Informal Functional Hearing Evaluation (IFHE)
Authors: Adam Graves, Education Consultant, Deafblind Outreach Program, TSBVI
Keywords: deafblindness, deafblind, deaf, hard of hearing, evaluation, functional hearing
Over the course of the past year, the Texas Deafblind Project of the Texas School for the Blind and Visually Impaired (TSBVI) has been developing a tool to help teachers of the deaf and hard of hearing (TDHH) describe how students who have difficulty responding to formal diagnostic hearing tests, such as those with deafblindness and/or multiple disabilities, use their hearing in a functional way. The assessment (which has been titled the Informal Functional Hearing Evaluation or IFHE) is designed to help record information about the behavioral responses of students with deafblindness to a variety of sounds in multiple settings. The information obtained from the IFHE can guide the development of accommodations and instructional strategies for the IEP team, as well as provide valuable information for educational audiologists as they perform subsequent diagnostic testing.
In the fall of 2014, Chris Montgomery, Adam Graves and Kate Hurst from the Deafblind Outreach Program at the Texas School for the Blind and Visually Impaired began a five-part webinar series describing and explaining hearing issues for students with deafblindness. During the course of theses webinars, the team conducted interviews with educational audiologist Lisa Sutherland and with Susie Tiggs, the educational lead for the Texas network for low-functioning deaf students. Much of the conversation with these hearing specialists centered on the fact that most audiologists and teachers of the deaf and hard of hearing (TDHH) do not have experience in working with students who are deafblind. As a result, many hearing professionals typically require additional information about how to identify the ways in which a child with a combined vision and hearing loss is using their hearing. In addition, the need for students who are deafblind to be able to hear, identify and listen for environmental sounds for the purposes of orientation was also discussed.
The team realized that the need for assistive listening devices to help provide access to environmental sounds makes a comprehensive functional hearing assessment especially important for a child who is deafblind and lacks formal language. This is because sighted children with a hearing loss are often provided with assistive listening devices that are programmed to block out environmental sounds in order to help eliminate auditory distractions and allow the child to focus on speech. As the team began to explore the differences between the hearing needs of sighted children and those with a visual impairment, they discovered the difficulties that arise when conducting standard audiometric testing for students with deafblindness and multiple disabilities. The importance of a comprehensive informal hearing evaluation that would be applicable for students with vision loss became very apparent.
Susie Tiggs provided the team with a number of resources and evaluation tools that provided functional hearing information for deaf or hard of hearing students who had typical vision but were unable to use formal language to answer questions or offer descriptions of what they were able to hear. The evaluations that the team encountered when researching evaluation tools that are currently available relied heavily on observing changes in the student’s eye gaze and visual attention as indicators of the child’s responses to specific sounds. Despite the emphasis on visual response in these assessments, Chris and Adam worked with a team from TSBVI to try to adapt the most comprehensive of the evaluations to collect hearing information on a student who seemed to be using his hearing in a manner that did not appear to be consistent with some of his audiological information.
After talking about the adaptation of this existing evaluation tool with the TSBVI team, it became apparent that the evaluation they were attempting to use did not adequately describe how the student was using his hearing in a functional way. More importantly, the evaluation did not provide any guidance on how to create a list of recommendations that could be included in the student’s communication report or list of accommodations. The team then reached out to the Texas School for the Deaf (TSD) and the Perkins School for the Blind to discover if those institutions were currently using or were aware of a functional evaluation that was specifically designed to provide information and recommendations on hearing needs of this low incidence population. When both TSD and Perkins indicated that they were interested in using a functional hearing evaluation specifically designed for these students, the team set about to develop just such a tool.
The Deafblind Difference
The most significant difference between the IFHE and similar functional hearing inventories is that unlike other functional hearing tools, the IFHE is specifically designed to account for the difficulties that students with deafblindness and multiple disabilities have in localizing and identifying sound sources due to their loss of vision. More emphasis is placed on encouraging the teacher of the deaf and hard of hearing to observe and document the child’s specific bodily behavioral responses to sounds. The IFHE places an increased emphasis on observing behaviors other than visual attention to help confirm that a student has heard, recognized, or understood a specific sound, even for students with some vision.
One example of the way in which the IFHE attempts to address hearing issues that are unique to deafblindness can be found in its description of some of the difficulties that a student with a hearing and visual loss may have in localizing sound sources. It includes an explanation of some of the subtle ways that a child might indicate that he has heard a sound when he cannot orient toward it, such as small arm or leg movements, changes in vocalizations, or changes in head position.
The IFHE also contains an extensive interview section so that parents and caregivers can help provide an inventory of non-visual responsive behaviors that the TDHH should be aware of when completing the evaluation. In addition, there is a section for Teachers of the Deaf and Hard of Hearing to include recommendations based on the observations recorded in the assessment tool. Recommendations that are made in the IFHE can then be incorporated into the student’s communication report and Learning Media Assessment. By including a section for recommendations on instructional delivery, based on the student’s deafblindness and other impairments, the IFHE should help teachers of the deaf and hard of hearing and teachers of students with visual impairment collaborate to create a more detailed description of the child’s multisensory needs. Improved collaboration can then inform the team on how to best address the child’s sensory needs through a variety of instructional strategies across multiple settings and environments.
The IFHE is currently undergoing a review process during which a select group of experts in the field of deafblindness will provide comments, corrections, and suggestions to prepare for the distribution of the evaluation. At the conclusion of the review, the IFHE will undergo a period of field-testing with the collaboration of the National Center on Deafblindness (NCDB) before it is made available to the public. During the field testing process, teachers of the deaf and hard of hearing will be asked to conduct an Informal Functional Hearing Evaluation on a deafblind student for whom they are currently providing services. Teachers will then be asked to complete a survey to measure the effectiveness of the IFHE as an evaluation tool and to provide feedback on how this evaluation may be implemented or improved.
The TSBVI team hopes to have a version of the IFHE available for field-testing beginning in January 2016. If you or one of your team members is interested in participating in the IFHE field test, please email Adam Graves at http://gravesa@tsbvi@edu to obtain a copy of the evaluation and discuss the field-testing protocol.