Hi, I'm Jim Cuddy and this is Ask The Hearing Doctors. And I'm joined today by Dr. Ana Anzola, doctor of audiology with Hearing Doctors. The Washington DC area's highest-rated audiology practice with over 1500, five-star reviews. Also joining us today, Shelley Millerson, teacher of the deaf and hard of hearing with Fauquier County Schools. Ana, Shelley great to see you both.
Shelley, why don't we start off if you could tell us a little bit about your background and your ascent to where you are today as teacher of the deaf and hard of hearing?
Sure. This is going to start my 28th year of being a special education teacher. I have an undergraduate and a master's degree in special education. I also have additional endorsements to teach children with intellectual disabilities, emotional disabilities, early childhood special education, learning disabilities and deaf education. So that has been really helpful in all of my years of experience working with lots of different children with different needs. And I'm currently the only teacher of the deaf in Fauquier County Public Schools.
And what kind of caseload do you manage in the school system?
A big one. I have close to 30 students in 17 out of the 21 schools in the county. Wow! And I understand you even have some students that come and see Dr. Ana. I do, I do we have a set of sisters that come and see Dr. Ana.
And tell us about that experience of working with with Shelley and and Fauquier County Schools.
You know it's so great. It's one of my favorite days when you bring me all the kids. Um, because I never get to see the teachers. So once we fit the kids with um hearing aids I never get to hear the after what happens. So she can keep me up to date as to what's happening and then it makes the management of their hearing loss a little easier.
How are most children identified with hearing loss?
You want me to speak to that? Yes. In the educational setting um all the children are, have a newborn screening and if they don't pass that then there's a series of events that happens after that. When the children become two, I can start working with children who are two in Fauquier County. And a lot of times they'll go to the pediatrician for their checkup and if the pediatrician is noticing that they have some hearing loss then they'll refer them to an ENT and an audiologist. Sometimes the parents have concerns and they will reach out to the school system to start the referral process because they have concerns in communication or speech and language. And we will do a screening and if the child doesn't pass the screening we re-screen within two weeks and if the child still doesn't pass then we will have asked the family to take them to the ENT or the audiologist for further testing.
Sometimes the teachers will actually voice concerns, academic concerns or the children are not paying attention or they don't seem to be following the directions or knowing what's going on in the classroom. And sometimes the nurses have to do hearing screenings at certain ages of public school children and if they don't pass those screenings then they alert me, at my request, so then I can follow up with the nurse in two weeks to see if that child still doesn't pass the hearing screening then I get in touch with the parents and we go forward.
Do you make a point of reaching out to all the teachers say ahead of a school, a new school year and just saying hey look if you happen to notice any of these types of warning signs please let me know because it may be something more than than what you think it is?
Um, especially when we went from in person to virtual I sent out, I made a power point of kind of do's and don'ts and things to look for for children with hearing loss and just kind of good teaching practices. Especially when we're going to this virtual model that really none of us have ever taught before. And that was really helpful and I got good feedback to say, “oh, I never considered that and I didn't know about that” so that was very helpful for that kind of professional development for all staff members whether it's your PE teacher, the music teacher, a general education teacher, the counselor, anybody who comes in contact with a student it was really helpful. I do ongoing professional development for the school system as needed. Um, like sign language, little professional development section and you know sessions that so they can learn some basic sign language to work with kids with hearing loss and for behavior management, things like that.
We've talked on this program plenty of times about how hearing loss impacts everybody. How in every area of development. How and when do you see these or what areas do you see most affected for children as they're coming up through the years?
For the really young kids really it's the the area of communication and speech and language development. Um, some children are just not developing communication and speech and language skills and so we need to find out why that is. Is it apraxia? Is it, is there a hearing loss? Is there something else going on? Is there another medical diagnosis or a genetic component? And so we really have to look really closely and see why are those children not developing those skills. Because language and literacy impacts everything. Everything we do in the world has to do with language and literacy. So if those skills aren't there they're going to struggle in all other areas of their life, essentially. And so we really look for those skills and also academic. They have difficulty with academic skills because if you are not hearing the auditory information given to you and the directions in the instruction then you're not going to be able to apply that and that's going to be very challenging in the academic realm for kids too.
When you notice a situation where a child there's something going on with the child that's obvious they're missing something. Does it start by going to see Dr. Ana, an audiologist or do you have to start with a medical doctor how does the process work with children?
Yeah, usually they go to the ENT and then they come to us. And then we can make uh
referrals as to for a medical clearance before they even get fitted with um amplification.
So, the so it starts for children it starts with an ENT versus say an adult where I can just come into an audiologist and make an appointment?
Right. Yeah. And even with younger kids it probably starts with a pediatrician, like with their annual checkups or if they're if they're having a lot of ear infections. Or if they have um wax or build up. You know they're just the parents are like, “they're really not responding to me”, I'm calling their name and they're not turning around. Usually they go to the pediatrician first and then the pediatrician will do a hearing test or hearing screening and then it will go to the ENT and then we come to Dr. Ana.
Gotcha. The eligibility process in the school system, what's it like for accessing support services in schools?
Well they're for, um, at least for Fauquier County there's a process that we go through and the child has to be screened first. Um, that hearing screening that I spoke about before, um and if they don't have that, they don't pass that screening and then they have to go to the audiologist. And they have an audiological exam and that shows that there is a hearing loss then there's certain criteria that we have to go through as an eligibility team which the parents are part of that team. And we go through all of the criteria to see - is there an educational impact, are their deficits in communication? And then, do they need specially designed instruction? And then what type of hearing loss? That's one of the first questions- what type of hearing loss and the severity of it. And so I’ll take all of that information that I get from the audiologist and I put it in that form and then discuss with the team how that hearing loss is going to impact the child socially, emotionally, academically, communication skills um and in every aspect you know even like social skills with students. Even psychologically like, how you know these these children need to have help. And need to have intervention. So that's an eligibility process we go through. Then if the child is found eligible for services, as a student with a hearing impairment then an IEP you know Individualized Education Plan is developed and then that's where I I come in and I provide services for them.
Now when children are identified with with hearing loss and they then they get fitted with hearing aids, if they've come and they've seen you does, the support system continue and how important is that for it to continue especially with children?
Oh yeah it's vital. Yeah. It's very pivotal. So they come in, we um manage their hearing loss, we make changes, we evaluate you know where they may be today compare that to they were you know whatever the last audiological evaluation. Whether it's a few months ago, a few weeks ago, or six months ago. Um, make changes, interventions, maybe the ENT needs to be pulled in again. And it's so nice to have this connection. Um, I never get to see the actual teacher coming to see us. I do love it, it’s such a great team and I feel like, you know, she trusts my efforts and vice versa and it just makes a very complete team so that you know the recommendations will be followed through.
And I can share what's happening in the school. Like what kind of studying the child is in. Are they in a special program with a lower student teacher ratio or are they in general education classes all the time. And then the student comes and they can say well when I go to the gym it's a little echoey or I have a harder time in music because everything's so loud. Or when I'm, when I'm working by myself it's fine but then when people start moving their chairs and there's background noise I have a harder time hearing. That's vital information that we share with Dr. Ana and then she can adjust accordingly and so they're getting maximum support out of their amplification devices to be successful in school.
Right. I'm not suggesting that every teacher has the time to bring in their kids but it just makes it so nice for us. Because I get tiny bits of information that are so critical for the success of the kids.
Yeah. Because you're not in the school and I'm not here every day. Right. Yeah and the kids cannot tell me exactly what's been going on at the gym, at the cafeteria, you know in the classroom and it's just it makes it so it's very nice.
It underscores the importance of a multi-faceted support system. Absolutely. And it made me think as you were talking about background noises and things when you're in school especially at the high school level, even the the middle school level. There is band practices or you're going to games and they're you're in a in the arena or you're even out at the football stadium or soccer field. Whatever it is, dances things like that that we all kind of take for granted as kids that we're all going to do that, but somebody that has hearing issues it's it's a completely different situation. That's something where you can help them based on the types of whatever it is?
I mean even, even I have some students that have cochlear implants and they play sports. And so they need certain types of helmets. And you know the coaches need to know that you have to look at them to give them directions instead of just everybody getting in a huddle and you're talking above them and giving directions or this is the play we're going to do. You need to really have that eye contact and their attention so they absolutely are hearing what you're saying to them and then they go off and they're just part of the team like everybody else. So, some of those accommodations to work with them, the coaches and the families to share with the coaches what they need too. So it really is a comprehensive team between the audiologist, the teacher, the parent, the student and then the additional school staff because everybody's working to maximize their potential.
Now I know that you often go on audiology appointments with your students. I do. And and so that's when you come in and you get to see Dr. Ana. But you can't always be there, right? You can't always be in every place. So what advice do you give to to maybe the parents and the kids you know on a day-to-day basis where they might be struggling. What, how do they stay focused and and kind of stay on that right path that you help guide them?
I really try to be very um integral in the process with the parents. Even if I don't go to the audiological appointment. I always ask the parents to share the report with me and then I will meet with the parents either in person or via Zoom or Google Meet and I'll go over what those results mean more in layman's terms. Because there's a lot of medical terms and information and a lot of times the parents don't understand what that means. So I'll say this this means he's hearing this and he's not hearing this and they and they're not saying their ‘s’ sounds well that's because they can't hear that sound based on the audiogram. So, um that's been really really helpful.
And then with the students I say to them you know I'm not here every day so you you've kind of got to find your people. Find find your person. So I show the kids you know who their resources are in the school between the counselor, the nurse, an assistant principal, their favorite teacher, a homeroom teacher, because I'm not always going to be there. I wish I was there every day. I just can't be being that I'm the only one in a lot of different places. So I say to them find somebody that you're really comfortable with. That you could go to to charge your device if you need to. To answer a question if you don't understand something. Maybe you need a quiet room to retake a test. Find your person and then a lot of times they're in the same school elementary until fifth grade and then sixth, seventh, and eighth for middle school so there's three years and then four years of a high school so a lot of times they can find that person, hold on to that person for several years.
What's nice about my job is I work with kids from age 2 to 22 and so I will follow them all the way through. So that we will have a long-standing relationship and so they learn to trust me. But my job is to help them advocate for themselves. What/ how do they learn best? What do they need in the school system? If I’m not there and how do I go about getting that? How do I get my needs met when I'm not there every day?
And then they're able to better deal with it on their own and go off? Well and because they're going to graduate and go to college or four year or vocational or the workforce or whatever. And they're still going to have hearing loss and so they need to learn to advocate for themselves and what do they need to be successful.
Shelley it's wonderful work you're doing. I wish that I really enjoyed it and I love to see you and I wish every school system had a Shelley Millerson. Oh thank you so much. I really enjoyed it. Ana, thank you. Thank you so much.
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