Hearing Impairment in Education — Missouri Reference

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Table of Contents

1. Definitions & Spectrum of Hearing Loss
2. Missouri Infrastructure (MSD, Resource Center on Deafness)
3. Identification & Evaluation
4. IEP Considerations for Hearing Impairment
5. Communication Approaches
6. Assistive Technology for Hearing
7. Interpreter Services in Schools
8. Classroom Accommodations
9. Deaf Culture & Identity
10. Early Intervention (Birth-3)
11. Cochlear Implants in the School Setting
12. Auditory Processing Disorder
13. Transition Planning
14. Physical Environment & Universal Design
15. Working with a Teacher of the Deaf (TOD)
16. Parent Resources
17. IEP Goal Bank — Hearing

1. Definitions & Spectrum of Hearing Loss

IDEA Definitions

• Deafness: a hearing impairment so severe that the child cannot process linguistic information through hearing, with or without amplification, which adversely affects educational performance
• Hearing Impairment: an impairment in hearing, whether permanent or fluctuating, that adversely affects educational performance but is not included under the definition of "deafness"

Degrees of Hearing Loss

Types of Hearing Loss

Fluctuating Hearing Loss

Many young children experience fluctuating conductive hearing loss due to chronic ear infections (otitis media). This is educationally significant — a child may hear well one week and miss 50% of speech the next. Teachers should watch for inconsistent responses to auditory instruction.

2. Missouri Infrastructure

Missouri School for the Deaf (MSD)

• Location: 505 East Fifth Street, Fulton, MO 65251
• Founded: 1851
• Serves: deaf and hard of hearing students grades K-12, ages 5-21
• Free of charge to all eligible Missouri residents
• Referral: IEP team placement decision made jointly by parents and LEA
• Programs: Stark Elementary, Wheeler Middle/High School
• Communication approach: bilingual — American Sign Language (ASL) and English
• Residential program: dormitory/cottage-style housing; students travel home weekends
• Transportation: MSD provides statewide transportation between campus and designated pickup points
• Superintendent: Christopher Daily, (573) 592-2504
• Website: msd.dese.mo.gov

MSD Resource Center on Deafness (Outreach — Statewide)

• Services to districts throughout Missouri:
• Audiological evaluations and Auditory Processing Disorder evaluations
• FM system leasing program for public schools
• Hearing aid loaner program
• Consultation and technical assistance
• Sign language instruction for families and school staff
• Early intervention support for deaf/HH children ages 3-5 (within 30 miles of MSD)
• Contact: (573) 592-2543

Missouri Commission for the Deaf and Hard of Hearing (MCDHH)

• State agency providing advocacy, communication access, and information
• Interpreter referral services
• Telecommunications access

3. Identification & Evaluation

Universal Newborn Hearing Screening (UNHS)

Missouri law requires hearing screening for all newborns before hospital discharge. Early identification enables intervention before critical language development windows close.

School-Based Hearing Screening

Evaluation Components

4. IEP Considerations for Hearing Impairment

Required IDEA Considerations

IDEA §300.324(a)(2)(iv) requires that for a child who is deaf or hard of hearing, the IEP team consider:

• The child's language and communication needs
• Opportunities for direct communication with peers and professional personnel in the child's language and communication mode
• The child's academic level
• The child's full range of needs, including opportunities for direct instruction in the child's language and communication mode

Key IEP Decisions

IEP Team Should Include

• Parent(s)
• Teacher of the Deaf (TOD)
• Audiologist or educational audiologist
• Speech-language pathologist
• Interpreter (if student uses one)
• General education teacher
• LEA representative
• Student (when appropriate — especially important for communication mode decisions)

5. Communication Approaches

Critical Principle

The IEP team — including the family and, when appropriate, the student — determines the communication approach. No single approach is universally best. The decision should be based on the child's hearing levels, language development, family communication, learning style, and cultural identity.

6. Assistive Technology for Hearing

Personal Amplification

Classroom Technology

FM/DM System Management in Schools

This is the #1 daily issue. The system only works if:

1. The teacher wears the microphone correctly (6-8 inches from mouth, centered on chest)
2. The teacher turns it on at the start of class and off during private conversations
3. Someone checks the student's hearing aids and FM receiver daily (listening check)
4. Batteries/charging is maintained
5. The system transfers between classrooms (or each room has a transmitter)
6. Substitute teachers are trained on the system (include in sub plans)

7. Interpreter Services in Schools

Types of Interpreters

Interpreter Standards

• Missouri does not currently require state licensure for educational interpreters, but national certification (RID — Registry of Interpreters for the Deaf) or EIPA (Educational Interpreter Performance Assessment) score of 3.5+ is strongly recommended
• Interpreters are NOT aides, tutors, or disciplinarians — they provide communication access
• Interpreter should be positioned where the student can see both the interpreter and the instructional content
• Teacher should speak to the STUDENT, not to the interpreter ("Tell him..." is incorrect)
• Build in processing time — the interpreter is always a few seconds behind the speaker

Interpreter in the IEP

If a student needs an interpreter, it must be documented in the IEP as a related service or supplementary aid/service, specifying: type of interpreter, hours/settings, and whether the interpreter should attend specials, assemblies, field trips, etc.

8. Classroom Accommodations

Environmental

• Reduce background noise — carpet, tennis balls on chair legs, acoustic panels, close doors/windows, turn off HVAC when possible
• Optimal seating — face-to-face with teacher; able to see all speakers; near front but with full visual field of the room
• Good lighting on the teacher's face — essential for speechreading; don't stand in front of windows (backlit face is unreadable)
• Minimize visual distractions behind the teacher (busy bulletin boards directly behind teacher's position)
• FM/DM system functioning every period
• Visual fire alarms (ADA requirement)

Instructional

• Face the student when speaking — don't talk while writing on the board, walking away, or looking at a screen
• Don't cover your mouth (hands, papers, masks obstruct speechreading)
• Repeat peer comments before responding (the student may not have heard classmates)
• Caption ALL media — videos, audio clips, announcements
• Pre-teach vocabulary — new terms with visual supports before the lesson
• Visual supports for everything — written agendas, graphic organizers, anchor charts, visual instructions
• Check for understanding frequently — "Did you hear me?" is NOT a check. Ask content questions. Have the student paraphrase.
• Provide written instructions in addition to verbal
• Reduce language complexity if needed — use clear, direct sentences (not simplified concepts, just clearer language)
• Signal topic changes clearly ("We're done talking about fractions. Now we're going to talk about geometry.")

Assessment

• Extended time (processing through an interpreter takes longer; reading may take longer for students whose first language is ASL)
• Interpreter during testing (for directions and content that is not testing language/reading)
• Preferential seating (away from noise sources)
• Separate room (if using interpreter or FM system)
• Captioned or transcript versions of any audio content
• Signed administration of tests when permitted by test publisher

Social

• Facilitate communication between deaf and hearing peers (teach basic signs to classmates)
• Ensure the student is included in group work (assign roles, use visual communication tools)
• Lunch, recess, and unstructured time — the interpreter may not be present; plan for access
• Deaf awareness education for the class (age-appropriate — what is deafness? how do hearing aids work? basic signs)
• Connect with Deaf peers if the student is the only deaf student in the school (MSD events, Deaf community events, online connections)

9. Deaf Culture & Identity

Key Concepts for Educators

• Deaf (capital D) refers to cultural identity — membership in the Deaf community, use of ASL, shared values and experiences
• deaf (lowercase d) refers to audiological status — the physical condition of not hearing
• Many Deaf people do not view deafness as a disability but as a linguistic and cultural difference
• Language deprivation — when a deaf child does not have access to a fully accessible language (either spoken through amplification OR signed) in the first years of life, it can cause permanent cognitive and linguistic harm. This is a critical equity issue.
• Deaf gain — the concept that deafness brings unique perspectives, cognitive strengths, and cultural richness rather than only loss

Educator Responsibilities

• Respect the family's and student's communication choices
• Provide full language access in the chosen communication mode — not partial access
• Recognize that isolation is the biggest challenge for many deaf students in general education (especially if they are the only deaf student)
• Connect families with the Deaf community and Deaf role models
• Never prohibit a student from signing (historically, sign language was banned in many schools — this caused significant harm)

10. Early Intervention (Birth-3)

Missouri First Steps

• Part C early intervention for infants/toddlers with hearing loss
• Family-centered services in natural environments (home, childcare)
• IFSP (Individualized Family Service Plan) developed with the family
• Key services: speech-language therapy, audiology, family education on communication approaches, ASL instruction for families, parent-to-parent support

Critical Period

Research consistently demonstrates that language intervention before 6 months of age produces significantly better language outcomes for deaf children, regardless of communication mode. Early identification through UNHS + immediate early intervention is essential.

Transition to Part B (Age 3)

• Planning begins 90 days before the child's 3rd birthday
• IEP must be in effect by the 3rd birthday
• MSD's early childhood program (within 30 miles of Fulton) serves ages 3-5
• LEA may also provide preschool ECSE services locally

11. Cochlear Implants in the School Setting

What Schools Need to Know

• A cochlear implant (CI) is a surgically implanted device — the school cannot adjust internal settings
• The external processor (the part the student wears) can be managed at school
• Staff should know: how to turn the processor on/off, how to change batteries/charge, basic troubleshooting (reboot, check coil connection), and when to contact the audiologist
• A CI does NOT produce "normal hearing" — the student still has a hearing impairment and needs accommodations
• Some students have bilateral CIs (both ears); some have a CI on one side and a hearing aid on the other (bimodal)

FM/DM Integration

• FM/DM systems can connect wirelessly to most CI processors
• The audiologist programs the CI to work with the FM receiver
• Critical: make sure the FM system is set correctly for the CI (different from hearing aid settings)

Water, Sports, PE

• External processor should be removed for swimming and contact sports (or protected with a waterproof cover)
• Static electricity can damage CI processors — be cautious with plastic slides, bouncy houses
• The student should have a safe storage place for the processor during these activities

12. Auditory Processing Disorder

What It Is

Auditory Processing Disorder (APD) affects how the brain processes auditory information — hearing is typically normal, but the student struggles to understand speech, especially in noise. It is NOT a hearing loss, but the educational impact can be similar.

School Accommodations for APD

• FM/DM system (teacher microphone → direct to student)
• Preferential seating (near teacher, away from noise)
• Visual supports for all auditory instruction
• Reduced background noise
• Pre-teaching vocabulary
• Repetition and rephrasing (not just repeating louder)
• Written instructions in addition to verbal
• Extended time for auditory processing

Eligibility

APD alone may qualify a student under "Other Health Impairment" or may be addressed through a 504 plan if it substantially limits learning.

13. Transition Planning

Employment and Post-Secondary

Transition IEP Goals Should Address

• Self-advocacy for communication access (requesting interpreters, captioning, accommodations)
• Technology skills for the workplace (captioned phone, email, video relay)
• Independent living (managing communication in the hearing world — ordering food, medical appointments, banking)
• Driver's education considerations (visual-only driving — no audio cues)
• Social and community access (Deaf community connections, hearing world navigation)
• Post-secondary planning (accommodations at college, disability services registration)

14. Physical Environment & Universal Design

Acoustic Standards

• ANSI/ASA S12.60 recommends background noise ≤35 dB and reverberation time ≤0.6 seconds in classrooms
• Acoustic treatments: carpeting, acoustic ceiling tiles, curtains, wall panels, door seals
• Avoid open-concept classrooms for students with hearing loss

Visual Access

• Visual fire alarms (strobe lights) — ADA requirement
• Visual announcements (PA announcements should also be displayed on screens or delivered in writing)
• Clear sightlines throughout the room (students need to see the teacher, interpreter, board, and classmates)
• Circular or horseshoe seating for discussions (so the student can see all speakers)
• Visual bells/timers for transitions

15. Working with a Teacher of the Deaf (TOD)

Role of the TOD

• Certified specialist with endorsement in Deaf/Hard of Hearing education
• Provides direct instruction in language, communication, self-advocacy, and ECC areas
• Consults with general education teachers on accommodations and modifications
• Manages hearing technology (hearing aid checks, FM system management)
• Provides pre-teaching and post-teaching of vocabulary and concepts
• May serve itinerantly (traveling between schools) or in a self-contained setting
• Critical shortage area in Missouri — many districts have difficulty finding qualified TODs

Classroom Teacher Responsibilities

• Learn to use the FM/DM system correctly
• Face the student when speaking
• Caption all media — no exceptions
• Repeat peer comments
• Provide materials to the TOD in advance for pre-teaching
• Include the student in ALL activities (don't pull them out for interpreting convenience)
• Learn some basic signs (if the student uses ASL) — even a few signs show respect and effort

16. Parent Resources

17. IEP Goal Bank — Hearing

Language Development Goals

• [Student] will comprehend [grade-level/adapted] vocabulary in [communication mode] with 80% accuracy across 3 consecutive sessions as measured by curriculum-based assessment by [date].
• [Student] will produce grammatically correct English sentences (written) containing [target structure] with 80% accuracy on written assignments by [date].
• [Student] will retell a [grade-level] story including [#] story elements in [ASL/spoken English] with 80% accuracy by [date].

Auditory/Listening Goals (for students using spoken language)

• [Student] will discriminate between [target sounds/words] in a quiet environment with 90% accuracy by [date].
• [Student] will follow [#]-step spoken directions in the classroom with FM system with 80% accuracy by [date].
• [Student] will identify when a communication breakdown has occurred and use a repair strategy (ask for repetition, ask for clarification, move closer) on 4 of 5 opportunities by [date].

Technology/Self-Management Goals

• [Student] will independently perform a daily listening check of their hearing aids/CI and report malfunctions to the teacher on 5 of 5 school days by [date].
• [Student] will independently manage their FM system (turn on, pair, troubleshoot, charge) with no adult prompting by [date].

Self-Advocacy Goals

• [Student] will explain their hearing loss and communication needs to a new teacher or adult using [a prepared script / their own words] covering [3+ key points] on 4 of 5 opportunities by [date].
• [Student] will request accommodations (captioning, interpreter, seating, repetition) in a new setting without prompting on 4 of 5 opportunities by [date].
• [Student] will advocate for communication access in a group setting by requesting that one person speak at a time or by asking a peer to repeat what was said, on 4 of 5 observed opportunities by [date].

Social Goals

• [Student] will initiate a conversation with a hearing peer using [ASL / spoken English / written communication] during unstructured time at least [#] times per week for 4 of 5 weeks by [date].
• [Student] will use appropriate turn-taking in a group conversation (visual attention, waiting for turn, appropriate volume) on 4 of 5 opportunities by [date].