Our%20Future

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Our Future

• Christine Yoshinaga-Itano, Ph.D.
• University of Colorado, Boulder
• Department of Speech, Language Hearing Sciences

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There are schools....
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...and then there are schools.
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Whats changed

• Almost every birthing hospital in the US has
  instituted a newborn hearing screening program.
• There are 4 million babies born each year in the
  US
• 2 of every 1000 of these babies will be
  identified with a permanent and significant
  hearing loss
• Diagnosis of hearing loss should occur by 3
  months of age

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Whats changed

• Referral to intervention should occur within 48
  hours of the diagnosis of hearing loss
• Where are the children going?
• Currently, the vast proportion of these children
  are referred to Part C, infant/toddler

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THE PROBLEM

• Optimal outcomes
• Require
• the highest level of expertise
• in deafness and hearing loss
• at the very beginning

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How many children?

• 8,000 to 12,000 children
• could be identified each year
• within the first two months of life

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Referral to intervention

• Too many points of entry into the system
• Public
• State Schools for the Deaf
• Education/Health systems
• Private
• Public
• Local Educational Agencies
• Part C/ Infant-Toddler
• Families are getting lost in the system or
  appropriate service is delayed.
• INFANT/TODDLER PART C
• IS THE MOST COMMON REFERRAL

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• NO OUTCOME DATA FOR NON-CATEGORICAL INTERVENTION

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Deafness/Hearing Loss system

• All of the successful outcomes data comes from
  programs with specialized services for families
  with children who are deaf or hard of hearing

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OUTCOME DATA

• Colorado Home Intervention Program
• Boys Town Institute Program
• Washington State Early Intervention Program
• Ski-HI early intervention programs
• Auditory-verbal program in UK

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SINGLE POINT OF ENTRY

• The Colorado System
• Birthing Hospitals
• Diagnostic Audiology
• Co-Hear Coordinators
• Categorical intervention services
• Quality Assurance
• On-going training
• Options
• Sign Language Instruction Deaf/HOH
• Integrated/Shared Reading Program
• Families for Hands and Voices

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Colorado system

• Referral from diagnostic audiology goes to one of
  9 regional Co-HEAR coordinators, who are
  specially trained early-intervention specialists.
  
• Originally, instituted by the Colorado Department
  of Public Health and Environment
• Now operated through the Colorado State School
  for the Deaf and Blind

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Co-HEAR system

• Insures that information provided to parents is
  similar for all families and as unbiased as
  possible
• Initial counseling and information provided to
  parents is by an individual with a very high
  level of knowledge and experience.

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(No Transcript)
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Transition from Diagnosis to Early Intervention
Audiologist Confirms Hearing Loss
Hearing Resource Coordinator is Contacted
Initiates data management
Contacts local agencies
Contacts family
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Qualifications of the CO-Hear Coordinator

• Experience working as an interventionist with
  D/HH infants and toddlers
• Ability to work in partnership with families with
  specific training for parents of children with
  hearing loss
• Ability to coordinate and organize activities,
  including training about hearing loss, with other
  agencies

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• Has sufficient knowledge about infants and
  toddlers who are D/HH to provide technical
  assistance to interventionists and professionals
  from other agencies
• Ability to assume a leadership role

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Credentials of the CO-Hear Coordinator

• CCC-A
• CCC-SLP
• Teacher of the D/HH

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Responsibilities of the CO-Hear Coordinator to
Support the EHDI Program

• Inputs referral data into the state EHDI program
  database
• Assists with development and implementation of
  early intervention programs policies and
  procedures to reflect best practices
• Collects data relevant to early intervention
  program growth program evaluation
• Monitors customer satisfaction

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• Participates on local ICC for Part C
• Maintains a working relationship with community
  programs (e.g., Part C, Child Find, local school
  district programs, local public health offices)
  by offering information about hearing loss,
  communication approaches, unique assessment needs
  of D/HH children

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Responsibilities of the CO-Hear Coordinator to
Support Direct Service Providers

• Hires and assists with training of new
  interventionists
• Supervises interventionists in the region
• Disseminates information
• Organizes regional workshops
• Monitors and reviews interventionists quarterly
  reports

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• Provides 11 mentoring to early interventionists
• Working with infants
• Implementing a family-centered approach
• Supporting selection of a variety of
  communication approaches
• Expertise in implementing each communication
  approach
• Learning the art and science of a home visit

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Responsibilities of the CO-Hear Coordinator to
Support the Family

• Providing information
• counseling strategies (e.g., grieving, coping)
• communication approaches
• program options
• Securing funding for amplification and early
  intervention
• Providing service coordination as the
  identified service coordinator or in
  collaboration with the identified service
  coordinator

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Recruiting and Training Hearing Resource
Coordinators

• Identify geographic regions
• Number of children with hearing loss
• Realistic driving range
• Familiarity with the communitys services
  supports
• Hold regular administrative meetings
• Provide reimbursement

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Coordinating with Part C State Level

• EHDI Advisory Committee
• EHDI Task Forces
• Document EHDI system for all stakeholders (e.g.,
  memos, phone conferences, etc)
• clarify the roles of people and organizations
  that have expertise specific to sensory
  disability
• An infant or toddler whose primary disability is
  a sensory loss must have an assessment team
  member with expertise specific to infants and
  toddlers with that disability

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• When a referral for a child with a sensory
  disability is received, an appropriate resource
  for children with sensory disabilities will be
  contacted so they may participate in initial
  contacts with the family
• Recommendation that the multi-disciplinary
  assessment include assessment procedures and
  instruments that are appropriate for infants and
  toddlers with hearing loss (e.g., emphasis on
  communication, language, modality, functional
  auditory skills)

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• Distribute names of the Hearing Resource
  Coordinators and their respective counties
• The Hearing Resource Coordinator might be the
  most appropriate person to act as the Service
  Coordinator

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Coordinating with Part C Community Level

• Hearing Resource Coordinators attend service
  coordinator training sponsored by the lead Part C
  agency
• Hearing Resource Coordinators, or their designee,
  attends the initial IFSP
• Hearing Resource Coordinator sponsors and attends
  meetings with local Part C staff

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Coordinating with Child Find

• Regional workshops
• EHDI statistics
• What parents want to know
• Unique elements of assessment (e.g., audiological
  report, modality preferences, functional auditory
  skills)
• Integrating federal and state initiatives (EHDI,
  Part C, Child Find, State school for the Deaf)
• Meetings in individual school districts
• Articles in newsletters
• Funding is assumed by the parent organization
  (e.g., EHDI funds, State School for the Deaf)

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Who are the children entering Kdg

• Early-identified prior to 6 months
• Early intervention in the first 6 months
• Language levels similar to children with normal
  hearing with similar cognitive levels on
  average (Yoshinaga-Itano, Coulter Thomson,
  2000, 2001)
• 75 with intelligible speech (mild through
  severe) and profound with cochlear implants by 5
  years of age (Yoshinaga-Itano Sedey, 2000)
• Social-emotional skills at age level
  (Yoshinaga-Itano Abdala-Uzcategui, 2000)

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INFANT/TODDLERS

• Hard-of-hearing children are more similar to
  children with
• Moderate to profound hearing loss
• Than to children with normal hearing
• In Speech Production (Yoshinaga-Itano Sedey,
  2000)
• And
• Language Production (Yoshinaga-Itano et al., 1998)

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PRESCHOOL-AGED CHILDREN

• Vocabulary levels are similar to normally hearing
  peers (Garafalo Yoshinaga-Itano, 2005)
• Spoken English syntax is still delayed, as speech
  production skills are developing (Sedey, 2004)
• Pragmatic language skills are delayed (Sedey,
  2004)
• Speech production skills are delayed
• (Yoshinaga-Itano Sedey, 2000)

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• Preschool-aged children with significant hearing
  loss require highly specific and specialized
  instruction specific to hearing loss
• In order to enter kindergarten with total
  language skills and speech production on par with
  their normally hearing peers

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Children who do not maintain age-appropriate
communication skills

• Later-identified children (Yoshinaga-Itano et
  al., 1998 Yoshinaga-Itano, Coulter Thomson,
  2000, 2001)
• Multiply disabled 40 of population but
  severity and impact on communication varies
  (Yoshinaga-Itano et al., 1998)
• Children from non-English speaking families
  (Nelson, Cardon Yoshinaga-Itano, 2005)

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Special populations

• Children with progressive hearing loss
• Children with acquired hearing loss
• Children with unilateral hearing loss
  transitioning to bilateral hearing loss
• Children with auditory neuropathy/dysynchrony

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Early-identified/early implanted

• Children with profound hearing loss
• Trends for cochlear implantation
• Early implantation
• Below 2 years of age (Yoshinaga-Itano, in press)
• Regardless of method of communication
• Developing intelligible speech before 5 years of
  age
• Maintaining age-appropriate language development

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Children with auditory neuropathy/dysynchrony

• Approximately 10 of children with bilateral
  hearing loss (Thomson, Portnuff
  Yoshinaga-Itano, 2005)
• Some children who once had otoacoustic emissions
  but have lost them
• Frequently poor hearing aid users visual
  learners
• Some are candidates for cochlear implants

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Children with unilateral hearing loss

• Children born with SN unilateral hearing loss who
  have progressed to SN bilateral hearing loss- 25
  of unilateral population
• Asymmetrical hearing loss
• Can have unusual configurations rising
  configurations
• 30 of remaining unilaterals have significant
  language delays
• Typically have intelligible speech
• Etiologies unknown in 80 of cases

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Children from non-English speaking families

• High proportion of later-identified
• High proportion of multiply disabled
• High proportion of auditory neuropathy/dysynchrony
  
• High proportion of genetic hearing loss
• Some cultures have consanguinity issues
• High proportion of ototoxicity
• Some cultures dispense ototoxic drugs over the
  counter (i.e. China, Mexico)

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Children with multiple disabilities

• Increase in low birth weight premature infants
• Severe neurological/cognitive deficits
• Visual disabilities
• Emotional/behavioral disorders
• Learning Disabilities
• Autism/Spectrum Disorder

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Deaf Education Reform

• Most children identified within the first few
  months of life
• More than 15,000 children identified each year
  and in intervention in the first 6 months
• Great intensity of service required in the first
  five years of life
• New populations Children with minimal hearing
  loss to profound hearing loss, unilateral and
  bilateral, auditory neuropathy/dysynchrony

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• Need for intensive language instruction
• Need for intensive auditory/speech stimulation
• Need for Parent education first five years of
  childs life
• Need for single point of entry into intervention
• Need to provide similar service to all families
  no matter where they live
• Need for expert knowledge in hearing loss

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Need for systems change

• Parent-infant programs
• Preschool programs
• Day schools center-based programs
• Residential programs
• THE GOAL FOR ACADEMIC/COMMUNICATION
  EXPECTATIONS
• COMPARABILITY
• WITH HEARING PEERS

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Accountability

• Assessments
• Consistency within state for assessment protocols
• Consistency nationally for assessment protocols
• Assessments that are necessary for intervention
  planning
• Goals guided by assessment data

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Statewide developmental databases

• What teaching strategies work?
• Are there some developmental areas that require
  additional in-service training of teachers and
  parent-infant interventionists.
• What sub-populations require different teaching
  strategies?
• State statistics- incidence/prevalence
• Success of EHDI/UNHS programs

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Single point of entry

• State Schools for the Deaf
• State-wide programs
• Infant programs
• Colorado enrolls almost 300 children birth
  through 36 months through the Colorado State
  School for the Deaf and Blind

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• Preschool-aged services would enroll
  approximately 300 more children
• Elementary school-aged children in center-based
  programs and residential programs is diminishing
• Programs for socialization
• Middle school/High school
• At-risk prevention for social/emotional issues

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Residential placement

• Children requiring individualized and intensive
  educational instruction
• Multiply disabled
• Neurological/cognitive disabilities
• Motor disabilities
• Autism
• Social-emotional behavioral disorders

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Challenge for Deaf Education

• Flexibility
• Adaptability
• Communication success
• Options
• Meeting diverse needs
• Rapid change

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A is for AccessCheryl DeConde Johnson,
Ed.D.Colorado Department of Educationjohnson_c_at_c
de.state.co.us www.cde.state.co.us

• Achieving Authentic Accessibility for Students
  who are Deaf and Hard of Hearing

High Standards
Communication- driven
Critical Mass
Full Access
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What does Communication Access Mean?

• Able to receive information
• Having language to identify what is received
• Interweave of cognition and language to derive
  meaning
• Able to actively participate in flow of
  conversation e.g., communication ease
• Communication access occurs when there is shared
  meaning.

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The Faces of Deaf Education
Modes of Communication listening/speaking
. visual/signing Languages English/Spanish
(spoken)American Sign Language (visual)
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Change in Educational Placements-D/HH Students
Ages 6-21Source US Dept of Ed., 24th Annual
Report to Congress, Appendix A, Table AB2, 2002
Year lt21 of time out of regular class 21-60 of time out of regular class gt60 of time out of regular class Separate Facility
1988-89 26.9 21 33.6 18.6
1992-93 29.4 19.7 28.1 22.7
1999-2000 CO 40.3 65.7 19.3 8.4 24.5 14.6 15.8 11.1
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• WE CAN MEET THE NEEDS OF THE NEW GENERATION OF
  CHILDREN WHO ARE DEAF OR HARD OF HEARING
• WILL WE ACCEPT THE CHALLENGE?