FUNCTIONAL SKILLS SUMMARY FOR STUDENTS WITH HEARING LOSS Student: Grade: School: Date: This form assists professionals and school teams in considering the communication access and other needs of a student with hearing loss. These measures relate to communication access or communication interaction issues for which students are most vulnerable. Reviewing the results of measures in these areas will assist the school team in determining if unmet needs in educational performance, including skill development, self-advocacy, and access accommodations that require classroom intervention, special instruction, or specialized support services are evident. ACCURATE FUNCTIONAL LISTENING Poor Below Average Average Good REPETITION EVALUATION < 80% 80-89% 90-95% 96-100% OF Soft speech (35 dB HL) in quiet Loud speech (50 dB HL) in quiet □ SENTENCES Soft speech (35 dB HL) at +5 S/N PHRASES □ Loud speech (50 dB HL) at +5 S/N SINGLE □ Soft speech with use of FM WORDS (no visual input) With visual cues Soft speech (35 dB HL) at +5 S/N IOWA MEDIAL CONSONANT TEST Poor Fair Good Excellent < 50 / 58 50 54 / 58 55-57 / 58 58 / 58 Precision Listening – 100% expected with early use of well-fit amplification and early auditory skill development if loss is 25-70 dB HL Student LIFE Listening Inventory For Always Mostly Sometimes Mostly Easy Always – Difficult Difficult Difficult Education Student Appraisal Gr 3+ Easy Record number per each rating to total 15 Classroom Listening Situations (1-10) using FM system Classroom Listening (1-10) with HAs/CIs only (no FM) Additional Listening Situations (items 11-15) Preschool SIFTER Content Areas At Risk Pass □ age 3-5 Screened SIFTER Fail Marginal Pass □ elementary Secondary SIFTER (Pre)Academics □ SCREENING Attention INSTRUMENT FOR Communication TARGETING Class Participation EDUCATIONAL RISK School (Social) Behavior LISTENING COMPREHENSION Below Average Low Average Good Excellent < 85 85 - 99 100 - 114 115+ The Listening Comprehension Test □6-12 □12-18 Ages Oral Passage Understanding Scale LANGUAGE ASSESSMENT Percentile Below Average Low Average Good Excellent INSTRUMENTS Rank <85 85 - 99 100 - 114 115+ Comprehensive Assmt of Spoken Language Clinical Evaluation of Language Function V Test of Auditory Processing Skills 3 Test of Narrative Language - 2 Pragmatic Language Skills Inventory Pragmatic Language Observation Scale Social Language Development Test
FUNCTIONAL SKILLS SUMMARY FOR STUDENTS WITH HEARING LOSS Student: Grade: School: Date: This form assists professionals and school teams in considering the communication access and other needs of a student with hearing loss. These measures relate to communication access or communication interaction issues for which students are most vulnerable. Reviewing the results of measures in these areas will assist the school team in determining if unmet needs in educational performance, including skill development, self-advocacy, and access accommodations that require classroom intervention, special instruction, or specialized support services are evident. ACCURATE REPETITION OF □ SENTENCES □ PHRASES □ SINGLE WORDS (no visual input) FUNCTIONAL LISTENING EVALUATION Poor < 80% Below Average 80-89% Average 90-95% Good 96-100% Soft speech (35 dB HL) in quiet Loud speech (50 dB HL) in quiet Soft speech (35 dB HL) at +5 S/N Loud speech (50 dB HL) at +5 S/N Soft speech with use of FM With visual cues Soft speech (35 dB HL) at +5 S/N IOWA MEDIAL CONSONANT TEST Precision Listening Poor < 50 / 58 Fair 50 – 54 / 58 Good 55-57 / 58 Excellent 58 / 58 100% expected with early use of well-fit amplification and early auditory skill development if loss is 25-70 dB HL Student LIFE – Listening Inventory For Education Student Appraisal Gr 3+ Record number per each rating to total 15 Always Difficult Mostly Difficult Sometimes Difficult Mostly Easy Always Easy Classroom Listening Situations (1-10) using FM system Classroom Listening (1-10) with HAs/CIs only (no FM) Additional Listening Situations (items 11-15) □ Preschool SIFTER age 3-5 Content Areas Screened At Risk Pass □ SIFTER elementary Fail Marginal Pass □ Secondary SIFTER (Pre)Academics SCREENING INSTRUMENT FOR TARGETING EDUCATIONAL RISK Attention Communication Class Participation School (Social) Behavior LISTENING COMPREHENSION Below Average < 85 Low Average 85 - 99 Good 100 - 114 Excellent 115+ The Listening Comprehension Test Ages □6-12 □12-18 Oral Passage Understanding Scale LANGUAGE ASSESSMENT INSTRUMENTS Percentile Rank Below Average <85 Low Average 85 - 99 Good 100 - 114 Excellent 115+ Comprehensive Assmt of Spoken Language Clinical Evaluation of Language Function V Test of Auditory Processing Skills 3 Test of Narrative Language - 2 Pragmatic Language Skills Inventory Pragmatic Language Observation Scale Social Language Development Test
FUNCTIONAL-SKILLS-SUMMARY-revised.docx