At the start of each school year, thousands of students enter classrooms with teachers who have never encountered a child with hearing loss.
The following list summarizes key needs of students who are deaf or hard of hearing and the critical role of teachers to set the stage for student success in the mainstream classroom.

Key Points to Keep in Mind About Learners who are Hard of Hearing

1. Hearing loss is an access issue, not a learning disorder. Job #1 is to ensure that the student receives the same amount of instruction and classroom communication as peers. The student’s learning issues are due to missing parts of communication experienced in the past and throughout every day.

2. Hearing devices do NOT restore normal hearing. Children who are hard of hearing continue to miss bits and pieces of what is said, especially when farther than 3 feet from the speaker, in noise, not able to see the speaker’s face, or when unfamiliar vocabulary is used. Using FM/DM/HAT hearing devices consistently helps to level the playing field for optimal access to classroom communication.

3. You will ‘see’ that the student hears based on his or her behavior. It is easy to assume that the student perceived 100% of what you or peers said. Instead students are often trying to fill in the blanks for unheard speech sounds. Cat, cap, calf, cast may all sound like ‘ca’; rhyming words like drought/trout, few/blue, and countless others will be mistaken for one another. Extra processing time is necessary.

4. There is typically a need for the teacher to provide more repetition, to use a slower rate of speech, and to ensure the student is able to see the face of the person talking. Even with an effort by the teacher to make sure these modifications happen consistently, the student may have a harder time keeping up with the pace of learning due to continuing difficulty fully accessing all that is said around him or her.

5. Group work and social situations can be especially challenging due to multiple speakers, fast speech, and background noise. Social awkwardness or ‘being out of step’ socially can often occur.

The Jul-Sep 2018 issue of Volta Voices provided the following information.

What Teachers Can DO to Help a Student with Hearing Loss

How to identify a communication breakdown

• Confused facial expression
• Inattentiveness
• Disinterest/withdrawal
• Frustration, anger or anxiety’
• Bluffing, smiling and nodding
• Inappropriate responses, such as changing subjects or off-topic responses
• Body gestures like a shrug
• Hesitation in responding or interrupting
• Not taking turns in conversation

Classroom Tips for Teachers – Speaking

• Stand or sit close to the child (3 feet is ideal at the hearing device microphone level if possible)
• Make sure the child has good visual access to the speaker’s face
• Stand still as much as possible when you are talking
• Speak clearly at a slightly slower rate with slightly increased intensity. Emphasize key words. Do NOT over enunciate
• Use natural gestures, exaggerated prosody, and facial expressions

Classroom Tips for Teachers – Engaging

• Ask for clarification: “What did you hear?” and “What are you going to do?” Look for clues that the child did not understand you. Do NOT ask yes/no questions such as “Did you hear me?” or “Do you understand?”
• If the child does not understand, simplify and shorten sentences. Rephrase with simple, more familiar vocabulary.
• Touch the child, call his name, make eye contact or give a visual signal when instructions are given: “Listen: this is important” or “Look at me.”
• Expect the child to participate in classroom discussions and group work.
• If you do not understand the child, repeat what you did understand and ask for the rest of the information: “Yes we are on chapter 3. What did you want to know about the instructions?”
• Repeat the essence of a classmate’s question or answer. Direct the child’s attention to the person speaking by pointing to them as you call on them to answer, and/or say their name.
• State the topic before initiating discussion and state when the topic changes. Preface a change in activity by stating, “Next, we will talk about…” or “Now we are talking about…”

Classroom Tips for Teachers – In the Classroom

• Provide lists to the parent and/or educational support staff prior to lessons with themes and vocabulary for pre-teaching.
• Ensure good lighting and recognize that dim lighting will impede the child’s ability to use visual cues. Do not stand in front of a brightly lit window as that interferes with speechreading.
• Ask classmates to speak one at a time during discussions.
• Use multimedia supports, visual aids, and hands-on demonstrations as much as possible.
• Make sure all visual/audio media is captioned.
• Make sure the child has the correct patch cords to allow use of the FM/DM/HAT system for any lessons or assessments provided by computer or media device. Do not assume that headphones will be sufficient to allow the child to hear with their hearing devices.
• If you or classmates are reading aloud, provide the book or a copy of the print for the child to follow along.
• Provide a written summary of any video material or any material that is read aloud.
• Modifications may be necessary, such as one or more peer note takers, extra time on in class assignments and tests, modifications of reading and written assignments, alternative tests, or allowance for oral tests or providing testing in a quiet room.

How a Teacher can Manage Peer Conversations

If a peer does not understand a child with hearing loss, the teacher can help the child:

• Repeat at a slower rate, use louder speech, or shorter sentences. “Did you say….?”
• Repeat, emphasizing key words
• Rephrase
• Add more information. “What happened next?” and “When did this happen?”
• Write it or use gestures. Ask the child with hearing loss to “show me”.

When the Child with hearing loss does not understand a peer, a communication breakdown has occurred. A repair strategy is needed. Ask the peer to:

• Repeat what was originally said (say it again)
• Rephrase what was said, using different words or breaking it into shorter sentences
• Elaborate by using more information to clue in the listener (tell me more)
• Cue by providing background information to focus on the topic and building from the known
• Spell out the letters to emphasize sounds in the misunderstood word or words
• Ask: “What did you hear? Did you say … or ….?

Heading into the Mainstream: Preparing your child for mainstream schooling also means preparing the teacher in the classroom. Velvet Buehler, MA, CCC, SLP/A. July-September 2018. https://www.agbell.org/Portals/26/PDFs/Volta-Voices-Jul-Sep-2018-Final.pdf.compressed.pdf?ver=2018-08-21-161818-920

Additional Resources

• Dear Classroom Teacher Letter
• Dear Classroom Teacher – You have a student with hearing loss (brief article)
• Refer to the Heading into the Mainstream article for tips for how parents can prepare their children for a good experience in the mainstream school setting.
• The Impact of Hearing Loss
• Describing the Impact of Hearing Loss to Parents/Teachers
• Teacher Inservice Combo: 17 handouts selected to help teachers quickly and effectively raise the awareness of classroom teachers regarding the impact of hearing loss on student performance. The Combo includes 5 checklists to assess practical function in the classroom and 12 handouts. All are digital downloadable PDF files.

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Advocacy Notes:

 My Supervisor says I can’t advocate for my students!

Hearing loss/deafness is a low incidence disability that requires specialists in the field to assess, plan and provide appropriate instructional programs. Yet, in some schools, the DHH specialist is told they cannot advocate for their students. This is primarily due to resistance to funding the extra costs to providing appropriate supports and services to students with hearing loss.

While it is very understandable for schools to be seriously concerned about budget limitations, the determination of a student’s free and appropriate public education (FAPE) must be based on individual needs as stated in the IEP and may not be based on the location of staff, on the funds that are available, or on the convenience of the school district. Under IDEA, lack of adequate personnel or resources does not relieve school districts of their obligations to make FAPE available to each disabled student in the least restrictive educational setting in which his or her IEP can be implemented. Exclusion of a student from an appropriate placement based solely on the student’s disability is prohibited by Section 504 of the Rehabilitation Act of 1973.

The scenario of advocating for more DHH instructional time, captioning, interpreter services etc. and then being told that this advocacy will no longer be tolerated during team meetings or in discussions with parents is familiar to many teachers of the deaf/hard of hearing and educational audiologists. Continuing to advocate can sometimes end up with the teacher being considered insubordinate.

Is it legal for a school to totally restrict a teacher’s ability to advocate for student needs? There are two court cases that deal with this question: that are worth consideration:

• Fales v. Garst(8th Cir. 2001) Three special ed teachers filed suit against principal who tried to block them from advocating for students. The case revolved around free speech versus employer’s rights. The teachers alleged that the principal had violated their rights to freedom of speech and association under the First Amendment by instructing them not to discuss incidents regarding special education students at their middle school and their rights to equal protection under the Fourteenth Amendment by lowering their evaluations. The court believed that speech “which centered around the proper care and education of special education students, touched upon matters of public concern.” Thus, the teachers’ speech would seem to be “constitutionally protected expression.” However, the Court noted that, “the court balances the teacher’s interest in speaking against her employer’s interest in promoting the efficiency of the public service it performs through its employees.

In pdf   Complaint   Analysis by Wrightslaw

• Settlegoode v. Portland Public Schools, (9th Cir 2004) The court upheld the jury verdict and reinstated a-1 million-dollar award to a special ed teacher who was retaliated against and fired for advocating for her students. Per the Court: “Teachers are uniquely situated to know whether students are receiving the type of attention and education that they deserve and, in this case, are federally entitled to. We have long recognized the importance of allowing teachers to speak out on school matters because teachers are, as a class, the members of a community most likely to have informed and definite opinions. This is particularly so with respect to disabled children, who may not be able to communicate effectively that they lack appropriate facilities. Teachers may therefore be the only guardians of these children’s rights and interests during the school day.” The decision further clarifies freedom of speech for teachers.
  Decision in pdf   Complaint

As employees, it is understood that we all want to comply with what our administrators require. Yet, very few professionals fully understand the impact of hearing loss and deafness on educational performance, and the components of supports and services that may be necessary for students to fully access and benefit from the general education curriculum.  The 2017 Division for Communicative Disabilities and Deafness Position Statement from the Council for Exceptional Children eloquently describes the role of the DHH professional as a critical resource needed for legal compliance. If you experience unusual resistance to your professional opinions about what is required for a student to receive FAPE, it is suggested that you share this Position Statement with your administrator, and if necessary, information about the two relevant court cases as a means to substantiate your important role in defining the appropriate individual educational program of students who are deaf or hard of hearing.

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Caseloads: According to the 2017 survey conducted by Supporting Success¹, the majority of itinerant teachers of the deaf/hard of hearing (ITDHH) have caseloads of 10-25 students in 10 different buildings, with 85% of students being served 1:1 or in small groups, and about 30% of caseloads being students who are ‘deaf-plus’.

Increasing challenges: Fewer new educators of the deaf are graduating from university programs and a large number of teachers who have been in the field 20+ years will be retiring soon. Teachers with new certification in the DHH field who have received very limited training are being made responsible to provide the varied nuances of services needed by students with hearing loss and are often unprepared to identify what student needs truly are, much less how to address these needs. Thus, providing appropriate levels of service and support to our students and their mainstream teachers is increasingly challenging.

Consultation requires real time! All too often consultation time is considered ‘flexible time’ that teachers can use when there are schedule changes, new students, or unforeseen issues arise.  Consultation for the ITDHH often involves monitoring amplification devices, contacting the student’s audiologist, extensive inservicing of the classroom teacher, connecting with other service providers, and keeping parents informed of issues and progress. This all takes significant time and organization to accomplish for a caseload of students. While consultation may require minimal effort for some types of students qualified for special education, it requires more substantial time and continued follow up for students who are deaf or hard of hearing.

Service decision-making: When asked about service provision decision-making, while 25% used a service matrix³, over half of the 2017 survey respondents indicated that when a new student is identified the amount of service time is dictated by the time available on the teacher’s schedule, even if there is a clear need for more direct ITDHH time. Students are most commonly served 60 minutes per week. It is not possible to close an academic gap of 6 months delay, and support an equal pace of learning, in just two 30-minute sessions per week, plus address self-advocacy and other expanded curriculum needs. Many, many of our students have greater language and academic gaps than 6 months and continue to receive less service than truly needed to rectify educational needs secondary to communication access issues. IEPs should reflect not only direct services, but also indirect services such as integrating IEP goals into the class curriculum and time needed to deal with hearing technology challenges.

Caseload caps – no-go: Use of caseload caps has often backfired in practice as some school administrators interpret the maximum caseload cap as a minimum. Caps also oversimplify the workload situation as the numbers do not allow for differences in workloads due to variations in itinerant travel and intensity of student needs.

What is an approach to providing services that can allow a realistic role for the itinerant teacher?

A model that has been receiving increasing recognition since 2014 among speech language pathologists, occupational therapists, and physical therapists, is called the 3:1 Workload Model. Per a recent ASHA article⁴, some of the benefits of the 3:1 Model include: improved quality of services, fewer vacancies, reduced litigation, increased opportunities for collaboration, greater ability to identify students needing services, significant reductions in professionals taking work home, better morale, increased ability to integrate IEP goals with classroom curriculum.

The 3:1 Workload Model, sometimes called the Flexible Service Delivery Model, is an evidence-based service delivery model that supports students in the least restrictive environment and encompasses direct services (teaching, assessment), indirect services (planning, teaming, meetings, teacher consultation, class observation, hearing device management, etc.), and district compliance services (IEP writing, assessment report writing, conferences, data logging, caseload management, team meetings, etc.). It may be most beneficial to call it the Flexible Service Delivery Model as those who do not fully understand the purpose of 1 week for indirect services may interpret this as an ‘easy week’ or ‘vacation week’ rather than a much-needed focus on collaboration and student supports.

In a typical school month, students receive 3 weeks of direct services and 1 week of indirect services. This allows for integration of targeted skills within core curriculum and increased collaboration between staff, parents, and IEP team members. The services provided during the 4^th week of the month would include: consultation/meetings, observations, developing treatment materials, providing make-up sessions, more intensive services, assessments, IEP writing, progress documentation, team meetings, staff training, consultation with audiologists/CI centers, more intensive amplification checks, etc.

Documenting the 3:1 Workload Model on the IEP: “Therapy will be provided using a 3:1 service delivery model.” For example, the direct services would be written as: Student will receive 29 sessions per year (old model it would be written as 1x/week).  Or student will receive 58 sessions per year (old model = 2x/week). Alternately, “Direct services will be provided by the itinerant DHHT X minutes per week, three out of four weeks per month. Direct services will focus on…” If you are interested in implementing this workload model⁵, you would write it into IEPs as they come up throughout the school year, changing the service minutes to reflect the 3:1 model that would begin the next school year. Students with the most intensive needs may not be appropriate for this model. Information on implementation of this model stresses the importance of ‘PR’ so that classroom teachers and families recognize the benefits of not only teaching students, but also supporting their ultimate classroom success.

References:

1. 1. Online survey, April 5-May 8, 2017: Roles of the Itinerant DHH Teacher. Download summary.
2. 2. ASHA position statement on caseloads: https://www.asha.org/policy/ps2002-00122/
3. 3. For information on service matrices, go to: https://successforkidswithhearingloss.com/for-professionals/issues-determining-service-delivery/
4. 4. May 2019 ASHA Leader, The 3:1 Model – A Workload Solution, page 36-37.
5. 5. https://thespeechroomnews.com/2015/07/31-flexible-service-delivery-model.html

Question from the field: We are a small school district and only offer an ASL interpreter for students with hearing loss, but more and more students are now using spoken language. Are there interpreting services or supports that we need to offer these students who do not use ASL?

Depending on a student’s mode of communication, there are various options available for providing access in the educational setting. For the students who are receiving access to spoken language earlier and have better hearing technology, ASL is often not their primary language.

There are language options and communication strategies available for families whose children have hearing loss¹. Families may decide to use any of or a combination of the following:

Supports – There are various strategies that support effective communication for students with hearing loss who use spoken language. Resources can be found on the Accommodations for Students with Hearing Loss webpage. The need for captioning, notetaking, captioned media, and other supports like preteaching/review of vocabulary also must be considered to ‘equal the playing field’ for students who are constantly missing information during classroom communication due to hearing loss.

IDEA – The IDEA requires that public school districts provide for a free, appropriate public education (FAPE) in the least restrictive environment (LRE). In the IEP meeting, the team must consider and document the students mode of communication in the IEP. This should not be assumed to be ASL if the student uses spoken language or an alternative mode of visual communication to access their education. Some students will need sign language interpreters who use ASL, Cued Speech, or SEE while other students who do not use visual modes of communication may require transcription services. (28 C.F.R. 35.104)

ADA – Under the Americans with Disabilities Act (ADA) and Section 504 programs which receive federal financial assistance need to “provide accommodations, such as qualified interpreters, real-time Captioning (also called CART), assistive listening devices, or other auxiliary aids, to people with disabilities when necessary to ensure effective communication.” (Section 504, 29 U.S.C. 794) Therefore, depending on the child’s language and mode of communication the district will need to ensure that the student is able to access not only instruction in all of their classes, but also all activities associated with the school experience to which their typically developing, typically hearing peers have access. The school district must provide whatever interpreting service is included in the IEP or 504 Plan for all school-related activities including assemblies, school-related field trips, extracurricular programs, teacher conferences, social and cultural activities, and summer school or hobby classes.

In the IEP document the need for access services would be included in the Special Factors section under considerations if the student is Deaf/Hard of Hearing. Many IEP teams will also include the interpreting service in the Low Incidence section, the Accommodations section, the service grid, and also in the discussion notes of the IEP and in the offer of FAPE.

Because special education and IEPs are based on a failure model, some teams struggle to find the justification for including interpreting services. This is when the family and team need to consider the regulations of the ADA in addition to the IDEA and focus on the need to provide equal access in the educational setting. The Office of Civil Rights has ruled that public school systems must give equal access to extracurricular programs. “School systems should routinely publicize the method that deaf and hard of hearing persons can use the request necessary services such as qualified interpreters, real-time captioning (also called CART), or assistive listening devices.”²

In my own experience I have seen all of the following successfully provided for students:

References

1. 1. Early Intervention: Communication and Language Services for Families of Deaf and Hard-of-Hearing Children; https://www.cdc.gov/ncbddd/hearingloss/freematerials/Communication_Brochure.pdf
2. 2. National Association of the Deaf; https://www.nad.org/…/education/…education/section-504-and-ada-obligations-of-public-schools

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Students with hearing loss have less access to communication. This will result in a slower pace of learning and fewer gains in academic knowledge unless appropriate services and supports are provided. At the end of the school year it is important to ask whether your students have learned the amount expected of their grade level. Has the level of support been sufficient? We need to use data in our planning for next year’s success!

Decreased speech perception translates into decreased comprehension, especially of novel words and new information. Most students who are deaf and visual communicators primarily receive communication from their classroom interpreter with little meaningful conversation or information exchange directly with peers. Regardless of the communication modality, progress through the curriculum at the same rate as class peers assumes that the student is fully participating and has received the same information as those peers. It’s all about access!

The law requires the IEP be reviewed at least once a year to determine if the child is achieving the annual goals (Section 1414(d)(4)(A)). The IEP team must revise the IEP to address any lack of expected progress and anticipated needs.

We need to not only strive to close language and learning gaps, we need to simultaneously support our students in keeping up with the day-to-day learning in the classroom. We MUST monitor progress to know if full access is truly occurring and to ensure that our students are keeping pace with classroom expectations. Without appropriate support, the trajectory of educational performance shown above is all too likely.

Students who are deaf or hard of hearing with no other learning issues – with full access to school communication – CAN progress at the expected rate IF they are receiving the appropriate intensity of focused support.

Compare Progress from Year-to-Year

Review your student files semi-annually for young children and annually for later elementary school-age students. If available, look at norm-referenced test results, like the high-stakes tests or language evaluations. Have the student’s percentile scores or standard scores stayed consistent? With your focused intervention and appropriate supports, have the student’s percentile scores improved? Or, like the previous figure depicts, has the student experienced inappropriate access and insufficient supports causing a decrease in performance over time?

For example, consider a student who scored in overall reading in

• grade 2 at the 48^thpercentile
• grade 3 at the 38^th percentile
• grade 5 at the 30^th percentile

The student still continues to fall within 1 standard deviation from the mean, or within the ‘average’ range. However, a drop of 18 percentile points over 3 years raises the question about adequate yearly progress and if the access accommodations and intensity of services have truly ‘leveled the playing field’ for the student with hearing loss. The school team may not be concerned because the student still scores ‘average’ but to a professional with a background in the impact of hearing loss on learning, this trend should demand that more focused and appropriate supports/access accommodations be provided.

Needed Supports for Keeping Pace in the Classroom

Background, or world knowledge is necessary to build surface level understanding of a specific topic. Prior knowledge is an excellent predictor of performance. Our students tend to have ‘Swiss cheese language’ with unpredictable knowledge gaps in vocabulary and concepts. They also are often limited in the number of attributes they use to describe objects or concepts, further contributing to their gaps and limited world knowledge. Imagine learning about the conquistadors if you lacked knowledge of geography, discoveries of early explorers, and that there are different countries and they may desire different things. Previewing and reviewing new vocabulary is critical for the student to ‘keep up.’

Filling the gaps. We can expect that surface learning will take longer for students with hearing loss than their typically hearing peers. Students who have a less complete understanding of surface level information are not going to benefit to the same degree, or at the same rate, during interactive activities meant to move them to deeper understanding.  “Closing the language gaps” is not just something that is a nice extra touch to provide to our students if there is a teacher of the deaf available; it is necessary for deeper learning. Add to this the fact that reduced listening ability often delays literacy skill development and slows reading fluency. Just teaching vocabulary, without sufficient phonological awareness, will not develop the reading fluency the students need for comprehension at the pace of peers. Filling in the gaps in prior knowledge is necessary if a child is to be able to develop the surface learning that is prerequisite to developing deeper understanding. Without this surface learning, a deeper understanding is not possible.

Conversational inequalities. Research⁴ has indicated that during one-on-one conversations in a quiet setting, students who are hard of hearing have conversational skills equivalent to their hearing peers. In a typical mainstream classroom, students with hearing loss make fewer overall communication attempts than their hearing peers. They also often seem unaware when their peers try to initiate conversation and do not attempt to maintain the conversation. When they attempt to maintain the conversation, they generally use one-to two-word phrases and do not add new information. The research found that in a 1:1 conversation, 75% of the conversation maintenance attempts by children with hearing loss were appropriate compared to 100% for hearing peers. They frequently tried to maintain the conversation by bringing up a topic that was unrelated to the conversation. In other words, they were not aware enough of the content of the conversation to contribute information, so they brought up a new topic.

Educational practices that seek to move students to deeper understanding typically involve interaction with peers. This is often very challenging for students with hearing loss when acoustic access inequality in the classroom results in conversational misunderstandings for students with hearing loss. This provides a powerful argument for the use of hearing assistance technology (HAT) that will improve perception of peer voices in 1:1 or group settings.

Challenges repairing breakdowns. Another aspect of conversation relates to what a person does when they do not fully understand. One study⁵ found that persons with hearing loss were able to cue into changes in topic but had much more difficulty when a shift in topic was made during the conversation. The research findings can be summarized as, “the more predictable the conversation, the fewer the likely breakdowns.” The teacher needs to be aware of this issue when pairing the student with different partners or groups. Moving to a quieter area for discussion will not ensure full participation by the student with hearing loss but it will make participation easier and more likely. Including him or her in a group that is more likely to stick to the topic will heighten the value of the exercise for the learner with hearing loss.

Keeping up in the classroom is a challenge for children with hearing loss due to access issues that interfere with understanding conversational communication and the gaps in knowledge resulting from decreased auditory access since infancy (or sign communication with limited language models since infancy). Filling the gaps of vocabulary and phonological awareness is necessary for students to keep up with class expectations for developing surface learning. Access to classroom discussion and for all group activities is a prerequisite for deep learning to occur. Providing the appropriate access technology is a necessity to facilitate deeper learning to occur within the classroom. Selecting appropriate group partners and honing communication repair skills is also critical to students with hearing loss achieving at the same rate and to the same level as peers.

Considerations for Monitoring Progress

ASL Content Standards – K – 12.  Whichever communication modality is used by a student, he or she must have the skills to adequately communicate both receptively and expressively.  Most families at this point prefer that their child learn to listen and speak. This preference does not always result in a child who has school entry skills. Whether the family has chosen to use sign from birth, or it is the modality deemed to be most effective for learning by a school team due to child’s lack of progress learning to listen and speak – a student must progress through learning ASL in a developmental sequence to prepare them to make academic gains at least at the rate of their class peers. Developed by Gallaudet, the ASL Content Standards for K-12 grade students  were developed to ensure that children learn ASL in much the same way that hearing children in the US acquire and learn English. The Standards are a huge step forward in determining the student instruction needed and monitoring progress of ASL knowledge and use.

CURRICULUM BASED MEASURES: There is a need for functional assessments to monitor students’ academic performance. Curriculum based measures provide a specific approach to measuring student learning that includes repeated measurement (weekly, monthly) across extended periods of time using general outcome indicators that are sensitive in the rate of change demonstrated in the performance of a task of the same difficulty. While curriculum-based measures (CBM) have been commonly used in public education, it is appropriate to consider CBM use for students who are deaf/hard of hearing specifically. Developed as part of a grant from the U.S. Office of Special Education Programs, the University of Minnesota has developed extensive progress CBM materials designed specifically for teachers of the deaf/hard of hearing to monitor students who have hearing loss and/or language differences. Go to the Education Resources for Teachers of Deaf/Hard of Hearing Students resource page for extensive training resources for teachers and specific means to monitor student progress. This truly is an amazing resource and would be great for professional learning collaboratives or self-study. The measures take only a few minutes each week!

MAZE ASSESSMENT: Monitoring performance via the MAZE assessment is a common form of curriculum-based measurement. Maze presents sentences or short stories with every 7th word missing. The student must select which of 3 words best fits the missing word in the sentence. Clearly, as can be seen in the bar graph, even our students with hearing loss who do not have IEP services and supports are not performing like their age peers. Learn more about creating MAZE reading passages here.

Monitoring Progress of Expanded Core Skills

Expanded core curriculum refers to those skills that students with hearing loss need to learn to be able to access the general education curriculum and fully participate. Even if a student is provided access to effective communication as required by Title II of the ADA, he or she still needs to learn the skills to independently, and confidently, navigate as a person with hearing loss in a mainstream setting. These areas will not be taught specifically and yet they must be learned if full participation in the classroom is expected.

Per the Iowa Expanded Core Curriculum guidance, hearing loss adds a dimension to learning that requires explicit teaching, such as information gained through incidental learning. It has been estimated that for persons without hearing loss, 80% of information learned is acquired incidentally. No effort is required. Any type of hearing loss interrupts this automatic path to gain information. This incidental information must be delivered directly to students who are deaf or hard of hearing.  Two hierarchies for self-advocacy are the Guide to Self-Advocacy Skill Development and the Student Expectations for Advocacy and Monitoring (SEAM).

Most teachers without specialized training related to hearing loss do not have the expertise to address the unique needs of students who are deaf or hard of hearing. Therefore, IFSP & IEP team collaboration with educational audiologists and teachers of students who are deaf or hard of hearing is necessary in addressing academic and social instruction and the assessment of these areas. In order to close this information gap, the Expanded Core Curriculum for Students who are Deaf or Hard of Hearing (ECC-DHH) was developed. Texas has developed a Livebinder with extensive information about ECC and resources to support implementation.

Collect and use data in planning for next year’s student success!

References:

1. 1. Fisher, Frey, Hattie (2016) Visible Learning for Literacy Grades K-12: Implementing the Practices that Work Best to Accelerate Student Learning. Corwin/SAGE, Thousand Oaks, California
2. 2. Yoshinaga-Itano (2010). The longitudinal language learning of infants and children with hearing loss. ASHA Virtual EHDI Conference, October.
3. 3. Meyer, Kym (8/17/2017). Wait – There’s a Student with Hearing Loss Coming into My Class? Webinar viewable at https://www.youtube.com/watch?v=r3ytOawiYuI&feature=youtu.be
4. 4. Duncan (2001). Conversational skills of children with hearing loss and children with normal hearing in an integrated setting. The Volta Review, 101(4), 193-211.
5. 5. Caissie (2002). Conversational topic shifting and its effect on communication breakdowns for individuals with hearing loss. The Volta Review, 102(2), 45-56

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Question from the field: I have a student whose IEP calls for an FM system. However, the system is not in place, and we are more than half way through the school year. What can I do as the teacher of the deaf to help get this student their system?

Why FM/DM Systems?

Many districts are now referring to FM/DM equipment as HATS, or Hearing Assistive Technology Systems. The use of HATS in the educational setting not only provides better access to the linguistic information, but as a result can help with development of speech and language skills, increase incidental learning, and can help with social skills in the classroom.

A powerful teaching tool that demonstrates the benefits of HATS in the educational setting as well as the difficulty without it can be viewed on YouTube (Hearing Loss in the Classroom, St. John’s Medical Center¹). This can be shared with families and educators alike to improve awareness of what a difference it can make to improve the signal to noise ratio.

HATS includes any of the following components²:

• Teacher transmitter or teacher microphone: This is worn by the teacher and is synced with the students’ personal receivers. It can easily be muted and us muted as needed throughout the day.
• Personal receivers (sometimes called boots): These are attached to the student’s hearing aids or cochlear implant processors.
• Classroom sound-field systems: This allows the teacher and students to use a microphone(s) and have their voices amplified above the ambient noise for all students including the student with hearing loss to have better access.
• Pass-around microphone: This is used by peers to provide access for the student during class discussions and peer-to-peer communication. If there is a sound-field system, then the student with hearing loss would also use the pass-around microphone. While a sound-field system typically does not provide a sufficient signal-to-noise enhancement for students with hearing loss², with planning, personal HAT devices can often work in conjunction with sound-field classroom amplification systems. When there is a sound-field system and the student with hearing loss uses the microphone, just like class peers, the student is not singled out, thus supporting them socially, and enables them to use their auditory feedback loop in order to monitor and correct their own speech production.

Timing is Essential for FAPE

All placement, services, and goals offered in the IEP are effective upon signature by the parent or legal guardian and should be implemented immediately. A court case⁴ ruled against a school district who delayed the repair of a student’s FM system, even through the student maintained good grades saying, “his maintenance of good grades was due to his own diligence. The school was found to have denied the student FAPE and violated section 504.

If the IEP team recommended and offered the FM/DM technology in the IEP, then it should be in place prior to the first day of school. Of course, if equipment needs to be ordered and the student is starting school immediately, then every effort should be taken to ensure the student has appropriate auditory access to everything being said in the classroom as soon as possible. Different school districts differ in the way in which they acquire technology. In speaking with and working directly with the companies that supply these systems, there is no reason for there to be a month-long delay (let alone half of a school year). Some companies are also willing to send a system for the child to use as a “loaner” device while the district is going through their procedural process to obtain the equipment offered in the IEP.

The Barrier of Lack of Audiology Expertise

Students who are eligible for specialized instruction as Deaf/Hard of Hearing comprise one of the populations considered under low incidence disabilities. The discussion of low incidence equipment is one that is unique to students whose eligibilities require “personnel with highly specialized skills and knowledge … to receive early intervention services or a free appropriate public education”⁵  The Educational Audiologist is the service provider responsible for ordering assistive hearing technology⁶. Sometimes, school administration will put pressure on the teacher of the deaf/hard of hearing or the speech language pathologist to obtain HAT systems for students, which is inappropriate as recommending HAT equipment is outside the role and responsibility of both of these professionals.⁷ If you are in a circumstance where your district does not have an Educational Audiologist on the team, or if there is a lack of audiology service time to ensure prompt provision of the equipment, it is important for you to approach the administrator to find a solution. A clinical audiologist, especially one specializing in pediatrics, has the expertise to recommend appropriate HAT equipment for use in the school setting.

Be Empowered to Advocate

Facilitating the ordering of the required technology is necessary for your student to receive appropriate access to instruction and classroom communication. As the teacher of students who are deaf/hard of hearing you should feel empowered to let your district know that for your student to spend any time without the FM/DM system is like asking a student in a wheel chair to wait for the district to build a ramp and widen the doorway before that student can enter class and begin to participate with their peers.

Melinda Gillinger, M. A.
Special Education Consultant
www.melindagillinger.com

1. 1. Hearing Loss in the Classroom, Pediatric Audiology Project: https://www.youtube.com/watch?v=RBrnvGKLF_Q
2. 2. Hearing Assistive Technology Systems (HATS) for Children https://www.asha.org/public/hearing/hearing-assistive-technology-for-children/
3. 3. See research posted on https://successforkidswithhearingloss.com/for-professionals/personal-fm-vs-sound-field-fm/
4. 4. https://successforkidswithhearingloss.com/wp-content/uploads/2019/03/504-case-due-to-lack-of-FM-repair.pdf
5. 5. IDEA Section 1462 (c) (3) (C) https://sites.ed.gov/idea/statute-chapter-33/subchapter-IV/part-B/1462/c
6. 6. Educational Audiologist Role http://edaud.org/educational-audiologist-role-defined/
7. 7. Roles of Educational Audiologists, Teachers of the Deaf and Hard of Hearing, and Speech Language Pathologists: http://www.edaud.org/position-stat/15-position-02-18.pdf

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“We don’t want to call attention to his hearing loss. We want him to be “normal.”

Students with hearing devices are typically educated in their neighborhood schools and are the only ones in their grade or the school to have a hearing loss. Everyone wants students to have a good experience in school. Often part of this desire by families is for their child to not feel singled out as ‘different.’ While it is true that our students are just ‘normal kids who happen to be hard of hearing or deaf’, it is also true that having a hearing loss means that they will be different in some ways from their peers.

What does this approach mean for the student?

It does not take calling attention to the hearing loss for the class peers to recognize that there is a hearing loss – or something – different about the child. In any group where the same people are together day after day the fact that one of the group wears hearing devices will soon become known. Either by seeing the hearing devices, or by experiencing the child not responding typically in certain situations (listening in noise, distance, fast/quiet conversations, etc.) the other students will identify the child as being different.

Psychosocial development informs us that between age 4-6 years that children are learning what is acceptable and not acceptable to the peer group. Research has indicated that early rejection by peers is associated with persistent academic and social difficulties. By including the child with hearing loss in the mainstream environment without letting the peers know anything about the child’s hearing devices or communication needs the child faces exclusion from the peer group and often has no knowledge or strategies to cope with the situation.

Example of cascading effects of not informing peers of the hearing loss/hearing devices:

Jimmy is excited to start kindergarten. The first day when he is sitting with the  group the boy next to him says loudly “What are those things in your ears.” Jimmy has always been around his family and others who know about the hearing aids so he hasn’t been prepared for questions like these. He feels confused and ashamed. He says, “They’re my hearing aids.” The other boy makes a grab for the aid so he can see it better and they get into a tussle. The teacher calls them out to stop fighting. On the first day of kindergarten Jimmy learned that his hearing aids get him in trouble, and other kids look at him funny. The students don’t know what ‘those things’ are or why he needs them so they start to tease and avoid him. Even though he has worn hearing aids as long as he can remember, he starts to wonder what would happen if he ‘forgets’ them at home…

Setting the stage for rejection of hearing devices

We develop our identifies by defining ourselves as members of various groups. To develop a healthy identity where it is okay to be a person who uses hearing devices, a child must be exposed to, and interact with, other children who use hearing devices. In the current model of full inclusion, it is becoming less and less likely that a student with hearing devices will see another student who is hard of hearing. As the acceptance of peers becomes more important in grade 2 and increases throughout middle school, it becomes more likely for the child who uses hearing devices to want to be ‘normal’, meaning not use hearing aids and/or a DM system. It is not surprising that there are now reports of more children rejecting hearing devices, especially DM systems, at earlier ages than previously, when they had regular interactions with peers who used hearing devices.

What can be done to develop students who feel good about themselves
and ready to deal with peer acceptance issues?

• Before he enters kindergarten if possible, prepare the child that he will be asked questions
  • Other kids probably haven’t seen a child using hearing aids and won’t know what they are
  • He will be asked questions about what the hearing devices are and why he uses them
  • Other children may want to handle the devices and he needs to be able to discourage this appropriately, so they are not broken
  • People do not understand what it means to have a hearing loss.

• Work with the child to develop an understanding of what a hearing loss is, and what that means
  • He knows he is the kid in the family that wears hearing aids but is likely to not have a clear understanding of why.
  • Use materials like the CHILD checklist questions and the My World tool (soon to be an app!) to discuss how the hearing loss means he has a smaller ‘listening bubble’ and challenges listening in noise, at a distance, and when people talk fast or have accents.
  • The hearing aids help him – A LOT! Unless he understands what it means to have a hearing loss and how the hearing aids help him, he won’t be able to explain it to others when they ask or to advocate for himself when he knows he will have a hard time hearing and understanding.

• • Inservice the class peers
    • Whether the child wants to play a role in talking about hearing and listening with his classmates or not, an adult needs to set the stage for student acceptance (teacher, parent, DHH specialist)
    • Discuss the importance of hearing and being a good listener in the classroom. What happens if someone can’t hear as well as others? Some children are born with ears that do not work as well as other peoples and they use hearing aids. Etc.
    • It is especially hard to understand in noise and when someone is talking at a distance. This makes it seem like the person could be ignoring you, but that is not true.
    • Read a book to the class, like Eggbert the Slightly Cracked Egg roughly for preschool through grade 2, Friends, Like You for grades 2-5, and El Deafo for grades 3-6.
    • Discuss how to be respectful when talking to others. Get their attention first, etc.
    • Demonstrate the use of the DM system. Allow the child to ‘shine’ as the teacher steps away and quietly asks a question that the rest of the class cannot hear but the child using the DM system can answer.
    • Answer questions – the classmates will be curious!

• He WILL be teased. What should he do?
  • While some children will ask about the hearing devices because they are curious, others will tease the child. Discuss teasing:
    • Why do children tease?
    • Is he the only one who gets teased? Only kids with hearing aids get teased?
    • How should he avoid bullying situations?
    • Practice responses to typical questions and teasing situations
  • Refer to Building Self-Confidence and Resilience to Maximize Acceptance for materials on teaching for resilience to teasing

• Make regular connections between DHH peers is critical for success
  • Children who connect with others who have similar hearing loss and device use will be more self-confident and resilient to peer pressure. Holding regular group meetings digitally (i.e., Skype, Zoom, etc.) among students to meet instructional goals for self-advocacy is an effective way to increase student success – socially, emotionally, and academically!

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Question from the field: Can early intervention pay for audiology evaluations and hearing aids?

Approximately 50% of young children served by early intervention programs are eligible due to communication development concerns. Are early intervention programs responsible for providing audiology evaluations to children referred to Part C and have communication delay concerns?

Audiology Services – A 2003 letter to the Office of Special Education Programs said:

“Your question focuses on infants and toddlers referred to Part C with delays in speech and language whose parents have not had their children’s hearing tested, sometimes because the family and/or physician feel that such testing is not warranted. Further, you state your agency’s belief that “the very fact that they have a speech delay means that further audiological testing is warranted to rule out any late-onset hearing loss.”… Specifically, you ask if an audiology evaluation is a required Part C service and whether the Part C lead agency is a payor of last resort for such services.”

The answer is YES. Early intervention services include those designed to meet communication and physical development issues, including hearing loss. Audiology is identified as an example of early intervention services. Part C regulations require evaluation and assessment of the child’s functioning in a variety of domains and a statement of the present level of hearing status. Under Part C, an infant or toddler suspected of a communication delay whose hearing has not been tested and an audiology evaluation is needed must receive that evaluation as part of the overall early intervention evaluation process to be able to reflect the child’s present level of functioning. If audiology services are identified as a need on the IFSP, they must be provided at no cost by Part C if the child is not entitled to coverage for this service under any other Federal, State, local, or private source.

Download this OSEP letter.

In many states the babies who fail newborn hearing screening and have been diagnosed with permanent hearing loss are referred to their local Part C early intervention program. Most of these infants require hearing aids and for some, use of DM Hearing Assistance Technology at home is appropriate. Are early intervention programs responsible for providing this assistive technology?

Hearing Devices – Another 2003 letter to the Office of Special Education Programs said:

Under Part C, appropriate early intervention services must be available to all eligible children and families. Assistive technology devices and assistive technology services are listed among the identified early intervention services. Assistive technology devices are required only if they relate to the developmental needs of infants and toddlers served by the program. Linking the provision of those devices to an educational benefit is not appropriate under a program that serves children from birth to age three.  The “Secretary reiterates that the purpose of assistive technology devices is to meet the unique developmental needs of the child, as determined on an individualized basis through the IFSP development process.”

The answer is YES. Hearing devices fit under the IDEA description of assistive technology as “any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of a child with a disability.” (20 U.S.C. 140(1)) Hearing devices are necessary to optimize the language development of children with hearing loss.

Download this OSEP letter.

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Who are our babies with hearing loss? Fewer than 15% of the babies identified by Early Hearing Detection and Intervention (EHDI) programs have bilateral profound hearing loss (deaf) and more than 50% have mild bilateral or unilateral hearing loss. The distribution of degree of hearing loss in diagnosed infants is depicted in the following figure. Fewer than 1 in 20 newborns with congenital hearing loss have two parents who are hard of hearing or deaf. ¹ Therefore, most families of these children have little or no knowledge of hearing loss and its potential impact on language and speech development, social skills, and future academic and life success. The following information will share recent research findings about the needs of these children and available materials to assist early interventionists and families facilitate good early childhood development outcomes.

The 2015 Outcomes of Children with Hearing Loss research² on children with permanent mild to severe hearing loss (25-75 dB) was a large-scale longitudinal study that followed children from six months of age to seven years old. There were 317 children who were hard of hearing and a comparison group of 117 children without hearing loss from 17 states. Almost all had permanent bilateral hearing loss and hearing aids. Three fourths were identified through newborn hearing screening. Assessment occurred every 6 months from age 6-24 months and annually thereafter to groups of children.

Summary of OCHL Findings:

In general, this collection of articles has now proven what experienced early interventionists know – for children who are hard of hearing, hearing aids need to be well fit and worn consistently and families need to know how to communicate effectively with their child to maximally develop spoken language. The richness of the parent’s talk with the child influences the child’s language outcome. This ‘formula for success’ for children who are hard of hearing is now supported by strong research.² To accomplish these ends requires very knowledgeable interventionists who have the time to provide continued support to families throughout early childhood and the involvement of someone with expertise in the educational impact of hearing loss once the child is in school.

The National Center for Hearing Assessment and Management (NCHAM) reports that detecting and treating hearing loss at birth for one child saves $400,000 in special education costs by the time that child graduates from high school.³ The amount saved can only be realized with the investment of early, appropriate services from experienced interventionists working to support families over time.

Early Intervention “Curriculums”

There is no single resource that will impart all the knowledge needed to adequately support families of young children with hearing loss. The interventionist must have a sufficient background in hearing loss, understanding audibility/speech perception, language development, the continuum of communication choices, and adult learning – as a start. The following are resources that have materials that can be easily shared with families to enhance intervention. The best intervention is reactionary, in response to the current concerns of the family, that builds skills over time in relation to the child and family’s needs. That said, it is very helpful to have resources at hand to draw from as you respond to different family learning styles and needs.

SKI*HI is perhaps the oldest and most recognized EI curriculum resource, especially for persons just starting to work with families of young children with hearing loss. The 2-volume, 2200-page resource includes information suitable to all degrees of hearing loss and exploration of and starting skill building in all communication choices. The visuals provided in the SKI*HI curriculum are something that interventionists use all the time!

EI Resources for Families Choosing to Use ASL

Gallaudet has some informational webcasts that will be of benefit to early intervention providers assisting families in learning sign language to use with their young children. Refer to the list of EI webcasts, online learning resources and publications here.

To learn any language, a child must be surrounded by fluent language users who dynamically involve the child in 2-way communication. Therefore, teachers of the deaf/hard of hearing who are highly skilled in the use of sign language and/or adults who have hearing loss and use sign language (Deaf Role Models) are the optimal choice for facilitating the family’s effective use of sign language.

Referencing sign language dictionaries such as Signing Fun, the Gallaudet Children’s Dictionary, and ASL Basics for Hearing Parents of Deaf Children is often very useful to families. It is important for EI providers to understand the developmental hierarchy for learning sign language. ASL developmental hierarchy information can be found at the end of this White Paper.

EI Resources for Families Choosing to Use Listening and Spoken Language

Listen Little Star is a tried and true resource from Australia that has 12 lessons for the family of infants (0-12 months). It is easy to use and has a DVD with professional grade video clips to accompany each lesson.

The Learn To Talk Around The Clock Toolbox is organized around a set of principles and provides hundreds of suggestions for natural practice in the family’s home or child care setting in an orderly presentation of skills known as “Signature Behaviors.” Author Karen Rossi, DHH teacher and LSLS, has an incredibly helpful website to support families, early interventionists, childcare and into preschool. The Language Development Knowledge Cards have many applications.

The Listening Room (Advanced Bionics AB4Kids) features three sections with content created specifically for age groups: Infants & Toddlers, Kids, Teens & Adults. Register to be able to see and download free activities and resources to support the development of speech, language, and listening skills. AB4Kids also offers the Baby Beats (video) app to develop listening and communication skills in young children. They also provide wonderful resources for preschool and school-aged children.

Cochlear Corporation has provided extensive, incredible resources with Sound Foundation for Babies and Sound Foundation for Toddlers. Designed for 12 months and up, the skills for babies start at a beginning auditory awareness level are applicable to children who are hard of hearing identified in the first few months along with those who are recently implanted. Babies Babble, Toddlers Talk, and Children Chatter are all videos that support the Listen, Learn, and Talk book. The Cochlear suite of materials is helpful to any interventionist or teacher working with children with useable residual hearing. There are also resource for parents of school-age children and could selectively provide some basic information for teachers. It is great to have this bank of resources videos at your fingertips.

MED-EL cochlear implant company also provides resources to purchase that will support listening and communication development.  Their free offerings include Ling Cards (set of 7 cards, 3” x 5”), Little Listeners comprehensive guide for preverbal speech, language and auditory development, Little Listeners in Spanish and other resources that can be ordered for free, or downloaded as PDFs.

Early Intervention Materials

Early Language Development Handouts and Activities with Bonus CD  This inexpensive resource provides 25 informational and activity-based handouts that will help you tell parents and caregivers at home how they can stimulate language development in their young ones. Copy the black and white handouts or print color versions from the CD.

Early Intervention Kit – Teaching Guide, Activities Book, Sign Language Cards While this is not a DHH-specific resource, this kit has the essential information and tools for successful early intervention services. Effectively address assessment, intervention, and documentation. The Activities Book is a gold mine of intervention objectives, goals, and specific suggested activities, for Pre-Linguistic Skills, Expressive Language Skills, Receptive Language Skills and Sound Production Development. 

Listen Little Star is for families of infants newly diagnosed with hearing loss. It is excellent for families to obtain and use independently as a supplement to their early services. It is even more effective when used as a family-friendly guide to early intervention whether used by a provider with limited background in DHH or a veteran early intervention DHH teacher. This colorful 160+ page guide is divided into 12 lessons and also includes an extensive Baby Response Checklist data gathering tool and other resource materials at the end.

A DVD with professionally recorded video lessons provides a description and video showing the lesson being done by a parent and child. It is an excellent way to teach the skill in the printed or digital guide.

Achieving Effective Hearing Aid Use in Early Childhood

The purpose of this guide is to further the understanding of children’s development, how developmental stages will affect hearing aid wear, and what families and early intervention teachers can do to achieve full-time hearing aid wear. By using the information in this guide, hearing aid retention accessories and specific age-appropriate strategies, it is hoped that families will be better prepared to manage their child’s hearing aid wear. The guide is 88 pages long and is available in digital or paper versions. Information written in this guide is directed toward parents, which makes it ideal to use as an intervention guide while providing services to families of infants, toddlers and transitioning preschoolers.

The Developing Child with Unilateral Hearing Loss

20%-30% of all infants diagnosed with hearing loss have unilateral hearing loss (UHL). The result is hundreds of

families of babies with unilateral hearing loss who are seeking assistance to understand what the hearing loss may mean to their child’s future and to receive direction on how they can best influence their child’s success.

The publication is a step-by-step guide to early intervention for children with UHL. It is available in digital and paper versions. The early intervention material is based on a 100-slide PowerPoint Presentation that explains what should be discussed at each of the first 5+ early intervention sessions along with family-friendly information to address each key point. Handouts have been drawn from the slide groups to serve as a summary of key concepts.

Social-Emotional Evaluation/Assessment Measure (SEAM)

The SEAM is an in-depth, easy-to-use tool, to reliably assess and monitor social-emotional development in

infants, toddlers, and preschoolers at risk for delays or challenges. The two-part SEAM™ assessment reveals

detailed qualitative information on children’s social-emotional competence – and identifies their caregivers’ strengths and areas of need. Easy to learn and implement, SEAM can be used by a wide variety of early childhood professionals, including those with little or no training in mental-health or behavioral interventions.

APPS!

There are literally thousands of apps available, with varying quality and effectiveness. Without any recommendations, the following are some resources regarding apps for babies/young children with hearing loss:

References

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Question from the field: We keep going around and around in the IEP process, not agreeing. What are our options?

We have had 4 amendment meetings since our daughter’s last IEP meeting. We are not in agreement, and at every meeting we seem to be going in circles. We have heard about due process, but don’t want the district to be mad at us. What happens in due process?

While the idea of due process or taking legal action can be scary for many families, and is not what anyone, either the family or the district wants, it can often have very positive results for the child, the family, and the district. If the team is continuing to have IEP meetings and getting no further in the process, then taking the conversation to the administration outside of the IEP meeting can lead to open, honest, and productive discussions.

Having multiple IEP amendment meetings to discuss the same requests, concerns, or disagreements can create frustration and ill will all around. When families feel that they are not being heard or that their child’s needs are not being addressed, it can lead to resentment and mistrust of the educators. When DHH Specialists and other district members of the IEP team, who are not administrators or decision makers, are put in the difficult position of defending an offer it can also lead to damaged relationships with the family. Once a family takes their requests to the next level of decision makers and opens the door to additional discussion, it provides an opportunity for some very productive conversations to take place.

While this is in no way a comprehensive guide, following are the basic stepping stones in due process. Prior to filing a request for due process, the district administrator may reach out to the family for an alternative dispute resolution (ADR) meeting. Parents may also choose to reach out to the district in an effort to explore if there is a willingness to meet outside of the IEP. All parties should be sure to not approach this meeting as an IEP meeting. It is not. This is an opportunity to think outside of the box in an effort to find a solution and to recognize that the family and district have many years to work together. I would advise parents to remember this and really advocate for alternative ideas, and to not have this meeting turn into another frustrating IEP-like meeting.

While different states may have some additions or differences in the timelines, what follows is a basic timeline of what to expect per IDEA requirements once a family files a request for due process:

1. Following receipt of the request for due process, the school district has 15 days to offer the family an Informal Dispute Resolution (IDR) meeting.¹ The IDR can be waived only if both the family and the district agree to waive the meeting. I would recommend attending IDR. It is a wonderful opportunity to explore misunderstandings, clarify what is being requested, and work with the decision makers to resolve the disagreements that have arisen from the IEP meetings. This is a meeting that typically will not include attorneys for either the family or the district. Because this is the first opportunity to speak candidly as well as confidentially, it can be quite beneficial for families of children with hearing loss. If this meeting begins to feel like another IEP meeting, it can be ended at any time.

2. The State Department of Education will set dates for both the mediation, which is completely voluntary and confidential,² and the hearing. A judge or mediator and representatives for the family and district voluntarily attend. For the mediation meeting the job of the judge is to facilitate a compromise. Surprisingly, while the unknown aspects of this process are understandably stressful for families, mediation can be the experience that repairs the relationship. This is not a promise, but a true possibility. As such, it is a wonderful opportunity for families of children who have hearing loss. There are so many unique and different needs regarding students with all degrees of hearing loss and all modes of communication that administrators do not always understand the nuances. Because hearing loss is a low incidence disability, many of these administrators have relied on regionalized programs or Non-Public schools to educate their students. These administrators may honestly be unaware, until the mediation, what the student needs are or that parents have options regarding mode of communication and language development. Administrators may not realize that students with hearing loss have the right to “opportunities for direct communications with peers and professional personnel in the child’s language and communication mode, academic level, and full range of needs including opportunities for direct instruction in the child’s language and communication mode.”³ In my experience supporting families and districts, as long as both parties are willing to participate in mediation, the strained relationships can begin to heal during mediation. In 2018 approximately 83% of cases were resolved in mediation in Minnesota⁴ and 97% of cases were resolved at, or just following mediation, in California.⁵

3. Should the case go to hearing, following a due process decision the family and district have 90 days to file an appeal.

The special education system can be overwhelming for families as it has a language all its own. Families do not need to enter any of these steps alone. Consulting with either a special education attorney or an advocate to prepare and navigate the process can be beneficial. Someone who not only understands special education law, but also understands the unique needs of children with hearing loss has the potential to facilitate getting appropriate placement and services, help to the repair of the relationship, and provide additional education for the district administrators. Just as the path of due process may feel intuitively adversarial, it may also feel adversarial to think about bringing an attorney or advocate. However, again, this can actually take the stress off of the family and provide the path to ending the cycle of IEP meetings and amendments that seem to be going nowhere.

1. 1. IDEA [20 USC 1415 (f)(1)(B); 34 CFR 300.510]; Preparing for Special Education Mediation and Resolution Sessions: A Guide for Families and Advocates
2. 2. IDEA [20 U.S.C. 1415(e); 34 CFR 300.506]; Preparing for Special Education Mediation and Resolution Sessions: A Guide for Families and Advocates
3. 3. IDEA section 300.324(2)(iv)
4. 4. ldonline.org/article/6302/
5. 5. amsterlawfirm.com/blog/what-happens-after-you-file-for-due-process

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A recent US court case¹ made it clear that students with hearing loss must receive an eligibility assessment that identifies areas of suspected need secondary to hearing loss must be evaluated with sufficient intensity to satisfy in depth evaluation. The special factors considerations² also needs to be applied throughout the evaluation process. Furthermore, the LEAD-K³ movement has spotlighted the need for appropriate, tailored assessment of children who are deaf or hard of hearing.  The big question from the field of education for children with hearing loss is ‘What assessments should we be using?’

The IDEA law is consistent about looking at educational performance needs when considering a student’s eligibility for specialized instruction and support.  Educational performance is not equivalent to academic performance. While academic performance needs to be considered, it is no more important to consider than the other areas specified by IDEA which are functional, behavioral, social needs and any other performance considerations relevant to the specific child. If a school team only considers grades for eligibility then they are using a sole criterion, which goes against the IDEA requirement that eligibility determinations be made with consideration of at-risk areas as determined by the suspected area of disability.

Our students with hearing loss may ‘look fine’ in the classroom, yet we realize that there are usually subtle differences/needs that, added together, cause academic performance to erode over time. Even ‘good’ students with hearing loss can qualify IF there is someone on the multidisciplinary team who truly understands the impact of hearing loss on development AND uses appropriate assessments to use to tailor the evaluation process to the risk areas of students with hearing loss. Teachers of the deaf/hard of hearing and educational audiologists should have/receive the training needed to feel comfortable in assessment.

The defined purpose of IDEA⁴: To ensure that all children with disabilities have available to them a free and appropriate education that emphasizes special education and related services designed to meet their unique needs and prepare them for further education, employment and independent living. Performance of the expanded core skills needed for full participation (self-advocacy, communication repair, knowledge about hearing loss, amplification independence, etc.) are necessary for a student to be fully prepared to function as an adult. These are NOT standard areas of evaluation for other students with special needs, but they must be considered as part of a tailored assessment for students who are deaf or hard of hearing.

LIST OF RECOMMENDED ASSESSMENTS: The list includes recommendations for both functional and formal assessments for ages 3-5 years and school-age students. In evaluations, it is appropriate to look closely at social/emotional, self-advocacy, and the possibly subtle phonological/morphological awareness and ‘swiss cheese’ language skills that impact comprehension and reading fluency.

Low average language results reflect the impact of hearing loss, not capability. So often for our students, qualification for specialized instructional services hinges on the results of language assessment. A study⁵ found that 40% of students with hearing loss have a capacity for higher language levels beyond what test scores indicate. Further⁶, language learning for students with hearing loss occurs on average at 70%, or just above 2/3, of the rate of children with normal hearing. It is appropriate to anticipate that most children with hearing loss upon school entry will have some delay in expressive and/or receptive language, with greater degrees of hearing loss predicting greater levels of language delay. Also, the nature of hearing loss causes incidental language to be missed whenever a child is further away from about 3-6 feet of the speaker. This typically results in ‘spotty’ or ‘Swiss cheese’ language rather than solid overarching language delays. A student may therefore score higher than his or her actual functional language ability, based on the actual questions asked during the assessment and the individual’s particular vocabulary or conceptual knowledge.

One strong finding from the robust 2015 Outcomes of Children with Hearing Loss Study⁷ was that normative test scores overestimate the abilities of children who are hard of hearing as they are unlikely to reflect the level of effort that students are expending to maintain competitiveness with peers. Although 80%⁸ of children born deaf in the developed world receive cochlear implants, the success rate with cochlear implants is highly variable and cannot be assumed to ever ‘fix’ all language development issues, even for children with the best outcomes. We must consistently communicate with our school teams that students with hearing loss are not language disordered. Language, social, and reading delays occur secondary to lifelong decreased access to communication.

EVERY student with hearing loss who is going through initial assessment needs to have IQ testing in order to accurately and appropriately estimate if/how much the hearing loss has impacted development based on the student’s ability compared to peers who do not have hearing loss.⁹ Students with hearing loss (DHH-only) experience delays secondary to access issues. It is important to know the cognitive ability of each student with hearing loss as their communication access needs must be accommodated so that they reach the same level of achievement as their cognitive peers.

Although testing is performed in a few weeks’ time, evaluation isn’t just about a snap shot, it is about performance over time. Case in point, we received a call from a parent of a 5^th grader who is hard of hearing. The child had an IEP in kindergarten and grade 1 and was then dismissed. By the end of grade 4 the reading scores had decreased. The school team wasn’t concerned because the student ‘wasn’t very bad yet.’  Time should be taken to consider the percentile scores on reading across time to see if there has been a decline.  When looking at eligibility, dig into prior testing and see if you can make the case with declining percentile ranking in test results over time. For example, in grade 2 did the child score at the 48^th percentile in reading as compared to the 26^th percentile in grade 4? A public agency must provide a child with a disability special education and related services to enable him or her to progress in the general curriculum. The fact that there is a decline indicates that there are special needs that have not been addressed for the student. Access needs and/or deficits in specific skills foundational to reading comprehension would then need to be identified.

Sometimes administrators make the point that schools must provide educational benefit for students but do not have to guarantee that the student reaches his or her potential. Per the March 2017 decision of the US Supreme Court, schools may not settle for minimal educational progress by disabled students. Educational programs must be reasonably calculated to enable a child to make progress appropriate in light of the child’s circumstances. In the case of students with hearing loss, the expectation would be to provide full access to school communication and specialized instruction to fill in learning gaps PLUS support typical/expected levels of progress in the classroom. Therefore, evaluation must be tailored to identify the access, learning, and functional performance needs of every student with hearing loss so that they can progress equal to their cognitive peers.

References

1. Ninth Circuit Court of Appeals, June 1, 2018, S.P. v. East Whittier City School District: https://successforkidswithhearingloss. com/wp-content/uploads/2019/01/Court-case-RE-need-for-thorough-assessment-highlighted.pdf
2. IDEA section 300.324(2)(iv): Consider the communication needs of the child, and in the case of a child who is deaf or hard of hearing, consider the child’s language and communication needs, opportunities for direct communications with peers and professional personnel in the child’s language and communication mode, academic level, and full range of needs, including opportunities for direct instruction in the child’s language and communication mode.
3. LEAD-K: Language Equality and Acquisition for Deaf Kids. https://successforkidswithhearingloss.com/wp-content/uploads/2019/01/Court-case-RE-need-for-thorough-assessment-highlighted.pdf
4. The 2004 IDEA Commentary provides an overall ‘setting the stage’ for the IDEA law; on this webpage.
5. Language underperformance in young children who are deaf or hard-of-hearing: are the expectations too low? Journal of Developmental & Behavioral Pediatrics. September 19, 2017. Results² focused on children with hearing loss who have language levels within the average range on standardized measures. Researchers identified a mismatch between the cognitive level children test at and the expectations for their language skills. In examining the abilities of their 152 young child subjects they found that at least 40 percent have a capacity for higher language levels – beyond what their language test scores indicate.
6. The Effect of IQ on spoken language and speech perception development in children with impaired hearing. Cochlear Implants International, (11)1, June, 370-74. A 2010 study³ found that children were learning language at approximately 2/3 of the rate (or 70% of the rate) of their normally hearing peers. Subjects were 62 children ages 5-12 years who used oral communication and attended oral early intervention or school settings. Children in preschool learned language at a faster rate than children attending primary school. On average, children attending preschool were learning at 0.78 of the rate for normal hearing children as compared to a rate of 0.67 for students in primary school. Speech perception scores did not plateau until children had, on average, the language ability of a typically hearing 7-year-old.
7. Epilogue: Conclusions and Implications for Research and Practice. Ear and Hearing, 36, 92S-98S. Sole reliance on norm-referenced scores may overestimate the outcomes ofCHH. When the children who are hard of hearing (CHH) were compared with the norm-referenced group on various measures, the differences were small. However, when compared the CHH to a sample of CNH who were matched on age and SES, the size of the effect of HL on language doubled to two thirds of a standard deviation. These results question the sole reliance on comparison to norm-referenced test scores for judging eligibility. Standardized test scores may overestimate CHH as they are unlikely to reflect the level of effort that students are expending (cognitive and perceptual resources) to maintain competitiveness with peers in secondary schooling, where the cognitive demands increase. We need to closely monitor the outcomes of CHH including comparing their performance relative to neighborhood grade-mates. Many CHH in the OCHL study represent the best-case scenario. We might expect that a sample with greater diversity on these dimensions would not perform as well as the OCHL cohort
8. Language acquisition for deaf children: Reducing the harms of zero tolerance to the use of alternative approaches. Harm Reduction Journal, 2012, 9-16. Today, 80% of children born deaf in the developed world are implanted with cochlear devices. Due to brain plasticity changes during early childhood, children who have not acquired a first language in the early years might never be completely fluent in any language. If they miss this critical period for exposure to a natural language, their subsequent development of the cognitive activities that rely on a solid first language might be underdeveloped, such as literacy, memory organization, and number manipulation.9. Addressing the Need for Appropriate Use of Norm-Referenced Test Instruments. Supporting Success, December 2017.

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Question from the field: My child’s IEP team shared that he is “a good reader,” but I know that he is not understanding what he reads. He struggles with vocabulary and comprehension, but because he is getting good grades and reads the words, I am having trouble getting goals and services in the IEP. How can I help him?

Reading and literacy development are critical for all children. As parents and educators of children with hearing loss, our ultimate goal is for them to be literate, self-sufficient, independent members of society. While our first thought after diagnosis is communication, we ultimately strive for them to be able to be happy, independent, have friends, self-advocate, graduate from high school, and pursue any advanced education and/or career direction they desire. Ideally, hearing loss will not create any unnecessary barriers to this future success. No matter which mode of communication the child uses, achieving higher levels of literacy will be an important key to removing barriers.

IEP services are based on goals; goals are based on needs; and needs are identified by assessments and concrete data. Grades do not equal access. Grades are often a reflection of the hours of intensive support from families and tutors supporting our children’s comprehension of what they are reading. Our students will very often struggle with following written and verbal directions on assignments and tests, understanding test questions that are not simple and direct, math word problems, and vocabulary in subjects such as science, social studies, electives, and physical education. It often helps to remind the IEP team that every subject in school becomes language arts instruction for the student with hearing loss.

Some IEP teams may only look at one aspect of reading or select a pre-written goal from an IEP goal bank that may or may not be appropriate for the individual child with hearing loss. It is helpful for the IEP team, including the family, to consider addressing the following specific aspects of reading separately by developing individual measurable and achievable goals:

1. Decoding
2. Fluency
3. Vocabulary
4. Reading comprehension
5. Higher order thinking skills (HOTS)¹

For students who have access to linguistic information through listening, the team should also consider listening comprehension needs. Often students will demonstrate comprehension of what they have heard at a higher grade level while they continue to work on improving grade level reading comprehension skills.²

It is also important to look at the accommodations page of the IEP and document anything the team agrees will support the student. Following are some examples of possible accommodations that may be added to the IEP:

1. Directions interpreted, read out loud, simplified, or clarified
2. Questions and answer choices interpreted or read out loud
3. Pre- and Post-teaching of key concepts and vocabulary
4. Development of a student generated vocabulary book
5. Opportunity to use pictures to define vocabulary words
6. Text to speech captioning or audio books

For all children, regardless of level of hearing loss, research has shown that “early cognitive and linguistic development predict later achievement.”³  The results of Betty Hart and Todd Risley’s 1995 study³ can be extremely effective in helping the IEP team members understand the importance of on-going and intensive attention to addressing all aspects of literacy. Hart and Risley studied children from 7 months to the age of 3 in order to determine how many words they were exposed to prior to entering school. This was not a special education study. Participants were divided by socio-economic status, and what was found was a 30 million word gap between the lowest socio-economic group and the highest socioeconomic group. Specifically, the higher socio-economic group were exposed to 45 million words, the middle socio-economic group heard 26 million words, and the children in the low socio-economic group heard 13 million words. These numbers resonate with educators who are not experts in teaching children who are deaf and hard of hearing. Additionally, these researchers followed up with approximately half of the families when their children were in 3rd grade. The results indicated that “measures of accomplishment at age three were highly indicative of performance at the ages of nine and ten on various vocabulary, language development, and reading comprehension measures.”⁴

For the IEP teams to understand the unique needs of our children with hearing loss, as well as the potential, we must continue to educate the educators. Teams should continuously gather actual data separate and apart from the grade reports. Parents and teachers of the deaf/hard of hearing can help to support the other IEP team members regarding the importance of closing this language gap for students with hearing loss. No matter which mode of communication the family has chosen, it is imperative that teams continue to address all levels of the foundations for reading, work to close the gaps, and provide meaningful access to language.

Sample Goals:

References

1. 1. www.readingrockets.org/article/higher-order-thinking
2. 2. https://www.theliteracybug.com/stages-of-literacy
3. 3. NELP Report: Developing Early Literacy (2009). Summary from Reading Rockets.
4. 4. The Early Catastrophe: The 30 Million Word Gap by Age 3″ by. University of Kansas researchers Betty Hart and Todd R. Risley (2003). Summary

What does it mean to teach kids how to read text effectively?¹ Initially, it means making certain that they can decode so proficiently that they can decode the words without much conscious attention. Texts are going to place increasing demands on students’ linguistic abilities, memories, conceptual analysis, logic, and knowledge of the world. Those demands — not question types — are the potential barriers to kids’ comprehension. The teaching of reading comprehension and learning from text should focus on how to help students surmount these cognitive, linguistic, and intellectual barriers. Students who can make sense of a text’s ideas will be able to answer any kind of questions about that text. While students who fail to scale those linguistic and conceptual barriers will struggle with the simplest of questions. All of this is especially true for students with hearing loss, who are at high risk for being a couple of years delayed in reading comprehension compared to their hearing peers.²

Research consistently has shown that phonological skills, specifically phonemic awareness, are strong predictors of later reading proficiency. Improving students’ phonemic awareness skills alone is not sufficient. It is also critical to explicitly teach students how to apply the phonological skills they learn and connect letters to sound.³ Students who are deaf or hard of hearing do not need to use (only) spoken language to understand and use phonological awareness, Supplementing this understanding through visual, tactile, and kinesthetic cues is often needed.⁴

Essential components of reading instruction⁵ for students with hearing loss means explicit and systematic instruction in –

 A 2015² study that compared children with hearing loss to typically hearing students found:

The teaching of reading comprehension and learning from text should focus on how to help students surmount these cognitive, linguistic, and intellectual barriers. Major attention needs to be spent on reading and making sense of texts rather than upon answering particular types of questions about texts.¹ Learning strategies that happen before and during reading can help students overcome challenges that they face when gaining access to and attempting to understand text, resulting in improved comprehension.²

Comprehension instruction should be aimed at teaching students:¹

Teaching morphology to students who are deaf or hard of hearing is often necessary.^6,7 Facilitating the learning of morphologically complex words is particularly important because these words comprise 60-80% of the new words that school-age children must acquire to successfully read grade-level text.³

Similarly, problems with understanding syntax may result in difficulties with reading comprehension.^3,8 These challenges become more pronounced when reading academic texts that comprise complex grammatical structures.⁸

Underdeveloped vocabulary becomes insufficient to support effective reading comprehension and writing, and in turn, has a negative impact on overall academic performance.³ Vocabulary is the key to content literacy for students with hearing loss.⁹ A variety of educational strategies are recommended to improve vocabulary and reading comprehension. ^{3, 10}  

For more information, see Maximizing Effectiveness of Reading Comprehension Instruction in Diverse Classroom.

References

1. 1. Shanahan, T. (2017). If you really want higher test scores: Rethink reading comprehension instruction. Website link to blog.
2. 2. Kyle, F.E., & Cain, K. (2015). A comparison of deaf and hearing children’s reading comprehension profiles. Topics in Language Disorders, 35(2), 144-156. Link to PDF
3. 3. Berkeley, S. & Barber, A.T. (2014). Maximizing Effectiveness of Reading Comprehension Instruction in Diverse Classroom. Paul H. Brookes Publishing, Baltimore, MD. Link to book source
4. 4. Narr, R.A.F. (2006). Teaching phonological awareness with deaf and hard-of-hearing students. Teaching Exceptional Children, Mar/Apr, 53-58. Link to PDF
5. 5. Antunez, B. (2002). English language learners and the five essential components of reading instruction. Website link to blog.
6. 6. Koppenhaver, D.A. & Wollak, B.A. (2014). Morphemic decoding instruction for students who are deaf or hard of hearing. American Reading Forum Yearbook, 34, 1-14.
7. 7. Bow, C.P., Blamey, P.J., Paatsch, L.E., & Sarant, J.Z. (2004). The effects of phonological and morphological training on speech perception scores and grammatical judgments in deaf and hard-of-hearing children. Journal of Deaf Studies and Deaf Education, 9,(3), 305-314. Link to abstract
8. 8. Cannon, J.E. & Kirby, S. (2013). Grammar structures and d3eaf and hard of hearing students: A review of past performance and a report of new findings. American Annals of the Deaf, 158(3), 292-310. Link to abstract
9. 9. Dunaway, A. (2017). Content literacy in students with hearing loss: Vocabulary is key. Link to blog
10. 10. New Mexico School for the Deaf. Educational Strategies that Work with Deaf and Hard of Hearing Students. Link to PDF of PowerPoint presentation

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Question from the field: “I have several students with hearing loss who are high functioning, fully mainstreamed, and get good grades. My administrators feel like the students can be dismissed from the IEP process, but I know there are still areas of need for me to work on. How can I support these students?”

As we know, in Special Education, grades do not reflect equal educational access¹. It is fairer to say that grades reflect a student’s background knowledge, and degree of student effort to try to figure out the information they regularly miss due to lapses in auditory access and incidental learning. Students with hearing loss are typically working much harder than their hearing peers in class due to many factors such as fragmented speech perception, ambient noise and distance from the speaker, which can affect access to what is being said by teachers, peers, and other speakers. No matter how successful the student with hearing loss is as measured by grades, the sheer volume of the amount of information coming at them all day causes auditory fatigue, anxiety, and at times even social isolation².

In addition to communication access factors that can get in the way, students  with hearing loss who have good grades often continue to have discrepancies in vocabulary, both foundational and academic, immature social communication skills, degraded auditory skills in the presence of noise, difficulties with pragmatic language, a lack of understanding of their own hearing loss and their accommodations, and a need for additional self-advocacy skills to be addressed and supported.

Below is a small sampling of students with whom I have worked who are very high functioning, and still have deficits that support the need for an IEP:

5th grade student: This boy uses both a hearing aid and a cochlear implant. He has been in the mainstream since early elementary school. His IEP team did see the need for goals and services, but the “aha moment” came during a Listening and Spoken Language session when it was discovered that, due to lack of incidental hearing, he had never learned all of the vocabulary that goes along with bedding and linens. With this clear example of how much incidental learning he was missing his team added CART to his IEP.

High school sophomore: This student has always been placed in the mainstream setting and is extremely bright. While she had been a candidate for a CI for many years, it wasn’t until her sophismore year that she decided to get the implant. With her hearing aids she could not hear the questions or comments from her peers or whole-class discussion. She told me that during unstructured times in class and on campus when her friends would talk to her she would just nod her head and hope it was the right answer. She was in honors classes, on a sports team, and earning good grades, but she was not accessing linguistic information in school.

High School senior: This girl wears bilateral hearing aids and has always been placed in the mainstream setting. She has always gotten good grades as well as being an accomplished athlete. Her testing showed that she did not have any academic needs, but the DHH providers were able to share data with the administration showing that she still had deficits in communication, auditory skills, and self-advocacy that needed to be addressed in IEP goals prior to graduation.

There are endless examples of high functioning students with hearing loss from every educational level who, despite their “good” academic grades and their ability to have conversations one-on-one in quiet, continue to struggle in the educational setting. Grades do not equal access to education.

To be considered eligible for specialized instruction in public school, the student (1) must have a qualifying condition (i.e., hearing loss), and (2) must need specialized instruction in order to get the benefit of his/her education. Another term for this is that the student must exhibit an adverse educational effect from the disability area, which is subject to local definition and interpretation. Nowhere in IDEA is it written that only students with academic deficits (aka ‘bad grades’) can be eligible for special education services. Access to education and proposed goals are not limited to reading, writing, and math. Often the tests used in an evaluation do not have sufficient scope or depth to identify the more subtle or underlying gaps in skills. Assessment in the areas of listening, auditory skill development, attention, pragmatic language, communication, and social and behavioral skills should be included in addition to an in-depth language assessment³.

For children who are deaf or hard of hearing, the definition of adverse effect should also be determined by a student’s progress as well as their performance at the time of evaluation. If a child has not met the expectation for one year of growth in one year’s time, he should receive special education and related services. Ultimately, the school district is accountable for students it finds ineligible for special education. If those students do not make adequate annual progress – one year’s growth in one year’s time – the parents can take legal action to prove the school’s liability⁴.

Teachers of the deaf/hard of hearing can obtain data in the following areas of need in preparation for an IEP in order to identify baselines and new goals:

1. 1. Listening to a degraded signal (noise, distance, audio recordings, videos)
   1. 1. Following class discussion
   2. 2. Following and participating in a conversation with a partner or small group with other small groups also conversing
   3. 3. Understanding verbal directions without visual support in the presence of noise (i.e., playground, PE, assemblies)
   4. 4. Auditory comprehension when listening to a recording or computer voice
2. 2. Social Communication
   1. 1. Independently initiating conversations with peers during unstructured times
   2. 2. Joining an existing conversation and maintaining topic not of their choosing
   3. 3. Explaining their hearing loss and/or accommodations to familiar/unfamiliar adults and/or peers
   4. 4. Communication repair when they are not understood
   5. 5. Asking for clarification when they do not understand their communication partner
3. 3. Self-Advocacy
   1. 1. Care and maintenance of hearing assistance technology (i.e., hearing devices)
   2. 2. Consistent use of hearing assistance technology
   3. 3. Using appropriate language to report when hearing technology is not working, needs to be turned on, or needs to be muted
   4. 4. Understanding and asking for accommodations as appropriate for grade level (this can grow over time)
   5. 5. Independently asking for clarification of directions/assignments/discussions in an age appropriate manner

Students with all levels of hearing loss can suffer from what is referred to as Swiss cheese hearing. They do hear, so they don’t always know what they did not hear. When the general education teacher or the student self-reports that they “heard everything” the teacher of the deaf/hard of hearing can support the team in ways to determine what may have been missed. They can advocate for self-advocacy goals, and other IEP goals as appropriate. A very helpful resource for on-going training of general education teachers and non-DHH providers and IEP team members is “I know he can hear me.” The surprising impact of hearing loss on comprehension⁵ and The Cascading Impact of Hearing Loss⁶.

References

1. Howey, Patrica (2016). Good Grades: Does My Child Still Need Special Instruction? https://www.wrightslaw.com/nltr/16/nl.0607.htm
2. Tiredness in Deaf Children http://www.ndcs.org.uk/family_support/education_for_deaf_children/education_during_school_years/tiredness.html
3. Johnson, C., DesGeroges, J., Seaver, L. (2013). Educational Advocacy for Students who are Deaf or Hard of Hearing: The Hands & Voices Guidebook. Chapter 3: A Question of Eligibility.
4. Forest Grove School District v. T.A. www.wrightslaw.com/law/caselaw/ussupct.forest.grove.ta.pdf
5. Anderson, K. L. (2014). Supporting Success for Children with Hearing Loss https://successforkidswithhearingloss.com/wp-content/uploads/2019/01/I-know-he-can-hear-me-handout-for-teachers.pdf
6. Anderson, K. L. (2017). The Cascading Impact of Hearing Loss: https://successforkidswithhearingloss.com/wp-content/uploads/2014/06/The-Cascading-Impact-of-Hearing-Loss2.pdf

Author: Melinda Gillinger, M. A.

Special Education Consultant

www.melindagillinger.com

Individuals with hearing loss often have difficulty detecting and/or interpreting sarcasm. These difficulties can be as severe as they are for persons with autism spectrum disorder and challenges often continue into adulthood ^1,2. Even children with good language and social skill development are at risk for comprehension of sarcasm, or verbal irony.

Even when children with hearing loss have mastered language and social skills milestones during the preschool years, there is no guarantee that they will develop an age-appropriate understanding of verbal irony later in life.

The ability to understand the different types of sarcasm gains importance when we recognize how useful verbal irony is in our social lives. When all academic and work settings are considered, about 8% of conversational turns among adolescents and adults ironic ^3,4. Being able to successfully use irony is associated with social competence, popularity, and peer leadership skills^5,6. Irony is used to express a wide range of pragmatic functions, including:

• Ironic criticisms (intended to rebuke; e.g., ‘You look fantastic’ said to someone who looks disheveled)
• Why is verbal irony so difficult for children with hearing loss?Ironic compliments (intended to praise; e.g., ‘You look horrible’ said to someone who looks stunning)
• Hyperbole (saying more than is intended; e.g., ‘Yeah, he’s the most talented person on the planet’ to communicate that someone’s talent is modest)
• Understatement (saying less than is intended; e.g., ‘You can tell he’s upset’ said about someone displaying rage to communicate that the discontent is obvious)
• Rhetorical questions (e.g., ‘How many times do I have to tell you to stop?’)
• Offerings (e.g., ‘Have another slice of cake’ to someone who has already eaten most of it)
• Over-polite requests (e.g., ‘Would you mind very much if I asked you to consider cleaning your room sometime this year?’ to a slovenly housemate)

There are a few reasons why verbal irony understanding is challenging for persons who are deaf or hard of hearing. The one we usually hear about involves difficulty picking up the auditory cues that signal irony:

“He can’t understand the tone in a voice. He never has been able to understand sarcasm. He doesn’t hear that change in the tone of voice, and he doesn’t know what it means.” ~Father of a 21-year-old with hearing loss⁷

When considering the importance of auditory cues, there are two crucial points to consider:

1. Speakers sometimes use an ‘ironic tone of voice’ (slow speaking rate, heavy stress, lower pitch) as a cue to irony. Visual cues can also signal irony (e.g., facial expression, body language).
2. Irony can be delivered in a completely deadpan style (no vocal or facial/body cues)

So, auditory cues are neither necessary nor sufficient to produce or detect irony. If the problem is not necessarily perceptual, it is likely conceptual and this is the preferred explanation among contemporary researchers studying hearing loss and its relationship to ‘Theory of Mind’. 

So how do Theory of Mind concepts undergird our understanding of verbal irony? Although the precise age of mastery depends on the kind of irony and the nature of the cues available, verbal irony comprehension is a late-emerging social competency in hearing children (around 10 years of age). This is, in part, because it relies on advanced Theory of Mind concepts. These include the ability to think about thinking (a.k.a. metacognition) which is a sophisticated intellectual achievement. Said another way, to understand verbal irony, “I need to understand what you understand, and I need to make inferences about what you intend for me to think or know.”

We see this clearly in what is called the ‘intentionality’ aspect of irony comprehension⁸. Intentionality refers to the fact that ironic statements are intentionally insincere, and the listener needs to understand that the speaker expects the listener to know that the insincerity is intended.

Verbal irony is a late-emerging, advanced social competency because children need years of experience to accrue the social knowledge needed to make accurate judgments about the meaning and intent of ironic statements. To interpret irony correctly, children also need to understand the utterance in context. All irony is context-dependent in that the meaning depends on the circumstances of which both the speaker and listener need be aware. This includes the ability to recognize and understand social norms and expectations. When it is raining at the beach and someone says, ‘What a nice day’, we understand that what they really want to communicate is ‘What horrible weather.’ They are also communicating disappointment and frustration with the situation. We know this because we are (implicitly) aware that our social norm or expectation is that people prefer to go to the beach when it is warm and sunny out.

Verbal irony can be ‘about’ a lot of different things. It requires a big general fund of knowledge, and degree of social and cultural learning matter. There is a lot of ‘stuff’ that we just know and that we expect everyone else to know too. This is the shared social and cultural knowledge that hearing children acquire over time through incidental learning and language socialization. Thus, the conceptual problem with irony is rooted in the ‘Conversation Deficit’⁹, a general paucity of social learning opportunities, and an inability to ‘catch the moment’⁶:

“You can’t carry on a normal conversation. It’s giving that instant comment; you can’t catch the moment. By the time you’ve got his attention, the situation might have passed. He doesn’t say he misses anything, but he wouldn’t know if he’s missing anything.” ~Mother of 21-year-old with hearing loss

A deficit in verbal irony is indicative of broader issues

Verbal irony seems to be especially difficult for a wide range of populations (e.g., developmental disorders, learning disability, psychiatric conditions, sensory loss). Yet, in all of these cases, the underlying problem appears to be conceptual, which often causes problems in other areas for which those concepts are relevant. Here is an example from hearing loss⁷:

“She doesn’t know the meaning of a joke; if you say something, it’s serious. She can’t see the double meaning. She’ll laugh at Laurel and Hardy, it’s visual; but as far as language goes, she doesn’t understand, you can’t play around with it.”
~Mother of a 19-year-old with hearing loss

And it isn’t only jokes. Difficulties with irony comprehension are usually accompanied by challenges in:

• More general humor detection and appreciation
• Distinguishing irony from other forms of non-literal language (e.g., lies, proverbs, metaphor, idioms)
• Understanding emotional display rules (e.g., smiling when you receive a disappointing gift; showing amusement when you feel embarrassed)
• Understanding ‘self-conscious’ emotions (e.g., embarrassment, pride, guilt; these also require sophisticated metacognition)
• Social common knowledge (again, understanding what members of a society ‘just know’ and expect everyone else to know too: e.g., there are cat people and dog people; kids would rather eat ice cream than clean their rooms. Everyone just knows this ‘stuff’!)

Professionals working with families with children with hearing loss often believe that if we teach the language, the social skills will follow. Yet, it is becoming increasing clear that this is not always the case and, in fact, good language often accompanies poor social competence.

The good news – WE CAN HELP CHILDREN IMPROVE!

When thinking about how to support social competence and pragmatic language then, it is sometimes most profitable to address Theory of Mind (the concepts behind the social skills). And here is the good news: research indicates that although persons with hearing loss often evidence severe challenges in Theory of Mind, they can also benefit greatly from appropriate Theory of Mind interventions in a short period of time^{10, 11}.

And there’s more good news. Recently, new assessment tools, educational resources, and treatment materials have become available to achieve these goals. The Theory of Mind Inventory – 2¹² is an assessment and treatment planning system specifically designed to support theory of mind in persons with social learning challenges. More specifically, Theoryofmindinventory.com offers:

• Sensitive, reliable, valid, and nationally-normed assessment of a broad range of Theory of Mind Competency areas (READ MORE)
• Electronically generated reports (EXAMPLE) which provide a list of likely developmentally appropriate treatment target for each client
• Access to the Theory of Mind Atlas: an educational resource that explains a broad range of Theory of Mind area (what it is, when it develops, and how it is disrupted in different clinical populations including HEARING LOSS). To register for free access to the Atlas, GO HERE.
• Downloadable Treatment Materials (see the Materials Room!) to address wide range of Theory of Mind targets

References

1. 1. Peterson, C., Wellman, H.M., & Slaughter, V. (2012). The mind behind the message: advancing theory of mind scales for typically developing children and those with deafness, autism, or Asperger syndrome. Child Development, 83, 469–485
2. 2. O’Reilly, K., Peterson, C., & Wellman, H. (2014). Sarcasm and advanced theory of mind understanding in children and adults with prelingual deafness. Developmental Psychology, 50(7), 1862-1877.
3. 3. Gibbs, R. (2000). Irony in talk among friends. Metaphor & Symbol, 15, 5-27.
4. 4. Hancock, J. (2004). Verbal irony use in computer-mediated and face-to-face conversations. Journal of Language and Social Psychology, 23, 447-463.
5. 5. Peterson, C., O’Reilly, K., & Wellman, H. (2016). Deaf and hearing children’s development of theory of mind, peer popularity, and leadership during middle childhood. Journal of Experimental Child Psychology, 149, 146-158.
6. 6. Peterson, C., Slaughter, V., Moore, C., & Wellman, H. (2016). Peer social skills and theory of mind in children with autism, deafness, or typical development. Developmental Psychology, 52(1), 46-57.
7. 7. Gregory, S., Bishop, J., & Sheldon, L. (1995). Deaf young people and their families. Cambridge: Cambridge University Press.
8. 8. Banasik, N. (2013). Non-literal speech comprehension in preschool children: An example from a study on verbal irony. Psychology of Language and Communication, 17(3), 309-323).
9. 9. Peterson, C., & Seigal, M. (1995). Deafness, conversation, and theory of mind. Journal of Child Psychology & Psychiatry, 36(3), 459-474.
10. 10. Richels, C., Bobzien, J., Raver, S., Schwartz, K., Hester, P., & Reed, L. (2014). Teaching emotion words using social stories and created experiences in a group instruction with preschoolers who are deaf of hard of hearing: An exploratory study. Deafness & Education International, 16(1), 37-58.
11. 11. Wellman, H., & Peterson, C. (2013). Deafness, thought bubbles and theory-of-mind development. Developmental Psychology, 49(12), 2357-2367.
12. 12. Hutchins, T., Prelock, P., & Bonazinga, L. (2016). Technical Manual for the Theory of Mind Inventory-2 (ToMI-2). Available at theoryofmindinventory.com

Supporting Success wishes to thank Dr. Tiffany Hutchins for sharing her expertise in this article.

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Author: Melinda Gillinger, Advocacy Consultant

2 questions from the field – same answer:

“My child was just diagnosed with hearing loss. How and where do I even start the process of getting services with our school district?”

“ Our child was attending a private school when we found out about his hearing loss. We have never worked with the public school system. How do we start, and are we too late?”

The entire process/journey of navigating the Special Education system can be overwhelming to both families as well as many professionals. Teachers and therapists often know their role and their unique piece of the IFSP and IEP puzzle, but they do not always have the full picture of what the family needs to do to get started or what they need to do in the case of a disagreement. The purpose of this article is to share, for both families and educators, the steps to getting started depending on the age of the child.

Depending on when your child has been diagnosed you will be initiating one of two plans, either the Individualized Family Service Plan (IFSP) or the Individual Education Plan (IEP). While the IEP is the responsibility of your local school district, the IFSP may be the responsibility of your school district or your state’s Early Intervention or early childhood disability services program (not all states use the term “early intervention”)¹ Either way, everything starts with a request in writing and comprehensive assessments.

The IFSP is a written treatment plan for children from birth to 3 years old that maps out the Early Intervention services a child will receive as well as how and when these services will be administered. It details a child’s current levels of functioning in all domains, specific areas of need, and goals for treatment, referred to as outcomes¹.

The IEP is a plan developed to ensure that children from 3 to 22 years old, or when they graduate from high school, who meet one of the 13 qualifying eligibilities identified under special education law (IDEA) receives appropriate placement, specialized instruction, and related services in the least restrictive environment (LRE) so that the child can receive a free and appropriate public education (FAPE).

Neither the IFSP meeting nor the IEP meeting is the end of the process in initiating services and supports for your child with hearing loss. This is just the beginning of your journey.

Step by Step Guide:

In most states when your child has been diagnosed, the clinical audiologist will send a referral to the local education agency which should trigger the school district or regionalized education office to reach out to the family and begin the process. That being said, the family can also initiate the process by submitting a written request for the assessment to determine eligibility for special education services.

Under the Individuals with Education Act (IDEA) Part C, which governs early intervention services, an IFSP is developed for children from birth to 3 who meet eligibility criteria¹. Services for children who have solely low incidence disabilities, such as hearing loss, may receive services through a path that is different from the majority of children with early delays in development.

IFSP

1. 1. Request for assessment is provided in writing or referral is made from clinical audiologist
2. 2. Assessment Plan generated for all developmental domains
3. 3. Assessments are conducted and reports are written
4. 4. Team meets to discuss assessment results and document the following components:
   1. 1. Parent Priorities and Concerns
   2. 2. Results of assessments and the child’s present levels of performance
   3. 3. Contact information for all additional providers serving the family
   4. 4. Outcomes to meet the needs for both the child and the family
   5. 5. How these outcomes will be measured and who will be responsible
   6. 6. Offer of services for the child and the family
5. 5. Parent Signature – “Parent signature” does not equal agreement*

For the IFSP, the team must take into consideration and address the family’s priorities and concerns as a means to develop the plan. These priorities and concerns drive the IFSP, so parents should plan to be as specific as possible in order to assist the team in the process. *Note, once the offer of services has been made, the family has the right to sign in agreement to implementation of the parts of the offer to which they agree and to sign in disagreement with the portions of the offer to which they disagree. There are avenues in place to support families and districts to work collaboratively in order to resolve these disagreements.

For children with developmental delays in addition to a low incidence disability such as hearing loss, the steps are all the same in the process however the EI program may be the agency responsible for managing the IFSP until they refer the child to the school district for an IEP prior to the 3rd birthday. Just because the school district is not the lead agency responsible for the IFSP does not preclude the district from serving children with hearing loss. School districts may, but are not required by IDEA to, provide early intervention services. The team is to be multidisciplinary and is to address all of the needs of the entire family.

IEP

1. 1. Written request for a full evaluation of your child
2. 2. Assessment Plan generated for all areas of suspected need within 15 days of request
3. 3. Assessment Plan signed by family within 15 days of parent signature
4. 4. Parent may put request in writing to relieve draft copies of reports and proposed goals*
5. 5. Assessments are conducted and reports are written
6. 6. Draft documents provided to the family prior to the IEP meeting
7. 7. Meet as a team to discuss assessment results and develop the IEP document within 60 days of parent signature on assessment plan
8. 8. Develop each required component of the IEP document as a team, which includes parents
9. 9. Offer of Free Appropriate Public Education (FAPE)
10. 10. Signatures

Just as in the IFSP process, the family has the right to agree or disagree in part or in whole with the IEP document and the district’s offer of FAPE. Just as with the IFSP, there are procedures in place in the IDEA that guide families and districts to resolve these differences.

Each step of the process should be documented in writing from the initial request for assessments to and including the IEP signature. It is important for each request to be in writing as this triggers the timelines. It is also important for parents to understand that their signature does not equal agreement. The parent signature is documentation of the components of the plan and the offer in the IFSP or the IEP to which the family both agrees and disagrees.

Many families will misunderstand the signature process in a couple of different ways. I have met families who disagree with the offer and therefore decline to sign the IFSP/IEP thinking that not signing is how to disagree. However, if there is no signature, then nothing can move forward – including the services with which you may agree as well as resolution to any differences. Everything comes to a standstill without signatures and documentation of parent input.

The other misunderstanding is when families or teams believe that the IFSP/IEP must be signed in full (i.e., all or nothing). This is not accurate. The family may sign in agreement to the portions of the offer with which they agree as well as documenting any areas of disagreement. This will actually move the process along much more quickly as the district then has permission to implement what was agreed to as well as to begin working with the family to resolve areas of disagreement.

Melinda Gillinger, M. A.

Special Education Consultant

www.melindagillinger.com

About 25-30% of children identified by universal newborn hearing screening have hearing loss in only one ear. This prevalence increases with age to about 1 ½ -2% of the school-age population. Students with unilateral hearing loss are at 10 times the risk for educational challenges as compared to their peers with typical hearing in both ears. Recent research has clarified the issues most likely to be experienced by these children.

Terminology

Unilateral Hearing Loss (UHL) is used to indicate ALL children who have hearing loss in one ear, and specifically for those with useable residual hearing. Single-sided deafness (SSD) is used only for students with severe-profound hearing loss in one ear. These two populations are treated differently for amplification solutions, but ALL of these students require FM/DM devices to improve classroom listening and ‘level the playing field’.

The Heart of the Resulting School Problems for Students with UHL

• 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.

Summary of Research Findings

In October 2017 Phonak held the Unilateral Hearing Loss in Children Conference. The PowerPoints and audio recordings of these presentations have generously been made available by Phonak and the speakers. Go to the following link to view the presentations about UHL in depth: https://www.phonakpro.com/us/en/training-events/events/past-events/2017/uhl-in-children-conference-philadelphia.html

Impact of UHL on Language and School Performance (Judith Lieu)

• 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.

Effort and Fatigue Issues for UHL (Ben Hornsby)

• 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.

Amplification Findings for UHL

• 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).

Elizabeth Fitzpatrick Phonak presentation:

• 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)

Erin Picou Phonak presentation:

• 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.’

Douglas Sladen Phonak presentation:

• 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.

Intervention for Students with UHL and SSD

• 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.

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Who should be the “DHH expert” on the student’s team?
Melinda Gillinger, Advocacy Consultant

Our question from the field:

“We recently had a student move into our district. She has bilateral cochlear implants and uses spoken language to communicate. Her previous district had completed a triennial IEP meeting which includes DHH Itinerant services as well as services from an Educational Audiologist. I am an SLP, and the district has asked me to work with all of the students with hearing loss. How can I help the district understand that we need a Teacher of the Deaf?

I was recently asked by professionals in 2 different states about the need for a Teacher of the Deaf (TOD) to support students in their schools. In one case the district contracts with an SLP to serve all of the students with hearing loss no matter their chosen mode of communication, and in the other state, the district did not include either a TOD or an Educational Audiologist in the student’s initial evaluations or any of his IEP meetings. There are many school district administrators who do not have a clear understanding of the role of the TOD and how it is separate and unique from the Speech/Language Pathologist (SLP) and the Educational Audiologist. Each of these experts should be included as members of the child’s IEP team.

If you’ve met one child with hearing loss, you’ve met one child with hearing loss. Children who are eligible for special education as deaf or hard of hearing do not all present with the same needs. They may have unilateral or bilateral hearing loss and use hearing aids, cochlear implants, or no hearing technology. Depending on the family’s choice, they may communicate using only ASL, only spoken language, or a combination of sign and spoken language. For this reason, there are many varying roles for Teachers of the Deaf.

The role of the Teacher of the Deaf is critical to supporting students who are deaf and hard of hearing (DHH) in the educational setting. As more and more students with hearing loss are included in the general education setting, it is important to understand the role of the DHH Itinerant teacher. These specialists should be included from the beginning to conduct assessments, identify needs, and propose appropriate goals during the IEP meetings. They provide services to students in the form of academic support which can be either push-in or pull-out depending on the IEP team’s decision. This support often includes preview and review of concepts and vocabulary that the student may not be familiar with, facilitation of communication with peers and adults, and monitoring of the educational environment. The DHH Itinerant also provides consultation with the general education teacher, SLP, administrators, and others who interact with the student on campus in order to support their understanding of the student’s unique and sometimes invisible needs. They also support staff with the use of the FM/DM technology and support students in developing their self-advocacy skills. Because the communication needs of students with hearing loss vary and are affected by their mode of communication as well as the length of time they have had auditory access to linguistic information, the itinerant DHH teacher is often involved in supporting language instruction and can collaborate with SLPs and AVTs who work with the student. For more detailed information and resources to share, professionals and parents can visit deaftec.org/itinerant.

Ensuring a TOD is available on the team. Hearing loss is a low incidence disability, and there continues to be a considerable lack of understanding across both general and special educators regarding how it affects students academically, socially, and with regard to communication in general. Some districts may not have a TOD on staff. “Almost every state in the nation has some type of regional entity that helps deliver special education services in a geographically broader area than a single school district.” (cga.ct.gov)  If a district does not have a TOD on staff, the option first would be to reach out to this regionalized program. If the regional program does not have the appropriate provider, then the district can choose to establish a contract with a TOD to be on the child’s IEP 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

While the educational prognosis for students with hearing loss has never been as promising as it is now, we continue to have students who are deaf or hard of hearing who have not been identified, or who have not received intervention, prior to school entry. We have all encountered students with two or more years of language delay at kindergarten age. The “Special Considerations” clause and other portions of the IDEA law provide requirements for how school teams should plan the least restrictive environment (LRE) to support effective educational programs for all students who are deaf or hard of hearing.

Lost intervention opportunities: Over 25% of infants who failed newborn hearing screening had no documented diagnosis of hearing ability. Although many students with hearing loss receive early identification followed by early intervention, almost 20% of those who were diagnosed with a hearing loss following newborn hearing screening did not receive early intervention.

Some children receive cochlear implants as infants or toddlers without the necessary intensive intervention to develop age-appropriate oral language. Other families choose to use sign language without the needed instruction in ASL or connections with the Deaf community to develop fluency, even to meet the vocabulary growth needs of a young child. Still other families ‘want it all’ but are not provided intensive support by skilled interventionists to be able to provide both a rich auditory and visual communication environment.

Such missed opportunities for early development can result in a scenario like the following:

“We have a student entering kindergarten who received cochlear implants at ages 2 and 3. His oral language development is 2 years delayed. Because he is so delayed, the school team is suggesting we put an interpreter with him in a regular kindergarten class. The family knows a few signs but they want him to listen and speak. How do we figure out the most appropriate program for him?”

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?)

Strategies to Obtain Information About Communication Needs

Considerations for the school team to answer what communication services are appropriate include:

1. 1. 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).

1. 1. 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.

1. 1. 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?

1. 1. 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.

1. 1. 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.

Targeted assessment data is necessary to determine appropriate placement and IEPs goals. Appropriately educating most students with hearing loss requires specialized knowledge, appropriate intensity of DHH  services, accessibility accommodations for effective classroom communication, and contact with DHH peers.

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The special education pendulum has swung away from segregated settings where students with special needs minimally mixed with ‘regular’ students in the 1980s to the current full inclusion model, where direct 1:1 instructional services are becoming rare. Students with hearing loss are already at high risk for ‘academic slippage’ due to their inability to completely access classroom communication without appropriate accommodations and supports. The move from pull-out services to provide intensive teaching in reading, language, and self-advocacy, places our students at even higher risk for developing increasing academic delays over time.

In light of this, I found a court case from 2002 that gave me pause, and hope. In Kevin T. V. Elmhurst Comm. School District No. 205 Kevin, who had a learning disability and ADHD, had received twelve years of special education (age 6-18). Kevin had average intellectual potential but his reading, math and writing skills were at the 3rd to 5th grade levels despite receiving special education services. Triennial assessments over 9 years showed that his IQ dropped nearly 20 points. Scores on academic achievement tests also decreased significantly over a 6-year period. The school was aware of his poor reading scores but did not make IEP changes to address his reading difficulties. It was stated multiple times that he should have been assessed for, and given, assistive technology (AT), but the district did not consider, let alone provide Kevin, with AT. Modifications or accommodations during state testing procedures were not included on his IEP. Although Kevin’s skills were deficient, at the end of his 12^th grade year while receiving all Fs, he graduated with a high school diploma. Per this court decision, “Automatic grade promotion does not necessarily mean that the disabled child received a FAPE or is required to be graduated.”

At the urging of the parents, the district transferred Kevin to a specialized day school where he received intensive instruction. In one year, Kevin made about 3 years of progress in reading, math, and writing. His parents then decided to bring the case to court. The court ruled that Kevin receive compensatory education. The school district was required to reimburse the parents for tuition paid to the specialized school and for his continued education at the school.

Where is the silver lining in this case?

First, schools can and should be held accountable when students with disabilities are not making sufficient progress. Indeed, the March 22, 2017 US Supreme Court decision rejected the standard of minimal progress. For children fully integrated in the regular classroom, the IEP should be reasonably calculated to enable a child to make progress appropriate in light of the child’s circumstances.

Second, a free and appropriate public education (FAPE) for students with disabilities includes specially designed instruction to meet the unique needs of the child. Present levels of performance and continuous performance monitoring are critical elements for determining student needs, and also identifying if the specially designed instruction is truly meeting the needs of the child. Children who display hearing loss as their only disability do not have a learning disorder. Issues in education are related directly to the access barriers caused by the hearing loss. These barriers must be accommodated per ADA and an IEP be suitably designed to close the existing gaps in learning and support the student’s ability to keep pace in the classroom.

Third, intensive instruction by persons who truly understand the unique learning needs of the specific disability is likely to result in substantial progress to close achievement gaps. If our students are 1+ years delayed in their achievement, it is unlikely that they will close this gap nor keep up with the current pace of learning UNLESS an appropriately intense program of specialized instruction – by a teacher of the deaf/hard of hearing – supports this progress.

Services need to be appropriate if a child with hearing loss is to receive FAPE.

Appropriate:

Accommodations to optimize access to school communication
Assessment to identify the learning needs unique to students with hearing loss
Intensity of specialized instruction tailored to meet these unique needs by a knowledgeable teacher with specialty in working with students with hearing loss
Continuous progress monitoring to measure progress in closing learning gaps
Revising IEP services and accommodations/supports to support GROWTH.

The ‘bread and butter’ of itinerant support to students with hearing loss is often considered to be ensuring communication access, supporting language development, and self-advocacy skills training. While access relates to ADA requirements, and supporting language is linked to academics, training in self-advocacy is too often considered to be non-academic and therefore not necessary. One thing we know for sure about our students is that they will miss or misunderstand more communication than their peers. This is the basis for ongoing language and vocabulary issues and underlies the need for self-advocacy. Access and teacher accommodations cannot close all ongoing speech perception or communication gaps. It truly is necessary to teach self-advocacy skills to enable students to fully participate in the classroom and act appropriately when they know they have not fully received or understood information.

If a student who was low vision was continually knocking into people, desks, and classroom walls due to the inability to clearly see everything, a vision specialist would likely be called in to assist the student in developing appropriate orientation and mobility skills. A student with hearing loss often incompletely hears, misses spoken information, or misunderstands what is said. Self-Advocacy training is to a student with hearing loss what orientation and mobility training is to a student with visual impairment.

Students do not know what they didn’t hear because they didn’t hear it – yet they are held accountable for receiving and fully understanding this information. Full participation in the classroom requires that a student recognize when a communication breakdown occurs, and self-advocate for their listening and learning needs. Students who are deaf or hard of hearing must have the knowledge and skills to access accommodations and support in any setting and as an integral part of an independent adulthood. Ideally, students would have instruction in self-advocacy from preschool through grade 4 (about age 10). As they reach the tween and teen years, focus should change on supporting the student’s ability to problem-solve communication issues as part of their self-determination of future goals.

Components of Self-Advocacy: Following are basic questions that students with hearing loss typically require instruction in so that they can understand their hearing needs and respond appropriately.

Self-Advocacy

1. 1. What does it mean to have a hearing loss?
2. 2. Why do I have problems understanding (relate to hearing loss and language issues)?
3. 3. How does my hearing loss affect me (school, socially)?
4. 4. When do I have problems understanding what people say?
5. 5. How important are my hearing devices?
6. 6. How do I know when my hearing devices are not working?
7. 7. What should I do when they are not working?
8. 8. What can I do when I know I have not heard what was said (specific self-advocacy & communication repair strategies)?

Self-Determination

1. 1. How much am I willing to have the hearing loss impact how well I do in school (planning/future goals)?
2. 2. When is it critical for me to disclose my hearing loss (problem solving)?
3. 3. What are my legal rights to access, supports, and services?

From the US Office of Civil Rights:

We need to encourage students to understand their disability.

• They need to know the functional limitations that result from their disability.
• Understand their strengths and weaknesses. Be able to explain their disability to others.
• Be able to their difficulties in the past, and what has helped them overcome such problems.
• This should include specific adjustments or strategies that might work in specific situation.
• They must practice explaining their disability, as well as why they need certain accommodations, supports, or services.

U.S. Department of Education, Office for Civil Rights, Transition of Students With Disabilities to Postsecondary Education: A Guide for High School Educators, Washington, D.C., 2007

He does not know what he did not hear.

This reality underlies the requirement to teach self-advocacy, specifically teaching the student about what he does hear, does not hear and under what conditions, and how to use situational awareness to recognize when he likely missed information. Some knowledge of hearing loss teaching and assessment resources:

1. 1. Advocacy in Action Self-Advocacy Curriculum
2. 2. Audiology Self-Advocacy Checklist – Elementary School  Middle School  High School
3. 3. Building Skills for Success in the Fast-Paced Classroom
4. 4. ELFLing
5. 5. Monkey Talk Self-Advocacy Game
6. 6. Phonak Guide to Access Planning
7. 7. Recorded Functional Listening Evaluation Using Sentences (FLE)
8. 8. Rule the School Self-Advocacy Game
9. 9. Steps to Success Sequence of Skills for Students who are Deaf/Hard of Hearing

Teaching Hearing Device Use and Troubleshooting

Some knowledge of hearing device use teaching and assessment resources:

1. 1. Advocacy in Action Self-Advocacy Curriculum
2. 2. Building Skills for Independence in the Mainstream
3. 3. SEAM – Student Expectations for Advocacy & Monitoring Listening and Hearing Technology (PDF)
4. 4. Steps to Success Scope and Sequence of Skills for Students who are Deaf/Hard of Hearing

Teaching Self-Advocacy Strategies

Some knowledge of self-advocacy skills teaching and assessment resources:

1. 1. Advocacy in Action Self-Advocacy Curriculum
2. 2. Building Skills for Independence in the Mainstream
3. 3. Building Skills for Success in the Fast-Paced Classroom
4. 4. COACH: Self-Advocacy & Transition Skills for Secondary Students who are Deaf/Hard of Hearing
5. 5. Guide to Self-Advocacy Skill Development: Suggestions for Sequence of Skill Attainment (PDF)
6. 6. Monkey Talk Self-Advocacy Game
7. 7. Phonak Guide to Access Planning
8. 8. SCRIPT 2^nd Ed: Student Communication Repair Inventory & Practical Training
9. 9. Steps to Success Scope and Sequence of Skills for Students who are Deaf/Hard of Hearing
10. 10. What’s the Problem Game

Success in the general education setting requires an ongoing instruction program in self-advocacy skills needs, including hearing aid independence, to be a part of the services provided to students with hearing loss as part of their IEP or 504 Plan.

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I am often asked, if I had to choose, which would be the most important assessments for teachers of the deaf/hard of hearing to routinely use during initial or triennial assessments.

• Assessments that reflect unique needs of our students
• Assessments to tease out performance issues in students who are ‘okay’ academically
• Assessments that will be helpful in planning intervention

Biggest areas of vulnerability are: speech perception, listening comprehension, syntax, morphology, memory, phonological awareness, conversational use of language, pragmatic language, ‘Swiss cheese’ language.

 Collaborate with your IEP team SLP: Tests need to be chosen that will evaluate syntax, morphology along with receptive/expressive language and conversational or social communication skills. Some tests are: CASL, CASLS, TOLD, TACL, CELF-V. Using test combinations to also identify issues with phonemic awareness and pragmatics/social language is important.

1. Determine level of communication access in the classroom – a necessity!

For ages 6-18
15 minutes to administer
Digital audio files – Use from CD or copy to your computer or phone
Perform all 8 conditions: Close/Far, Auditory only/ Auditory + Speechreading, Quiet/Noise (in +5 S/N classroom noise)

Continuous recording allows you to finish an 8 condition FLE in 10-15 minutes. Uses 5-word HINT sentences. Comes with computer fillable response form and auto calculating summary. Administration of the FLE can be adapted for SimCom/TC users. EVERY student with hearing loss who has useable residual hearing should have an FLE at least triennially.

2. What does s/he comprehend? – typical classroom language

Ages 6-11, Grades 1-6 or Adolescent version: Ages 12-18, Grades 6-12
35-40 minutes to administer
Subtests: Main Idea, Details, Reasoning, Vocabulary, Understanding Messages. The Listening Comprehension Tests focus on:

• Summarizing and Sequencing
• Participating in Discussions
• Following Directions
• Understanding Language Concepts
• Problem Solving and Predicting
• Listening for Meaning 

RESULTS ARE PREDICTIVE OF HOW WELL A STUDENT WILL BE ABLE TO FUNCTION IN THE CLASSROOM.
Can be administered through amplification (no speechreading) and/or via visual communication/ASL.

3. What does s/he comprehend? – deeper language

For ages 5 to 21 years
10 to 20 minutes to administer

OPUS identifies how well a person can integrate and apply knowledge in three structural categories of language:

• Lexical/Semantic: knowledge and use of words and word combinations
• Syntactic: knowledge and use of grammar
• Supralinguistic: knowledge and use of language in which meaning is not directly available from the surface lexical and syntactic information.

OPUS IS SENSITIVE TO FUNCTIONAL COMPREHENSION AND SYNTAX ISSUES. Can be administered auditorilly and/or via visual communication/ASL. Results of OPUS and the Listening Comprehension Test provide a clear reflection of daily comprehension ability and needs for planning. Listening comprehension is a higher order auditory development skill. Evaluation must occur to determine each student’s specific abilities and needs along the hierarchy of auditory skill development (such as evaluating with the SPICE).

4. How well does s/he interact with others? – social language use

A. If the student was found to have language within average

For ages 4 to 16 years 
15 to 20 minutes to administer
Test of Narrative Language 2 identifies our student’s issues carrying on conversations, relating experiences. No transcription required.

• a functional assessment of narrative comprehension and narrative production;
• 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.

B. If pragmatic language was not evaluated (thoroughly) by the SLP
Obtain information from the classroom teacher about how well the student uses social language.
Takes classroom teachers 5-10 minutes to complete.
PLSI for ages 5 to 13 years
Students with hearing loss often have a 3+ delay in pragmatic language!

PLSI has 3 subscales:

• Personal Interaction Skills
• Social Interaction Skills
• Classroom Interaction Skills
• Clear cut-off scores
• Guidelines for interpretation
• Useful diagnostic instrument

Need to dig deeper? Use the Social Language Development Test – Elementary

5. How does s/he process language?

Ages 5 to 21 years
<60 minutes to administer>
The TAPS-4 provides information about language processing and comprehension skills across three intersecting areas: phonological processing, auditory memory and listening comprehension.
These areas underpin the development of effective listening and communication skills and are critical to the development of higher order language skills, including literacy skills.

Phonological Processing Index:

• Word (Pair) Discrimination: Assesses ability to discriminate whether a given word pair is the same or different
• Phonological Deletion: Assesses ability to manipulate phonemes within words
• Phonological Blending: Assesses ability to synthesize a word given the individual phonemes
• Syllabic Blending (Supplemental): Assesses ability to synthesize a nonsense word given the individual syllables

Auditory Memory Index:

• Number Memory Forward: Assesses ability to recall an auditory sequence of numbers in the given order
• Word Memory: Assesses ability to recall an auditory sequence of words in the given order
• Sentence Memory: Assesses ability to recall a spoken sentence
• Number Memory Reversed (Supplemental): Assesses ability to recall a reverse auditory sequence of numbers

Listening Comprehension Index:

• Processing Oral Directions (without background noise): Assesses ability to process and recall oral directions when presented in quiet listening conditions
• Auditory Comprehension: Assesses ability to comprehend oral language at the sentence and narrative level, including literal recall, inference, and higher order language tasks such as idioms and figurative language
• Auditory Figure-Ground (Processing Oral Directions with 4-speaker babble background noise) (Supplemental): Assesses ability to process and recall oral directions when presented with competing background noise

Assesses 5 narrow abilities across 3 broad skill areas as defined in the CHC theory of cognitive abilities:
Short-Term Memory: Memory Span (MS); Working Memory Capacity (MW)
Auditory Processing: Phonetic Coding (PC); Resistance to Auditory Stimulus Distortion (UR)
Comprehension-Knowledge: Listening Ability (LS)

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Can a 504 Plan be ENOUGH Support?

Many more students with hearing loss are being denied eligibility for specialized instruction and provided 504 Plans to meet their accommodation needs. The US Department of Education provides extensive answers to 47 FAQs on Section 504. Because hearing loss substantially limits one or more major life activities (hearing) virtually all students with hearing loss are qualified to receive a 504 Plan. Eligibility is considered per the student’s function without use of hearing devices.

If there is a question as to whether the hearing loss poses a “substantial limitation” tests tailored to evaluate the specific areas of educational need must be used. View the Estimating Access White Paper for information on this tailored assessment. Once a student is identified as eligible he or she will always be entitled to receive 504 Plan supports and services as long as the limitation of major life activities continues. Periodic reevaluation is required to verify that the impairment continues to limit the student’s ability to learn or other major life activity (i.e., hear).

“What does this student need to have equal access and to communicate in school as effectively as others?” is the guiding question for school teams to consider in developing a 504 Plan for a student with hearing loss. Section 504 requires recipients to provide to students with disabilities appropriate educational services designed to meet the individual needs of such students to the same extent as the needs of students without disabilities are met. Since 504 Plans are used in public schools to provide the accommodations and supports required by the Americans with Disabilities Act for students with hearing loss, the language specific to auxiliary aids and services within the ADA can help to further understand the extent of these supports.

Appropriate educational services can include:

• Adjustments or accommodations in the regular classroom so that students can receive and convey information as effectively as peers.
• Related/auxiliary aids consist of devices, technologies, and methods for providing effective communication, as well as the acquisition or modification of equipment or devices (i.e., computer connection for hearing devices). Auxiliary aids can also include, but are not limited to, interpreters, note takers, and closed or open captioning.
• Related services refer to developmental, corrective, and other supportive services needed to ‘level the playing field’ for access and effective communication. In terms of students with hearing loss this can mean monitoring of auditory access/devices by the educational audiologist, inservice of classroom teachers and periodic progress monitoring (observation) and/or ongoing parent/teacher consultation by the teacher of the deaf/hard of hearing, teaching a student to effectively use hearing devices (i.e., operation, monitoring, troubleshooting of devices), etcetera.

Once the need for an auxiliary aid or service has been identified, the public school district must provide it as soon as possible. If the school suspects the auxiliary aid or service to be an undue financial burden, the complete resources available to the school district, not just the school, need to be considered for funding. An appropriate education for a student with a disability under the Section 504 regulations could consist of education in regular classrooms, education in regular classes with supplementary services, and/or special education and related services.

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Each Fall, teachers of the deaf/hard of hearing scramble to contact each of their student’s classroom teachers about the impact of hearing loss on educational performance and what the teacher needs to do to accommodate the student’s unique learning needs.

Without inservicing the teachers, it is likely that they will believe:
(1) hearing devices will ‘fix’ all of the listening issues,
(2) the student will ask when they missed something or didn’t hear completely,
(3) the student is distractible or inattentive, does not pay attention during class discussion
(4) the student may have a learning disorder because they don’t seem to be able to follow directions and get to work like other students,
(5) they do not participate equally in group activities, letting their peers do most of the work

Students with hearing loss don’t know what they didn’t hear because they didn’t hear it, yet they are routinely held accountable for information that they never perceived.

A student will not receive equal access to classroom communication unless the teacher is aware of the impact of the hearing loss and what is required to ‘level the playing field’ for these students.

With sizable caseloads across a number of schools, getting to all of the teachers before the year starts or during the first week of school for a face-to-face meeting can be impossible.

How can the itinerant teacher of the deaf/hard of hearing more effectively contact classroom teachers early in the school year?

INTRODUCE THE STUDENT HEARING ISSUES AND NEEDS VIA EMAIL

• When you send out an email to the teacher, if possible, set it up so that you receive a receipt when the teacher has read the email. This identifies a good window to follow up quickly with the teacher while the information is still fresh in her mind. A lack of a receipt also lets you know those teachers who have not read the information and will need another email contact or personal visit.
• In the email, give the teacher a ‘heads up’ that you will be contacting her to spend some time talking about the students needs. An example of this ready-to-go letter has been included: Dear Classroom Teacher (Word/PDF).
• Once you meet with the teacher, you can further share a general description of the impact of the hearing loss, such as the Relationship of Hearing Loss to Listening and Learning Needs or the NEW inservice handouts now available (see below).
• Share the SIFTER checklist the previous year’s teacher completed in May, with the new classroom teacher. Include the LIFE-R results as well if possible. This will prepare the teacher to expect to fill out these checklists about one-month into the school year. Summarize other test results, like the Functional Listening Evaluation, Listening Comprehension Test, or examples from observations of the student in previous classrooms.
• Alternately or additionally, provide a brief description of the results such as:
  Through the use of the Listening Inventory For Education checklist, John identified that he has significant difficulty hearing class discussions, social interactions, and communication when there is any noise in the classroom. He is challenged when the teacher moves about the classroom as it prevents him from speechreading, which improves his understanding. Last May, this student’s third grade teacher identified that John continues to perform lower academically, has periods of inattention due to listening fatigue, hesitates after directions, and rarely participates during class discussion. Thus, his hearing loss impacts his ability to fully participate and perceive communication in the classroom environment. John has IEP goals related to developing self-advocacy skills as he has identified that he mainly waits for teacher clarification rather than letting the teacher know, or otherwise getting assistance when he does not completely hear class instructions.
• Some teachers benefit from receiving a link to YouTube videos that describe general information teachers should know when supporting a student with hearing loss in their classroom (example 1, example 2, example 3, example 4, example 5, or search yourself – there are lots of videos available!).
• Alternately, you or your DHH Team can prepare your own brief YouTube videos. Use a private YouTube channel to ensure that no confidentiality questions arise. Develop videos for alike student groups, such as unilateral hearing loss, mild loss with consistent hearing aid use, mild hearing loss with challenging hearing aid use issues, etc. Emphasize educational performance issues (what the teacher will SEE and how it relates to the hearing loss), legal requirements (ADA access, equipment monitoring), and necessary teacher/instructional accommodations.
• Develop a YouTube video that shows what the teacher needs to do to appropriately use and maintain the student’s hearing assistance technology.
• Share equipment cheat sheets (example). Tech Talk of the Teacher Tools e-magazine provides wonderful resources.

USING THE TEACHER INSERVICE COMBO TO MAKE AN IMPRESSION!

For students who have used hearing aids (consistently) since infancy it is no longer most appropriate to share descriptions of the impact of the hearing loss levels with teachers, as the students are actually functioning based on their hearing ability while aided. Due to consistent aided hearing and in recognition of frequent non-use by students with mild hearing loss, there are four versions of this new inservice handout: 20-25 dB, 25-30 dB, 30-35 dB, and 35-40 dB. For other types and degrees of hearing loss the freely available Relationship of Hearing Loss to Listening and Learning Needs still remain relevant.

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!

All 12 Inservice-related Materials in DIGITAL DOWNLOAD Format
for only $39.00 on SALE through September for $30.00
The $99.00 license for use of these materials
by up to 5 professionals is still a fabulous deal!

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Assessment of Students with Hearing Loss MUST Consider Their Full Range of Needs

Speech Language Results and Observation Alone are Insufficient

S.P. v. East Whittier City School District, Pasadena, California

One June 1, 2018, the Ninth Circuit Court of Appeals reversed and remanded the district court’s decision in favor of the plaintiff (parents) on the grounds that the East Whittier City School District violated the Individuals with Disabilities Education Act (IDEA) “by tying S.P.’s eligibility for special education services to only her speech and language disorder and not also her hearing impairment.” The District also failed to provide S.P. a FAPE by using insufficient evaluative measures to disqualify her from eligibility as a student with a hearing impairment.

To arrive at this decision, the appellate court addressed two questions: 1) Did the Whittier City School district comply with evaluation procedures set forth in IDEA? and if failing to do so; 2) Did the Whittier City School district deny the student a Free and Appropriate Public Education (FAPE)?

Part 1: DHH eligibility needs to look beyond just speech and language

IDEA requires that a student’s Individualized Education Plan (IEP) “determine whether a child is a child with a disability”, and “determine the educational needs of such child.” 20 U.S.C. § 1414(a)(1)(C)(i). By tying the student’s special education services only to her speech and language disorder and not her hearing impairment as well, the appellate court judged the District violated IDEA. Under California Education Code § 56333 (e), a student may be eligible for special education services if it is determined that the hearing loss results in a language or speech disorder and significantly affects educational performance. One of the District’s mistakes was to base their eligibility criteria for hearing impairment solely on the definition of “Deaf” (“a hearing impairment so severe that the child is impaired in processing linguistic information through hearing with or without amplification, and adversely affect a child’s educational performance.”) 34 C.F.R. § 300.8 (c)(3), and ignore the definition of “hearing impairment”. Defined, “hearing impairment” is “an impairment in hearing, whether permanent or fluctuating, that adversely affects a child’s educational performance.” Id. § C.F.R.300.8 (c)(5). What does all of this mean? A student who receives special education for a speech or language disorder due to a hearing loss (see definition of “hearing impairment”) may also be eligible to receive services for that hearing loss.

Part 2: Assessment must occur to identify a student’s full range of needs

In determining the student eligible for speech and not as a child with a hearing impairment, the district court recognized that the error in classification (meaning the absence of the HI eligibility) “was harmless because the District otherwise provided S.P. with a FAPE.” However, by basing their decision not to qualify a hearing-impaired student on weak methods (see Part 3) as a child with a hearing impairment, the District denied her a FAPE, therefore it was not “harmless.” Why? 20 U.S.C. §1414 (d)(3)(B)(iv) states that for deaf or hard of hearing students, the IEP team “must consider the child’s language and communication needs, opportunities for direct communications with peers and professional personnel in the child’s language and communication mode, academic level, and full range of needs.” Because the IEP only addressed goals for speech and language, her range of needs due to her hearing impairment specifically were not assessed or considered.

Source:  https://codes.findlaw.com/ca/education-code/edc-sect-56333.html
Source:  https://www.law.cornell.edu/cfr/text/34/300.8
Source:  https://www.law.cornell.edu/uscode/text/20/1414

Part 3: All suspected areas of the disability need to be evaluated

Because the impact of S.P.’s hearing loss and consequent needs were not considered, IDEA’s requirement of assessing students in “all areas of suspected disability” was not met. S.P. underwent assessments heavily focused on her speech and language disability. S.P.’s parents produced an audiogram, but the District was still under obligation to conduct a full and individual evaluation in all areas suspect of disability, which it did not do. The District’s assessment of S.P.’s auditory skills consisted only of “observation and review of records.” The appellate court judged that “such a limited review was insufficient to satisfy the District’s evaluative obligation.”

Because the District violated S.P.’s procedural rights under the IDEA and denied her a FAPE, the appellate court reversed and remanded the district court’s decision calling for it “to determine the appropriate remedy.”

What do the results of this court case mean for teachers of students with hearing loss?

It is inappropriate to consider speech and language results only as primary determinants of eligibility for students with hearing loss. School teams must assess more broadly, and more appropriately to identify a student’s full range of needs in areas most vulnerable to impact on educational performance. Formal and informal data in all areas of suspected disability are necessary for a FAPE under IDEA.  Observation can certainly be a part of an evaluation, but it is not a rigorous enough assessment of all areas of potential need. Refer to Steps to Assessment and information within the Supporting Success website for more information on areas of development that should be assessed for students with hearing loss.

Think of it this way:  Would you accept or question an IEP team’s decision to qualify a student as intellectually disabled because a school specialist simply observed the child in a classroom setting without administering any formal intelligence tests? Of course not!

By Brenda Wellen, M.S., Education of the Deaf for August Bimonthly Update, Supporting Success for Children with Hearing Loss. http://successforkidswithhearingloss.com

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The abilities of children with hearing loss, whether they are exiting from early intervention or are already school-aged, are typically evaluated to identify overall delays or learning disorders. Since children with hearing loss have access issues learning language due to barriers caused by the hearing loss, they often score ‘low-average’ on norm-referenced language tests. Rather than having overall delays, the access issues caused by hearing loss often result in ‘spotty skills’ or learning gaps that are not identified by typically used evaluation instruments. Because these needs are not identified by typical measures, our students are often denied eligibility for specialized instruction and supports. The specialist in education of students with hearing loss needs to be a member of the evaluation team to help tailor the assessment process to identify the unique needs of these children.

Research has consistently revealed that a ‘good’ result of early intervention for children with hearing loss is a standard score of -1 SD to -1.5 SD on norm-referenced language tests (standard score 78-88 range). All too often teachers of the deaf/hard of hearing have sat in meetings where the evaluation team has described these results as ‘normal’ and ‘he will be okay.’ After all, special education is not preventative, it is for children who have identifiable disabilities. ‘Low-normal’ does not equal a disability. Yet professionals who work with these students realize that there ARE language issues, including ‘Swiss cheese language’ which influences comprehension, delays in syntax learning, and in early literacy skills.

Using Norm-Referenced Tests to Determine Eligibility

The purpose of the testing is to identify an educational disability or adverse educational effect on educational performance. For children with hearing loss, assessment needs to be sufficient in scope and intensity to identify gaps in auditory (or sign language development), language, narrative discourse, academic, literacy, and social language skills. Information needs to be collected that reflects the student’s ability to function in situations similar to the school setting, including typical use of amplification.

Norm-referenced tests typically have various subtests, each of which assesses one type of ability area. These subtest scores are rolled together into an overall or total score for the norm-referenced test. It is often claimed that only the overall score from the norm-referenced test can be used to determine eligibility. This is frustrating to persons who work with students with hearing loss as there are often one or more subtests that show areas of need, but the overall score average is within the acceptable range.  Section 300.304(b)(2) of IDEA states that a single measure or assessment cannot be used as a sole criterion for eligibility. So yes, a single subtest score cannot be used to determine a child as eligible. This is misleading. If the area of need identified by the low performing subtest(s) was also demonstrated by other norm-referenced and/or functional measures, then the child’s area of need would have been demonstrated with more than one measure. If there is a substantial need identified, go the extra step to verify it. This can make the difference between eligibility for supports and services or no specialized help for the child. For more discussion on using subtest results to determine the need for further testing, read here.

Another aspect of norm-referenced testing is that the measures are designed to identify areas of delay or disorder. To use an analogy, we can compare the knowledge and skills learned each year to a row of 12 bricks to build a wall. Every year there would be a row built up, starting from infancy. Think of each brick as collectively representing vocabulary and concepts learned during one month of exposure. Consider our students who did not consistently use amplification, or were not consistently exposed to fluent sign, during early childhood and how that would impact their ‘row of bricks development’ as compared to typically developing hearing peers. Norm-referenced tests, specifically the overall scores, consider development as ‘How high is the wall?’ as compared to typical learners. Children who have cognitive delays or learning disorders would have shorter walls. Children with hearing loss are typically found to have walls almost as high as their age peers (low average) but what is NOT identified is the gaps in learning that are typical of children with hearing loss due to communication access limitations that vary over time.

To combat this, the person specializing in the education of children with hearing loss needs to be part of the evaluation team (IDEA Section 300.321(4)(i)(5)). We need to press for evaluation in the areas that we know are at highest risk for issues due to the impact of hearing loss. In looking at the list below, it is clear that the test battery typically used by the school team to evaluate children suspected of learning disorders will not capture the most likely areas of need for students with hearing loss. Moreover, we need to work with the team to discuss evaluation measures that can provide the norm-referenced results of the specific skills needed to tailor the assessment to specific areas of educational need, as required by IDEA (Section 300.304(c)(2)). Refer to Steps to Assessment for information on specific measures.

Areas of learning most likely to be impacted by hearing loss:

• Understanding group discussions or participating in small group work due to distance/noise in class and socially
• Vocabulary:  Gaps due to decreased ability to overhear incidental language (‘Swiss cheese language’)
• Syntax: Incomplete understanding of rules (i.e., cannot hear /s/ or /ed/; do not understand plurals, possessives, past tense)
• Working Memory: ability to retain fragmented parts of words heard and new spoken/signed vocabulary
• Listening skills:  Can be challenges with simple discrimination of sounds, phrases or comprehension of conversation or verbal instruction in class (they may hear but not process the full meaning)
• Attention: Periodic inattention due to listening fatigue and gaps in understanding; ‘tuning out’ when it is challenging
• Early reading: Phonology/phonemic awareness issues related to not distinctly hearing speech sounds
• Language processing: due to fragmented hearing, vocabulary gaps, syntax and morphology gaps, slower listening rate, reduced understanding words in context
• Viewing information from different perspectives, understanding emotions of others, critical thinking
• Social language: Socially awkward, delays in pragmatic language, nonverbal social cues, and appropriate peer interactions
• Passive or immature skills in responding when they do not understand what was said; lack of self-advocacy

Influence of CONSISTENT use of hearing devices on language outcomes: Consider our students who did not consistently use amplification, or were not consistently exposed to fluent sign, during early childhood and how that would impact their ‘row of bricks development’ as compared to typically developing hearing peers. Children with more consistent DAILY hearing aid use have better language and auditory outcomes than children with less consistent use, averaging 2/3 of 1 standard deviation difference². This is especially true for children with hearing loss of 41-70 dB. If children with hearing loss already perform in the low average range for language, an additional 2/3 of 1SD delay can make a lifelong difference in school outcomes. Consistent hearing use is a big key to protecting against language delay and catching up or keeping up with language/learning.

A Predictable Downslide in School Performance: With exposure to a dynamic language environment in a structured classroom setting, many typically hearing children who have low-average language ability can begin to catch up to their more average peers. This assumption cannot be applied to children with hearing loss. A dynamic classroom language environment typically provides less access to communication than what the child experienced in early childhood. It is typical for our students to have their learning trajectory decrease once they enter school, meaning their rate of learning actually declines due to increased issues clearly accessing communication. If a child was not made eligible for specialized instruction, be sure that a 504 Plan is developed and include periodic monitoring by a DHH specialist as part of the necessary auxiliary aids and services (education in regular classes with supplementary services, read FAQ 4).

An evaluation team has the responsibility to appropriate assess students to identify areas of need that will interfere with educational performance. To this end, IDEA Section 300.304 requires that teams gather relevant functional, developmental, and academic information about the child. Academic information is only one part of educational performance. This is especially important for students with hearing loss who often have functional performance issues related to decreased access, such as challenges following directions, participating in group work, listening comprehension, and fatigue. These are all relevant functional performance issues that must be considered when evaluating a student’s need for specialized instruction and support.

References

1. Spencer, P., & Marschark, M. (2010). Evidence-Based Practice in Educating Deaf and Hard-of-Hearing Students. “Children who are identified early and receive early intervention have been found to demonstrate language development in the “low average” level compared to hearing children.” (pg 42) Read more about book.

2. McCreery R. W., Walker E. A., Spratford M., et al. (2015). Longitudinal predictors of aided speech audibility in infants and children. Ear Hear. 36:24S–37S Go to article.

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Grade Retention

Question from the field:

I was wondering if there was any research or insight on retaining kids who are Deaf/HH for one school year. There have been a few small cases where student who were able to repeat one grade level helped to close that wide gap that they had and eventually (with DHH support) catch up to those of their peers. However, I think the first reaction is – do not retain kids with special needs. Any insight pro or con?

In looking up research on this topic, I found a study of Portuguese students comparing 24 with typical hearing to a group of 20 who were Deaf and implanted and 24 who were Deaf without cochlear implants, in grades 4, 7, 9, 12. In my international travels I have found that many countries have no formalized special education services and all cognitively able students are in the general education setting. Where in the US we do not usually ‘fail’ students with disabilities, this is not necessarily true in other countries. In the case of this Portuguese study, the students who were implanted had a higher failure rate than the typically hearing students, and the students who were considered Deaf but not implanted had a higher rate of repeated school years than the implanted students. See Figure.

While this research finding answers the question of whether students who are deaf would be retained at a higher rate if there is a practice of grade retention for lack of performance (yes), it does not answer the question from the field in terms of pros or cons to retention for students with hearing loss. A 2015 study of predictive factors for academic achievement of this population analyzed data of about 500 DHH secondary students. The authors found that having attended regular secondary schools (vs a deaf school or deaf ed program) and having better spoken language were associated with higher test scores. Predictors of poorer academic achievement test scores included having an additional diagnosis of learning disability, having a mild degree of hearing loss, and being African American or Hispanic.

A really fascinating, but old (1999) study looked at the academic achievement of 75 third grade students who failed first grade screening tests, comparing those who did seek medical attention for the hearing issue to those who did not. The author concluded that more children who had not sought medical attention after failing hearing screening, failed either the first or second grade. The typical retention rate between grade 1 and grade 2 was 9% whereas the students who did not seek medical follow up for hearing issues had a retention rate of 28%. It must be noted that in 1999, the field of education had not embraced the ‘do not retain’ policy held by most school districts today.

Thus, the research reinforces that hearing loss can have a very significant adverse effect on academic achievement, but the studies are very limited. Looking more broadly at the practice of retention of students with disabilities has a bigger research base that has been consolidated nicely into an article by the National Association of School Psychologists. In essence, retention in any grade level is associated with later high school dropout, as well as other deleterious long-term effects. Typically, test scores of retained students in the primary grades increase for a couple of years and then decline below those of their equally low-achieving students who had not been retained. NASP declared that retention is a failed intervention which was partly due to a lack of specific remedial strategies to help enhance student social or cognitive competence.

Summary and Karen Anderson’s reply to the field:
In general, we don’t retain kids anymore. I agree that there are exceptions for students with hearing loss.

Example:

Tommy attended kindergarten. He was an inconsistent hearing aid user and upon entry, the school did not see it necessary to provide DHHT support or the specialized instruction/support provided was not appropriately intensive. Now a year has gone by with only a couple of months of progress made during the year. There were just too many access issues that interfered with Tommy’s instructional progress, too little support for the teacher to understand the behaviors she observed were related to hearing loss, too little support with the parents to recognize the 1:1 correlation between lack of hearing aid use and lack of school progress/behavior/social issues. Now it is spring and people have finally gotten around the table to discuss this Tommy’s lack of educational progress and future needs. He is NOT ready to go on to gr 1 as he really never had access to instruction during Kindergarten. The team agrees that Tommy should repeat Kindergarten but only if he has the intensive support he needs along with consistent hearing aid use. They decided that Tommy will receive strong support (i.e. 1 hour/day) from the DHHT, with 1x/week in the classroom and the rest pull out 1:1 services. This time will be devoted to 1) language development 2) social skills 3) self-advocacy/understanding of hearing loss impact/hearing aid use. At the end of the year the school team expects to see the expected annual yearly progress for a student in the class (hearing) and readiness for grade 1.  If this student were to be retained without the intensity of service and consistent hearing aid use, it would be another wasted year from his education.

Note: The Advocacy section does not constitute legal advice and provides information for thoughtful consideration only.

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The U.S. Department of Education gives each State the right to determine what constitutes adequate yearly progress (AYP) based on that State’s final assessment system. Instruction must be rigorous enough to demonstrate “continuous and substantial” yearly progress. High-stakes standardized testing is one measure of school achievement and competency. At the least, the results of this testing can determine whether accommodations have been successful, and services have been effective in preventing a widening achievement gap. At most, results can determine whether a student is promoted to the next grade or graduates. Though high-stakes testing is one measure of academic achievement, it cannot be the only source of data used to determine whether a student has made substantial gains toward AYP. With the weight of these considerations at stake, it is no wonder parents, students, and teachers may feel pressured by the impact of these tests.

The number of students who are deaf and hard of hearing (DHH) served in the general education setting continues to grow. However, these students still lag behind their hearing peers, specifically in language and reading, secondary to the impact of hearing loss. This has made the need for appropriate supports and services by personnel with highly specialized skills and knowledge a critical factor for success. Under IDEA, states must use information about the performance of children with disabilities in state and district-wide assessment programs to revise their State Improvement Plans, as needed, to improve their performance.

Educators cannot wait until the end of year to determine if teaching practices, accommodations, and services have been effective. Progress monitoring is critical.

Disadvantages of High-Stakes Testing for Students with Hearing Loss

• Results of high-stakes testing may underestimate a student’s actual skill and abilities. Students who are DHH, especially those included in a general education setting, are often at a disadvantage during high-stakes testing due to their limited knowledge of the language style and structure of the tests. Tests use phrasing, grammar, and syntax that differs from everyday English, often including idioms, multiple meaning words, and complex grammar that is unnecessary to comprehension of text. For a student with an interpreter, the interpreter may account for the student’s language ability and modify communication to assist comprehension. If familiar presentation of the language is not used during high-stakes testing, the consequence is an unfair disadvantage when the testing is presented in written form.
• For students who use sign language to communicate, some schools allow only a verbatim interpretation of the test. For a student who receives the accommodation of signed translation for test items and/or questions, the ASL interpreter must now change the communication system to present the test items as they are written.
• Students who are DHH being educated in the general education setting are typically the only student in that classroom with hearing loss. The student’s teacher is likely to be unfamiliar with the effects that hearing loss can have on equity of test results in comparison to typically hearing peers.

Is RTI the Same as Progress Monitoring?

Progress monitoring includes forming a baseline for present levels of performance and completing weekly or monthly assessments with a number of tools to verify small incremental gains in student progress. Response to Intervention (RTI) techniques are often used to monitor progress of students who are DHH included in the general education classroom. RTI was originally intended to identify hearing students who have learning disabilities. This type of monitoring includes selection and implementation of “evidence-based tools, with consideration for cultural and linguistic responsiveness and recognition of student strengths.”  According to the National Center on Response to Intervention, RTI is a framework for providing comprehensive support to students. It is not an instructional practice. RTI is a prevention-oriented approach linking assessment and instruction that can inform educators’ decisions about how best to teach their students. A goal of RTI is to minimize the risk for long-term negative learning outcomes by responding quickly and efficiently to documented learning or behavioral problems and ensuring appropriate identification of students with disabilities.” Though this type of formative assessment is used by districts, it is not intensive enough, tailored to DHH unique needs, nor can it be applied appropriately, as our students have education issues secondary to access barriers and not learning disorders.

Challenges in Collecting Valid Data on Students with Hearing Loss

Collecting accurate and valid data on students who are deaf or hard of hearing is an ongoing challenge. Educators in the field have struggled with finding, modifying, and “reinventing the wheel” when it comes to assessments that can provide parents, school teams, and administrators with valid information reflecting present levels of performance. Part of the difficulty for educators is that there is no one progress monitoring tool or assessment that is appropriate for all students with hearing loss. Student’s variability in type and degree of hearing loss, age of onset, language exposure, and modes of communication are a few of the variables that can complicate the process of choosing the correct monitoring instrument. In addition, assessment for students with hearing loss is largely misunderstood and assumed to be covered by the typical tests and data collection used with students who have common disability conditions. The type of assessment that is needed is often overlooked in favor of the type of assessment that schools require.  Many educators of the deaf and hard of hearing providing itinerant services, are forced to rely on the general education teacher, who is unfamiliar with the unique needs of a student with hearing loss, to collect informal data on a daily or weekly basis.

Common Progress Monitoring Procedures

To intervene with school teams appropriately, educators of the DHH must be attentive to the curriculum being presented to our students in order to plan, accommodate, modify and collaborate to provide tailored instruction prior to valid progress data collection. It is also essential that educators of DHH have a working knowledge of the progress monitoring tools used to assess students’ skills.

• Students in early elementary grades are often given formative assessments that test their ability to use phonological knowledge and apply it to the written word. Due to auditory access issues, phonological awareness is frequently delayed. Students who cannot access sound and whose teachers and interpreters are unfamiliar with Visual Phonics as a strategy may make little progress. Even if they are familiar, this strategy may not be implemented intensely or consistently enough to result in true progress. In this case, training may need to be offered to the educational team, a more appropriate monitoring instrument may need to be used. For some students, progress monitoring may need to be overseen by the Teacher of the Deaf. Equally, students who use ASL may not be assessed appropriately with data gathering that includes the phonological aspects of ASL.
• Concurrently, many schools use computer-based progress monitoring which depends upon auditory skills to access the information. This may not be appropriate for students who have delays in auditory skill development or minimal auditory access as well as those who use ASL or other manual communication systems. Measuring these skills equitably may (again) require alternate presentation methods such as the use of Visual Phonics. For a student who uses ASL, Gallaudet University has developed ASL Assessment Toolkits that measure ASL phonological awareness and receptive skills (insert link here).

Are Standardized Test Scores Enough as a Measure of Achievement?

No, high-stakes test results are an insufficient measure of achievement. Without additional data, standardized testing results have limited meaning, and provide little insight for planning instruction. When preparing for end of the year meetings with other teachers, parents, and professionals, it is essential to use data from additional sources as well as the data retrieved from high-stakes testing. IDEA mandates that other sources as well as high-stakes testing be considered when evaluating yearly student progress.

What Additional Data Should be Gathered?

• Progress data on standards-based goals and objectives (criterion)
• Progress data on curriculum-based measures (CBM) that have been administered equitably
• Comparison to age-anchored hierarchies of skill development (i.e., listening skill development, self-advocacy, independence with hearing aids, etc.)
• Observation data – this can be qualitative as well as quantitative.
• Teacher reports that include present levels of functional, behavioral, developmental, and academic performance.
• Parent information (i.e., Parent language survey)
• Language samples – spoken and/or signed, and written communication. This can be done with a voice recorder, video, and by collecting samples of written language throughout the year.
• Student interviews (when appropriate) – how does the student feel about his/her educational experience?
• Student-completed checklists (i.e., LIFE-R and After LIFE, CHILD)
• Social-emotional measures
• Daily records of hearing technology use.

With the amount of collaboration necessary among a child’s educational team, collecting data on students who are DHH is no small task. Teachers who provide services via the itinerant model and classroom teachers of the deaf and hard of hearing rarely have the time in their schedules required to do all that is needed to support good student outcomes (e.g., teach to the unique needs of students, consult enough with the school staff to accommodate or modify to meet student needs, and gather relevant and valid progress monitoring data). Therefore, relationships with school staff are a critical component of this data gathering process. It is often the responsibility of the teacher of the deaf/hard of hearing to establish relationships with campus administrators, general education teachers, and other service providers to effectively collaboration in data gathering.

The challenges presented touch only the surface of the issues with high-stakes testing and continuous monitoring of our students who are DHH. As long as high-stakes test results continue to be used as a primary gauge of adequate yearly progress, educators must be cognizant of the demands it places on students with hearing loss. It is critical to ensure that the progress monitoring tools being used are the most valid (appropriately matched) and accurate measure of student skill.

References

Test equity for individuals who are deaf or hard of hearing. (2008). PePNet Test Equity Summit. Retrieved from http://resources.pepnet.org/files/356_2010_2_1_16_35_PM.pdf.; Cawton, S., & Leppo, R. (2013). Assessment accommodations on tests of academic achievement for students who are deaf or hard of hearing: A qualitative meta-analysis of the research literature. American Annals of the Deaf, 158(3), 363-376.

U.S. Department of Education. Adequate Yearly Progress. Retrieved from https://www2.ed.gov/policy/elsec/guid/standardsassessment/guidance_pg5.html

Retrieved from http://www.wrightslaw.com/law/osep/faqs.idea.assessment.htm

Anderson, K.  (2018). Is the inclusion model good for students with hearing loss. Retrieved from http://successforkidswithhearingloss.com/2017/10/01/is-the-inclusion-model-good-for-students-with-hearing-loss/. Antia, S.D., Jones, P.B., Reed, S., & Kreimeyer, K.H.. (2009). Academic status and progress of deaf and hard of hearing students in general education classrooms. Journal of Deaf Education and Deaf Studies 14(3), pp. 311. Doi 10.1093/deafed/enp 009

PePNet Test Equity Summit Highlights. (2008).

PePNet Test Equity Summit Highlights. (2008).

Center on Response to Intervention. Retrieved from https://www.rti4success.org/essential-components-rti/progress-monitoring

About the Author: Brenda Wellen has been a teacher of the deaf/hard of hearing in center-based and itinerant settings for 28 years. She recently completed a graduate degree in Deaf Education and Reading Specialist certification.

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The Power of an Appropriate Program of Special Education Support

The special education pendulum has swung away from segregated settings where students with special needs minimally mixed with ‘regular’ students in the 1980s to the current full inclusion model, where direct 1:1 instructional services are becoming rare. Students with hearing loss are already at high risk for ‘academic slippage’ due to their inability to completely access classroom communication without appropriate accommodations and supports. The move from pull-out services to provide intensive teaching in reading, language, and self-advocacy, places our students at even higher risk for developing increasing academic delays over time.

In light of this, I found a court case from 2002 that gave me pause, and hope. In Kevin T. V. Elmhurst Comm. School District No. 205 Kevin, who had a learning disability and ADHD, had received twelve years of special education (age 6-18). Kevin had average intellectual potential but his reading, math and writing skills were at the 3rd to 5th grade levels despite receiving special education services. Triennial assessments over 9 years showed that his IQ dropped nearly 20 points. Scores on academic achievement tests also decreased significantly over a 6-year period. The school was aware of his poor reading scores but did not make IEP changes to address his reading difficulties. It was stated multiple times that he should have been assessed for, and given, assistive technology (AT), but the district did not consider, let alone provide Kevin, with AT. Modifications or accommodations during state testing procedures were not included on his IEP. Although Kevin’s skills were deficient, at the end of his 12^th grade year while receiving all Fs, he graduated with a high school diploma. Per this court decision, “Automatic grade promotion does not necessarily mean that the disabled child received a FAPE or is required to be graduated.”    

At the urging of the parents, the district transferred Kevin to a specialized day school where he received intensive instruction. In one year, Kevin made about 3 years of progress in reading, math, and writing. His parents then decided to bring the case to court. The court ruled that Kevin receive compensatory education. The school district was required to reimburse the parents for tuition paid to the specialized school and for his continued education at the school.

Where is the Silver Lining in this Case?

First, schools can and should be held accountable when students with disabilities are not making sufficient progress. Indeed, the March 22, 2017 US Supreme Court decision rejected the standard of minimal progress. For children fully integrated in the regular classroom, the IEP should be reasonably calculated to enable a child to make progress appropriate in light of the child’s circumstances.

Second, a free and appropriate public education (FAPE) for students with disabilities includes specially designed instruction to meet the unique needs of the child. Present levels of performance and continuous performance monitoring are critical elements for determining student needs, and also identifying if the specially designed instruction is truly meeting the needs of the child. Children who display hearing loss as their only disability do not have a learning disorder. Issues in education are related directly to the access barriers caused by the hearing loss. These barriers must be accommodated per ADA and an IEP be suitably designed to close the existing gaps in learning and support the student’s ability to keep pace in the classroom.

Third, intensive instruction by persons who truly understand the unique learning needs of the specific disability is likely to result in substantial progress to close achievement gaps. If our students are 1+ years delayed in their achievement, it is unlikely that they will close this gap nor keep up with the current pace of learning UNLESS an appropriately intense program of specialized instruction – by a teacher of the deaf/hard of hearing – supports this progress.

Services need to be appropriate if a child with hearing loss is to receive FAPE.

Appropriate:

• Accommodations to optimize access to school communication
• Assessment to identify the learning needs unique to students with hearing loss
• Intensity of specialized instruction tailored to meet these unique needs by a knowledgeable teacher with specialty in working with students with hearing loss
• Continuous progress monitoring to measure progress in closing learning gaps
• Revising IEP services and accommodations/supports to support GROWTH.

Note: the views expressed are those of Karen Anderson, PhD, and do not constitute legal advice.

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Transition services are required for students who are receiving specialized services under IEPs, starting no later than age 14. Unfortunately, Transition is often thought to be satisfied by a check off form with little true instruction. Effective and timely instruction during Transition is necessary for the future success of students who are Deaf or hard of hearing.

For more than 45 years, researchers have demonstrated how transition from school to postschool environments can be affected. The keys to success in transition are not many, and they are not complex. Nonetheless, few schools “do” transition successfully. The National Deaf Center has links to Postsecondary Outcomes of persons who are deaf or hard of hearing in each state. Nationally, only 48% of persons who are deaf or hard of hearing are employed and employment rates increase with education and training. Good Teen Transition services mean better readiness for post-secondary success. How did students in your state do in postsecondary achievement?

Transition services means a coordinated set of activities that are outcome oriented, based on the student’s individual needs and preferences, to prepare them to face life as an adult. In 2007, the Office of Special Education Programs required states to develop a comprehensive state plan on 20 specific indicators; Indicator 13 dealt with Transition. The questions that the IEP team should ask of each student’s education program at Transition are:

1. Are there appropriate measurable postsecondary goals in the areas of training, education, employment, and, where appropriate, independent living skills?

2. Are the postsecondary goals updated annually?

3. Is there evidence that the measurable postsecondary goals were based on age appropriate transition assessment(s)?

4. Are there transition services in the IEP that will reasonably enable the student to meet his or her postsecondary goals?

5. Do the transition services include courses of study that will reasonably enable the student to meet his or her postsecondary goals?

6. Is (are) there annual IEP goal(s) related to the student’s transition service needs?

7. Is there evidence that the student was invited to the IEP team meeting where transition services were discussed?

8. If appropriate, is there evidence that a representative of any participating agency was invited to the IEP team meeting?

From the National Deaf Center, a 2-page transition guide specifies Essential Transition Questions:

• What kinds of extracurricular experiences will provide opportunities to learn social and problem-solving skills?
• What kind of classes will prepare the student for postsecondary programs and/or employment?
• Will the student work in high school?
• Will the student participate in general education classes or will they need more intense training to achieve their postsecondary goals?
• What types of accommodations are needed in different situations?

Per the Minnesota Transition Guide for Teachers of the Deaf/Hard of Hearing (see Goodies below), throughout transition planning students should continue to increase their self-advocacy skills:

• Ability to describe their own skills and needs
• Ability to set their own goals and create a plan to reach them
• Knowing the how, who, and when to ask for assistance
• Ability to make decisions and take responsibility for the consequences of those decisions

Teaching Transition Skills

1. Refer to C.O.A.C.H. for specifics on how to work with tweens and teens to teach these skills! Self-advocacy skills are taught beginning in preschool through grade 4, switching to problem-solving for self-determination by age 12. If you only teach self-advocacy without teaching problem-solving for self-determination you are doing only half the job! See the self-advocacy webpage for more information on skills and age expectations.

2. The Ida Institute has free Transition Management resources to enhance teaching tweens and teens

a. Telecare for Teens and Tweens assist students in formulating questions for their audiologist, describing their hearing loss to others, getting family members involved in supporting communication needs, learning communication strategies, and learning how to self-manage their hearing loss.

b. Transitions Management is a suite of materials, including nice videos, that relate to different transition periods in the life of the child with hearing loss. Check out the Being a Tween and Being a Teenager videos and the other well-designed materials this extensive website has to offer. Although the videos feature British children, they are captioned and provide a rich resource for discussion and learning.

c. 12 free lessons for teens on legal rights, self-advocacy, personal and interpersonal skills. Thanks to Dr. Kris English for making her e-book, Self-Advocacy for Students who are Deaf or Hard of Hearing freely available on the SSCHL website. Scroll to the bottom of the self-advocacy webpage to access each of these lessons

Communication skills and access to communication are critical to success in employment settings. Being well versed in communication strategies to support successful interactions is an important skill that needs to be further honed during the transition years. Transition-aged students should have a good understanding of their hearing loss and have practiced explaining its impact in preparation to do so with an employer or coworkers. Other communication skills include:

• sharing communication strategies that were previously successful in other settings,
• showing employer inexpensive options for making environmental cues visible,
• asking available resources to offer deaf awareness training for employers, and
• knowing about and communicating workplace accommodations.

In addition to meeting academic requirements, students need to have strong self-advocacy, time-management, money management, and independent living skills to be successful in postsecondary settings. By using the Postsecondary Competency Skills Checklist (see Goodies below), IEP teams can help the students evaluate their readiness for postsecondary settings.

Transition for Students Who are “Low Functioning Deaf”

In 1999, an estimated 2000 students in the US who were deaf or hard of hearing were identified by state vocational counselors as “low functioning deaf.” This term is defined as having reading levels under second grade, low math, reading and other subjects (second to fourth grade), and/or have a secondary disability. These students drop out of school at a higher rate than other students with hearing loss. They require a much greater emphasis on vocational and independent-living skills than is now provided in most secondary schools. Read the article by Bowe, below, for more information. With many similarities to programs for higher functioning students, transition programs for lower functioning students with hearing loss should include:

• training students in job-specific skills, preferably on site
• prepare them to make good decisions and advocate for themselves
• emphasize the “unwritten rules” of the workplace and key skills of good team members
• introduce students to available vocational rehabilitation resource to support career transitions
• develop an understanding of civil rights (Americans with Disabilities Act) on the job and in the community
• help students appreciate the opportunities and limitations of government supports (i.e., Supplemental Security Income)

A Step Toward Post-High School Readiness

The Rochester Institute of Technology (RIT) Communication Studies and Services Department provides a broad range of support to expand post high-school student’s communication skills. Contact RIT to receive a $65 voucher your students can use toward one of RIT’s summer camps for middle or high school students who are deaf or hard of hearing (grades 5-12).

References

• National Deaf Center on Postsecondary Outcomes (2017). Transition Planning. https://www.nationaldeafcenter.org/sites/default/files/asset/document/Transition%20Planning.pdf
• Bowe, F. G. (2003). Transition for deaf and hard of hearing students: A blueprint for change. Journal of Deaf Studies and Deaf Education, 8(4), 485493.
• Minnesota Transition Guide for Teachers of the Deaf/Hard of Hearing (2012)
• Ida Institute: https://idainstitute.com/toolbox/
• Supporting Success for Children with Hearing Loss, Self-Advocacy: 12 free lessons for tweens and teens
• Rochester Institute of Technology Summer Camp Program http://www.rit.edu/academicaffairs/koc/

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Who is Responsible for Providing FAPE?

I enjoy receiving e-newsletters from WrightsLaw and found their information on a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to be very interesting. Although it is written for the parent’s perspective, the responses may be equally appropriate when professionals are advocating for access and reframing the concept of LRE in terms of students who are deaf or hard of hearing.

The purpose of the IDEA is “to ensure that all children with disabilities have available to them a free appropriate public education that emphasizes special education and related services designed to meet their unique needs and prepare them for further education, employment, and independent living…” 20 U.S.C. 1400(d). Is the IEP designed to meet the child’s unique needs? Will the goals in the IEP prepare the child “for further education, employment and independent living?” The answers to these questions will help to determine if the IEP is appropriate and provides the child with a free, appropriate public education.

Educational Benefit

Courts have held that to receive a free appropriate public education, the child must receive meaningful educational benefit. How will you know if the child is receiving “meaningful educational benefit”? As this issue of the Bimonthly Updates discusses, you use objective information from tests that measure the child’s knowledge and skills.

The legal landscape is changing. The No Child Left Behind Act of 2001 requires states to adopt high academic standards for all children. The law also requires schools to test all children to determine if they are mastering these standards. When Congress reauthorized IDEA in 2004, the focus shifted from access to the schoolhouse and compliance with procedures to improved outcomes for children who receive special education services.

In Endrew F. v Douglas County (March 22, 2017), Chief Justice Roberts explains that SCOTUS is not reversing the old Rowley standard, but – if a child is not fully integrated in the regular classroom, the focus on FAPE shifts even more to the “unique circumstances of the child.” Read the analysis.

Who is Responsible for Providing Free Appropriate Education (FAPE)?

The school is responsible for providing the child with a free appropriate education (FAPE). The child’s Individualized Education Program (IEP) is the roadmap that describes how the school will provide your child with a FAPE.

“The IEP provisions [of IDEA] reflect Rowley’s expectation that, for most children, a FAPE will involve integration in the regular classroom and individualized special education calculated to achieve advancement from grade to grade.” (Page 11)

“When a child is fully integrated in the regular classroom, as the Act prefers, what that typically means is providing a level of instruction reasonably calculated to permit advancement through the general curriculum.” (Page 13)

The decision is clear. Being “fully integrated” and “making progress in the general education curriculum” are the keys. If a child is not fully integrated, the focus shifts even more to the “unique circumstances of the child.”

The “IEP Must Enable Child to Make Progress: A Plan for Academic and Functional Advancement”

Resources

Wrightslaw article: Who is responsible for providing FAPE?

Wrightslaw analysis of Endrew v. Douglas County: IDEA demands more: Inclusion & Progress in Regular Curriculum: IEP Tailored to Unique Needs.

Note: the views expressed are those of Karen Anderson, PhD, and do not constitute legal advice.