided and unaided hearing assessed within three months of initial fitting, then at six months and again at twelve months according to the NDCS guidelines outlined in the document NDCS Quality Standards (Volume 2).

Gathering audiological profiles showing the full extent (across the frequency range) of a child's hearing difficulty can be a lengthy process which may take place over a number of assessments and therefore a number of months. It is thus very important that the monitoring process after the 3-3-6 monthly cycle is maintained. It is therefore expected that TODs will refer children for assessment when there are indications that further information is needed or a child is experiencing any audiological difficulties.

Children with known hearing loss who are held on TOD's caseloads always receive an annual assessment of hearing along with educational testing. Where there is cause for concern, a more detailed audiological assessment will be undertaken by the Educational Audiologist.

There are a number of children who are not held on any specific TODs caseload because they do not require intervention. These children/young adults are held in a pool known as the 'bank; and receive an annual hearing test from the Health Authority (Fosse Health Trust). These results are forwarded to the Team in order that children can be regularly monitored and it can be decided if they require intervention.

Children/young adults who have special needs and also attend schools for the severely learning disabled sometimes present difficulties to the assessor as they may not respond to tests which the TOD has been trained to carry out. Often however they will respond to tests designed for young children which the Educational Audiologist has been trained to perform and thus referrals will be made to the EA. These will often be performed in the school setting as mobility and transportation can be a problem for some children with severe learning difficulties. On occasions they may be referred on to the paediatric audiology clinic when appropriate.

There are some children who are not able to respond reliably to any behavioural tests and at this point, it is possible for the EA to set up further electrical testing in conjunction with the child's ENT specialist which is carried out at the Leicester Royal Infirmary NHS Trust.

The Educational Audiologist is responsible for the full assessment of school leavers and the forwarding of audiological reports to the Further Education Co-Ordinator. In a similar way, those in further education or at university are entitled to audiological assessments, hearing aid recommendations and referral if necessary to hospital ENT Departments for treatment.