Download fisher`s auditory problems checklist

Dr. Barry Galasso
Executive Director
Bucks County Schools Intermediate Unit No. 22
705 N. Shady Retreat Road
Doylestown, PA 18901
Voice: 1-800-770-4822 FAX: 215-340-1639
TDD/TTY: 215-348-1127
2011-2012 HEARING SUPPORT,
AUDIOLOGICAL & AUDITORY PROCESSING TESTING
SERVICES REFERRAL PACKET
TO:
SPECIAL EDUCATION COORDINATORS
SCHOOL PRINCIPALS
SCHOOL NURSES
HEARING SUPPORT TEACHERS
FROM:
KEVIN J. MILLER, Ed.D., SPECIAL EDUCATION SUPERVISOR
HEARING SUPPORT PROGRAM
DATE:
SEPTEMBER 2011
The Hearing Support Program of the Bucks County Intermediate Unit #22 provides various services to the school
districts of Bucks County. These services are provided for the purpose of enhancing the educational program of
students with learning challenges.
Services provided by the Hearing Support and Audiology Program include the following:
AUDIOLOGY:
HEARING SUPPORT:
Annual Audiological Evaluations
Classroom & Itinerant Hearing Support Services
Initial Audiological Evaluations
Interpreter Services
Hearing Aid Evaluations
C-Print Captioning
Auditory Processing Evaluations
Soundfield Consultation
Impedance/Otoacoustic Emissions Screenings
Noise Awareness Program
Sound Field Consultation
Noise Awareness Program
Loaner hearing aids & FM systems for students with hearing loss
Please consult the procedures outlined in this packet to request the services listed below:
Referral form for:
Hearing Support Itinerant Services, Interpreter Services, C-Print Captioning, Initial Hearing/Hearing Aid Evaluations,
and Auditory Processing Evaluations
Annual Student Audiological Evaluation Referral Form
Otoacoustic Emissions (OAE) & Impedance Evaluation Form
Assistive Technology (ALD) Requisition Form
Directions to both testing centers (BCIU #22 in Doylestown; Tawanka School in Langhorne)
If you have questions concerning Classroom & Itinerant Hearing Support Services requests or referral procedures,
please contact Beth Josuweit, Program Secretary, by phone 800-770-4822 ext. 1241 or email: [email protected].
If you have questions concerning Audiological or Auditory Processing Testing requests or referral procedures, please
contact Debra Camburn, Audiology Secretary, by phone 800-770-4822 ext. 1525 or email: [email protected]
If you would like to schedule Otoacoustic Emission & Impedance testing, please contact Alicia Simon, by phone
800-770-4822 ext. 2451 or email: [email protected] , or Kristin Peppiatt, 800-770-4822 ext. 1718 or email:
[email protected]
BCIU #22 School Nurses’ Referral Packet
2011-2012 School Year
1
HEARING SUPPORT AND AUDIOLOGY PROGRAM
BCIU #22 MAIN SWITCHBOARD:
Student Referral Fax:
Audiologists’ Fax:
TTY Relay Service:
215-348-2940 or 1-800-770-4822
215-340-1639
267-897-9220
1-800-654-5988
ITINERANT HEARING/SPEECH & LANGUAGE SUPPORT PROGRAM SUPERVISORS:
Dr. Kevin J. Miller
1-800-770-4822 ext. 1240
[email protected]
Serving:
Quakertown, Pennridge, Palisades, Pennsbury, Central Bucks
Jill Seidman
Serving:
1-800-770-4822 ext. 2179
[email protected]
Morrisville, Bristol Twp., Bristol Borough, Centenial, Bensalem
Marguerite Vasconcellos, Program Director
Serving:
1-800-770-4822 ext. 1679
[email protected]
Neshaminy, Council Rock, New Hope
ASSISTANT TO HEARING SUPPORT PROGRAM:
Beth Josuweit
1-800-770-4822 ext. 1241
[email protected]
(Please forward Hearing Support Classroom, Itinerant & Interpreter Services requests to Beth Josuweit)
AUDIOLOGISTS:
Alicia Simon, Au. D., CCC-A
Ann Crawford, M.A., CCC-A
Kristin Peppiatt, Au. D., CCC-A
1-800-770-4822 ext. 2451
1-800-770-4822 ext. 2159
1-800-770-4822 ext. 1718
[email protected]
[email protected]
[email protected]
AUDIOLOGICAL & AUDITORY PROCESSING EVALUATION SCHEDULING SECRETARY:
Debra Camburn
1-800-770-4822 ext. 1525
[email protected]
(Please forward Audiological and Auditory Processing Testing requests to Debra Camburn)
OAE & IMPEDANCE SCHEDULING:
Alicia Simon
Kristin Peppiatt
1-800-770-4822 ext. 2451
1-800-770-4822 ext. 1718
Questions about Testing procedures and results, Equipment, Hearing Aids, FM systems and Audiometers:
Contact:
Alicia Simon
1-800-770-4822 ext. 2451
Kristin Peppiatt
1-800-770-4822 ext. 1718
Ann Crawford
1-800-770-4822 ext. 2159
SOUND FIELD EQUIPMENT:
Alicia Simon
Kristin Peppiatt
1-800-770-4822 ext. 2451
1-800-770-4822 ext. 1718
GUIDELINES FOR
BCIU #22 School Nurses’ Referral Packet
2011-2012 School Year
2
INITIAL & ANNUAL HEARING EVALUATION PROCEDURES
INITIAL REFERRAL-(students being referred for BCIU audiological testing for the first time)
USE PAGE 4----Refer any student:
 Whose hearing-screening test is felt to be unreliable and/or school professionals suspect a hearing loss.
 Who has chronic fluctuating hearing loss.
 Who has failed the BCIU #22 OAE testing.
 Who repeatedly fails the school nurse’s hearing screening evaluation.
ANNUAL REFERRAL- (students previously tested by BCIU Audiology)
USE PAGE 5---Refer any student:
 Who wears amplification or uses auditory assistive technology
 Who has a diagnosed hearing loss
 Who receives Hearing Support services
School Nurse’s Responsibility:
1. Please complete the appropriate evaluation form Please include the current student information with any
changes in address and telephone number.
BOTH ANNUAL & NEW
2. Send the completed form via Email/U.S. mail /interoffice mail or fax to:
Bucks County Intermediate Unit # 22
Attn: Debra Camburn, Audiological Secretary
Hearing Support Program
705 North Shady Retreat Road
Doylestown, PA 18901
Fax: 215-340-1639
Email: [email protected]
**Please Note: To assist us in eliminating ‘no-shows,’ please advise parents that appointments are at a premium.
If an appointment is missed, it may take several weeks for the next available appointment.
It is also the parent’s responsibility to contact Debra Camburn to reschedule the appointment.
I.U. Responsibility:
1. Debra Camburn, scheduling secretary, will contact the student’s parent to schedule an appointment
upon receipt of the referral form.
2. Confirm the student’s appointment date and time with the school nurse by phone or email.
3. The student’s parent will receive an appointment confirmation and permission form, driving
directions and case history.
4. Send a copy of the Audiological Evaluation Report to the student’s parent and the appropriate
school personnel within one month of the test date.
5. If the scheduled appointment is cancelled or the student does not attend, the school nurse will be
contacted by phone or email.
6. If Debra Camburn is unable to reach the parent to schedule an appointment, the school nurse will
be notified by phone or email.
BCIU #22 School Nurses’ Referral Packet
2011-2012 School Year
3
2011-2012 HEARING SUPPORT, AUDIOLOGICAL &
AUDITORY PROCESSING EVALUATION REFERRAL FORM
STUDENT’S NAME: _________________________________ DOB: ____/____/____ Grade: ________ Male/Female
ADDRESS: ______________________________________________ HOME DISTRICT: ________________________________
SCHOOL: _______________________________________________ TEACHER: _______________________________________
HOME PHONE#: _________________ WORK#: _________________ CELL #: _________________ TTY: __________________
PARENT/GUARDIANS’ NAME(S): ___________________________________________________________________________
**********************************************************************************************************
1. Reason for Referral: _______________________________________________________________________________________
2. Has parental permission been obtained? ________ Method_________________________________ Date: _______________
**Will this student need assistance in the testing booth? YES NO
3. Services Requested (Please check all that apply):
___ INITIAL AUDIOLOGICAL EVALUATION by an educational audiologist Please complete ONLY page 4
(students being referred for BCIU audiological testing for the first time)
___ ANNUAL AUDIOLOGICAL EVALUATION Please complete ONLY page 5
(students previously tested by BCIU Audiology)
Please note any equipment the student currently uses:
___ Hearing Aids
___ FM/Soundfield
___Edulink/MicroEar
___ Cochlear Implant
___ AUDITORY PROCESSING EVALUATION-Please complete pages 4, 9 and 10. Pages 9 & 10 must accompany this form
Statement of General Scholastic Achievement:_____________________________________________________________________
Recent Test Results (past 2 years):
Assessment:
Date
Verbal
Non-Verbal
I.Q.
Administered by:______
Assessment:
Date
Verbal
Non-Verbal
I.Q.
Administered by:______
4. Background Information:
Hearing Test:
Date _____/_____/_______
Results: R________dB ;
L_________dB
Significant Physical Limitations (hearing, vision, serious illness, etc.): ____________________________________________
__________________________________________ ____________________________________
School Nurse Making Referral
Telephone Number
________________________
Date
___ HEARING SUPPORT ITINERANT SERVICES EVALUATION by a Teacher of the Deaf/Hearing Support Teacher
(Please attach current audiogram and Permission To Evaluate and comply with all district procedures for eligibility.)
___ INTERPRETER SERVICES
___ C-PRINT TRIAL—(2 weeks)
Please complete this section for C-Print Trials. Attach student schedule if available.
Reading Level Assessment Tool: _____________________________ Reading Level: ______________________________
Class(es): __________________________________________________________________________________________
5. Is the child currently enrolled in any of the following? Circle all that apply:
Speech/Language Therapy
Resource Room/Open Classroom
Remedial Reading
Preschool Services
Learning Support
Multiple Disabilities Support
ABA Class
Physical Support
Language Learning Support
Itinerant Hearing Support
Autistic/PDD Support
Emotional Support
Neurological Impairment Support Other (Please Specify):________________________________________________________
____________________________________________________
Principal Signature
Date
BCIU #22 School Nurses’ Referral Packet
__________________________________________________
Special Education Supervisor
Date
2011-2012 School Year
4
2011-2012 ANNUAL AUDIOLOGICAL
EVALUATION REFERRAL FORM
(**to be used for students previously tested by BCIU Audiology**)
DISTRICT: _________________________
SCHOOL: _________________________
DATE: _________________
NURSE: ____________________________ NURSE’S EMAIL:____________________________________________
NURSE PHONE:______________
Student’s Name
FAX: _____________ HEARING TEACHER: ____________________________
Date
of
Birth
Date
of
Last Test
Student wears
Hearing Aids?
Uses FM or
Soundfield?
STUDENT
DIFFICULT
TO
TEST*
EMail/Mail/Fax to: Debra Camburn, Audiology Secretary,
BCIU #22 Hearing Support Program, 705 N. Shady Retreat Rd. Doylestown, PA 18901
Changes in Student’s
Address &
Phone/TTY Number
Appt.
Date
215-340-1639 (Fax)
*Children who are difficult to test require an audiologist and an assistant.
Please √ this box for children in the following classes: Applied Behavior Analysis, Multiple Disabilities, Physical
Support, Neurological Impairment, Emotional Support, Pervasive Deficit Disorder or Preschool.
GUIDELINES FOR
AUDITORY PROCESSING EVALUATION
BCIU #22 School Nurses’ Referral Packet
2011-2012 School Year
5
REFERRAL PROCEDURES
Refer Any Student:
 Who has a chronological and language age of seven years.
(APD evaluations are suggested for children aged seven and up.)
 Whose intellectual ability falls in the “normal” range.
 Who has normal hearing acuity.
 Team should screen student for significant learning difficulties—if student demonstrates problems in areas deemed
“auditory processing,” implement common educational/classroom strategies for these suspected problems.
(Strategies are enclosed)
 Who does not demonstrate academic improvement following a trial period of educational/classroom modifications.
 Only if the formal auditory processing test battery will contribute to the overall management of the student in the
academic setting.
School Personnel Responsibility:
School personnel complete the referral forms on pages 4, 9 and 10
1. School personnel complete the referral form and obtain the signature of appropriate district personnel.
2. The speech consultant is responsible for language screening and completes the screening form.
3. The classroom teacher(s) completes the Fisher’s Auditory Checklist.
a) I.U. Referral form—page 4
b) Speech and Language Evaluation—page 9
c) Fisher’s Auditory Checklist—page 10
4. Referring person send the completed via Email/U.S. mail/interoffice mail or fax to:
Bucks County Intermediate Unit #22
Attn: Debra Camburn, Audiology Secretary
Hearing Support Program
705 North Shady Retreat Road
Doylestown, PA 18901
Fax: 215-340-1639
Email: [email protected]
**Please Note: To assist us in eliminating ‘no-shows,’ please advise parents that appointments are at a premium.
If an appointment is missed, it may take several weeks for the next available appointment.
It is also the parent’s responsibility to contact Debra Camburn to reschedule the appointment.
I.U. Responsibility:
1. Debra Camburn will contact the student’s parent to schedule an appointment upon receipt of the completed
referral form, Fisher’s Auditory Checklist and Speech/Language Evaluation.
2. Confirm the child’s appointment date and time with the school nurse/referring party by phone or email.
3. Parent will receive an appointment confirmation and permission form, driving directions and case history.
4. Send a copy of the Audiological Evaluation Report to the parents and the appropriate
school personnel within one month of the test date.
5. If the scheduled appointment is cancelled or the student does not attend, the school nurse will be
contacted by phone or email.
6. If Debra Camburn is unable to reach the parent, the school nurse will be contacted by phone or email.
AUDITORY PROCESSING EVALUATION
PROCEDURE FLOWCHART
BCIU #22 School Nurses’ Referral Packet
2011-2012 School Year
6
AUDITORY PROCESSING REFERRALS
Student considered has a chronological and language age of at least 7 years?
DO NOT
REFER
No
YES
Student’s intellectual ability within normal range?
DO NOT
REFER
No
YES
Student has normal hearing acuity?
No
DO NOT
REFER
YES
Building Team has implemented instructional strategies
to maximize processing?
No
DO NOT
REFER
YES
Significant academic improvement has been observed?
No
Continue
Strategies—
DO NOT
REFER
No
Complete Referral Packet for
Auditory Processing Evaluation:
BCIU Referral Form (page 4)
Speech & Language Screening Form (page 9)
Fisher’s Auditory Checklist (page 10)
Send COMPLETED Referral Packet to
BCIU #22 via Email/U.S. mail/interoffice mail/
[email protected]
FAX # 215-340-1639
BCIU #22 School Nurses’ Referral Packet
2011-2012 School Year
7
EDUCATIONAL AUDIOLOGISTS ASSOCIATION’S
SUGGESTIONS FOR APD STRATEGIES
Classroom Modifications for children with APD
Preferential Classroom Seating:
 Seat the student away from distracting noises
 Seat the student near the teacher’s area of instruction
 Allow flexibility of seating if the area of instruction changes
 Seat the student so that the better ear, if there is one, is favored
 Isolate the student, using study carrels if available, for individual seatwork, tests, or tutoring
 Allow the student to use earmuffs or earplugs when working individually
Peer Assistance:
 Use a “buddy system” to alert the student to attend and to be sure student has assignments
and special instructions
 Use a note taker to take or copy notes
Alerting: Look and Listen:
 Gain eye contact with the student before giving class instructions
 Tap the student gently to gain attention
 Use a “secret sign” to remind the student to listen
Teaching Techniques:
 Speak distinctly and at a moderate rate
 Give clear and concise directions
 Use familiar vocabulary and less complex sentence structures when giving instructions
 Simplify information by giving it in small segments
 Rephrase or restate instructions in simple terms
 Require the student to repeat instructions to ensure understanding
 Preview the topic to be presented by introducing new vocabulary and outlining new subjects
 Use visual aids such as overhead projectors, illustrations, and maps
 Use concrete, experiential lessons when possible
 Write assignments on the board, as well as giving them orally
 Be sure the student writes assignments in a specific place
 Allow breaks between intense periods of instruction
 Alternate difficult instruction with simpler activities to avoid fatigue
 Use a consistent routine of activities to allow the student to have a smoother transition from one subject to the next
BCIU #22 School Nurses’ Referral Packet
2011-2012 School Year
8
AUDITORY LANGUAGE SCREENING SHEET
FOR AUDITORY PROCESSING EVALUATION
(To be completed by speech consultant)
STUDENT’S NAME: _______________________________________________
Date Completed: ___________
SCHOOL/DISTRICT: ______________________________________________ Chron. Age: ____ GRADE: _____
*Indicate test version: _____ CELF-4 Screener
_____ Other
________________________________________________________________________________________________
Spoken Language
Refers to a child’s overall language proficiency including semantics (the meaning of language) and syntax
(forming and understanding sentences)
__________________________________________________________________________________
Listening/Understanding
Refers to the manner in which language is understood
__________________________________________________________________________________
Organization
Refers to the organization of incoming information
__________________________________________________________________________________
__________________________________________________________________________________
Articulation: _____________________________________________________________________
__________________________________________________________________________________
Additional Comments:
• Distractibility: _____________________________________________________________________
• Sound-letter association: _____________________________________________________________
• Discrimination of sounds in all positions in words:________________________________________
• Sound blending or transpositions: ______________________________________________________
Student is currently:
____ enrolled in speech/language therapy for _______________________________________
____ being considered for speech/language therapy for ________________________________
____ not enrolled in speech/language therapy
_______________________________________________
Speech Consultant’s Signature & Credentials
BCIU #22 School Nurses’ Referral Packet
(___)___________________
Telephone
2011-2012 School Year
9
FISHER’S AUDITORY PROBLEMS CHECKLIST
FOR AUDITORY PROCESSING EVALUATION
(To be completed by classroom teacher)
Student’s Name: _________________________________ Grade_______
Date Completed: _____________
District/School: _________________________________ Observer/Teacher:
Please place a check mark before each item that is considered to be a concern by the observer.
1. Does not pay attention (listen) to instruction 50% or more of time.
2. Does not listen carefully to directions - often necessary to repeat instructions.
3. Says “Huh?” and “What?” at least five or more times per day.
4. Student cannot attend to auditory stimuli for more than a few seconds.
5. Short attention span (check the most appropriate time frame):
___ 0-2 minutes ___ 2-5 minutes
___ 5-15 minutes
___ 15-30 minutes
6. Daydreams - attention drifts - not with it at times.
7. Easily distracted by background sound(s).
8. Difficulty with phonics. What is the reading program being used?
_________________________________________________________________
9. Problems with sound discrimination.
10. Trouble recalling a sequence student has heard.
11. Forgets what is said in a few minutes.
12. Does not remember simple routine things from day to day.
13. Problems recalling what was heard last week, month, year.
14. Difficulty following auditory directions.
15. Often misunderstands what is said.
16. Does not comprehend many words - verbal concepts for age/grade-level.
17. Slow or delayed response to verbal stimuli.
18. Has a language problem (morphology, syntax, vocabulary, phonology).
19. Has articulation (phonology) problem (difficulty with expressive speech sounds).
20. Child cannot always relate what is heard with what is seen.
21. Learns poorly through the auditory channel.
22. Lacks motivation to learn. What behavior noted to substantiate?
________________________________________________________________________
_________________________________________________________________
23. Performance is below average in one or more subject area(s).
24. Difficulty with reading comprehension
• Classroom Strategies already implemented and effects (circle): +positive change
-no change or worse
COMMENTS: ___________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
BCIU #22 School Nurses’ Referral Packet
2011-2012 School Year
10
IMPEDANCE & OTOACOUSTIC EMISSIONS
EVALUATION REFERRAL PROCEDURES
The Pennsylvania State Department of Health mandates that all children with a current IEP must have their
hearing screened annually.
Refer Any Student Who:
 Has a current IEP and cannot be routinely screened by the school nurse.
 Cannot condition to the school nurse’s screening.
Nurse’s Responsibility:
1. Contact Alicia Simon at 1-800-770-4822 ext. 2451 or Kristin Peppiatt, ext. 1718, if you wish to
schedule.
NOTE: Please call early, dates fill quickly.
2. Please have the Parent Permission Form (pg. 13) signed. Hold the form until the date of evaluation.
3. Schedule a quiet room for audiological testing.
4. Contact the parent/guardian regarding the test results.
5. If the child fails and requires additional testing, refer for an initial audiological evaluation on a
preschool day (child will be tested by an audiologist and assistant).
6. If the child failed impedance testing only, it is suggested that the student be referred to his/her
physician.
7. If further testing by the BCIU is requested, the parent/guardian should contact Debra Camburn,
scheduling secretary, at 215-348-2940 ext. 1525.
8. If a child is absent on the day of the evaluation, the audiologist will be unable to schedule a
make-up test. The parent/guardian should contact Debra Camburn at the BCIU to request a
complete audiological evaluation.
I.U. Responsibility:
1. Complete tests on scheduled date.
2. Consult with the school nurse regarding test results.
3. Give the school nurse a copy of evaluations at time of testing.
BCIU #22 School Nurses’ Referral Packet
2011-2012 School Year
11
IMPEDANCE & OTOACOUSTIC EMISSIONS TESTING
Some children with special needs typically cannot respond to traditional hearing screening evaluations
administered by the school nurse. Pure tone screening evaluations generally are not successful with this
population, as these children cannot understand the task required when administering the hearing screening
evaluations. It should be emphasized that the hearing status of every child must be evaluated yearly to meet
Pennsylvania’s requirement for placement in special education.
With the school nurse’s current resource, the screening audiometer, the terminology DNT (did not test) or
CNT (could not test) does not have to be accepted as the final hearing screening result for any child.
Otoacoustic emission’s can provide frequency-specific, objective data. Otoacoustic emissions in combination
with impedance testing (test to determine if a medical problem exists) have become valuable diagnostic tools
to identify hearing loss in children.
Tympanometry
Tympanometry is an important part of the audiological assessment. Tympanometry measure the mobility of
the eardrum. The vibration of the eardrum is essential to normal hearing. This measurement is important in
determining the possible cause of a hearing loss that is generally not permanent, but medically correctable. A
recording of the eardrum’s response to pressure changes will help the audiologist determine if the eardrum is
moving normally. If the eardrum is not moving normally, the child should be referred to their pediatrician for
a medical examination. Possible problems could include impacted cerumen, foreign objects, fluid, eardrum
perforations, or a blocked P.E. tube.
Otoacoustic Emissions
Otoacoustic Emissions (OAE) are sounds produced in a healthy ear when a sound is delivered through the ear
canal. The audiologist introduces a sound that travels past the eardrum and to the inner ear (cochlea) via the
bones of the middle ear.
The cochlea produces an echo that is measured by the instrument the audiologist has placed in the ear canal.
The echo is compared to normative data. The test must be conducted in a silent environment in order to avoid
corruption of the sounds measured. The child is required to remain relatively quiet for about 3 minutes. If the
cochlea (outer hair cells) is normal, and OAE’s are present, hearing acuity is presumed to be normal. A good
rule of thumb is that if OAE’S are present, hearing is 35dB or better. If OAE’s are depressed or absent,
further audiological evaluations are suggested to rule out a sensorineural (permanent) hearing loss.
BCIU #22 School Nurses’ Referral Packet
2011-2012 School Year
12
Dear Parent/Guardian,
Your child is scheduled to receive an impedance/otoacoustic emissions evaluation at school. These screening
tests require no active cooperation from your child and help identify hearing problems.
Please sign and complete the permission form at the bottom of this page authorizing the school to conduct this
evaluation. Return the permission form to the school as soon as possible.
If you have any questions, please contact the school nurse at your child’s school.
Sincerely,
____________________________________________
School Nurse/Teacher
***************************************************************************************
CHILD’S NAME: _____________________________________________
DATE OF BIRTH: _____________
DISTRICT OF RESIDENCE: ___________________________
SCHOOL:___________________________
If tubes are present, please check: Right ear: __________________Left ear: _______________________
If your child is presently under the care of a physician for any conditions affecting his hearing, please explain.
_______________________________________________________________________________________
_______________________________________________________________________________________
Permission for my child to have an impedance/otoacoustic emissions test?
YES
NO
Parent/Guardian Signature: ________________________________________________________________
BCIU #22 School Nurses’ Referral Packet
2011-2012 School Year
13
PROCEDURES FOR REQUESTING ASSISTIVE LISTENING DEVICES (ALD)
FOR CHILDREN WITH AUDITORY/LANGUAGE LEARNING PROBLEMS:
1. School district should implement the SETT process.
2. Submit an audiological report requesting the trial use of all ALD equipment to the BCIU #22
Doylestown office. Please also include a medical clearance from the student’s physician for
Individual FM system requests.
To request FM system equipment, contact:
Alicia Simon at 800-700-4822 ext. 2451 or
Kristin Peppiatt at 800-770-4822 ext. 1718 or
Ann Crawford at 800-770-4822 ext. 2159
3. The BCIU #22 sets up equipment for trial usage for the maximum period of two months.
4. The BCIU #22 audiologists in-services the student, teacher, parent, etc. on the use of the equipment.
5. SETT team documents student’s behavior before, during and after the trial period.
Various behavioral checklists such as, “Teacher’s Appraisal of Classroom Amplification Trial
Period,” are available to assist with documentation.
6. The BCIU #22 audiologists, hearing consultant or speech/language consultant is responsible
for the return of the ALD to the BCIU #22 after trial use.
7. After the trial period, it becomes the school district’s responsibility to decide whether to purchase
a similar device. The BCIU #22 can provide the school district with a list of manufacturers.
DOYLESTOWN OFFICE-BCIU #22
BCIU #22 School Nurses’ Referral Packet
2011-2012 School Year
14
705 North Shady Retreat Road Doylestown, PA 18901
FROM THE QUAKERTOWN AREA:
Use Rt. 313 East to the 611 South Bypass. Proceed to the Broad St. exit. Turn left onto Broad St.
Turn right onto Shady Retreat Rd. The BCIU is at the first driveway on the left.
FROM THE LOWER BUCKS AREA:
Use Rt. 413 North Rt. 202 South. Turn left onto Rt. 202 South.
Continue on Rt. 202 South to Rt. 313 West in Doylestown. Turn right onto Rt. 313 West.
Continue through intersection at Rt. 313 West and Rt. 611 South, traveling through the stoplight to the
611 Bypass South; turn left onto the bypass.
Proceed to the Broad St. exit. Turn left onto Broad St.
Turn right onto Shady Retreat Rd. The BCIU is at the first driveway on the left.
FROM THE MONTGOMERYVILLE, NEW BRITAIN, CHALFONT AREAS:
Use Rt. 202 North to the Rt. 611 Bypass North. Proceed to the Broad St. exit. Turn right onto Broad St.
Turn right onto Shady Retreat Rd. The BCIU is at the first driveway on the left.
FROM THE WARRINGTON, WILLOW GROVE AREAS:
Use Rt. 611 North to the 611 Bypass North (bear left.) Proceed to Broad St. exit.
Turn right onto Broad St. Turn right onto Shady Retreat Rd. The BCIU is at the first driveway on the left.
FROM SPRING-FORD SCHOOL DISTRICT AREA:
Take the I-76 W exit towards I-276 E/PA. Turnpike/New Jersey/Harrisburg.
Take the I-276 E exit towards I-476 N/Northeast Extension/Allentown/New Jersey/EXITS 25-39.
Merge onto PA. TURNPIKE E. Proceed to the Willow Grove exit (Rt. 611 N.) Keep right at fork in the ramp.
Take Rt. 611 North to 611 Bypass North (bear left.) Proceed to the Broad St. exit.
Turn right onto Broad St. Turn right onto Shady Retreat Rd. The BCIU is at the first driveway on the left.
LANGHORNE OFFICE-TAWANKA BUILDING
2055 Brownsville Rd., Langhorne, PA. 19053
*Note: If using G.P.S. Unit, please use Feasterville for the City;
**Please park in the back lot and enter the door closest to the flagpole.
FROM THE BRISTOL, LEVITTOWN AREAS:
Take I-95 North to PA-413/US-1BR exit (Exit 44) toward Penndel/Levittown.
Turn Left onto E. Lincoln Highway/US1 BR/PA-413. Continue to follow E. Lincoln Highway.
East Lincoln Highway becomes Old Lincoln Highway.
Turn Right onto East Bristol Rd.
Turn Right onto Brownsville Rd. Tawanka will be on your Right.
FROM THE MORRISVILLE, YARDLEY AREAS:
Take US-1 South (Philadelphia) towards Neshaminy.
Take the Neshaminy exit and proceed to the ramp toward Eastern State School & Hospital.
Bear right and merge onto Rock Hill Dr.
Turn slight Right onto Old Lincoln Highway. Turn Left onto East Bristol Rd.
Turn Right onto Brownsville Rd. Tawanka will be on your Right.
FROM THE PHILADELPHIA, BENSALEM AREAS:
Take Roosevelt Blvd North (which becomes US-1 N.) Philadelphia, PA
Take the PA-132 (Street Rd.) ramp on right. Continue on to PA-132 North (Street Rd.).
Turn Right onto Old Lincoln Highway. Turn Left onto East Bristol Rd.
Turn Right onto Brownsville Rd. Tawanka will be on your Right
BCIU #22 School Nurses’ Referral Packet
2011-2012 School Year
15