Download Our Future

Our Future
Christine Yoshinaga-Itano, Ph.D.
University of Colorado, Boulder
Department of Speech, Language & Hearing
Sciences
What’s 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
What’s 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
THE PROBLEM
• Optimal outcomes
• Require
• the highest level of expertise
• in deafness and hearing loss
• at the very beginning
How many children?
• 8,000 to 12,000 children
• could be identified each year
• within the first two months of life
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
• NO OUTCOME DATA FOR NONCATEGORICAL INTERVENTION
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:
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
SINGLE POINT OF ENTRY
• The Colorado System
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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
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
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.
Transition from Diagnosis to
Early Intervention
Audiologist Confirms Hearing Loss
Hearing Resource Coordinator is Contacted
Contacts local
agencies
Contacts family
Initiates data
management
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
• 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
Credentials of the CO-Hear Coordinator
• CCC-A
• CCC-SLP
• Teacher of the D/HH
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
• 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
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
• Provides 1:1 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”
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
Recruiting and Training Hearing Resource
Coordinators
• Identify geographic regions
• Number of children with hearing loss
• Realistic driving range
• Familiarity with the community’s services
& supports
• Hold regular administrative meetings
• Provide reimbursement
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
• 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)
• 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
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
Coordinating with Child Find
• Regional workshops
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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)
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 (YoshinagaItano & Sedey, 2000)
• Social-emotional skills at age level
(Yoshinaga-Itano & Abdala-Uzcategui,
2000)
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 (YoshinagaItano & Sedey, 2000)
• And
• Language Production (YoshinagaItano et al., 1998)
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)
• 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
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 & YoshinagaItano, 2005)
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
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
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
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
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)
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
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
• Need for intensive language instruction
• Need for intensive auditory/speech
stimulation
• Need for Parent education – first five years
of child’s 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
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
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
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
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
• 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
Residential placement
• Children requiring individualized and
intensive educational instruction
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Multiply disabled
Neurological/cognitive disabilities
Motor disabilities
Autism
Social-emotional behavioral disorders
Challenge for Deaf Education
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Flexibility
Adaptability
Communication success
Options
Meeting diverse needs
Rapid change
A is for Access
Cheryl DeConde Johnson, Ed.D.
Colorado Department of Education
[email protected]; www.cde.state.co.us
Achieving
Authentic
Accessibility for
Students who
are Deaf and
Hard of Hearing
High
Standards
Communicationdriven
Full
Access
Critical Mass
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”.
The Faces of
Deaf Education
Modes of Communication
listening/speaking…………………………………………. visual/signing
Languages
English/Spanish (spoken)………American Sign Language (visual)
THE SPIRALING EFFECTS OF DEAFNESS
source unknown
CULTURAL
ECONOMIC
ECONOMIC
VOCATIONAL
VOCATIONAL
VOCATIONAL
PSYCHOLOGICAL
PSYCHOLOGICAL
PSYCHOLOGICAL
PSYCHOLOGICAL
SOCIAL
SOCIAL
SOCIAL
EDUCATIONAL EXPERIENTIAL
COMMUNICATION
LANGUAGE
AUDITORY
EDUCATIONAL EXPERIENTIAL COMMUNICATION LANGUAGE AUDITORY
EDUCATIONAL
EDUCATIONAL
EDUCATIONAL
EXPERIENTIAL
SOCIAL
SOCIAL
EXPERIENTIAL COMMUNICATION
EXPERIENTIAL
EXPERIENTIAL
COMMUNICATION
COMMUNICATION
COMMUNICATION
COMMUNICATION
LANGUAGE
LANGUAGE
LANGUAGE
AUDITORY
LANGUAGE
LANGUAGE
AUDITORY
AUDITORY
AUDITORY
AUDITORY
AUDITORY
AUDITORY
LANGUAGE
Change in Educational PlacementsD/HH Students Ages 6-21
Source: US Dept of Ed., 24th Annual Report to Congress, Appendix A, Table AB2, 2002
<21% of time 21-60% of
>60% of time
out of
time out of
out of
regular class regular class regular class
Year
Separate
Facility
1988-89
26.9%
21%
33.6%
18.6%
1992-93
29.4%
19.7%
28.1%
22.7%
1999-2000
40.3%
19.3%
24.5%
15.8%
65.7%
8.4%
14.6%
11.1%
CO
• WE CAN MEET THE NEEDS OF THE
NEW GENERATION OF CHILDREN
WHO ARE DEAF OR HARD OF
HEARING
• WILL WE ACCEPT THE
CHALLENGE?