TRANSCRIPT - Informal Functional Hearing Evaluation: A Tool for the Whole Team! Ð 3/4/24

>>Kaycee: So today we're going to be talking about the informal Functional Hearing Evaluation and we're going to be talking about conducting the evaluation but we're also going to be talking about how the results from this can really benefit everybody on the team. My name is Kaycee Bennett, as Kate mentioned. Many of you may know me as the Coffee Hour lady. But I am also a Deafblind education consultant on the Texas Deafblind Project, which is part of Texas School for the Blind and Visually Impaired. And our team developed this tool back before -- long before I was on the team. And I used to use this tool all the time when I was an itinerant teacher for the Deaf and Hard of Hearing. An itinerant teacher for students who are Deafblind. So I'll get to share some personal experience with it and then also just share a little bit about how other members of the team could find this information really helpful for students who are Deafblind. Before we get into the actual tool itself, I want to talk about a couple of things to set it up. One of those is just talking about functional hearing. What is functional hearing? So we're going to go through some stuff about functional hearing and we're going to go through some stuff about who are these children that are Deafblind that we're talking about. On the screen, there is a chart to show the continuum of all things Deafblind. So on the screen we've got from top to bottom, typical vision, low vision, progressive visual condition, blind, and then CVI. And then from left to right across the top is typical hearing, mild, moderate, or severe, progressive hearing loss, profoundly deaf, and auditory neuropathy. And everything that has typical hearing across -- typical hearing down. It has visually impaired. And then everything that has "typical vision" across has deaf/hard of hearing. And anything that overlaps is colored purple and says Deafblind. What we're talking about here is any student who has a combination of one of those two things outside of the two that read "typical" all the way down are who we're considering a Deafblind. So when we're talking about students who are Deafblind, it can be any combination of these. So keep that in mind as we go on. And that fits into this next question. If the children are Deafblind, why are we considering functional hearing? And that's because the vast majority of individuals and children and students who are Deafblind have some functional hearing. There's some that don't but the vast majority do. So we need to know how they're using that hearing so that we know how to support their programming, how to help them travel safely, how to motivate them, how to support them. So, so many things. So, you know, just a quick reminder that Deafblind doesn't mean no vision and no hearing. It can mean that but in most cases the individuals and students who are Deafblind have some hearing and/or some vision. And our child count shows that is a very small percentage of the individuals who are Deafblind who do not have any hearing at all. So we're here to support that, today to talk about how to support those students who do have at least a little bit. So now we're going to talk about functional hearing. We're going to talk a little bit about the hierarchy of hearing. Just kind of how people use hearing in general and the different kind of stages of being able to use hearing. Some of you may have heard this before. We use this information when we talk about sound travels, those tools. If you aren't familiar with sound travels, I'm going to show you that set in just a little while as well. But it's a really great set of tools, especially if you're an orientation and mobility specialist, to check out. We're going to start with this, just to kind of give an overview of hearing in general so we know what we're talking about when we're talking about functional hearing. The very first stage of hearing is detection. So that's that I hear it. I hear something. And then the very next one is discrimination. I know that those two sounds aren't the same. There's something different about those two sounds, okay? We can find that information, detection information, I hear it, I hear something, we can find that on an audiogram. So when we look at an audiogram, we've got the chart with the blue Xs and the red circles and that tells us what they're able to detect, okay? That they can hear something at those thresholds, at those levels. I'm going to click this and show you an example. Don't mind my 4 million tabs that are opened. It always looks like that, in case you're wondering. And I've got an unaided audiogram graphed on a speech banana that's on the screen. And it shows that in the left ear, it goes all the way from normal hearing and slopes down and then drops off. And we're down into these arrows at the bottom mean "no response." So in the low frequencies, this young lady -- this is a real audiogram. This young lady has normal hearing. And in the high frequency she has no response. Absolutely profoundly deaf in those high frequencies. And then in the right ear, she has no response all the way across. This was her unaided audiogram and she had a cochlear implant in that right ear, which is why it's completely no response all the way across. Okay. So this audiogram showed us what she was able to detect, what she was able to say I hear something. Or her brain would say I hear something. Discrimination, we can get that information on our eligibility forms. If you work here in Texas, you may have seen an eligibility form that looks something like this. I'm going to scroll, scroll to -- oh, I scrolled too far. Here. Gosh, I missed right over it. Sorry. Where it says "speech" at the bottom of this first page, it's asking for word discrimination in quiet and word discrimination in noise. It gives a place to write a stimulus and a presentation level. All that means is a stimulus is a specific set that audiologists use and so they'll write down kind of how our diagnosticians use certain tests. This is the same kind of thing as audiologists, which lists they use. And then the presentation level, so that's how loud it was presented. And then they'll write how they did on the right, how they did on the left, and how they did using both ears at the same time. Okay. So this discrimination information is written here. But I'll warn you it often comes back to us blank. It doesn't always get tested, which is really a bummer. It takes time and, you know, these clinicians don't always have the time to spend with the patients that come in or there may be external factors as to why they come back blank like that. But it can be helpful to share that that information is really important to you or if you have an educational audiologist, that's something that they could gather for you as well. But that's just going to tell you -- they're able to tell between two words in a set which one was said. Which sound that they heard or word that they heard, depending on what level they're at. The next one is identification so that I know what that sound is. I know that you said my name. I know that that was a dog barking. I know what that is. I know what I heard and I can name it. Know what it is. And then comprehension, I know what that sound means. I know you said my name because you want my attention and you want me to turn around. I know that was a dog barking so I know that I need to look around and make sure I'm safe and it's not coming at me. Okay. So knowing what it is, knowing what it means. Those are the next two steps: Identification and comprehension. Then, after all four of those -- so we've got detection and then discrimination and then identification and then comprehension. Now we can talk about utilization, how they're using their hearing. So often we just jump there, right? We want to talk about how they're using their hearing and we don't really know what level they're at. It's really important to think about those things. When we're talking about utilization, that's where some of these pieces fall into talking about localization. Very important in orientation and mobility. And estimation, also very important for orientation and mobility, how far away is that sound. Where's that sound? Is it moving? When will it arrive to me? Especially in thinking about, like, traffic and things like that that are moving. Also falling under this could be different orientation topics and can be echolocation, if students are using that, both passive and active echolocation. So which specialists are involved in, you know, considering and using and planning for the ways that students use their functional hearing. Well, pretty much all of them. On the screen right now it says educational audiologist, family, teacher of the deaf and hard of hearing, speech and language pathologist, teacher of students who are Deafblind, intervener, orientation and mobility specialist, teacher of students with visual impairments, classroom teacher and on and on and on. Pretty much anybody who is interacting with this individual needs to know what they have access to and how they're able to use their hearing. So that brings us to the tool. So we've got the informal Functional Hearing Evaluation. We call it the IFHE. This is an awesome tool that is made for evaluating functional hearing in children and young adults who are Deafblind, specifically for this population. And the purpose is to determine the impact of a potential hearing loss on educational performance. I use that word "potential" there because this can be a really great tool to use for students who you think might have a hearing loss. This can be a really great screening tool to use and can be really helpful in trying to make those determinations, specifically for those students who either haven't yet been to a physician or who may not be a candidate to do testing. Oftentimes to get accurate testing for our students, they have to go under sedation to have an ABR done, automatic brain stem response. Sometimes our kids are medically complex, could be medically fragile. Could have heart conditions or seizure conditions that could make physicians a little leery about putting them under anesthesia. So sometimes we can't get the data we need and we need to use some functional evaluation to determine if they can benefit from Deafblind support. This is one of the really great tools that you can use for that. There's lots of functional hearing evaluations, Functional Listening Evaluations out there. This doesn't require formal language or formal responses. I have used several in the past, like the Functional Listening Evaluation that students share out when they hear better or what they hear, what it sounds like, when it's more clear. Not all of our students can share that in a formal way where we understand exactly what they're hearing based on how they explain it to us. So this is really, really helpful in that. Another thing that makes this unique is that most of the functional hearing evaluations use speech as the measure. But the IFHE looks at lots of different sound sources. Not just speech in order to determine what they're hearing, what they prefer, their access and all of that. There's a question on what is the role of the IFHE in a student with a known bilateral sensory neural hearing loss or a student with suspected CAPD? I shared a little bit about using a screening tool but you can also use this to just evaluate the functional hearing. So we know that a student has a specific hearing loss , sensory neural hearing loss in both ears that tells us the detection level. We know when they could hear something but we don't know how they use that or what their preferences are or what their access looks like in a real-world situation. We just know in a clinical situation what they were able to detect. And so the IFHE can help us figure out how to actually use that hearing, that utilization, the functional piece of it and learn preferences and things like that as well. We'll get a chance to look at the tool in a minute and hopefully that will be a little more clear to you to use this to evaluate how those students are actually functioning with that hearing loss. Or processing. So the IFHE is made up of three different parts. The first is an interview. There's one interview within the IFHE but it can be used for so many different people. Family members for sure. The family members know these students better than anybody else. So interviewing family. Interviewing school staff who know the student really well, in addition to the family. So we don't have to pick one of these. We can do the same interview with several different people. A lot of times the classroom teacher will be a good choice for this. If the student has an intervener, they often know the student really, really well and can be a really great choice for that. Or if the student has the same teacher of the deaf for a long time and they have a close relationship, they know them really well or teachers for students with visual impairments often follow the kids in the same way, know them very well. Those people can be really great choices to interview. And then medical professionals. I have found really the only place that I have found that this one really makes the most sense is if the student has like a personal care nurse, like a personal nurse that's with them often throughout the day or throughout the evenings, they often know the students really, really well. And so they can be very helpful, if you have permission to interview them. Their input is very valuable. So you can do the interview with one person or with lots of people. Whatever makes sense for that specific situation. And then the second part of the IFHE is an observation checklist. Normally this part is led by the teacher of the Deaf and Hard of Hearing. We'll get a chance to look at that. It has so many detailed questions in there for the person who is completing it to actually look for, either in realtime or through video analysis, and check, write in notes about. And then there's a part that helps you summarize all that data so that you can report on it. And we'll get a chance to kind of see how different people may report on these results. All right. Where to find it. So I do have the link here for you, which is on your handout. But I also put where to find it so that you know where to look when you go to the website. So it's on our website, which is the Texas Deafblind Project website. Tx Deafblind Project.org. If you're not familiar with that website, I want you to spend some time checking it out. There's so much on there. Then you go to books, publications, and newsletters. You'll find it there. Informal Functional Hearing Evaluation. You can click it. It's free. You can direct download it. You have access to that so you can save that information. Okay. And we'll look at it. I'll go back and click it in a second. Nope. I'm going to go back and click it now. Sorry. Changed my mind. [Laughter] I'll go ahead and open it so we can go through it a little bit. This is what it looks like. It's got an introduction, which I explained how we're going to use it. What we're looking for, that we're determining strengths and needs and it can help you make recommendations. We're going to start with this interview. These are the types of questions that are included. So, again, these questions can be asked of the family, of staff that know them really well. Of medical professionals that they know them really well outside of a clinical setting. And they're very broad questions. Like what do you think the child hears? What makes you think that they're hearing that? Does the child seem to associate any specific sounds with specific people or activities? Do they seem to have favorite sounds or favorite songs? Or sounds created by certain toys, certain animals? Are there sounds that seem to frighten or upset the child? Or, opposite of that, are there sounds that seem to calm or soothe the child? Are there specific environments in which the child consistently requests or rejects their hearing aids or cochlear implants? So if they're amplification users, are there times when they always rip them off? I was talking to a family the other day that said every time he's in the car, he takes them off. That's great information. Great information to know. Does the child vocalize? When and under what conditions? Does the child seem to respond to his or her name in most conditions? Does the child respond to other phrases? Do you think there are sounds that the child does not hear? And then why do you think they don't hear those sounds? And then some background pieces that really make more sense for the family. Does the child have a history of ear infections? Does anybody in the family have hearing loss? Has the child been treated with medicines for major infections, ear cancer, et cetera? And that is related to ototoxic drugs. Sometimes when children have infections, diseases, or disorders they have to use drugs that cause hearing loss but it saves their lives. That's why that question is asked, in case anybody was wondering. Then there's a place to put some notes. If there's anything else that the person shares that you're interviewing, you can document that there. So these interviews, anybody can use. It's not specific to a teacher of the Deaf. The tool itself is informal. So anybody can use this at any time to gather information. Something else I really like about it. And you can see how, like a mom might give different answers than the intervener, than the personal care nurse. The student is in different settings for those times. The family is typically more in tune with the child and notices things that others don't. And so that can be really helpful to gather this information across settings and from different people. Kind of compare what different people are seeing in these different situations. Okay. That was the interview part. The next part is that observation checklist. This is the one that gets really detailed. So the first parts are talking about -- the first section is talking about general functioning and awareness. They show any awareness of any sensory information I don't know if I have ever seen it say no. There's going to be awareness of some sensory information, likely. And that's a great place to just kind of describe overall how they're accessing sensory information. And then it kind of breaks it down a little further. Does the child show awareness of auditory information? How do you know? What about with familiar sounds in a familiar environment? What about familiar sounds in an unfamiliar environment? What about new sounds in a familiar environment? New sounds in an unfamiliar environment? Kind of breaks down all the scenarios there. Gives you a place to check yes or no but also describe, maybe give some examples. The next section is called sound is meaningful. Does the child associate with their sources? Yes or no and describe. Does the child show anticipation of an event or recognition of a person or object through the use of hearing? It has an example. The child giggles and claps her hands at the sound of her mother's voice in another room. Or the music produced by a favorite toy hidden from view. The reason it denotes in another room or hidden from view is we want to make sure it's an -- it's a response to auditory information and not visual stimuli. And then it breaks it down again. Familiar context, unfamiliar context. We know often our students respond very differently in familiar environments and with familiar people and objects than they do in the unfamiliar. So it's broken down that way throughout in a lot of different places. The next section is auditory patterning. Does the child show awareness when sound starts and stops? Is there a difference in their performance based on the sounds that are happening? And then this is broken down so much. So we're, again, looking at is there a difference in their performance, in the student's performance, based on the different types of sounds. Based on if it's a high pitch or a low pitch. If it's a simple rhythm or a complex rhythm. If it's a loud intensity or soft intensity. Short duration, long duration. Near distance and far distance. If the sound is moving toward them versus the sound moving away from them. If they are vowel sounds in isolation or consonant sounds in isolation. If the sound source is a voice versus environmental sounds, if it's a male voice versus a female voice. If it's a familiar voice versus an unfamiliar voice. If there are specific types of music or specific instruments. All of that is under Number 6. Again, there's a place to describe in all of those situations. 7 is: Is there a difference in behavior based on environment? If it's quiet or noisy. If it's a place with a high level of reverberation versus a place where it is dampened. The gym is an example of this. So many times we hear the student does not like gym. They freak out in the gym. Well, it's terrible acoustics in there. Cafeteria, same way. Even if it's empty, even if there's not a bajillion children in there, the reverberation is crazy. So that is a great place to note things like that. And in comparison to a carpeted classroom or something with much higher acoustics. Places with competing vocal and environmental sounds. If there's, you know, a bunch of background noise going on, that type of thing. Places with competing sensory information. The lights are really bright in a certain place or, you know, you're near the kitchen when they're making lunch and there's strong smells, that type of thing. If there's a delay in response. That latency piece, auditory latency. In a quiet environment versus on the playground. For looking at quiet versus noisy. And it also breaks down in familiar versus unfamiliar. So denoting that in that describe section can be a great place to denote how long is their delayed response. What's that time between when they have the stimulus and when they respond. The next question is are there different responses based on the child's bio-behavioral state or at different types of the day. We see this all the time in our students who are Deafblind. And students, in general, but especially for our students who are Deafblind. Before or after meals, they may have very different bio-behavioral states. If you're unfamiliar with that term, we're talking about whether they are alert or they are, like really sleepy or really agitated. There's all these different states. And so looking at how that may change based on what's going on throughout their day. Before they eat and after they eat. Before or after they take medication. Just the time of day. Could be more alert in the mornings and very tired or really agitated in the afternoon. Quiet alert or active alert versus fussy or agitated. Does the child recognize when an adult mimics his or her vocalizations? So if an adult, like, copies the sounds that a child makes, does the child stop or do they smile and laugh and try to respond to that? Or do they just keep on like they don't have awareness that you're mimicking them. Something to try and then note out those responses. And note out the differences based on all of these things. These four here. Whether it's a familiar adult with a familiar pattern. So oftentimes it will be like a game that a student plays with a specific adult. If that's the case. Or if it's an unfamiliar adult but it's that same pattern that they're used to using. Or if it's a familiar adult with a random pattern or an unfamiliar adult with a random pattern. All four of those can be noted here. Does the child try to mimic familiar vocal patterns? They may mimic the rhythm, the pitch, the vowel sounds, the consonant sounds, the animal sounds, lines from a song or rhymes. Sound as meaning is the next section. Does the child startle to sound but otherwise does not pay much attention? That's that reflexive awareness. Does the sound help the child enter and maintain a quiet alert or active alert state? So basically are they using sound for self-regulation. Are there sounds that make the child fussy or agitated? And those answers that you got from the interview can help you look for that here. If the teacher told you that they get really upset by the sound of the fire alarm, I know when the next fire drill is. You can observe those things that you find out through that interview. Also be a great place to find out how to put a plan in place to support the child during that time so they're not in distress. That's a different training. Vocalization is the next section. Does the child turn toward, move toward or reach for a sound source? That's unfamiliar voices, objects, and environmental sounds. Auditory feedback is the next one. Does the child enjoy making noise, either with his or her mouth, by activating switches, banging two objects together, playing musical instruments. Does the child vocalize when amplification is turned on? Does the child vocalize in response to other people's vocal play? Short-term auditory memory. Does the child associate a particular sound with a particular event? And does the child attempt to repeat familiar vocal sequences or sounds? And then the last section, linguistic auditory processing. Does the child recognize any common words, especially his or her name? And does the child try to use any sounds consistently to communicate? This could be a great one to lean on those interviews for. Sometimes these sounds that they may make have low readability. They may be hard to recognize if you don't have familiarity with that child but leaning on those people that do, who really know that student well so you know what you're looking for when you're in there completing this observation. Okay. And then there's a place to just put some notes and summarize those things. And that last part is that report summary. It gives you a place to summarize the interviews that you did. Again, could be all of those, could be one of those, whatever makes sense for that kiddo. And summarize all of that information that you gathered, both through the interviews and through the observation. There's also a place to summarize the formal test results from the speech language pathologist. When the speech language pathologist did their speech and language testing, being able to pull that information over and summarize that here so that we're looking holistically at that student's hearing information. That would be the formal piece that comes from elsewhere. This test itself is informal. Okay. Gives you the different sections that were noted throughout. And a place to summarize the information that you found when you were completing that observation. Okay. That's the tool. I'm going to jump back. So all of that, again, is at this link or through these steps on our website where you can download that and have it and share it with your team. Now that you have all this information, these results can go in lots of different places. They can go in the orientation and mobility specialist report, in their evaluation. It can definitely go in the teacher of the deaf and hard of hearing's communication evaluation, for sure, for sure. We should always be looking at functional hearing when we're evaluating a student's communication. And this is a great tool for that. And then it can help drive Learning Media Assessment decisions. For those of you who are teachers of students who are blind or visually impaired, when you're looking at LMA, Learning Media Assessment, you have to know the student's functional hearing. We have to know how they're accessing information. And oftentimes our students who are blind or low vision are going to access some information auditorily. We know that with our students who are Deafblind, we have to make sure that that's accessible or have to know what is accessible. It may be accessible in some situations and not others. So they can definitely help drive those decisions. And can be really helpful to the audiologist. The audiologist can absolutely be the one doing these observations and using this tool. But it may be the teacher of the deaf and hard of hearing. So whoever is, you know, taking the lead, making sure that that's shared with the other professional to help with that. The educational audiologist is probably the one programming equipment, bringing out hearing assistive technology and knowing how the student uses their functional hearing will, you know, drive those decisions as well. What hearing assistive technology makes the most sense for this child, in what situation should they use it. In what situations will it not be very helpful? Super important to share with all of those folks. Because this is informal, it doesn't have to be done at the same time as other formal evaluation. This can be done any time and the results can go into the PLAAFP which is awesome. This likely is changing and developing, especially if they're recently amplified. They're going to be learning how to use sound and it's going to be shifting. So this is something that you can update all the time. You can get some accommodation out of this that are specific to that student. You can see how you could very easily find likes and dislikes in here, right? So we can use those likes and dislikes to help create meaningful and functional instruction for that student. Instruction that is accessible as well. And we can drive goals from this too. We can know where strengths are, where weaknesses are. What we want to work on and how we can work together to support the student's functional hearing and help develop their functional hearing. So goals can come out of this as well. And not just goals for the teacher of the deaf and hard of hearing but goals for lots of different people. Okay. Why is this valuable information? I'm going to open this up to the chat here for your specific roles, why do you think information regarding your student's functional hearing would be helpful to you and to your other teammates? So if you're a teacher of the deaf, it's obvious how it can be helpful to you. How it can be helpful to your teammate. Share in the chat why you think information regarding your student's functional hearing could be helpful to you. In your specific role, why do you think information regarding your student's functional hearing would be helpful to you? And if you are a teacher of the deaf, why do you think it would be helpful to your teammates? All right. Make sure your chat is set to "everyone." That's a reminder so we can all see what you say. Lori shared students who don't see well usually rely heavily on auditory information and we need to know what they can and can't access. Yeah. That's fabulous. SLP here. I need to know functional hearing for language development and articulation purposes. Absolutely. I think you worked with my best friend, if I remember correctly. Okay. Sara. It can be good to know if they have a progressive hearing loss. Yes! Doing this over time can help show us things like that. Absolutely. Britney said to help give access to the classroom environment. Yeah! Jane said understand your student's ability to be able to create and to be able to create meaningful goals. Absolutely. Karen said I feel like as an organization we focus so much on using sign language, which is great, but to be able to give individuals who are Deafblind a total communication approach and use any hearing that they have would be best. But we know what that hearing level is is key. Definitely. We have to know what it is. Absolutely. And functionally, right? Okay. We've got Amanda. She said knowing what their functional hearing is helps me plan lessons better as far as what they can hear when we're outside in a noisy environment. Yes. I wonder if you're a COMS, Amanda. Shannon said when a student has a visual impairment, they're relying on their other senses. If they're hard of hearing, I'm needing to try other senses of learning. Deidre said accessibility and motivation. Yeah, motivation's a big one for sure. Jana said as a COMS it's important to know and understand the environmental commands and the auditory input my student is receiving to help with progress. For sure. Crucial for teams to understand unique strategies to meet that student's needs, inclusive of the social-emotional aspects that can be integrated with academics. I love that. We've got Darten? My students are not asking to just use their FM systems because they say they can hear okay, in quotes. That's a really common issue, especially for students in middle school. And this can be really great data to show not only the staff, if they really are missing things or if they're not missing things, but also show students and families as well. And if your student is in a general education setting, there may be more appropriate tools where you're getting a little bit more direct feedback from the student. And that may be something to look at too. Amanda said also I have some clients who don't disclose when we begin working that they have a hearing loss until they get to street crossings and they're struggling. A little scary. Yes, she's a COMS. As soon as you find out hearing info, please. Michelle said they may hear but processing is the oral information to understand the concept being heard. Yeah. Knowing what they detect, like we shared before. They can detect whatever they can detect but if they don't know how to use that information, it's not very valuable to us as the educators. So absolutely. It's really, really important. Angela said if everyone knows the student's functional hearing it helps with everyone using the same strategies to help the student be successful. That, yes, Angela. That is the whole goal, right? That is what we want to do. We want to make sure that the student is successful. That we're using strategies that make sense for this student. Absolutely. Thank you all so much for sharing all of that. There's way lots of things on this screen. It's not meant for you to read. It's just meant for me to be able to share some of this with you all. This was an excerpt from an actual FVE LMA for a student who is Deafblind. I changed the names. This is an example of how we did the IFHE. Again, I was the teacher of the Deaf. And my counterpart, the TSVI, found this information so valuable that she did this with me. And she put this in her functional vision and Learning Media Assessment. This is the part that she put in her vision side of things. I'm going to read it. I thought it might be helpful -- I know a lot of you are from the -- are teachers of the blind and visually impaired. So I thought it might be helpful to see how this information could fit into how you report. Okay. So it says -- by the way, I did like a find and replace. If the grammar is weird, I just replaced with the word "student." Student is using photographs, grunts, and a few signs to communicate. He will reach for objects, look around when sounds are heard, and grab for preferred people's hands when he wants assistance. With familiar sounds in both familiar and unfamiliar routines, student will show awareness of sound by pairing the correct movement to the correct song or performing the correct familiar action to the word spoken by an adult. An example of this is when the song head, shoulders, knees, and toes plays. The student will hold a familiar adult's hands and perform the motions. Student is able to identify his male teacher's voice and will look for him when his voice is heard, even if the teacher is in the next room. Student will show anticipation of events or familiar people in a familiar context. He knows when a certain song plays that it is time for circle time or that when he hears his teacher's voice that it's him. When the music stops playing, the student knows that -- student shows that he knows the cessation of sound by stopping the movement he was doing to the music. He prefers sounds that have instruments over singing without music or talking. Student performs better in a quiet environment and in carpeted rooms. In the gym he likes to remove his baha, a bone anchored hearing aid. He tends to have a delayed response and requires extra wait time. If the student is hungry he will not participate and will often cry or refuse to walk. He will express his hunger by choosing his photograph of food if it is presented to him. He is not mimicking sounds or speech at this time. Student does not easily startle to sounds but will be aware of the sounds around him. He does not seem to use sound for self-regulation. Loud sounds can make him fussy. He is able to localize familiar objects and familiar human voices within his classroom. He enjoys making noise in appropriate contexts such as music class. He does not make a lot of noise when in quiet environments. Student's only vocal play is a grunt when agitated. He's not vocalizing when amplification is turned on or when others vocalize. He is able to associate sounds with particular events. Student recognizes some common words and will follow the requests such as sit, stand, stop, eat, et cetera. Recommendations for student in the education setting are consistent baha use, picture schedule with real photographs, sequence boxes, choice board, access to sign, and photographs for all activities and extra wait time. It was long. Thanks for hanging with me for that. But I wanted to share that with you guys to kind of give you an idea of some things that a vision professional found helpful and relevant enough to include in her Functional Vision Evaluation and Learning Media Assessment about how this student accesses learning, accesses his environment. I am constantly talking about how functional hearing information has to be in vision report and functional vision information has to be in the teacher evaluation. They have to have that crossover because both things affect the child as a whole. We can't talk about communication without talking about their visual access. We can't talk about how they access literacy without talking about their communication and their hearing access. So we have to cover all the things. And this is a great tool to help do that. Two other resources I want to share with you guys in one minute, before I turn it over, are sound travels. It's a collection of tools about how orientation and mobility and the hearing professionals should collaborate and tools to actually help you make that possible. If you are unfamiliar with this, I did a Coffee Hour on it not too long ago that's archived, so you can go back and watch that session and gather way more information. That whole set of tools is free and on our website. Txdeafblindtxdeafblindproject.org, the topical page is really, really helpful. On the screen right now is my e-mail address. It's Bennettk@tsbvi.edu. Or we actually have an e-mail address that goes to our whole team. If you have a general question for us, that's Txdeafblindproject@tsbvi.edu. We have a question. It says I fully agree. It's another reason to use protactile ASL when applicable. Co-presence and co-navigation is extremely beneficial especially when the students are battling with limited or low vision but still desire their full autonomy during daily life. Hearing stable, intermittent, or diminishing, knowing our student's triggers, social emotional regulations and overall well-being before applying any strategies making sure we respect the parents' goals, dreams and acknowledging what we do today will matter throughout their future and during academic transitions. Really the reason why we do evaluation as a whole. We're gathering all that information from all of the players at the table. And making sure that everyone who has their own expertise for supporting that student, including the student themselves and the family, are able to share those things and that we can make a plan that everyone understands and is on board with. And this is part of that. This is that data gathering piece about how the student is using the hearing that they have and able to use that in an educational setting and in home and community settings. And I'm going to share one point of data really quickly and I'm turning it back to Kate. In our child count from January 2023 in Texas we had 845 kiddos on that child count. Of that 845, only 51 were reported as profoundly deaf without any type of amplification. So 794 out of 845 have some level of auditory access. That's why we have to be talking about functional hearing for these students. It's the vast majority of our students who are Deafblind. Thank you, guys. 

>>Kate: I just want to say amen. And since a lot of our audience are people that have backgrounds in working with kids who are blind or have low vision, we would never serve a kid without a Functional Vision Evaluation. Doing this functional hearing is just as important for our students with -- who are even suspected Deafblind students. So thank you, Kaycee so much for sharing this information.