1. Pre-hearing loss: age, attitude, gender; etc
2. Onset of hearing loss: may not realize
3. Diagnosis: time when identified, reactions vary; time to decide on amplification, Assistive listening devices, "communication strategies", psychological counseling; look at the whole person using "PEMICS" ; this is the time to do the "communication handicap, and "communication disability".
4. Adjustment-counseling provides information, technology that have value; aural rehab happening in this stage; must show value