Advocacy Notes: How do I start the process of getting services for my child?

- 1. Request for assessment is provided in writing or referral is made from clinical audiologist
- 2. Assessment Plan generated for all developmental domains
- 3. Assessments are conducted and reports are written
- 4. Team meets to discuss assessment results and document the following components:
- 1. Parent Priorities and Concerns
- 2. Results of assessments and the child’s present levels of performance
- 3. Contact information for all additional providers serving the family
- 4. Outcomes to meet the needs for both the child and the family
- 5. How these outcomes will be measured and who will be responsible
- 6. Offer of services for the child and the family
- 5. Parent Signature – “Parent signature” does not equal agreement*
- 1. Written request for a full evaluation of your child
- 2. Assessment Plan generated for all areas of suspected need within 15 days of request
- 3. Assessment Plan signed by family within 15 days of parent signature
- 4. Parent may put request in writing to relieve draft copies of reports and proposed goals*
- 5. Assessments are conducted and reports are written
- 6. Draft documents provided to the family prior to the IEP meeting
- 7. Meet as a team to discuss assessment results and develop the IEP document within 60 days of parent signature on assessment plan
- 8. Develop each required component of the IEP document as a team, which includes parents
- 9. Offer of Free Appropriate Public Education (FAPE)
- 10. Signatures
Only One Ear CAN be a Big Deal
- Poorer ability to listen and localize sound in noisy environments.
- Even a very low level of noise is likely to interfere with listening, especially when speech is presented toward the poor ear and noise is toward the typically hearing ear.
- The amount of difficulty localizing and processing speech in noise increases with degree of hearing loss.
- These children require speech to be at a higher signal-to-noise ratio if they are to perform similar to normal hearing peers (NH).
- It may take longer for these students to localize the speaker. Some children may benefit from seeing the talker (young children) however the effort required to localize who is speaking may impact the ability to comprehend what was said.
- Children are not always aware that they experience more difficulty listening than peers with NH.
- The first 2-word phrase occurs at 18 months for UHL versus 15 months for NH.
- Delays in auditory behavior were found in 21% of UHL versus in 4% of NH.
- Delays in preverbal vocalizations were found in 41% of UHL versus only 2.6% of NH.
- Preschoolers ages 4-6 years were found to have delayed language development and have poorer scores on the Children’s Home Inventory of Listening Difficulties (CHILD) checklist.
- Early childhood: the mean total language score = 91.78, almost 10% lower than ‘average’. Converting this difference to age equivalence results in language delays of 6 months for children with UHL. These language findings were not correlated with the severity of the loss or side of UHL.
- Lower scores have been found for syntax, morphology, vocabulary for children with SSD.
- Lower scores on oral language skills, especially oral composite scores (standard score (SS) of 90 vs 99, which was a significant difference).
- Impact of cognitive ability: children with UHL who had a higher IQ (90+) had higher oral skills. Their oral skills improved over time (ages 6-12 years). Children with lower IQ (90 or less) did not improve or improved at a much slower rate in their oral skills over time. Lower IQ UHL students who were on IEPs had oral skills that improved over time whereas those who were not on IEPs decreased in their oral skills relative to age peers over time. (Longitudinal study 2013).
- Academic difficulties are apparent to the teacher: Comparisons of SIFTER checklist scores for students with UHL compared to NH indicated significant differences across SIFTER content areas: Academics – 8 vs 11, Attention – 7.8 vs 12, Communication – 8 vs 11, Class Participation – 9 vs 12.5, School Behavior – 11.5 vs 13.5.
- Quality of life: On the HEAR-QL checklist, children with UHL scored substantially lower than NH (as in scores of 72-80 compared to NH scores of 95).
- Speech/Language Summary: UHL is associated with language delays in young children and school-aged children. There is improvement over time, especially for children with 90+ IQs and those with 90 IQs or less who were on IEPs. Children with UHL do not catch up to the language level of their siblings over time. Risk factors for language delays include: Profound UHL, lower IQ, poverty, maternal education, male.
- Educational Consequences Summary: Children with UHL have an increased risk of grade failure, increased risk to be on IEPs, increased academic weaknesses per teachers, high rates of speech therapy (~50%). Language delays in infancy through adolescence may widen with age and do NOT disappear. Verbal IQ differences may widen with age and do NOT disappear.
- Fatigue can look like tiredness, sleepiness in the morning, inattentiveness and distractibility, mood changes (irritability, frustration), changes in classroom contributions, difficulty following directions.
- Listening-related fatigue may be associated with factors that increase perceived effort. UHL or BHL can increase listening difficulties, which increases listening effort, increases risk for fatigue. This may impact the individual’s evaluation of the effort-reward ratio, meaning when a listening problem is detected the student may initially increase their effort so that they can understand. When, too often, they are not successful in understanding despite the greater effort committed, they can learn that trying harder ‘isn’t worth the effort’.
- As language ability (i.e., as determined by a CELF score) improves, evidence of fatigue secondary to UHL is reduced. Better language = less risk for fatigue.
- Children with UHL who have the largest asymmetry between their ears report the most overall fatigue. SSD likely to have greater fatigue than mild/moderate UHL.
- Adults with UHL were 5 times more likely to report severe fatigue than adults with no hearing loss.
- Younger children (6-9 years) who received their first hearing aid by age 5 showed benefit in localizing sound when they were using the hearing aid in their poor ear (UHL, not SSD). Older children (10-14 years) who received a hearing aid at age 7 or older indicated that the hearing aid was detrimental to localization. Providing early ‘balanced’ hearing to children with usable hearing in the poor ear prior to age 3 provides the best results. Early intervention success was linked to bilateral ‘balanced’ hearing. If a hearing aid is going to be fit, it should happen prior to age 3. Waiting until kindergarten will likely result in rejection (2010).
- Retrospective parent survey results: 72% of parents felt their child improved or greatly improved using a hearing aid in the poorer ear in various listening situations. Of this group of parents, 100% were happy they chose to have their child fit with a hearing aid and 50% expressed that they wished a hearing aid were fit sooner (2002).
- At diagnosis, the degree of hearing loss for 154 children with UHL was 31% mild loss, 19% moderate loss, 19% moderate-severe loss, 9% severe loss, 15% profound loss, 7% high frequency loss.
- Based on 337 children, only 21% received amplification shortly after diagnosis. Most take a year or more to get their first hearing device. Average age of diagnosis was 13.9 months; average age at amplification was 42.9 months.
- Of those who received hearing aids, 37% of children with UHL did not use them. (2010)
- This researcher studied whether CROS aids improve speech recognition and comprehension in the classroom. Findings indicated that in comparison to FM use, the benefit of a CROS hearing device is most notable in multi-talker situations with peers who are not using the remote FM microphone. Benefits were most apparent for speech from the ‘bad side.’
- Cochlear implants for students with SSD: The most improvement in speech understanding is in the first 3 months after implant activation. Words/sentence scores prior to implantation are about 5% correct. After 3 months they are 35 and 55%, after 6 months they are 40 and 60%, and 12 months post-activation scores are 45 and 65%.
- CI for SSD can improve speech understanding but may have a negligible impact on listening effort.
- Seating: When possible, the classroom should be arranged in a U-shape, with
the child’s poor hearing ear facing away from the students.
- Amplification options:
- Roger FM – microphone should be passed during small group activities and discussions (i.e. Touchscreen has automatic omnidirectional mics when in group)
- FM/DM (i.e. Roger Focus) receiver is placed in the typical ear
- Soundfield (CADS) amplification is an option but this does not improve access during noisy group activities. CADS + FM/DM is a good option, but the teacher may have to use 2 microphones.
- Even with optimal amplification, we cannot assume students are fully accessing communication or that they understand and process what they hear.
- Direct teaching:
- Language, syntax, and listening comprehension should be assessed for intervention needs.
- Students need to learn to use their hearing devices and monitor/troubleshoot appropriately.
- Students need to learn self-advocacy skills, including communication repair strategies.
- Students are at risk for identity, self-concept, and social/pragmatic communication skills. They need to connect with other students with UHL to develop a healthy self-concept.
“Special Considerations” and LRE for Students who are DHH
Early January 2019

Advocacy Notes: Who should be the “DHH expert” on the student’s team?

NOTE:
The IDEA defines the IEP team as “a group of individuals composed of” the following members https://sites.ed.gov/idea/statute-chapter-33/subchapter-II/1414:
1. The parents of a child with a disability 2. Not less than 1 regular education teacher of such child (if the child is, or may be, participating in the regular education environment) 3. Not less than 1 special education teacher, or where appropriate, not less than 1 special education provider of such child 4. A representative of the local education agency who is qualified to provide or supervise the provision of, specially designed instruction to meet the unique needs of children with disabilities; is knowledgeable about the general education curriculum; and is knowledgeable about the availability of resources of the local education agency 5. An individual who can interpret the instructional implications of evaluation results, who may be a member of the team described 6. At the discretion of the parent or the agency, other individuals who have knowledge or special expertise regarding the child, including related services personnel as appropriate
Whenever appropriate, the child with a disability
A few years back a district in Montana had two students with cochlear implants who use spoken language move to their schools. Their district hired a TOD from out of state for the purpose of serving these students. In California, as more and more students are being placed in their neighborhood schools in inclusive classrooms, thereby increasing the need for DHH Itinerant services, one of the regionalized county programs also reached out of state and brought in an appropriately trained TOD. Another way to facilitate that a TOD is on board is for the family to request an assessment with a TOD in writing. The district is then required to either provide the assessment or formally and in writing deny the request. (specialeducationguide.com) While the SLP and Educational Audiologist are highly trained individuals with knowledge and expertise, unless they have 2 degrees, they are not Teachers of the Deaf. Even among Teachers of the Deaf there are critical variables in training, knowledge, and expertise depending on the student’s language. Each of these three specialists is important, and each is needed on the IEP team in order to appropriately serve and support both the student with hearing loss as well as to support the general education teachers/staff who do not have the unique lens of the TOD. Melinda Gillinger, M. A. Special Education Consultant www.melindagillinger.com“Special Considerations” and LRE for Students who are DHH

Note:
The recent Optimizing Outcomes for Students who are Deaf or Hard of Hearing Educational Service Guidelines (NASDSE, September 20181) and the still relevant policy guidance on Deaf Students Education Services (US Department of Education, 19922) are both valuable resources in helping to answer this question.
Full-Inclusion as a Driver: With the push toward full inclusion in the classroom, including limiting pull-out for specialized instruction, school teams may seek to provide an interpreter in the situation above as a way to address communication needs in the inclusive environment. However, for the varying communication needs of students with hearing loss, an interpreter may be an inappropriate solution, or only a part of a solution, to meet these communication needs. As made clear from the following paragraph2, school teams must thoroughly understand a student’s communication needs, how to provide the least restrictive educational environment and the appropriately intensive specialized instruction in light of those communication needs. Meeting the unique communication and related needs of a student who is deaf is a fundamental part of providing a free appropriate public education (FAPE) to the child. Any setting which does not meet the communication and related needs of a child who is deaf, and therefore does not allow for the provision of FAPE, cannot be considered the LRE for that child. A full range of alternative placements as described at 34 CFR 300.551(a) and (b)(1) of the IDEA regulations must be available to the extent necessary to implement each child’s IEP. There are cases when the nature of the disability and the individual child’s needs dictate a specialized setting that provides structured curriculum or special methods of teaching. Just as placement in the regular educational setting is required when it is appropriate for the unique needs of a child who is deaf, so is removal from the regular educational setting required when the child’s needs cannot be met in that setting with the use of supplementary aids and services.” 2 To consider these language and communication special factors, the IEP team should ask1:- What is the child’s primary language and mode of communication?
- What communicative needs and opportunities does the child have? Can he comprehend what is said in school?
- Does the child have the skills and strategies necessary to meet those communicative needs and take advantage of communication opportunities? (social, self-advocacy)
- Can the child fulfill his or her need to communicate in different settings? (listening in noise, social situations)
- Does the child communicate appropriately and effectively, and if not, why not? (full participant in class?)
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- 1. What is his most effective communication mode of communication? The PARC checklists should help to tease this out (PARC Instructional Communication Access Checklist, followed by the appropriate grade level readiness checklist).
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- 2. What is his degree of delay compared to the language level of typical peers? An extensive language assessment must be performed, including listening comprehension. If providing an interpreter is being discussed, then assessment needs to be performed to determine his development level with both languages. Assessments that provide age expectations for learning ASL can be found in this document.
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- 3. Is there reason to believe that there is a cognitive component that is further impairing language growth (nonverbal IQ measure by someone skilled in DHH cognitive assessment)? When provided appropriately intensive services focused on oral language development was rapid progress made? Given intensive ASL instruction, not just interpreter services, does he pick up language at a rapid rate?
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- 4. What intensity of services are required for him to learn language at a pace of more than one month of development for one month of time? The school team can complete this matrix that assists teams in teasing out student communication, skill level, impact of hearing loss on education and resulting service intensity needs. This is a situation where it is highly likely that a full-day inclusive classroom setting is the most restrictive placement for a student to receive FAPE.
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- 5. What service providers are need for him to develop language quickly? A teacher of the deaf/hard of hearing and/or speech clinician with extensive training in oral education of students with hearing loss is likely necessary to reach the eventual goal of age-appropriate language.