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«National Vision and Hearing Screening Protocols Revised 2014 Citation: Ministry of Health. 2014. National Vision and Hearing Screening Protocols: ...»

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National Vision

and Hearing



Revised 2014

Citation: Ministry of Health. 2014. National Vision and Hearing Screening Protocols:

Revised 2014. Wellington: Ministry of Health.

Published in November 2009 (updated 2014)

by the Ministry of Health

PO Box 5013, Wellington 6145, New Zealand

ISBN 978-0-478-42792-9 (online)

HP 5847

This document is available at www.health.govt.nz

This work is licensed under the Creative Commons Attribution 4.0 International licence. In essence, you are free to: share ie, copy and redistribute the material in any medium or format; adapt ie, remix, transform and build upon the material. You must give appropriate credit, provide a link to the licence and indicate if changes were made.

Contents Introduction 1 Programme summary 2 The programme 2 Cohort groups 2 Test environments/locations 3 Competencies 3 Test equipment 3 Resources 4 Quality requirements 4 Hearing screening 5 Overview of hearing screening 5 Pathway 1: Initial screening audiometry (sweep test) or rescreen 9 Pathway 2: Screening audiometry (hearing concerns) 12 Screening technique: tympanometry 16 Vision screening 19 Overview of vision screening 19 Screening technique: Parr letter-matching vision charts or Sheridan Gardner charts 22 Screening technique: Snellen eye chart 28 Colour vision: Ishihara pseudoisochromatic plate 30 List of Tables Table 1: Risk factors for hearing related developmental and learning diffic

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List of Figures Figure 1: Pathway 1 – initial screening (sweep) or rescreen audiometry clinical pathway 14 Figure 2: Pathway 2— Screening audiometry (hearing concerns) clinical pathway 15 Figure 3: Vision screening clinical pathway and referral at four years old 25 Figure 4: Vision screening clinical pathway and referral at five to seven years 26 Figure 5: Vision screening clinical pathway and referral for Year 7 (and others) 26

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The National Protocols provide an outline of the screening process, but are not a training manual. Personnel delivering this screening programme need to have attained or be working towards the NZQA National Certificate in Community Support Services (Vision and Hearing Screening) (Level 3) and comply with national competencies (refer to page 3).

This document should be read in conjunction with the appropriate National Service Specifications, which the Ministry of Health uses to purchase Vision Hearing Screening services from District Health Boards.

This document is in two sections:

Hearing screening protocols (pages 5–18) Vision screening protocols (pages 19–30) If you have any questions or queries about the National Vision and Hearing Screening Programme or this document, please contact the Ministry of Health (info@health.govt.nz).

National Vision and Hearing Screening Protocols Programme summary The programme Mass screening of a defined cohort of children (4 and 11 years old) to identify undetected • hearing loss and reduced visual acuity requiring further assessment and/or treatment.

Follow up and targeted screening of children who may have missed earlier screening • opportunities.

Referrals to appropriate health professionals, using identified pass/fail criteria.

• Documentation and reporting of vision and hearing screening data.

• Cohort groups 4 years (B4 School Check) Initial screening (sweep) or rescreen audiometry (and tympanometry if required).

• Distance visual acuity screening is used to identify children with reduced vision and possible • amblyopia.

New entrants and new immigrants Initial screening (sweep) and vision screening ie, children who have not previously had a • B4 School Check.

Follow up testing from B4 School Check.

• Hearing concerns Screening audiometry depending on the ability of the children.

• Year 7 (11-year-olds) Distance visual acuity screening to detect children with myopia or other conditions causing • reduced acuity.

Ishihara colour vision screening for boys.

• 3 years At individual DHB’s discretion, targeted tympanometry screening of groups at high-risk of • harm from glue ear.

2 National Vision and Hearing Screening Protocols Test environments/locations Registered pre-school/early childhood education centres and kohanga reo.

• Community venues including churches, marae and community halls.

• State/private primary schools.

• State/private intermediate schools.

• Defined clinic settings.

• All environments are to comply with National Protocol requirements for light and sound • levels or the VHT must make arrangements to use the environments at times when compliance is achievable.

Competencies VHTs who provide vision and hearing screening services must have attained or be working towards the National Certificate in Community Support Services (Vision and Hearing Screening) (Level 3) (see www.careerforce.org.nz).

They must also:

be employed for a minimum of 16 hours per week for vision and hearing screening work • receive ongoing professional development relevant to the screening processes specified in the • National Protocols and attend the annual Training Seminar (at least every second year) have a biennial review/assessment of their competence • have completed training in the use of the Ministry of Education’s ENROL database and the • Ministry of Health’s B4 School Check database.

Where personnel provide either vision screening or hearing screening alone, they still must meet the above requirements for employment, experience, review and training.

In cases where registered nurses or other health professionals carrying out vision and hearing screening, they do not need to be dedicated to vision and hearing screening for 16 hours per week but must meet all other competency requirements.

Test equipment Screening audiometer calibrated annually (0.5 kHz to 4kHz @ 0–100 dB presentation range) • fitted with noise-attenuating audiocups.

Screening tympanometer calibrated annually (+200–-400 daPa range).

• Pebbles and a container • Sound level meter • Parr letter-matching vision chart (with and without confusion bars) or an equivalent • Sheridan Gardner chart.

Snellen eye chart.

• Ishihara pseudoisochromatic plates for colour deficiency (24-plate edition).

• Retractable 5 m tape measure.

• Rigid plastic eye patch.

–  –  –

Alcohol wipes, handrub and Milton solution.

• Light level meter (illuminance meter, lux meter).

• Resources Keeping an eye on your child’s vision (B4 school vision screening) (HE2278) is a Ministry of Health resource available from HealthEd website (www.healthed.govt.nz) in multiple languages.

Pass and refer brochures for use with all four and five year olds screened are available on line (www.health.govt.nz) Copies of the Spectacle Subsidy brochure can be ordered through Enable New Zealand (freephone 080017 1981). Copies of the subsidy for glasses and vision test brochures in a number of languages can be printed from the Ministry of Health’s website (www.health.govt.nz).

Quality requirements Standard consent process prior to screening.•

Standard format for feedback of screening results to parent/caregiver of each child post screening.

Standard format of recording results onto the relevant national database to enable national • reporting.

Ministry of Health requirements as specified in the relevant National Service Specification • and the National Protocols.

4 National Vision and Hearing Screening Protocols Hearing screening The hearing screen of four-year-olds is part of an overall framework of hearing screening and Well Child/Tamariki Ora hearing surveillance. This screen follows the newborn hearing screening as part of the Universal Newborn Hearing Screening and Early Intervention Programme (UNHSEIP) shortly after birth and subsequent surveillance at core well child checks.

Screening audiometry and tympanometry (if required) are the screening tests to be administered.

Overview of hearing screening Purpose

The purpose of this component is to:

detect the presence of hearing impairment and/or otitis media effusion • refer to appropriate agencies.

• Key messages The screening protocol is designed to identify hearing loss that is likely to interfere with normal speech, language development and learning, and to find children with persistent middle ear disorder as this also causes a significant hearing loss. This screen is also designed to target, detect and refer children where there are hearing-related developmental or learning difficulties (referred to as risk factors), so that appropriate intervention can be provided prior to or early in a child’s primary education.

Funding for services Parents of children under 18 years who are eligible for health services and who have hearing problems are not asked to pay for audiological services, rehabilitation services or assistive devices. These costs are funded by the Ministry of Health and the Ministry of Education.

Age of child This screening is conducted as soon as possible after the child turns four years old.

If a child has missed this component of the B4 School Check before starting school, then they will be checked at school (following consent process).

Repeat screening will also be provided to those children who need a follow-up test as a result of earlier screening.

Personnel This screening is normally carried out by a VHT, but sometimes by other competent health practitioners.

National Vision and Hearing Screening Protocols Protocols Frequency of visits Venues should be visited regularly to ensure that all children are screened and that rescreens can be done in a timely fashion. Several visits may not always be possible in very small, remote rural areas. In these cases, serial testing could be carried out in a scheduled clinic setting.

Venue organisation

Before visiting an early childhood centre or school for screening, you should:

notify the venue of your intended visit and ask that quiet activities are planned for when • hearing screening is being carried out obtain the list of children requiring screening (ie, ENROL, preschool attendance list •

ensure consent process with parents has been completed.•

Consent Although VHTs are still covered by Section 125 of the Health Act (1956), all DHBs should now have implemented a consent process to encourage parents to make informed choices about their child’s health. In addition, the recording of results in the national B4 School Check database requires the informed consent of parents. Therefore, all services delivering vision and hearing screening should implement an opt-off consent process. Section 125 should only be used in exceptional circumstances where the school, early childhood centre, or health services have concerns for a child’s welfare.

The consent process should include information for parents about what their child is being screened for and questions about whether the child is already under the care of an audiologist or ORL, and/or has grommets or a hearing aid.

Setting for hearing screening Preschool hearing screening is generally carried out in community based early childhood education centres or in clinic settings. Screening of school-age children is generally carried out in schools.

It is important that the VHT obtains a suitable room for hearing screening. Inappropriate conditions may compromise the validity of screening. A range of setting may be used for hearing screening, according to local availability. The conditions discussed below apply to community settings, as well as clinic settings.

Type of room: The room in which the hearing screening (and tympanometry if required) takes

place must:

be quiet and free of distractions • have soft furnishings and floor coverings to absorb noise.

• In a school or preschool, the most suitable room is usually the school library or an office.

Minimise ambient noise: The degree of ambient noise in the room in which the hearing screening will take place must be less than 40 dBA. Check the ambient noise with a sound level meter at the beginning of the screening session and at any other time you consider it necessary, when ambient noise levels increase.

6 National Vision and Hearing Screening Protocols If the noise level exceeds 40 dBA, speak to the staff and ask for noise levels to be reduced. Use approved noise attenuating headset cups in noisier environments to offset the noise to the required level. If appropriate background noise cannot be obtained, do not continue with the testing as the results are likely to be invalid.

Equipment needed for hearing screening

To conduct a hearing screening, you will need:

an audiometer, tympanometer and ancillary equipment • an appropriate chair and a table or desk on which to set up the audiometer and paperwork • a set of record sheets • a sound-level meter • headphones • pebbles and a container • a chair for the child being screened.

• Audiometers and tympanometers need to be calibrated regularly. An independently audited laboratory must conduct a basic calibration annually with full traceability to National Standards (International Accreditation New Zealand). Headphones are calibrated to a particular audiometer and so are not interchangeable.

Hygiene protocols for hearing screening

Audiometry: Hearing screen involves the placement of headphones over a child’s ears. (Note:

Audiometry should not be performed on children with discharging ears, or where the ear or surrounding skin is inflamed or broken. These children need referral to the GP or ear nurse and should be offered a rescreen when the issue is resolved).

Procedures: Back at base – Check headphones regularly. If cleaning is required, carefully remove rubber cushions from headphones and wipe with warm soapy water. Ensure cushions are totally dry before replacing. (Note: If headphone cushions become cracked or porous they must be replaced to maintain hygiene).

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