Hearing impairment - assess plan and strategies

First concerns - stage one

- Assess

Child or young person may exhibit some emerging and/or fluctuating difficulties with the following:

• With receptive (understanding) and expressive (producing) language
• Attention and concentration
• Following instructions
• Missing and misunderstanding key information
• Listening in the presence of background noise and/or locating the person speaking in large/noisy environments
• Acquiring and retaining vocabulary (may be observed as vocabulary gaps or poor language skills where they may have missed early vocabulary)
• Often asks for repetition
• Volume of voice (i.e. abnormally loud or quiet voice)
• Acquisition of phonic skills (which may impact early stages of reading)
• Frequent colds/ear infections
• Problems with self-esteem, emotional wellbeing and social interaction
• Fatigue due to level of concentration required

- Plan

Class teacher liaises with parents and child/young person on a regular basis – minimum of 3 meetings within a 12-month period.

• Establish whether the child or young person is known to have a hearing loss/impairment
• Ask them to request a referral for a hearing assessment via GP or school nurse

If available and/or appropriate:

• Examine Early Years Foundation Stage (EYFS) Data and/or previous school records
• Consider past teacher observations and views
• Collate current assessments related to area of concern – qualitative, quantitative and summative
• Signpost child or young person, parents and staff to relevant information and services in the Blackpool Local Offer

- Strategies

• Implement advice from SALT, if already involved
• Plan seating arrangements to ensure that the child or young person can see the teacher clearly and also see other speakers
• Keep hands away from mouth and avoid standing in front of windows – your face becomes difficult to see
• Encourage child or young person to pay close attention to the speaker’s face
• Ensure you have child or young person’s full attention before important information is given
• Allow more thinking and talking time in group discussions
• When asking a direct question to the child or young person, use appropriate and simplified language and allow additional time to respond
• Repeat contributions from other children – their voices may be softer and their speech more unclear
• Provide key words and/or additional visual support as prompts or to reinforce learning

First concerns - stage two

- Assess

Child or young person may exhibit some ongoing and/or fluctuating difficulties or deterioration with the following:

• Attention and concentration
• Understanding verbal (spoken) information
• Following instructions
• Missing key information
• Misunderstanding key information
• Processing auditory information, including verbal and non-verbal information
• Listening in the presence of background noise and/or locating the speaker in large/noisy environments
• Acquiring and retaining vocabulary (may be observed as vocabulary gaps or poor language skills where they may have missed early vocabulary)
• Often asks for repetition
• Volume of voice (i.e. abnormally loud or quiet voice)
• Acquisition of phonic skills (which may impact early stages of reading)
• Frequent colds/ear infections
• Problems with self-esteem, emotional wellbeing and social interaction
• Fatigue due to level of concentration required

- Plan

SENCO, class teacher, parents, child/young person and any external professionals involved liaise on a regular basis – minimum of 3 meetings  within a 12-month period.

At this time:

Following referral for a hearing assessment, ask parents/carers to confirm whether the child or young person is known to have a hearing loss/impairment.

• If there is no hearing loss identified, revisit First Concerns Stage One and possibly explore stages within Communication and Interaction and Cognition and Learning.
• If a hearing loss has been identified, obtain and record parental information to establish the level and type of hearing loss and what the next steps/advice is from the audiology service. Audiology will gain permission from parents/carers to inform Blackpool Inclusion Team Teacher of the Deaf. The child will move to SEN Support and school are to complete a request for involvement for Blackpool Inclusion Team Teacher of the Deaf.
• Obtain and record child or young person’s views

If available and/or appropriate:

• Collate current assessments related to area of concern – qualitative, quantitative and summative
• Discuss concerns with SENCo

- Strategies

Class teacher to discuss finding with the SENCo and plan for interventions

Continue to use the strategies suggested in the initial observations and First Concerns Stage One plus

• Implement strategies (including targeted support and/or resources) based on audiology reports.
• Consider Continuing Professional Development (CPD) requirements and support for staff, and implement.

SEN support stage one

- Assess

The child or young person has observed persistent and moderate difficulties with the following:

• Receptive and expressive language – BPVS, TROG, RENFREW Action picture assessments could be used to establish their level of understanding
• Attention and concentration
• Understanding verbal (spoken) information
• Following instructions
• Missing key information
• Misunderstanding key information
• Processing auditory information, including verbal and non-verbal information
• Listening in the presence of background noise and/or locating the speaker in large/noisy environments
• Acquiring and retaining vocabulary (may be observed as vocabulary gaps or poor language skills where they may have missed early vocabulary)
• Often asks for repetition
• Volume of voice (i.e. abnormally loud or quiet voice)
• Acquisition of phonic skills (which may impact early stages of reading)
• Frequent colds/ear infections
• Problems with self-esteem, emotional wellbeing and social interaction
• Fatigue due to level of concentration required

At this stage, the child/young person will have:

• a confirmed hearing loss
• auditory neuropathy, APD or hyperacusis (with white noise generators) which impacts on their academic achievement

- Plan

SENCo, Class teacher, parents and child/young person and Teacher of the Deaf continue to liaise on a regular basis with the SENCo taking the lead, having a minimum of 3 meetings within a 12 month period

At this time:

• Obtain and record updated parents’ views
• Obtain and record updated child or young person’s views
• Check with parents to see if all hearing checks are up to date
• Complete an SEN Support Plan and review on a regular basis (e.g. at least termly)
• Place child/young person on register as SEN Support (Code K)
• Teacher of the Deaf will complete a functional auditory assessment and a speech discrimination test.
• Implement and review strategies (including targeted support and/or resources) up to agreed financial levels: Universal funding (AWPU) plus up to a maximum of £6,000
• Ensure Class teacher and Teaching assistants receive relevant Continuing Professional Development (CPD).

- Strategies

• Implement advice from SALT if involved
• Follow advice from the Teacher of the Deaf (TOD) regarding appropriate classroom management strategies, as detailed in the records of visit
• Teacher of the Deaf (TOD) will check equipment, undertake advisory or teaching visits and may provide additional specialist equipment, following Service criteria

School led interventions may be required for the following: 

• Language development including vocabulary
• Pre/post tutoring of subject-specific curriculum vocabulary and/or concepts
• Social Emotional skills
• Development of listening skills

SEN support stage two

- Assess

Child or young person:

Has a diagnosed hearing impairment (which is confirmed by up-to-date information from Audiology) and/or has hearing aids, cochlear implant or an assistive listening device

Observed persistent and moderate difficulties with the following:

• Receptive and expressive language
• Attention and concentration
• Understanding verbal (spoken) information
• Following instructions
• Hearing or understanding key information
• Processing auditory information, including verbal and non-verbal information
• Listening in the presence of background noise and/or locating the speaker in large/noisy environments
• Acquiring and retaining vocabulary (may be observed as vocabulary gaps or poor language skills where they may have missed early vocabulary)
• Volume of voice (i.e. abnormally loud or quiet voice)
• Acquisition of phonic skills (which may impact early stages of reading)
• Frequent colds/ear infections
• Problems with self-esteem, emotional wellbeing and social interaction
• Fatigue due to level of concentration required

- Plan

SENCo, Class teacher, parents, child/young person, Teacher of the Deaf and any external professionals liaise on a regular basis – minimum of 3 meetings within a 12-month period

Continue to:

• Check with parents to see if all hearing checks are up to date
• Obtain and record updated parents’ views
• Obtain and record updated child or young person’s views
• Complete a SEN Support Plan and review on a regular basis (e.g. at least termly)
• Implement strategies (including targeted support and/or resources) up to agreed financial levels: Universal funding (AWPU) plus up to a maximum of £6,000
• Ensure Class teacher and Teaching assistants receive relevant Continuing Professional Development (CPD). Liaise with the Inclusion Team regarding possible training opportunities
• Discuss possible interventions from the Teacher of the Deaf in 1:1 or small groups
• If difficulties with language development and/or accessing the curriculum persist despite interventions consider a referral with parental consent to the Educational Psychology Service or other advisory teachers

- Strategies

Continue with any relevant strategies from First Concerns stages and SEN Support Stage One, plus:

• Ensure access arrangements for exams are applied for and provided
• School may wish to purchase an auxiliary aid, such as Roger or Soundfield etc., which will further enhance the pupil’s access to sound.

Complex

- Assess

The child or young person has a diagnosed permanent bilateral hearing loss and will require hearing aids or cochlear implants in order to access sound.

The child or young person will also have observed persistent and significant difficulties with a number of the following:

• Delayed language development
• May have BSL as first language
• An inability to access the mainstream curriculum through personal amplification alone within the allowed timescale and at normal teaching pace
• A requirement for high levels of targeted intervention to facilitate access to a differentiated curriculum
• Support with social and emotional aspects of learning
• A requirement for alternative modes of communication
• Additional learning difficulties and disabilities
• Difficulty establishing friendships with hearing peers
• May need to focus their visual attention for long periods of time (e.g. to watch a signer or lip)

- Plan

Class teacher, SENCO, parents, Teacher of the Deaf and child/young person continue to liaise on a regular basis

• Obtain and record updated parents’ views
• Obtain and record updated child or young person’s views
• Review SEN Support Plan (at least termly)
• Consider a request for EHC needs assessment (see section on EHC needs assessments)
• Continue to act on external advice from educational and health agencies as necessary. Specialist teams may include hearing assessment clinic/cochlear implant centre, Teacher of the Deaf (TOD), community paediatrician and educational psychologist
• Deaf awareness training for all staff

- Strategies

Continue with any relevant strategies from First Concerns and/or SEN Support levels, plus:

• Facilitate child or young person’s use of the following if required according to their needs (following advice from the Inclusion Team and/or Speech and Language Therapy):
• May need intensive hearing, speech and language rehabilitation following hearing aid fitting or cochlear implant surgery
• Use of sign language to supplement delayed or limited spoken language
• Provide support to meet needs as detailed in TOD recommendations
• Reinforcement of curriculum through additional methods, e.g. sign, use of visual resources, pre/post tutoring, small group work
• Maintain frequent contact with specialist teacher of the deaf (TOD), for example to provide: specialist teaching and assessment, pre and post tutoring, auditory rehabilitation, plus staff training

Specialist

- Assess

In addition to impact at First Concerns, SEN Support and consideration of Statutory Assessment, the child or young person may have one or more of the following:

• An inability to access the mainstream curriculum without additional specialist support
• A requirement for a differentiated/modified curriculum
• A need for a signing environment
• A need for the curriculum to be delivered through sign language or alternative modes of communication
• A need for small group teaching
• A requirement for a specialist TA/HI professionals to facilitate access to a differentiated curriculum (e.g. through sign language)
• A requirement for on-site access to speech therapy and other agencies

- Plan

Class teacher, SENCO, parents and child/young person and Teacher of the Deaf and any external professionals involved continue to liaise on a regular basis – minimum of 3 meetings within a 12 month period

• Obtain and record updated parents’ views
• Obtain and record updated child or young person’s views
• Change code on SEN register to indicate child/young person has EHC plan in place (code E)
• Refer to described outcomes and provision and implement - the class teacher, SENCo and assistant working with the child should have regular sight of the EHC plan
• Continue to plan, do, review against the specified outcomes in EHC Plan – the targets on assess plan do review will be broken down into smaller targets as the EHC plan outcomes are usually end of key stage
• Complete Annual Review of EHC Plan – The annual review process | (IPSEA) Independent Provider of Special Education Advice
• Continue to act on external advice from educational and health agencies as necessary
• Carry out and review further assessments as advised by outside agencies and implement their recommendations
• Liaise with named local authority 0-25 SEND officer for child or young person if needs change or for transition purposes
• Implement strategies (including provision of targeted support and/or resources) up to agreed financial levels for specialist provision (see finance section)
• Ensure all staff receive Continuing Professional Development (CPD) and training as required. Access any appropriate training from SALT

- Strategies

In addition to strategies at First Concerns, SEN Support and Complex:

• Suitable/alternative curriculum, exams, vocational assessments/learning environment
• Specialised teaching from a Teacher Of the Deaf (TOD)
• Curriculum delivered through sign language or alternative modes of communication

If required:

• Implement SALT Care plan
• Liaise with Speech and Language Therapist