Bi-Monthly Update: Determining Appropriate Service Delivery to Improve Outcomes

Early January 2018

Regardless of the move to full inclusion and the shortage of teachers of the deaf/hard of hearing, school teams remain obligated to student identify areas of educational need, appropriate IEP goals, amount of service time needed, by whom, and in what setting.

In the March 22, 2017 US Supreme Court decision, Chief Justice Roberts wrote, “…IDEA demands more. It requires an educational program reasonably calculated to enable a child to make progress appropriate in light of the child’s circumstances.”  If a child is not fully included, school officials must look at the child’s unique needs and required level of specialized instruction before developing an IEP that is “pursuing academic and functional advancement.” If a child is 6 months behind expected achievement levels, an itinerant DHH teacher cannot maintain a year’s growth and also make up the level of delay with only twice per week 30-minute sessions of service. Providing an inappropriate amount of educational support will not result in the needed level of student outcomes nor will it make teachers of the DHH appear effectual.

One result of the Supporting Success survey last April to identify the roles and responsibilities of itinerant teachers of the deaf/hard of hearing indicated that 25% of respondents used matrices to guide to their discussions in the determination of the level of service delivery.

Continue reading the Early January 2018 Update

Upcoming Presentations

Karen Anderson, PhD, Director of Supporting Success

  • February 26 – March 1 – invited Denmark presentations
  • March 29 – TX (Houston)
  • April 10 – IL (Tinley Park)
  • October 18-19 – VT (VSHA – Vermont Speech, Language, Hearing Association + Outreach Consultants)

Now Booking for Summer 2018 Presentations!

Contact for more information on specific speaking engagements.

Refer here for more information on presentation services.


February 26 – March 1: Denmark presentations – pending.

March 29, Houston, TX. Region 4 ESC Workshop. Supporting Full-Participation of Students with Hearing Loss in the Mainstream Classroom. Outreach via TETN to other ESCs across Texas.

April 10, Tinley Park, IL. ISRC Behavior Team Training. Self-Advocacy. Holiday Inn Conference Center, Tinley Park, IL.

October 18-19, 2018, Vermont, Speech Language, Hearing Association and DHH Outreach Staff Training.


Advocacy Notes

Assistive Technology and Student Access

Strategies for Assistive Technology Negotiations is written for the parent’s perspective however, the responses may be equally appropriate when professionals are advocating for necessary captioning, Hearing Assistance Technology, interpreter services, etc. for their students. It may also be useful to share this information with school teams in preparation for responses parents may have in discussions about needed assistive technology.

Strategies for Assistive Technology Negotiations
Adapted from and Advocacy Institute presentation
by Dave Edyburn, PhD, University of Wisconsin – Milwaukee

If a school official says….

A parent might respond…


1. We’ve considered your child’s need for assistive technology and have determined that s/he will not benefit…

I would like to review the documentation that supports your decision. In particular, I would like to see the data regarding performance with assistive technology and performance without.

1, 2, 3, 4

2. Best practice suggests you always begin with no-tech solutions first…

Consideration should not be a linear process of trial and error. Rather, all possible solutions should be explored.

4, 5

3. We can’t afford that…

Cost is cannot be considered a factor in AT consideration.


4. We are not sure what types of AT are out there…

What steps will you take to fulfill the AT consideration mandate?

7, 8

5. It’s not clear that (the student) actually does better with the AT…

I would like to see the data that supports such a conclusion. Typically, we need to review performance data over time, with and without the technology to come to such a conclusion.

9, 10

6. We don’t want him to become dependent on a text-reader…when will he ever learn to read…

Since the student doesn’t have the independent reading skills and the expectations in grade 4 and beyond is to access large amounts of text, how will you demonstrate that he has access to the curriculum without a text-reader?

1, 11

7. Your child is not the only one that struggles with this problem…

I can appreciate your concern, but my primary interest is the success of my child. As a result, what are you going to do to ensure that my child is successful?

12, 13

8. We will provide some specialized technology but there is no need to write it on the IEP…

I am pleased to hear that assistive technology will be provided. However, to ensure the rights of all parties are protected, our plan for acquiring and using AT should be written on the IEP.


9. We are not authorized to make a decision about AT…

I am disappointed to hear that. I guess we will need to adjourn the meeting until an appropriate administrator is here.


10. The textbook is not available in digital format…

That’s unfortunate. That means that the textbook must be scanned using a “scan and read” program such as Kurzweil or WYNN or be professionally scanned.


11. Copyright laws do not permit us to have your child’s textbook scanned

Because my child is reading is ___ grades below grade level, s/he requires alternative ways to access the general curriculum. *

16, 20

12. The student isn’t eligible for AT because he does not meet criteria for a “print disability” under Chafee…

Many students with learning, hearing, or other cognitive disabilities who need AIM will not qualify under copyright law as a student with a “print disability” (e.g., dyslexia); yet it is still the responsibility of SEAs (State Education Agencies) and LEAs (Local Education Agencies) to provide AIM to them.

16, 17, 18

13. The student must have an Assistive Technology evaluation before s/he can be provided with grade level textbooks in accessible formats…

Accessible Instructional Materials (AIM) must be provided in a “timely manner” (“at the same time as other children receive instructional materials”).

16, 18, 21, 23

*“With the advent of cost-effective and efficient digital scanning technology, local districts have significantly increased their capabilities to digitize books directly into more accessible digital formats. … in the absence of accessible materials from publishers, scanning a book may be the most effective method of providing instructional materials to print-disabled students, at least for the immediate future.”

An Educator’s Guide to the Acquisition of Alternate Format Core Learning Materials for Pre-K-12 Students with Print Disabilities


1. Remediation vs. Compensation

2. WATI Assessing Student Needs for AT – 5th Edition

3. Chapter 1 – Consideration Guide

4. WATI Assessment Package

5. Assessing AT Student Need

6. Funding AT

7. Texas AT Training Modules

8. AT Parent Guide – AT Tools

9. How do you know?

10. Decision-Making

11. Learning from Text

12. Teaching Every Student

13. Fairness

14. Documenting AT Needs in the IEP

15. Scan to Speak Programs

16. Ensuring Access for Students with Print Disabilities

17. Legal Issues Associated with the Provision of AIM to Students with print Disabilities

18. Legal Issues: Laws, Regulations, Guidelines

19. Accessible Textbooks in the Classroom: An Educator’s Guide… (2010 Revision)

20. 34 C.F.R. §300.172(b)(4) Access to instructional materials. (IDEA Regulations, Subpart B, p.18)

21. OSEP Q and A In order to meet its responsibility under paragraphs (b)(2), (b)(3), and (c) of this section to ensure that children with disabilities who need instructional  materials in accessible formats are provided those materials in a timely manner, the SEA must ensure that all public agencies take all reasonable steps to provide instructional materials in accessible formats to children with disabilities who need those instructional materials at the same time as other children receive instructional materials.

22. While comprehensive assistive technology evaluations are important and needed, a 60 day wait to establish the need for Accessible Instructional Materials is not necessary.  IEP teams have sufficient existing data – test scores, grades – to establish a student’s need for text-to-speech software and accessible instructional materials without an assistive technology evaluation.


2018 © Compiled by Karen L. Anderson, PhD. Supporting Success for Children with Hearing Loss.

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Using the Recorded Functional Listening Evaluation Using Sentences

There is no more effective way to estimate a student’s level of auditory access in the classroom! This functional assessment is easy to perform and can take only 15 minutes. Find the size of your student’s listening bubble and compare speech perception accuracy at 3 feet in quiet/noise to 10-15 feet in quiet/noise.  Examine the results to identify phonemes that are commonly missed or misunderstood. 

Using the Recorded Functional Listening Evaluation Using Sentences

This 1:15 minute webcast is only $24.00. Purchase the digital FLE audio files and pdfs for only an additional $13.00 ($37.00 for webcast and the digital FLE). Load it onto your SmartPhone, computer, or DropBox/GoogleDocs.  Purchased separately, the FLE on CD is $20.00. Pricing also available for licensing use for your whole district.

2-minute video – very brief demonstration of using the Recorded FLE Using Sentences or on YouTube.

IDEA FROM THE FIELD: I have used the Recorded FLE Using Sentences with a number of our HH kids and they seem to have real speech perception challenges.  I tried the FLE with my 7 year old grandson, whose hearing is fine, and he got almost all the items right. The couple that he missed were corrected by his 4 year old brother who told him what the sentence actually was! I notice that my two CI kids, whose CI team feel they are hearing at 20 dB or better, tend to omit is, past tense markers and present progressives as they repeat the sentences. They tend to get the key words correct but due to missing so much they really don’t understand what is presented. Even when I question them they can’t explain what the idea of a sentence was with clarity. The Recorded FLE has really helped to identify issues beyond simple audibility.         

– Teacher of the Deaf/Hard of Hearing

 IDEA FROM THE FIELD:  It is important to note not only the errors the student makes in repeating the sentences, but HOW the student repeatsFor example, I had to pause several times throughout the testing to remind one student to repeat any words of the sentences she heard even if she didn’t catch the whole sentence. That wasn’t easy for her to do…it was either repeating the whole sentence or nothing…she was usually able to repeat 2 of the 5 words of a sentence when I paused to ask if there were any of the words she heard.  Another observation of the HOW was that most of the responses she gave at the far distances were as if she was repeating it as a question (e.g., The fruit came in a box???). The few that she clearly repeated as a statement showed her confidence that she was sure of what she heard.  I think these observations are also very important to share when we discuss results of the FLE with the school team. There was much more of a lack of confidence at the far distance.  Plus, it demonstrates the added effort a student has to make to listen.     

– Teacher of the Deaf/Hard of Hearing

Test of Narrative Language

So often our students test out ‘normal’ on receptive/expressive vocabulary or other language tests but you KNOW that he cannot carry on a typical conversation or relate a story of an event like age peers. The Test of Narrative Language is a fast, easy to use test that provides insights to a student’s ability to interact, that are not identified by standard language tests.

Ages: 4-0 through 15-11; testing time: 15 to 20 minutes; individual administration $192.00

The Test of Narrative Language–Second Edition (TNL-2) is a norm-referenced test that measures children’s narrative language abilities (i.e., children’s ability to understand and tell stories). Narration is an important aspect of spoken language, not usually measured by oral-language tests, that provides a critical foundation for literacy.

The TNL-2 enables clinicians and teachers to assess important aspects of narrative language without having to transcribe children’s stories. This saves hours of transcription time, and provides a valid and reliable metric of narrative language development.

Features of the TNL-2
The TNL-2 is:

  • a functional assessment of narrative comprehension and narrative production;
  • a dynamic assessment in which comprehension and production tasks are alternated so children have the opportunity to profit from adult narrative models;
  • a measure of the ability to comprehend and produce three types of stories: a script, a personal narrative, and a fictional narrative;
  • a system for scoring oral narratives that does not require clinicians to transcribe the stories;
  • a normative test with clear, well-organized norms tables and administration procedures, as well as an easy-to-use record form; and
  • a fair and equitable assessment of narrative discourse for all children.

Story Topics

  • 2 children going to eat at McDonalds with their mother
  • school art project
  • boy late for school
  • finding treasure at a park
  • aliens


Teacher Inservice Combo

The Impact of Hearing Loss on Listening, Learning, and Social Interactions included in the Teacher Inservice Combo provides a visual example of how various levels of hearing loss fragments speech and describes the impact of a smaller listening bubble. The Impact of Hearing Loss handouts are part of the 12 downloadable handouts and checklists (including fillable SIFTERs!). A great deal of information at a great price – especially through September!  30 pages of resources not found on the website!                    

What makes this new Impact of Hearing Loss on Listening, Learning, and Social Interactions handout different from the old/free Relationship of Hearing Loss to Listening and Learning?

1. The sections of possible impact on understanding, possible social/emotional impact, and potential educational accommodations have been thoroughly revised.

2. Audibility of speech sounds for soft speech (35 dB), conversational speech (45 dB), and teacher speech (50 dB) have been included. A percent audibility is specified as are missing or audible speech sounds.

3. An example of fragmented listening is provided via a paragraph of instructions with parts of speech eliminated based on decreased audibility.

4. Possible listening challenges in school have been included, derived from the LIFE-R Student Appraisal. You can either check off the items that the student has identified as challenges, or leave them as is to raise awareness of difficult listening situations.

5. The footnote contains a check off of important teacher accommodations that you can review to reinforce the necessary accommodations specified in the student’s IEP or 504 Plan.

6. An instruction sheet has been included with suggestions for use with TODAY’S STUDENTS WITH HEARING LOSS!

What else comes in the Teacher Inservice Combo along with the newly revised Impact of Hearing Loss handout?

The Teacher Inservice Combo is fully digital and includes the following pdf handouts:

1. Impact of Hearing Loss on Listening, Learning, and Social Interactions (5 pages)

2. Emailable, computer fillable SIFTERs (Preschool, Elementary, Secondary) (6 pages)

3. Emailable, computer fillable LIFE-R Teacher Appraisal (2 pages)

4. Emailable, computer fillable Access to Curriculum Inventory (ATCI) for General Education Teacher (3 pages)

5. Children with Hearing Loss Miss More Than You Think (1 page)

6. Listening Comprehension Exercise – Mother’s Aprons (1 page)

7. Barriers to Listening – Visual analogies of listening in noise, reverberation, and distance (5 pages)

8. Student Listening Challenges – Understanding the Missing Pieces (1 page)

9. Attitude is Caught, Not Taught (teacher version) (1 page)

10. Hearing Aid/Cochlear Implant Monitoring and the Law (1 page)

11. Hearing Aid Monitoring – An Important Daily Activity (4 pages)

12. Emailable Tips for Teachers (Early Childhood + K-12) Word version (15 pages)

All 12 Inservice-related Materials in DIGITAL DOWNLOAD Format for only $39.00

So many of our student cannot hear the insalient parts of speech (cannot perceive the high frequencies and/or the quiet parts of speech) – EVERY TEACHER needs to have easy to use syntax-building materials! Cracking the Grammar Code is a perfect fit for your needs whether you are an itinerant, or provide center-based, resource room, or push-in services. Keep the CGC materials on your media device to present the items to your students or copy the pages you need as you go.

Within the FREE downloadable  Syntax Skill Pretests and Simple Skill Activities sample book, there are pretests teachers can use to identify students’ skill levels. Each pretest has a rubric to diagnosis specific skills in the broader category.

When you are ready to dive into the full curriculum, there are four comprehensive downloadable books for purchase. The books provide a year’s-worth of teaching materials at your fingertips! Each book contains assessment and teaching materials. The books are available as a complete package as well as separately. Books can be taught in any order depending on the students’ skill levels; however, for a complete year’s-worth of lessons, present the books in the following order:
Nouns, Articles & Conjunctions (173 pages for $27) and its companion Vocabulary Enhancement – Simple Picture Glossary (128 pages for $20 digital or $28 printed)
(2) Verbs (143 pages for $18)
(3) Pronouns, Adjectives, Adverbs, & Prepositional Phrases (94 pages for $13), and
Finding the Subject & Subject-Verb Agreement (141 pages for $14).
Each book contains individual subject pretests and teaches concepts in incremental steps.

All 4 Books (Nouns, Verbs, Pronouns, Finding the Subject)
Digital downloads for individuals only $62.00
Digital downloads for groups of up to 8 users only $248.00

All 4 Books (Nouns, Verbs, Pronouns, Finding the Subject) + Vocabulary Enhancement Glossary
Digital downloads for individuals only $79.00
Digital downloads for groups of up to 8 users only $315.00

Digital downloads of all 4 books + 1 Printed Vocabulary Enhancement Glossary $86  individuals only
(no group  pricing)

A Few of the New Features for Interact-AS™

Register for the Next Free Webinar to Learn About Technology Advancements for Interact-AS

Increasingly, students who are hard of hearing are requesting captioning as an accommodation in secondary school. Interact-AS is a computer program that provides realtime captioning on a media device on the student’s desk. Only the speech that is picked up from a microphone is captioned. Interact-AS now has microphone options to assist in providing access during discussion group situations.

Register for the next Free Interact-AS webinar on January 17 at 2:30pm CST.    

Download a PDF of the following information HERE.

A Few of the New Features for Interact-AS™

Supporting Success is proud to be the sole source to offer Interact-AS captioning technology to schools!  The new products described below will soon be added to those offered by Supporting Success.

Welcome to the new school year. We’ve got some good news for you. Two of the requests that we received from teachers during the 2016-2017 school year was a way to better support team teaching situations and also student discussion groups. Plus, there were several other suggestions we received. Thanks for forwarding those ideas to us. By partnering together we can help ensure every student has equal access to classroom discussions. Here is a quick summary of how over the summer we took your suggestions and came up with solutions.

Voice Training is No Longer Needed: With Interact-AS™ Version 6 you no longer need to train voice profiles. You still can train a voice profile, and it is recommended that each teacher do this, but training is no longer required. Having the ability to recognize speech without having pre-trained voice profiles means students can now pass a microphone around their group and whatever they are saying will be captioned. Also, a substitute teacher no longer needs to train a voice profile. Instead you can just create a User Account called “Substitute Teacher” and use the default “English Speech” option. Also, training a voice profile is now much faster. Instead of taking about 8 minutes to do this, with Version 6 it only takes about a minute. That was step one in our summer efforts. Next, we worked on microphones…

Team Teaching: To support team teaching situations Auditory Sciences is now offering a new dual-channel wireless receiver. This new Dual Receiver includes a second audio channel, so now two wireless microphones can be simultaneously connected to the student’s computer. You still need to take turns speaking, but two teachers can now easily be part of the same captioned conversation. There’s no longer a need to switch user profiles, or hand over a microphone, or to turn off and on a transmitter. Just turn on your microphone and it automatically connects to the student’s computer. The new Dual Receiver includes a built-in audio output jack. This makes it easier to connect an earbud, headset, hearing aid or CI to the wireless microphone. All you do is plug the device into the receiver, that’s it. Plus, this new receiver includes a built-in digitizer, meaning you no longer need a USB adapter to connect the receiver to the computer. Fewer parts, not as many connections, and more functionality, all built in to a receiver that can still fit in a student’s pocket.

New Handheld Wireless Microphone: The previous handheld wireless microphone was designed for use in adult conference rooms — the setup time was way too long for classroom use. That issue is now solved. The new handheld wireless microphone automatically connects to the new Dual Receiver.

Mix and Match Components: With the new Dual Receiver and handheld and wireless transmitters you can mix and match components to meet your needs. You can use two wireless headsets (e.g., for two teachers); or one wireless headset and one wireless handheld (e.g., for a teacher and a group of students); or two wireless handhelds (e.g., for a large auditorium assembly). Plus, there are more options…

1:1 Teaching or Meetings: In addition to the new wireless components, we also developed a new Y-Cable (part Z.DUAL.CAB) that allows multiple microphones to be connected via cables to a student’s computer. This is an extremely low-cost team-teaching solution ($14.95). It’s a cabled versus wireless option, so this is not a solution designed for use in a classroom, but it works great for 1:1 meetings with the student, or during an IEP where multiple people may be speaking.

More Captioning Options with Multiple Speakers: So, what about situations where you have dozens of people speaking? We’ve got an answer for that as well. We’ve added a new feature to Interact-AS that is called Streamer™. With Streamer™ you can connect as many people as you want to a student’s computer. Literally, you can have hundreds of people speaking, even speaking at the exact same time, and whatever they say is labeled with the speaker’s name, captioned, and displayed on the student’s computer. The way this works is that each person that is speaking needs to have a copy of Interact-AS running on their computer (such as the teacher’s computer). Whatever they say is captioned on that computer and then “streamed” to the student’s desk. The student can view the captioning on any device that can connect to the internet, including iPad, Chromebooks, Android Phones and iPhones. Note that student does not need to install any app on their device, all they’ll do is go to and enter the name of your Streamer™ account (usually the name of your school) and that’s it.

You can have as many students as you want connect to the Streamer account. So, for example, if you have 20 students in an all-school assembly that want to see a captioning and/or translation of what is being said, with Streamer™ you’re all set. The same for enabling those students to view a captioning of the morning announcements, or an announcer at the football game. The Streamer™ module costs just $99, and like Interact-AS, this is for a permanent unlimited use license.

More Comfortable Teacher Microphone: This past year many teachers requested that we offer a behind-the-head microphone versus the over-the-top version. So, we’ve done that as well. You now can choose the style of microphone that you would like to use with your Interact-AS Captioning and Translation System. You can now select the traditional over-the-head option or the behind-the-head option.

A More Cosmetically Acceptable Student Receiver: For students where “fitting in” is a priority, we’ve developed a receiver that looks like a USB thumb drive. This USB model receiver was designed to be as small as possible. It does not have dual channels (just a single channel), nor an audio output jack for a hearing aid or CI, but it is incredibly small. For some students, this may be the key to having them be excited about using a captioning system. Keep it in mind as an option when configuring a captioning system for your students.

Easier Phrase Building: Interact-AS™ includes at no extra charge the complete set of PhraseBuilder™ features. These are used by students that are non-verbal. This past year many teachers requested an improved way to create and maintain Favorites Lists. These are lists of phrases and/or sentence constructs that students can use to easily ask questions in the class or hold conversations with others. So, we did it. You can now use basically any text editor (such as Microsoft Word or Google Docs) and with a single click convert that document into a Favorites List. Likewise, you can export a Favorites List into your preferred text editor. This new module is free, just ask, and we’ll be glad to send you a download link.

Thanks Again for your Suggestions. Together, Interact-AS, Supporting Success and YOU are making the classroom more accessible for everyone, including students that are Deaf, Hard of Hearing and/or non-verbal. You, the teachers, are the most important members of our team. Thanks for all you do to help so many students !!!




Robert Palmquist
President & CEO, SpeechGear, Inc and Auditory Sciences, LLC.

205 South Water Street, Northfield, MN . 55057 | 507.645-8924

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Determining Appropriate Service Delivery to Improve Outcomes

Regardless of the move to full inclusion and the shortage of teachers of the deaf/hard of hearing, school teams remain obligated to the student to identify areas of educational need, appropriate IEP goals, amount of service time needed, by whom, and in what setting.

In the March 22, 2017 US Supreme Court decision, Chief Justice Roberts wrote, “…IDEA demands more. It requires an educational program reasonably calculated to enable a child to make progress appropriate in light of the child’s circumstances.”  If a child is not fully included, school officials must look at the child’s unique needs and required level of specialized instruction before developing an IEP that is “pursuing academic and functional advancement.” If a child is 6 months behind expected achievement levels, an itinerant DHH teacher cannot maintain a year’s growth and also make up the level of delay with only twice per week 30-minute sessions of service. Providing an inappropriate amount of educational support will not result in the needed level of student outcomes nor will it make teachers of the DHH appear effectual.

“Kids in the middle” refers to students who may not be served in delivery models that consist of direct services from a teacher of the deaf and hard of hearing. Therefore, the resulting services may, or may not, adequately address the communication, social, and academic needs of these students. Central to the concept of special education is the idea that the Individual Education Planning Team will collaboratively determine the special and general education services a student needs, based on the goals and objectives developed for him or her. This process is meant to ensure that each student will receive services tailored specifically to his or her unique set of needs. With the recent clarification by the US Supreme Court it is anticipated that school teams will once again consider the amount and intensiveness of services necessary to allow students with hearing loss to progress at a rate typical of hearing peers. Our goals should focus on helping students become effective communicators, competent readers, and knowledgeable consumers of goods and services.

One result of the Supporting Success survey last April to identify the roles and responsibilities of itinerant teachers of the deaf/hard of hearing indicated that 25% of respondents used matrices to guide their discussions in the determination of the level of service delivery. With increased pressure to ‘serve less, more remotely’ under the assumption that the student will learn as well when teacher of the DHH services are minimized, many teachers and districts are exploring or implementing the use of service delivery matrices.

It is important to preface this discussion recognizing that a service delivery matrix can only be a guide to decision making, assisting in team discussions and not the final word in appropriate levels of service. The focus needs to remain on “what the student needs to catch up and keep pace.”

Hearing loss results in learning needs that are unique, including some areas of need that cannot be effectively addressed in a mainstream classroom (refer to Early October Bimonthly Update). For the teacher(s) of the DHH who would like to begin the conversation of using a service delivery matrix, the following handouts may be a helpful addition to discussions with administration:

Below are examples of matrices that are already in use. Some are DHH specific while others are not. Some take into account the social, technology, accommodations, and self-advocacy needs of students and others do not.

Use of a service delivery matrix may provide the evidence basis needed for justification of appropriate levels of service to meet student needs – academic, class participation and expanded core skill development. 

Example Matrices for Determination of Level of Service Delivery

  • Educational Impact for Students who are Deaf or Hard of Hearing The Michigan Department of Education – Low Incidence Outreach has produced an exceptionally helpful tool that has recently been made computer fillable. It is suggested that persons interested monitor their website for the new fully accessible version to be released.
  • Hearing Itinerant Services Rubric Many varying factors are considered within the 3-page matrix. Individual child issues or circumstances need to be carefully considered as well as the rubric recommendations. Thanks much to SEDOL in Illinois for sharing this 2014 resource.
  • Service Delivery Guide for Educating Students Who are Deaf and Low Functioning was developed by Region 4, Houston Texas in 2016. As the title indicates, this matrix is different from the others as it is specific to students who are Deaf-plus.
  • Matrix of Services was developed by the Florida Department of Education Bureau of Exceptional Education and Student Services in 2017 as guidance to indicate the intensity of support required to meet the needs of students identified as exceptional. It is not DHH specific. Be sure to download the large Matrix of Services Handbook that provides detailed explanations of all domains for appropriate use. Note: this large file may take extra time to access.

2018 © Karen L. Anderson, PhD, Late November Update, Supporting Success for Children with Hearing Loss This information is not intended as legal advice.

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Bi-Monthly Update: One Cost of Being the Lone ‘DHH Kid’ & the Need to Assess Social/Emotional Issues

Early December 2017

Increasingly, students with hearing loss are educated in their neighborhood schools and often the only student in their grade or school to use hearing devices or sign language. They are at higher risk than peers for teasing, and often have difficulty developing a healthy identity as a person who has a hearing loss. A thorough evaluation of educational performance includes considering social/emotional issues. Only looking at grades and receptive/expressive language is NOT an in-depth assessment! Why are children with hearing loss prone to these issues? What ARE the concerns we should be trying to identify? What are some means to identify social/emotional issues occurring in students with hearing loss?

Continue reading the Early December 2017 Update

Advocacy Notes

Addressing Children with Hearing Loss:
Appropriate Use of Norm-Referenced Test Instruments

The purpose of this document is to explore information available regarding use of normative tests with children who are deaf or hard of hearing. Very few tests have specific norms for this population. In comparison to pre-newborn hearing screening, the population of children with hearing loss has become increasingly heterogeneous, affecting the relevance of averaged, normative responses. Also, increasingly, students are fully included in their neighborhood schools, often as the only student with hearing loss/hearing devices/sign language interpreter in their grade or school. The expectations are that they have the capability to compete in their classroom settings. Thus, it is now being strongly suggested that students be evaluated with test instruments that may not include the deaf/hard of hearing population in the norming group; with the caveat that communication during testing be maximized, and the purpose of the testing is to assess the student’s skills in comparison to the performance of classroom peers.

The following information has been identified as being pertinent to this topic. Highlighting has been added for emphasis. Readers are encouraged to refer to original source information.

1. 2015 Guidance about the WPPSI-IV. Normative data section, page 3. This same paragraph is provided in 2015 guidance about the WISC-V.

“Examiners must determine whether the general normative sample is an appropriate comparison group for the child. While normative information for the general population is provided on the WPPSI-IV/WISC-V to assist with interpretation of scores, the WPPSI-IV/WISC-V normative sample did not include individuals with uncorrected hearing loss. Thus, comparison of standard scores for some deaf and hard of hearing children with the normative population may be limited, particularly for those without corrected hearing loss and/or whose primary language is some form of signed communication. In contrast, for deaf and hard of hearing children who use assistive technology, such as cochlear implants or hearing aids, and who are primarily spoken language users, a comparison with the normative sample may be appropriate.”

Comment: Most students are hard of hearing and are included in the mainstream with expectations that, with necessary supports and services, they perform at the same rate and to the same level as their class peers who are typically hearing. Comparison of their skills to this normative sample would therefore, usually be appropriate assuming communication optimization at testing occurs.

2. 2011 Page 4, number 3.

“The use of standardized tests to determine the cognitive abilities, academic achievement, and mental status of people who are deaf or hard of hearing may result in inaccurate or misleading results. Few tests have been normed on deaf and hard of hearing populations. Comparison norms are made to English-speaking, same-age students without a hearing loss. Assessment results need to be considered and interpreted in this light. Misdiagnosis can follow an individual throughout his/her lifetime. Scores from standardized tests should be interpreted in conjunction with other assessment information.”

Comment: The evaluator must always take the impact of the hearing loss on communication and attention into account during the assessment process. Most students designated as hard of hearing may be the only one in their grade or school to have hearing loss and use hearing devices. Comparison of their skills to the averaged responses of the very heterogeneous population of students who are deaf or hard of hearing can arguably be seen as less relevant for educational planning than comparison to their typically hearing peer group.

3. 2011  Page 9

“VI. Guidelines for Selecting Tests

1. General Considerations

a. Few standardized tests include specific norms for comparisons with people who are deaf or hard of hearing.

b. Some standardized tests provide guidelines for administration of test items to people who are deaf or hard of hearing.

c. Due to the problems encountered with standardized instruments, the inclusion of informal assessments is suggested. The use of informal assessments (such as interviews, observations, and work samples) can provide additional information on the student’s skills.

d. A word-for-word transliteration of standardized administration procedures may not adequately convey test instructions or student responses.

2. Achievement Testing

a. There are many facets to consider when selecting standardized, norm-referenced achievement tests for students with hearing loss, considering the student’s communication modality, difficulty translating questions into sign language, and the lack of validity studies of such techniques.

b. Achievement testing is beneficial to establish baseline levels of an individual’s educational performance and to monitor their academic progress over time.

c. Consider the use of hearing impaired norms (if available). This approach is valid when the desire is to compare the student with other hearing-impaired children.

d. It is suggested that academic achievement testing be conducted along with a communication assessment (expressive and receptive language skills) to identify the student’s strengths and needs.

e. Curriculum-based measurements (CBM) and criterion-referenced tests may also be used to monitor academic progress over time. With these measures, a student’s performance is compared to his/her own baseline rather than same age peers without hearing loss.

f. Oral reading CBM measures should not be used with students who are deaf except in highly specialized circumstances.

g. Classroom observations and portfolios are additional sources of educational data.”

Comment: Again, as most students with hearing loss are educated in the inclusive mainstream education environment, there is limited utility in assessing their performance in comparison to group norms of students who are deaf or hard of hearing. Informal assessment of the student’s functional performance in the classroom, including social interactions, participation in group settings, pace of learning over time and fatigue can be very valuable in determining the adverse effect hearing loss has on educational performance.


“Recommended Assessment Tools: The specific tests listed under each area represent possibilities from which to choose. Many tests are usable only in part, such as the use of only visual or performance subtests from a more comprehensive standardized evaluation. Almost all evaluation tools require some form of modification which the evaluator must note in the student’s record.”

Comment: For students who are hard of hearing with educational performance close or on par with classmates the modifications to testing may be to reduce background noise, ensure good lighting in the test space, ensure that hearing devices are functioning properly, and to control distance between the evaluator and student so that it is no more than 3-6 feet (unless an FM/DM hearing assistance technology system is in use). Note should be made of atypical number of requests for repetition, length of pauses between the question and response (processing time), and evidence of listening fatigue. These test considerations must be included in the description of test results.

4. NASP Position Statement file:///C:/Users/Karen%20L%20Anderson/Downloads/ServingStudentsWhoAreDeaf%20(2).pdf

Assessments and other educational support services need to address all domains in the life of the students who is deaf or hard of hearing, including social, emotional, physical, and cognitive development, and should use multiple sources of information for decision making. Due to etiological, neurobiological, and social factors, some students who are deaf or hard of hearing may be at risk for academic, social, or emotional difficulties. A successful educational program should proactively address the needs of these at-risk students and provide school psychological assistance to educators and support personnel working with these populations.”

“For students who use cochlear implants or hearing aids, the school pshychologist, in conjunction with other professionals, should determine how well the student can understand and communicate with these assistive devices and whether an interpreter (e.g., sign language, oral, or cued speech) may also be needed to access the curriculum.”

“School psychologists should collaborate with specialists knowledgeable in working with students who are deaf or hard of hearing (e.g., certified teachers of the deaf, speech and langauge pathologists, audiologists, ASL/deaf studies teachers) to assess how the student can communicate in a variety of settings. A mechanism should be in place to provide ongoing progress monitoring and, when progress is deemed less than adequate, additional assessment and intervention should be provided.”

A certified teacher of the deaf should always be part of the team.”


The assessment process should include professionals knowledgeable about the educational impact of hearing loss, specifically teachers of the deaf/hard of hearing and educational audiologists. The purpose of the assessment, and the group with whom it makes the most sense to compare the abilities of students who are deaf or hard of hearing, must be considered. This initial decision must be made if the results are to be most useful for eligibility and individual educational planning purposes. Administration of norm-referenced tests that do not include deaf/hard of hearing students in the norming group can be very appropriate if the student is primarily educated in the inclusive mainstream setting with few or no peers with hearing loss. The test administrator must provide an environment for optimal communication for the student who is hard of hearing, with special attention to the student’s attention, processing time, and level of listening fatigue. Students who use sign language must be tested with the involvement of their sign language interpreter, or if equally skilled, the teacher of the deaf/hard of hearing. All results must be reported specifying any significant alterations to test procedures.

Comments by experienced school psychologists with specialization in assessing students who are deaf/hard of hearing:

As a Licensed Psychologist and Teacher of the Deaf and Hard of Hearing, I have been conducting psychological and psycho-educational evaluations with students with hearing loss, as well as combined vision and hearing loss, for the past 12 years. In that time, I have seen numerous heart-wrenching situations where children’s cognitive skills have been tragically mislabeled because they were evaluated by a psychologist that either did not communicate with the student directly in the student in the student’s primary language OR the psychologist did not have training, education or experience working with children with hearing loss or combined hearing and vision loss. These professionals were well-intentioned. They read the manuals for intelligence tests such as the widely used Wechsler Intelligence Scale for Children (WISC) and the manual suggests giving just the “non-verbal” scales to children with hearing loss. Many respected sources also recommend that the “verbal” scales of intelligence tests NOT be given to students with hearing loss due to their limited exposure to language. Students with hearing loss have less access to language than their hearing counterparts and, as the “verbal” scales of intelligence tests are based on English, it puts children with hearing loss at a disadvantage.  I do not agree, however, that Deaf/Hard of Hearing students should not be given the verbal scales – even students who are profoundly Deaf and/or whose primary language is ASL. The following provides a very brief summary of why I believe it is usually necessary to give both the verbal and nonverbal scales of intelligence tests:

1. If you only give the nonverbal half of a standardized test, such as an intelligence or “IQ” test, then you remove half of the student’s opportunity to succeed. The assumption is that a child with hearing loss will not perform well on the verbal scales, but that is not always true.

2. Some students with hearing loss, even a profound hearing loss, perform better on the verbal scales of an intelligence test. I personally have tested numerous students who performed significantly higher on the verbal scales than the non-verbal scales. For example, I assessed a profoundly Deaf student who lived in a third world country until age 7, with no exposure to any type of signed or visual language (and therefore virtually no exposure to language as he had no access to spoken language). This student moved to the United States at age 7 and received exposure to ASL. At age 9, he was given the non-verbal scales of an intelligence test and those results suggested his intelligence fell in the Low Average to Below Average range. When I tested him at age 11, I gave him both the verbal and non-verbal scales and he earned scores in the Superior range on the verbal subtests and in the Low Average range on the non-verbal subtests, but his overall IQ score came out in the Superior range due to his extremely high verbal scores. If I had followed the guidelines printed in the manual or the guidelines provided by many respected resources for Deaf/Hard of Hearing students, then this student’s intelligence would have been estimated to fall within the Low Average range, instead of the Superior range. This student was struggling at school therefore his school performance did not reflect his Superior level of intelligence, either.  After this testing was performed, his academic program was adjusted to include teaching strategies that focused on language (ASL, as that was his primary language) and within 18 months he was earning A’s. Previously, his teachers had focused on visual teaching strategies because they assumed he would be a “visual” learner due to his lack of exposure to language and hearing loss, but he actually struggled with visual skills. This student eventually took Advanced Placement classes in high school and earned A’s. The student would be considered the “prime example” of a student that should NOT be given the verbal scales due to his extreme lack of exposure to language. Had I followed that logic, this student might still be struggling with “visual” teaching strategies. Note: Identifying details were changed to protect the identity of the student.

3. It is true that some students with hearing loss do not perform well on the verbal scales, most likely due to a lack of exposure to language. If the evaluator is trained and experienced working with students with hearing loss, then he/she will know which aspects of their social/educational/medical/audiological history should be considered as part of the interpretation of scores and will provide an effective discussion of the student’s scores, as well as strategies that are likely to be effective for improving the student’s language skills. In order for a psychologist to provide appropriate recommendations regarding a student’s cognitive skills, they need adequate information, which includes the student’s verbal/language-based cognitive skills. A trained/experienced psychologist will base their estimate of the child’s overall cognitive skills on a wide variety of factors, not just an IQ score. If there are lower verbal scores, a trained psychologist will interpret those in a way that includes the student’s hearing loss as well as their history.  That interpretation should result in specific recommendations aimed at improving their areas of need to help the student succeed. A trained evaluator should not underestimate the student’s overall cognitive abilities based on a small subset of verbal scores.

4. Verbal subtest scores are very highly correlated with an individual’s performance at school and work. If a student with hearing loss earns low scores on the verbal subtests (as well as any other measures of language), it is our responsibility as professionals to collect as much data about those challenges as needed to develop effective teaching strategies to improve language skills. Language skills, whether we like it or not, are highly correlated with both academic and vocational success. Refusing to test a student’s “verbal” cognitive skills because the scores might be low is very unfair to students with hearing loss. Professionals need to be trained to effectively evaluate a student with hearing loss so that their overall cognitive abilities are not “underestimated” based on lowered verbal subtest scores.   

Dr. Nanette McDevitt, Minnesota Specialist in Assessing Students who are Deaf/Hard of Hearing

CBM/progress monitoring should be considered an important tool in tracking a student’s growth and development. Children who are D/HH may start out at or close to age/grade level expectations due to intensive intervention provided during the preschool years. These interventions often taper off as the child enters the K-12 system. Deficits in communication/listening skills in the form of a slowly increasing gap in academic skills could easily be missed, or misidentified as a learning disability.    

Retired School Psychologist with DHH Advanced Graduate Certificate in School Psychology and Deafness

Supporting Success sincerely thanks the professionals who provided their comments on this important question.

2017 © Compiled by Karen L. Anderson, PhD. Supporting Success for Children with Hearing Loss.

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