7 Ways to Gather Great Information
for Early Intervention to Preschool

Communication skills are at the heart of our concerns about the development of young children who are hard of hearing or deaf.

We need easily administered, functional, and fun ways to assess children’s development and to plan needed intervention.

Check out 7 ways we recommend gathering information on the communication of active children in early intervention to preschool!

• Do you work on communication needs with families of infants and toddlers with hearing loss?
• Are you part of an evaluation team assessing children with hearing loss exiting early intervention services?
• Do you sometimes have preschoolers on your caseload and need a place to start?
• Would you like functional assessments for young children that have been used with children who are deaf or hard of hearing?

Read on for 7 Ways to Gather Functional Information and Plan Intervention

1. 1. Teddy Talk Test

We were so excited to come upon the British Teddy Talk Test! Fully adapted for North American users, it is a simple, easy to use language assessment for children 18 months to 5 years. It has been successfully used in the UK by hundreds of professionals, including teachers of the deaf/hard of hearing. Test materials come in a drawstring bag and the test items are simple to administer. The comprehensive instruction book explains administration. Included are 6 action pictures and 6 talk about pictures to engage young children and provide plenty of opportunity for evaluating vocabulary and simple sentence structure, whether the child is using spoken or signed language.  Results are correlated with the CDC Developmental Milestones. The Teddy Talk Test Summary sheet enables a profile of the child’s skills to be created regarding play and social skills, understanding spoken language, talking and communication, and speech sound development. Any caregiving adult interested in monitoring children’s communication skills can use the Teddy Talk Test.

2. 2. DRIP-EY – Diagnostic Record Intervention Plan for Deaf and Hard of Hearing

The Diagnostic Record Intervention Plan for Deaf and Hard of Hearing was an immediate HIT when it was first announced a month ago. Why? Because the DRIP-EY provides you with a concrete document to collect the necessary language data, as well as a graph to monitor and analyze a child’s developmental progress in both ASL and English. It has an easy-to-use system to help you calculate the quantity of intervention needed, based on the size of the language gap, as well as tools to aid the professional in developing appropriate language 6-month and 1-year goals of the highest quality. The DRIP-EY targets birth to 3 services as our goal, regardless of communication mode, time of identification, and hearing technology, is to have an age-appropriate language level by kindergarten. The manual very clearly lays out the necessary components of language acquisition versus language learning and why children with hearing loss are often at risk for language delays. The authors are strong proponents of bilingual instruction (ASL as L1 and English through print as L2) and this tool was specifically designed to monitor bilingual language acquisition. However, the DRIP-EY can be used with listening and spoken language users too as a way to figure out the language gap and specific benchmarks to be met to close that gap. The DRIP-EY is a powerful addition to any DHH educator working in early childhood.   

3. 3. Early Listening at Home Curriculum

This is a curriculum for early intervention providers working with parents of children from birth to age 3 who are deaf and hard of hearing and beginning to learn listening and spoken language. It outlines skills and strategies to support parents and caregivers, including techniques for effective coaching, planning, and reflecting. There are 47 one-page activities for families to practice early listening skills and a simple form to track and follow up on progress. Transition to preschool with this information solves the question about the need for auditory skill development and appropriate goals. It also offers practical, shareable resources in English and Spanish and a tool for EI providers to help parents help their child become comfortable with hearing device use during all waking hours.

4. 4. Carolina Curriculum

The Carolina Curriculum is a long-time staple in providing assessment and intervention to infants, toddlers, and preschoolers with special needs. The curriculum comes with two parts, one for infants/toddlers (0-36 months) and one for preschoolers (24-60 months). Each item on the assessment tool is linked directly to a curriculum item that describes procedures for teaching the assessed skill. Assessment is linked to intervention through hierarchies of developmental tasks that are both relevant to typical routines and pertinent to long-term adaptation—thus integrating the intervention in a meaningful way into the child’s life. The Carolina Curriculum provides a comprehensive picture of the child’s development and helps teachers to clearly track child progress. There are domains of focus in the curriculum: personal/social, cognition, communication, fine and gross motor skills. Where the DRIP-EY and Early Listening at Home curriculums focus on the communication needs of young children with hearing loss, the Carolina Curriculum provides a broader context of overall development, which is key for planning appropriate placements.

5. 5. MacArthur Communication Development Inventories – customized for young children who are Deaf and Hard of Hearing

Larry Fenson, author of the MCDI, has very generously allowed use of communication development inventories that have been customized for children with spoken, signed, or cued expressive language – at NO COST. These simple inventories are provided to families to indicate the growth in expressive language over time, from 8 months to 36 months. Each of the inventories has been customized so families can indicate expressive language that is spoken, signed or cued, so that a complete picture of growth across modalities can be captured and compared to typically developing peers. The MCDI is an integral part of many early intervention programs. Download these customized inventories and the norm graphs from Teacher Tools Takeout. Part of the Teacher Tools Library!

6. 6. Parent Interview Progress Report

If a family wants their child’s language to progress at appropriate rate of development, there are some basic things they need to be aware of and include in their daily lives to facilitate communication. This free checklist is designed to allow the interventionist to discuss the child’s progress in language within the context of their consistency in providing communication access. Can be combined with the Formula for Success Contract, which helps clarify the responsibility of the family, and the early interventionists, in facilitating child communication development.

7. 7. Early Intervention Kit

The Early Intervention Kit is a great supplement to the hearing-loss-specific materials you already may be using (i.e., DRIP-EY, Early Listening at Home). Whether you are new to early intervention or a seasoned veteran, this Kit has ‘grab-and-go’ information that you will find yourself using with families again and again. Effectively address assessment, intervention, and documentation for pre-linguistic skills, speech and language development, and sound production. Filled with intervention techniques and skill hierarchies, the Kit will be a good resource for planning your intervention services and is complete enough to be a useful text for university programs. The Therapy Guide has information on assessment, goals, treatment, 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. Ages: Birth-3 Grades: Birth-PreK.

 

Children who are deaf or hard of hearing are not ‘just kids with language delay who use hearing devices or sign’. They require the involvement of interventionists with a deep knowledge of how hearing loss impacts communication and other areas of development. In turn, these professionals need to have the tools they need to appropriately assess, plan intervention, and work with the families of these children. These 7 items all contribute to appropriate services for young children who are deaf or hard of hearing, birth to 3, and to gather information for preschool transition and beyond.

Captioned Media to the Rescue!

Our overall goal is to ensure that students with hearing loss have the same access to instruction as their peers – this includes educational media.  Professionals and family members of students who are early learners through high school and have a disability are eligible for a free membership to an extensive library of captioned educational media. This is an EASY way to make sure students who are deaf or hard of hearing can access educational videos as readily as their classmates.    

The Described and Captioned Media Program (DCMP) is a federally funded project whose mission is to promote and provide equal access to communication and learning through described and captioned educational media.  If you haven’t taken a look at DCMP in a while, look again!

DCMP maintains an online video library of thousands of accessible educational titles

Videos are a matchless educational tool that can inspire and engage students.  They are uniquely suited to take students on impossible field trips inside the human body or into outer space.  They can introduce students to different cultures, peoples, and environments. They can reach students with a variety of learning styles, build critical thinking skills, and provide common experiences to begin discussions.  But they can’t do any of this if they aren’t accessible to everyone.   A teacher of the deaf said, “Lack of access deprives students of opportunities for learning and places them at a serious disadvantage.”

Students who are deaf or hard of hearing need captions to be able to access the audio portion of a video.  Students who are blind or have low vision need audio description to understand the visual components of a video.  However, the accessibility features also benefit students with learning disabilities, those on the autism spectrum, and many more.  Captions have been shown to increase reading skills and audio description improves vocabulary.

Another important point about captions and audio description is that these accessibility features must be high-quality to be effective learning tools.  If they are not high-quality, they can lead to misunderstandings and misinformation.  One clear example is captions created by inferior automatic speech recognition (ASR) software, such as that used by YouTube automatic captions. When inferior ASR software is used, the captions may be 80 – 90% accurate.  This doesn’t sound so bad but in reality, it can leave huge gaps in content.  Also, ASR captions may not include speaker identification, punctuation, or sentence structure.  An individual who is a fluent reader may be able to understand some of the content this way, but for emerging readers these captions are less than useless.  DCMP is a leader in high-quality captions and audio description.  To learn more about captioning standards, refer to the Captioning Key and for information on description standards, refer to the Description Key.

Teachers and parents need look no further than www.dcmp.org to find high-quality accessibility along with high-quality educational videos.  DCMP videos are selected for their educational content and are correlated with Common Core and State Standards.  Thus, teachers will see all the standards a video matches when they click on the “Standard” link, or they can search for a video to teach a specific standard required by their curriculum. 

Here is what one educational interpreter had to say about the need for accurate captions: I have found through the years that much of the captioning on the internet and television programming is not accurate… Whenever DCMP material is used, it is always accurate, matching to what was truly spoken.  It can be depended on to provide an equivalent learning experience for all of the students in the classroom.

Once teachers have selected appropriate videos, they can begin to build assignments around the video by use the Clips and Lessons features.  These features allow teachers to select portions of DCMP videos, create clips, and then use those clips as standalone videos, or as part of a lesson. A lesson can include clips, full videos, quizzes, text, and user-submitted files. DCMP has created a six-minute walk-through video to help teacher get started using these features.

To help students gain full benefit of the DCMP site teachers and parents can create subaccounts for them.  This allows the adult to assign the student videos for classwork or as a reward and ensures that the student does not have unmonitored access to videos in the collection.

Viewing DCMP videos is as easy as accessing the internet.  Almost any internet enabled device will work: desktop computer, laptop computer, smartphone, or tablet.  There is an iOS app, a Roku app, and an Apple TV app.  Videos can also be embedded in learning management platforms.  The website has an interface that allow users to choose the audio language, description, and captions, then generates the embed code.  This means teachers can easily share videos with their students.

A sign language interpreter shared how important equal access is for the students she works with: Within the school, it is very hard to find free resources that can help the students feel as inclusive as possible and DCMP has help to provide that. By working within these environments, I have personally seen the benefit that they have provided. Seeing a student become engrossed in participating in classroom discussion because of the Caption Media videos provided by DCMP is gratifying. We have a very rewarding feeling knowing that showing these videos gives the student confidence and educational success. Without DCMP it would become more of a struggle giving the student a more accepting environment to learning in. I am very thankful for all the tools they provide.

DCMP recently changed video players to one that supports player-based accessibility.  This means that users have more options in customizing how they interact with a video.  The caption settings can be customized.  Users can choose the font style, size, and color, as well as the background color and drop shadow.   Video speed can be adjusted by clicking the Playback Rate icon. The pitch of the audio remains the same, regardless of the speed. Students who need additional time to process the video and captions can slow the speed.  Users can choose to turn on both captions and description for the same video.  With the legacy player, users were forced to choose one or the other.  And with the new player, users can mix and match the audio tracks.  Some videos have both an English and Spanish version.  For these, a user can choose English audio and Spanish captions or vice versa.  This feature is very helpful to bilingual families.  Read more about Player-Based accessibility in the Learning Center.

Another new feature that has recently been added is the ASL pop-up.  While DCMP has hundreds of videos in ASL (which can be identified by the circular ASL icon), our new pop-up feature allows for the addition of sign language interpretation to content that is not natively in ASL. Videos with the pop-up feature have an “interpret” icon at the bottom of the player window. Click the icon to launch the pop-up, and reposition the window by clicking and dragging.  There are currently a limited number of videos with the ASL pop-up, but don’t worry; DCMP will be producing more. 

A school curriculum coordinator shared: Not only has DCMP changed the way that I am able to teach and engage students over the years, it has helped me educate my teachers on best practices. I was fortunate enough to partake in the Using Accessible Media in the Classroom with Students who are Deaf and Hard of Hearing QuickClass. The information that I learned from this course and was able to bring back and share with my teachers has changed our entire approach to using media in the classroom and throughout the entire school.

DCMP videos also allow users to view, download, and print the transcript of the captions and/or the audio description. Transcripts can be used to pre-teach vocabulary, as a study guide, and much more. Downloading the caption and audio description transcripts together make the videos accessible to students who are deaf-blind.

Students are not the only ones who will benefit from DCMP.  There are many videos for educators and families to learn more about working with and raising a child with a disability.  Additionally, DCMP offers several opportunities for professionals to earn Continuing Education Credit through online modules, workshops, and facilitated QuickClasses.

DCMP is a free resource for educators and families of students who are early learners through high school and have a disability.  There are videos on all academic topics as well as self-advocacy, independent living, transition, and so much more.  A teacher of the blind summed it up very well when she said, “The quality of the materials presented, as well as the selection, is outstanding. I often turn to DCMP for media that can be used to enhance understanding for my students and make my lessons more meaningful and engaging.” 

The DCMP is funded by the U.S. Department of Education and administered by the National Association of the Deaf. 

 

Author: Cindy Camp, DCMP Marketing and Communications Specialist

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What is Appropriate School Progress?

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!

If the collected data on annual yearly progress indicates that the student has an increasing gap in academic skill achievement then the type, degree, and/or level of support needs to change to increase the level of access and improve understanding of classroom communication and curricular information.

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 learn 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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Fatigue from Listening with Hearing Loss in School

Individuals with hearing loss must put forth more “listening effort” and cognitive resources to attend to auditory information, which can be exhausting. The repeated need for extra listening effort in challenging situations can lead to listening-related fatigue. For children, severe fatigue is associated with increased stress, poorer performance in school, and increased absences. Educators, audiologists, and other hearing health professionals can support students dealing with listening-related fatigue. Read on to learn about how to help your student avoid or recover from listening-related fatigue.

Fatigue is often described as being extremely tired, a lack of energy, and/or a lack of motivation to continue on with a task. Intuitively, we understand that we can get worn out from time to time, from both physical tasks (e.g., running) or mental tasks (e.g., focusing all day at work). It is very common to experience this type of fatigue and healthy individuals can bounce back relatively easily with breaks or recovery periods. However, for some individuals, fatigue can be debilitating, and recovery is difficult. This is concerning as long-term outcomes related to fatigue can be negative, affecting quality of life and work performance in adults. For children, severe fatigue is associated with increased stress, poorer performance in school, and increased absences. It can also be a precursor to mental health problems in adulthood.

What does fatigue have to do with listening and children with hearing loss? Recent research has shown that even the “simple” act of listening and understanding can be exhausting. Individuals with hearing loss must put forth more “listening effort” and cognitive resources to attend to auditory information. The repeated need to expend effort to listening in challenging situations can lead to listening-related fatigue. For children with hearing loss, the school classroom and associated listening requirements can be fatiguing. We know that most modern classrooms can have poor acoustics with significant reverberation times and elevated background noise (challenge #1) and that students have to listen to multiple talkers throughout the day (challenge #2) while multi-tasking by listening and performing other functions, such as note taking (challenge #3). These factors, as well as others, may contribute to a child with hearing loss developing listening-related fatigue.

Children with hearing loss reported feeling physically and/or mentally tired as the result of noisy listening situations. Teachers reported increased distractibility and off-task behaviors compared to children without hearing loss, especially at the end of the school day. Parents noted several coping strategies, including removing amplification devices (e.g., hearing aids, cochlear implants), taking a rest/nap after school, and avoiding noisy social situations as methods to deal with fatigue.

Of course, not all children experience the same challenges or have the same needs. We are interested in determining which children with hearing loss are most at risk for significant fatigue so that we can help them clinically and educationally. To do so, we have been developing pediatric fatigue questionnaires that specifically target listening-related fatigue in children. First, we wanted to better understand the concept of fatigue from children with hearing loss, their parents, and their teachers by hosting focus groups and interviews. Example quotes obtained from participants in the focus groups follow on the next page. These responses, as well as others provided by the participants, helped us to write items (i.e. questions) for our fatigue scales. While analyses are ongoing, we hope to have the Fatigue Scales available online for widespread use later in 2021.

“Yesterday we took a field trip to a museum. The gentleman was great, but he spoke so fast—she was still missing stuff in a very hectic environment. If things go really, really quick for her, I can tell it’s a lot for her. She has to make an effort and it wears her out.” –Parent of a child with hearing loss             “When I get tired of listening to things, I just tell my friends, “I’m tired of listening to you, I’m gonna turn you down [turn volume down on hearing aids]. If you need me, tap me.” And I just do that for fifteen, thirty minutes.”–Teen with hearing loss             “I must remember to give my student a break during one-on-one sessions. He needs a moment to not have to listen and to tune out. If he doesn’t get that break, his behavior is significantly impacted.” –Speech-language pathologist

Educators, audiologists, and other hearing health professionals can support students dealing with listening-related fatigue. Consider signs and symptoms of listening-related fatigue in your students. We found that many children did not realize they were experiencing fatigue throughout the school day. In fact,

Do your students complain of being tired or worn out more frequently than students without hearing loss? Do they zone out or have trouble concentrating during long periods of listening? Do they take their devices off throughout the day? Do their parents note that they require listening breaks or naps after school? If so, talk to your student about fatigue.

several adults with hearing loss told us that they could not articulate their difficulties with listening-related fatigue until young adulthood.

Students may need support to better understand challenging listening situations and how to advocate for themselves, if needed. Discussing this topic with parents, teachers, and administrators is important too. The students who participated in our study felt limited in their abilities to ask for interventions, such as breaks, because of the structure of the school day. It is important for the whole team to strategize best practices to support each student.

What will help your student avoid or recover from listening-related fatigue?  Although no systematic research has been completed on listening-related fatigue interventions, there are several considerations that may be beneficial for your students.

• Assess the student’s listening environment. Look for ways to improve acoustics by minimizing background noise or reverberation in the space. Participants repeatedly reported background noise as fatiguing.
• Provide accommodations, such as preferential seating, captioning, or note-taking by a peer. Anything that may help reduce effort while listening could be helpful for your student.
• Review the student’s amplification use (both personal amplification and school-owned remote microphone technology). Although research on amplification and fatigue reduction is mixed, teachers reported that students appeared less fatigued when utilizing their technology consistently.
• Employ good communication strategies (and encourage others to do the same). Participants reported that children got fatigued more quickly when others spoke too quickly or had their back turned. Ensure the child can see the person talking.
• Review the student’s schedule. Many teachers said the students were worn out toward the end of the day/end of the week. If you can, schedule auditory-heavy content at the beginning of the day or at a time when your student can do their best work.

Counsel the student about fatigue. Discuss challenging listening situations and involve them in determining potential interventions or coping strategies to alleviate fatigue if it arises. Practice scripts so the child can appropriately ask for an intervention if needed.

• Schedule “listening breaks” so the student can intentionally turn off from listening. There is no current consensus on the duration, frequency, or type of break required. Needs may vary based on the individual student. Suggestions from participants in our study included allowing the child to rest their head on the desk, take off their device for a short period of time, complete a leisure activity that does not require listening, or complete a movement break.
• Be on the lookout for the Vanderbilt Fatigue Scales! Analyses are ongoing but we hope to have the assessments available online for widespread use later this year. Check our website for links to our publications and to keep up-to-date on the release date for the scales.

   

Hilary Davis is a pediatric audiologist at the Vanderbilt University Medical Center in Nashville, TN. She sees patients in the Bill Wilkerson Center, provides contract educational audiology services to local school districts, and collaborates on several research studies within the department. Her current interests are fatigue in school-age children with hearing loss and supporting educators as they work with students with hearing loss.

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Study Skills for Children who are DHH

Research2,3 indicates that healthy executive function skills do not require hearing. Age-appropriate language proficiency, whether in sign or speech, is crucial for the development of healthy executive function skills. The greater the language delay the greater the probable need for development of executive function skills. There is also research4 that indicates if a preschool child with hearing loss scores within the normal range in language skills, but exhibits executive function issues, it is predictive of subsequent language development issues.

All Children need direct teaching of study skills so they can efficiently process the information they encounter in school. Executive function issues require direct teaching in study skills. Students with hearing loss can benefit greatly from strategies to help them stay focused on tasks to do. Read on for more about executive function and specific study skills strategies.

Study skills help us manage tasks. People with executive function issues need greater attention to study skills. Executive function refers to mental skills including¹ working memory, flexible thinking, inhibition/self-control including controlled attention. Executive function is responsible for many skills, including:

• Paying attention
• Organizing, planning, and prioritizing
• Starting tasks and staying focused on them to completion
• Understanding different points of view
• Regulating emotions
• Self-monitoring (keeping track of what you’re doing)

Students with hearing loss often have difficulty with many of the items listed above, secondary to missing part of communication messages and continually trying to catch up and keep up. Structure is often key to the success of our students, in terms of predictable learning routines and expectations. Yet, outside structure alone will not compensate for the extra organization and strategies our students need to keep pace with their peers. Below is a list of study skills in context to the broader areas of learning. ⁵

Activities Related to Learning	Study Skills Strategies
Processing information	Graphic organizers Comprehension strategies
Retaining and recalling information	Mnemonic strategies Note-taking
Organizing materials and managing time	Time management Materials organization
Selecting, monitoring, and using strategies	Self-regulation strategies

Strategies to Build Better Study Skills

The time-honored quotation, “When the student is ready, the teacher will come,” reassures that learning will happen when the time is right. Unfortunately, our standards for teaching and learning are not set up to patiently wait for that time!  Learning requires students to assimilate and generalize information in quick order.  For many of our students who are deaf or hard of hearing, the explicit teaching of study skills will help them become “ready.”

Learning styles, personality traits, interests, motivation, energy level – each student comes with a jumble of these variables.  Keep in mind these personal characteristics in determining which study skills to promote and practice.

Organizational Strategies

Organization is key.  Helping our students become organized begins at the earliest stages of development.  Review these tools for fostering language and cognition, the “pre-study skills” of a study skills curriculum.

Sorting and categorizing:  Emergent language learners are surrounded by disconnected sights and sounds. Structure the environment with items to sort (color, shape, size) or categorize in groups (types of animals, cars, toys).
For older students: group multiplication facts by number; group story events by beginning, middle or end; or group historical events by country or decade or impact.

Break it down:  Prevent the learning task at hand from becoming a drudgery by breaking it down into small parts. Those multiplication facts are overwhelming unless taken one number group at a time.  Drill and practice are most effective if kept in small doses.

Using a Planner: These come in a variety of shapes and sizes and are worthwhile aids for many students.  At best, they foster independent study skills.  At worst, they become one more skill to learn in an already overloaded heap.  Recognize what your student is capable of fitting into his or her study schedule and introduce sparingly.

Clean Workspace: No extraneous devices allowed! The first rule for students of all ages is to keep distractions at a minimum. Provide a designated area in the classroom or home that is well-lit, quiet, and dedicated to studying.

Comprehension Strategies

Study skills provide the framework for comprehension:  their strategies go hand-in-hand. Working on auditory memory to improve retention and recalling information is a natural goal when working with DHH students.

Retelling: Once we tell something in our own words, we begin to implant it in memory. Retelling is a powerful comprehension and study strategy when carefully matched to communication abilities, attention, and interests. Ask young students, “what happened?” and wait, patiently, for the response.  For older students keep your questions specific and structured: instead of asking, “What happened in school today?” ask for the details: “Tell me three new spelling words;” or “tell me 3 things that happened in science,” or “What are 3 things that happened in the story?” Start small and build on the responses.

Visualizing: Another powerful strategy to stimulate memory and learning is to provide students with visual cues.  Take full advantage of manipulatives, videos, photographs.  Language experience stories (pairing pictures with the steps of a science experiment or social studies chapter or fieldtrip) give students visual reminders.  If your only device is paper and pencil, a “quick draw” sketch activates memory and prompts conversation: “Did you actually see bugs in the science lab? Is that a molecule? What are these parts?”

Memorization:  Memorizing just for the sake of memorizing, without context, may be outside the sphere of critical thinking and learning, yet there are times when facts need to be memorized. There are ways to make memorization less tedious:  mnemonics (remembering a list of facts by the first letter of each word such as the names of the Great Lakes: “Super Man helps every one!”), flash cards, treasure hunt to find fact cards, rewards for progress goals, homemade game boards. The bottom line:  make goals achievable, make the activity fun, and make the reward worthwhile to the student.

Writing on paper versus typing on a screen: Researchers suggest that the physical act of writing on paper increases focus and critical thinking. Henriette Anne Klauser, Ph.D.⁶, believes that writing on paper triggers and 

activates the brain to “wake up!  Pay attention!”  Writing may seem tedious to students when curriculum has been centered on computers and tablets, yet It makes good sense to incorporate writing on paper as one of many options.

Taking Notes: Whether a student is writing on paper or typing on a de vice, the act of taking notes is a skill that requires practice. Provide note-taking materials and directions prior to a video or presentation and options (planner, targeted computer file, PPT handout, etc.) for filing and organizing the information when completed. Graphic organizers designed ahead of time can provide designated spaces for students to write down things to remember and learn. Use these notes to retell and reflect on the event so the purpose for taking them is recognized.

Graphic Organizers: These are invaluable in breaking down information, visualizing, organizing, simplifying, mapping. There is no need to rely on premade materials: simply draw circles or boxes to separate ideas, facts, number families, and there you have it!  Find patterns to copy online or use suggested graphic organizers below to adapt and personalize.

Motivation

The heart of self-determination is personal goal setting. The more you allow students to establish their own goals for learning, the more motivated and successful they will be. Writing personal goals gives students a sense of control, self-awareness, confidence.  Help your students set up attainable daily or weekly goals and use charts or graphic organizers to visually show progress.
Motivation to persist with any task relies on your student’s attention span. After five or ten minutes, take a break!  For students who need activity, give them a chance to move their bodies or run around the playground.  For students who need to be calm, do some coloring or painting.
Remember to provide rewards (tangible or intangible) for time spent on task even when learning the facts or concepts is not yet accomplished.  The primary goal of a study skills curriculum is to establish the routine of studying.  The mastery of information to be learned will be its own reward.

See some materials in Teacher Tools Takeout that relate to areas of study habits include:

https://teachertoolstakeout.com/search?insubgrp=all&q=setting+goals https://teachertoolstakeout.com/0715-specific-advocacy-strategies https://teachertoolstakeout.com/0748-specific-advocacy-strategies https://teachertoolstakeout.com/0842-multiple-meaning-words
https://teachertoolstakeout.com/0901-science-specific-language https://teachertoolstakeout.com/0980-visual-supports-reading

References:

• https://www.understood.org/en/learning-thinking-differences/child-learning-disabilities/executive-functioning-issues/what-is-executive-function
• Figueras, Edwards, Langdon (2008). Executive Function and Language in Deaf Children. Journal of Deaf Studies and Deaf Education, 13:3,  362-377.
• Hall, Eigsti, Bortfeld, Lillo-Martin (2018). Executive Function in Deaf Children: Auditory Access and Language Access. Journal of Speech, Language, and Hearing Research, 61, 1970-1988.
• Kronenberger, Xu, Pisoni (2020). Longitudinal Development of Executive Functioning and Spoken Language Skills in Preschool-Aged Children with Cochlear Implants. Journal of Speech, Language, and Hearing Research, 63, 1128-1147.
• https://iris.peabody.vanderbilt.edu/module/ss2/cresource/q1/p01/.
• Henriette Anne Klauser, PhD https://srcxp.com/why-writing-is-important-for-students/#:~:text=Below%20are%2043%20of%20the%20reasons%20why%20writing,you%20have%20to%20talk%20to%20someone%20in%20person.

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Can Kids with Hearing Loss in Private or Charter Schools Receive DHH Support Services?

I recently had a call from a parent of a kindergarten student with hearing aids who was told by her private school that 1) the parent must pay for the FM/DM system and 2) that the child could not receive any special support for her learning needs due to the impact of the hearing loss. Like many parents she wanted to know if it was true that students in private or charter schools cannot receive special supports and services. The answer? Yes and No.

PRIVATE SCHOOLS – Some do, some don’t provide specialized services and supports

No private school can discriminate on the basis of race, color, or national origin, in admissions or in hiring, or anything else; those that do would lose their non-profit status from the Internal Revenue Service.

Many students with disabilities attend private schools that are under contract with public and charter schools; these students retain their right to a “free and appropriate public education,” or FAPE, in a “least restrictive environment,” or LRE. If the private school accepts students with disabilities and agrees to provide specialized services and supports, then these services should be appropriate to meet the identified needs of the student. This would include services by a teacher of the deaf/hard of hearing, speech language pathologist, and/or educational audiologist whenever needed to meet appropriate IEP goals or supports, like selection and fitting of hearing assistance technology (HAT).

If a private school does not offer programs designed to meet a student’s special needs, the private school’s inability to serve that child is not considered discrimination.

When families are seeking private school placement, they may be told that the school does not provide any special education services, meaning that if they choose to enroll their child in such a private school, they will be waiving the right to LRE and IEP services. If a family chooses to forego the services offered by their public schools, required by their Individualized Education Plan, and opts for a “parental placement” for their child instead, they also give up FAPE and LRE.

Under the Americans with Disabilities Act, private schools must provide “auxiliary aids and services” to students with disabilities who are otherwise qualified for admission, so long as these accommodations would not change the fundamental nature of the program or result in significant difficulty or expense. The clause about expense is why many parents of children in private schools must pay for HAT equipment for their child rather than having the school bear this expense.

Additional requirements under the ADA follow if the school receives public funds (such as through a state voucher program). In that case, schools cannot exclude a voucher participant based on disability if, “with minor adjustments,” such a student could reasonably participate in the private school’s education program. Religiously-controlled schools are exempted from these ADA requirements unless they receive federal funding.

SOURCE:   https://www.educationnext.org/private-schools-allowed-discriminate/

CHARTER SCHOOLS – All do, with the same expectations for appropriate services and supports

A charter school may not counsel out, i.e., try to convince a student (or parents) that the student should not attend (or continue to attend) the school because the student has a disability.

Section 504 requires charter schools to conduct any recruitment activities and provide the opportunity to apply to a charter school on an equal basis. During the admissions process, a charter school may not ask a prospective student if he or she has a disability. Limited exceptions include that, if a school is chartered to serve students with a specific disability, the school may ask prospective students if they have that disability. When a student with a disability is admitted to and enrolls in a charter school, the student is entitled to FAPE under Section 504. After enrollment, a charter school may ask if a student has a disability, which includes, whether a student has an individualized education program (IEP) or Section 504 plan.

Students with disabilities attending charter schools and their parents retain all rights and protections under Part B of IDEA that they would have if attending other public schools.

The primary purpose of the IDEA Part B program is for States and school districts to make FAPE available to eligible children with disabilities and to ensure that IDEA’s rights and protections are afforded to eligible children and their parents. Under IDEA, all students with disabilities, including charter school students with disabilities, must receive FAPE through the provision of special education and related services in a properly-developed IEP.

A charter school may not unilaterally limit the services it will provide a particular student with a disability. The responsible charter school LEA, or the LEA that includes the charter school, must provide a program of FAPE for the student in the least restrictive environment (LRE) in which the student’s IEP can be implemented.

States must ensure that charter school LEAs and LEAs that include charter schools meet all their responsibilities under Part B of IDEA, including the LRE requirements. In this context, the LRE provisions require that, to the maximum extent appropriate to their needs, students with disabilities attending public charter schools be educated with nondisabled students.

SOURCE: https://sites.ed.gov/idea/files/dcl-factsheet-201612-504-charter-school.pdf

PARENTS HAVE CHOICES
The typically smaller class sizes and high expectations of private schools are attractive to many families as their children with hearing aids or cochlear implants can perform age-appropriate work, but struggle in large group listening environments. Yet most young children with hearing loss continue to require specialized supports and services, such as work on auditory skill development, language, self-advocacy, and social communication, especially in the first years of elementary school. Private schools may or may not provide any of these supports. Charter schools can provide more creative environments or specialized themes that may suit a student with hearing loss. If families choose to go the charter school route, then they must be very involved in IEP planning and discussions of needed supports and accommodations. Whatever specialized services would be expected in a public school should also be provided in a charter school. Public schools may struggle to extend the staff and supports needed so that all students under their jurisdiction will receive appropriate services. A fully involved IEP team, including families, can make well-informed placement decisions for students who are deaf or hard of hearing.

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 10 Low-Tech Ideas for Virtual Instruction

 

Using technology with deaf and hard of hearing students has proven to be a learning experience for all of us.  Many of them do not have reliable internet connections, others prefer to use their parent’s phone to access virtual sessions,  and others did not have adult assistance to help them log on and learn the functions of buttons, etc.  The “learning curve” felt more like a never-ending steep uphill climb. And that’s just the technology aspect of the virtual session.   For these students, I had to go back to basics. I’d like to pass on a few ideas for fun and effective activities that can be used in online learning situations.

10  Low-Tech Ideas

1. Scavenger hunts – Using vocabulary words your students are learning, have them find objects in their home for a show and tell. I created a grid for opposites. We used shapes, colors, the five senses, multiple meaning words, comparatives and superlatives (big, bigger, biggest), object functionality, and container types.  Emotion words can be used as well, though not necessarily with tangible objects (describe a situation that made/makes you happy, angry, thankful, laugh out loud, etc.). For middle school students, you could use the periodic table of elements (show a household  example of the element Fe).

2. Vocabulary and Following directions – one of my student’s goals was to follow a two to three-step direction. I gave her directions to go to a specific room in her house, find something, bring it back and describe it. For example: Go to the kitchen, find something you eat for breakfast and the utensil/dish  you use to eat it, and bring it back.

3. Language and vocabulary – A tour of the home (with parent permission). My students enjoyed being able to show me around their homes and some of the things that were special to them (stuffed animals, pets, games). This was a great conversation starter and allowed us to also learn terms for some common objects and work on conversational turn taking.

4. Memory and vocabulary – Remember that game where items were put on a tray and shown for 10 seconds or so, and you were asked to write down or say what you saw? Start with 2 or 3 items and go up to as many as you can with students either putting answers in the chat function, writing on a whiteboard, or signing/saying what they saw. Share your screen with photos you’ve taken of the items, then “unshare” when the ten or so seconds are up.

5. Sequencing – For students who had a computer and a phone, take pictures of something that can be broken into steps, or has an obvious progression and show them. For example, making a sandwich, brushing teeth, doing a puzzle.  Ask students to describe the sequence using their pictures.

6. Math – if you and the student have a deck of cards, War is a game you can play to learn or reinforce the concepts of more than, less than. The winner of each hand has to state the math sentence, for example, “Five is greater than three.” The loser has to state the math sentence, “Three is less than five.” Math fact flashcards can also be used to practice facts.

7. Language, Vocabulary, Grammar (tense) markers – School or family pictures . My students love seeing pictures of my family, and especially pictures of me when I was in school (now quite some time ago!). With parent assistance, ask your student to find some pictures of their families and talk about them. Because I am with my students for years, I have scores of pictures of them. The older students enjoy seeing pictures of them and their classmates in their younger years.  For digital pictures, you can put together a deck of ten slides with pictures (it doesn’t have to be elaborate). For those of us who have actual photos, gather them up and show them. This is fun with school yearbooks as well.

8. Movement – Virtual dance party. I asked students for their favorite (school appropriate) songs, and then put together a playlist of dance videos. I had a group of students attend, but most of the movement was done by me. It worked better when they brought a stuffed animal or other prop and made it dance, and then got into dancing with their toy.

9. ‘Deaf’ Days – Schedule an optional call with your group and use one of the activities here as an icebreaker. My students enjoyed seeing each other online and getting to know more about one another. We had virtual ‘picnics’ and just visited with each other.  Some students had questions about the quarantine, the virus, and what it all meant for their families. It was a good non-threatening way to talk through some of their concerns and fears, and of course, challenging communication situations.

10. Writing – Using a predetermined topic, or just a chat, let students know that the only way to communicate is to use the chat function. Have them turn off their voices or signing hands and type.

Virtual learning can be fun AND effective with some creativity. Despite the obvious challenges, we have learned to persevere through the access challenges of virtual learning and in doing so have learned so much about ourselves and each other. From Teacher Tools Takeout here are some downloadable worksheets and/or more ideas on vocabulary development and attributes:
https://teachertoolstakeout.com/0842-multiple-meaning-words https://teachertoolstakeout.com/0882-attributes https://teachertoolstakeout.com/0883-attributes https://teachertoolstakeout.com/0884-attributes https://teachertoolstakeout.com/0885-attributes https://teachertoolstakeout.com/0886-attributes https://teachertoolstakeout.com/0888-attributes https://teachertoolstakeout.com/0889-attributes

Auditory memory:
https://successforkidswithhearingloss.com/product/no-glamour-memory-second-edition/
Auditory skill development:
https://successforkidswithhearingloss.com/product-category/auditory-skill-development-products/
Following Directions:
https://successforkidswithhearingloss.com/product/no-glamour-following-directions/

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ACCESS….Check!

 

Online education has been a struggle for many students. Those with hearing loss have additional issues when accessing virtual education. The CAVE Checklist or Communication Access in Virtual Education has been increasingly in use by DHH professionals since last fall. To learn about the CAVE and see some results in report form, Read More.

Timing is everything. The CAVE Checklist  was released just as many educators of students who are deaf or hard of hearing were searching for ways to ensure their students were receiving appropriate access to online learning AND ways to illustrate to school teams the need for appropriate access if the student’s access was less than required to meet class expectations. The CAVE  was received with much excitement and relief as a means to obtain information about student access levels during online learning.
Download:   English CAVE,   Spanish CAVE,   French CAVE,   Fillable English CAVE.

  The CAVE Checklist poses 10 questions that students must read (or consider in interview format) and then select the answer that applies in the situation most of the time. Very similar to the LIFE-R Student Appraisal (online, fillable form, or with pictures), the student must select  one of 6 responses.  Not every situation will apply to every student. Situations indicating appropriate access will be marked by the student as always or mostly easy. Situations in which difficulty was indicated need to be addressed for appropriate access needs.

The CAVE further asks the student what they think would help them most during online learning:

1. 1.) To have/use at home during e-learning I would like to:
2. 2.) During only learning my teachers would:
3. 3.) My comments about online learning

Example Use in Assessment Reports

Excerpts from example reports were provided by Vicki Anderson, AuD, Educational Audiologist. Details have been altered for student confidentiality.  Excerpts relate specifically to online learning situations to illustrate how the CAVE Checklist and an online FLE can assist in identifying access needs and recommendations.

Kindergarten (bilateral loss moderate, hearing aids, DM system, classroom amplification system):

Communication Access in Virtual Learning (CAVE Checklist): Developed by Karen L. Anderson, Ph.D. (2020), this self-assessment tool was designed to identify possible communication access issues that may occur during virtual education situations. Students check off closed-choice emojis representing their responses ranging from “Always Easy” to “Always Difficult” or “Doesn’t Happen”. The CAVE was completed on STUDENT’s behalf by her father and older brother, who help her with her online classes.  There were no online learning situations that were rated as Easy for STUDENT.  Even the best-case scenario (teacher’s face is visible on screen and a boom microphone is used) was rated as Sometimes Difficult for her to hear and understand the words the teacher is saying.  When (1) the teacher’s face is visible but she is not using a microphone, (2) when her face is not visible (e.g., showing a worksheet but she is using a microphone), (3) when her face is not visible nor is she using a microphone—any of these virtual situations are Mostly Difficult for STUDENT to access the content.  An interpreter and/or captioning is currently not used and captioning, nor is any other accommodation made to allow STUDENT to understand her classmates in discussions.  It was indicated that during e-learning, family thinks it helps her most to listen through the built-in speaker of her tablet, and to be able to see teacher’s face and the faces of her classmates when they are talking. In virtual learning, the teacher should use a boom microphone and assure STUDENT can see her face, with the computer camera on to allow student speechreading.  Age-appropriate captioning (e.g., key words and vocabulary) is recommended for all live or recorded sessions, including, PowerPoint and video presentations. With continued exposure, captioning and speechreading will improve her communication access and support her listening.

Elementary (bilateral loss mild, hearing aids, DM system)

Online Functional Listening Evaluation: this functional assessment samples the communication access of hard of hearing students in various virtual learning conditions.  We know that students with typical hearing respond with 90+% accuracy when listening in noise, even when the noise level is equal to the speech presentation level.  It is reasonable to assume that the degradation in sound that occurs when a teacher’s voice is presented over an internet streaming service (like Zoom) will not significantly decrease the speech perception and auditory comprehension ability of students with typical hearing.  For equal access, students with hearing loss should be able to perform with at least 90% accuracy during online learning presentations.

STUDENT was administered the online FLE test by the educational audiologist during a Zoom meeting accompanied by his IEP Manager.  Nonsense Children’s Phrases (C.D. Johnson, 2011) were presented under conditions representing the various teaching scenarios experienced during on-line learning. Nonsense Phrases were used to simulate new curriculum or new vocabulary.  STUDENT was wearing headphones over his hearing aids. Three conditions were tested. (1) In the ideal or “best” virtual condition, the presenter wore a boom microphone, the camera was on and STUDENT was encouraged to watch the face of the person speaking. The camera was turned off, as in a PowerPoint presentation, but the boom microphone was still used.(3) the computer microphone only was used along with the camera (visual speechreading cues). After that the computer mic was used and the camera was turned off, which exemplifies a typical live PowerPoint presentation.  Finally, to sample two in-person learning scenarios, a clear face mask was worn with only the computer microphone (no boom microphone), and lastly a clear mask was worn while using the boom microphone (this would also represent use of the Roger microphone plugged into the STUDENT’s tablet). Results show that for STUDENT to achieve equal access to school curriculum as his normally hearing peers, for virtual learning he needs the “ideal” teaching modality where teachers use a boom microphone AND allow speechreading with the cameral ON. For in-person education in a COVID environment, teachers should wear a clear mask AND use his remote microphone system.  In virtual learning, teachers should use boom microphones and assure he can see their face with the computer camera on, and use captioning for PowerPoint or video presentations.

High school (fluctuating conductive hearing loss, student choice to not use DM system, classroom amplification systems in use in each classroom)

Communication Access in Virtual Learning (CAVE Checklist): Developed by Karen L. Anderson, Ph.D. (2020), this self-assessment tool was designed to identify possible communication access issues that may occur during virtual education situations. Students check off closed-choice emojis representing their responses ranging from “Always Easy” to “Always Difficult” and “Doesn’t Happen”.  STUDENT reported appropriate (“Mostly Easy”) access in 5 of 10 online learning situations.  Two situations were rated as “Sometimes Difficult”: 1) When teachers show information on the screen and their face is not shown, and they are not using a microphone (only the computer microphone); 2) When classmates are talking into the microphone of their devices during a group discussion.  Three accommodations she indicated “Doesn’t Happen” included use of her remote microphone technology during online learning, teachers’ use of captioning, and captioning of students’ comments.  Teachers’ wearing a boom microphone, assuring teacher’s face is visible on the screen, repeating or rephrasing students’ comments, and consistently using closed captioning for all talkers will improve and assure appropriate and equal access to online learning for STUDENT, compared with her typically-hearing peers. Peers’ comments in class discussions should be repeated in-person and in virtual settings. In virtual learning, teachers should use boom microphones and assure she can see their face, with the computer camera kept on.  Captioning should be used for all live or recorded sessions, including, PowerPoint and video presentations.

Summary

Access denied is opportunity denied. Children with IEPs due to being deaf or hard of hearing comprise only 1% of the total number of children receiving special education services. For almost all of the other 99% the educational issue is due to a learning disorder, and not secondary to sensory access issues. Virtual education adds greater challenge to students who are deaf or hard of hearing. Having the tools to identify student access issues and the data to make the case for appropriate access accommodations to be provided is a necessary step for students with hearing loss. Academic success is driven by communication access. I encourage you to use the CAVE Checklist and perform the online FLE to gather the access data needed so that our students CAN be full participants in learning at the rate expected of their peers.

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Strength in Numbers

Being alone is hard!  We often hear the term “Critical Mass” and its value wi th studends who are deaf or hard of hearing (DHH), not only when budgeting for services, but to help students recognize that they are not alone. Similarly, teachers of the deaf or hard of hearing and others who support students with hearing loss educationally derive significant benefits from having a DHH professional ‘community.’ [Read More]

Critical mass. A past Hands & Voices article titled “How Many are Enough? Defining ‘Critical Mass’ ” defines critical mass as the number of students in a classroom, program or school that share a common communication mode  and characteristics that are sufficient to support direct interaction opportunities. Critical Mass helps build a stronger identity, provides role models, and enhances self-esteem and a better concept of self. In today’s mainstreaming environment, more than 88% of students who are DHH attend school in their home district. The number of DHH students who receive special services is approximately 1% of total students. If you are no t in a big school, it is possible that a child with hearing loss may be the only one in the entire district.

Changed landscape. My nearly 25-year career as a teacher, interpreter and consultant working with children with hearing loss has provided me many experiences working with families, children and adults who are deaf or hard of hearing. I have witnessed the changing landscape in service delivery from self-contained classrooms to the itinerant model. This change not only impacted the critical mass of students and their families, and how they gain support, but also impacted teachers of the deaf and hard of hearing. These teachers and professionals lose their own critical mass of peers who help provide them stronger identity, role models, self-esteem and concept of self.  While a student may be the only student in the district with a hearing loss, an itinerant DHH teacher may be the only teacher of the deaf in an entire region, sometimes with drive times of an hour or more to see a single student. With teachers being spread so thin and being so isolated It is very difficult for professionals to gain the support they need to have strong confidence in what they are doing and to keep up with current best practices. 

Who does one go to for answers? The day-to-day challenges and questions related to the needs of children with hearing loss, even for veteran teachers, yields new questions and new needs each day. If you are alone in the mainstream as an itinerant teacher, you most likely do not have ea sy access to a professional critical mass that can support you and provide those  answers. Even those who have support may not have the time or easy access to the resources and community you need.  The need for ongoing support for professionals in the field related to school issues is undeniable.

These resources already exist and require no prep and little to no organization and allow you to connect whenever you want and need to. They can be easy to incorporate into your schedule and can truly meet this need.

4 IDEAS for how you can access or create a professional critical mass, helping you to build a stronger identity, access role models, enhance your self-esteem and a better concept of self.

1. Email the staff in your school/district/region…. and celebrate!   Of course, the best way to create professional critical mass is to connect face-to-face, but these days, everyone is accessible via Zoom or another virtual platform.  If you have a network of professionals around you, then send an email out to get everyone together!  Use this time to debrief, network and share.   But don’t make it only business.  Make sure there’s some fun mixed there, too.  Celebrate the end of the year, a big success, or that even that the sun is out!

2. Get on Facebook. Check out the group Professionals Working with Deaf and Hard of Hearing Students.  This Facebook group is not only Teachers of the Deaf and Hard of Hearing, but also SLPs, Audiologists,  program co ordinators, OTs, Interpreters – you name it!  It is very active and a great way to get input on questions, get resources, and just hear and see what others are doing in the field.

3. Try the Marco Polo app Many DHH professionals are using the app Marco Polo to connect with each other.  Marco Polo is a video instant messaging app.   Wondering about certain signs?  Marco Polo is also a great way to “ask around” when trying to know how to sign something.  Marco Polo is free and available on both Google Play and in iTunes.   Learn more about Marco Polo HERE.

4. Enroll in the Professional Academy through The Online Itinerant. Okay, DISCLAIMER:  This option is my favorite because…. well, I founded it.   I founded The Professional Academy to accomplish a few goals:  1.  To provide stand-out professional development for professionals who work with deaf and hard of hearing students and 2.  To create an active, live community of professionals who have a passion for advancing, uplifting and empowering deaf and hard of hearing students – who, in my opinion, are the most amazing, fun, underappreciated, and misunderstood (on a needs level) population of students that exists.

 

This February, the Professional Academy will launch a weekly Power Hour, providing 1 hour of networking, brainstorming, and resource sharing each week.

The Professional Academy offers a professional community that you can access through monthly online get-togethers,  trainings or the members only Facebook group.  Everything is easy to access and available when you need them, even if you are on the road.

To kick off the new year, you can now purchase a 6-month rolling membership   for only $99.00.  JOIN THE PROFESSIONAL ACADEMY NOW.

However you look at it, you need a community.  A tribe.  A critical mass.

As you kick off the new year, what will YOU do to build your identity and support a stronger concept of self? 

Stefanie Kessen has more than 25 years in the field of Deaf Education, as a Teacher of the Deaf, interpreter, and Education Specialist for Deaf and Hard of Hearing Students.  She founded The Online Itinerant in 2018 because she recognized that the key to changing the lives of the children was to support the adults who love and work with them.  Currently, The Online Itinerant works with Supporting Success to offer professional development, parent support, and sign language classes, as well as an active community for all!!

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Accommodations – Lifeline to Equal Access

Classroom hearing assistance technology, interpreting services and captioning are often viewed as expensive within tight school district budgets and special accommodations are often seen as a hassle. Yet without these necessary provisions students who are deaf or hard of hearing are discriminated against due to a lack of equal access to school communication. Sometimes school teams with limited experience in the needs of students with hearing loss choose to refuse to provide necessary accommodations, take a ‘wait and see’ attitude, or downplay their importance if any difficulties arise in their consistent use. DHH professionals and families of children with hearing loss must be prepared to respond.

The primary difference between students with hearing loss and their typically hearing peers is that they do not access verbal communication as fully as others. Accommodations are truly the lifeline to our students being able to achieve and progress as effectively as peers.

Accommodations are sometimes seen as ‘being taken care of’ by making a quick statement on the IEP or perhaps checking off some boxes. Since the learning issues caused by hearing loss are due to decreased access to verbal information, accommodations – including appropriate auxiliary aids and services – are intended to ‘level the playing field.’ Accommodations need to be considered carefully, discussed thoroughly, implemented consistently and then monitored to ensure that they are indeed, providing equal access to classroom communication.

Regardless if the child is on a 504 plan or an IEP, an FM/DM/HAT system would be considered “Assistive Technology” in order to access the curriculum and receive a Free and Appropriate Public Education (FAPE)

Unless appropriate and effective accommodations are provided, the student with hearing loss will be discriminated against in the classroom as they are expected to perform as well as other students without being provided the same information. Of course discrimination is a harsh word and educators do not intentionally discriminate against any student. In the US, the Americans with Disabilities Act requires schools to ensure that communication for students with hearing loss is as effective as communication for others. Accommodations, specifically auxiliary aids and services must be provided to afford these students an equal opportunity to obtain the same result, to gain the same benefit, or to reach the same level of achievement as that provided to others.  Whenever accommodations are not provided, not used consistently, or not effective the student does not have an equal opportunity to achieve as their peers.

How well a student is able to perceive speech in a classroom will impact educational performance. Students who are deaf or hard of hearing are at high risk for delayed vocabulary acquisition, vocabularies of smaller size and sophistication, struggling with the English verb system, lack of access to morphological information. This overall may appear insignificant (low average performance per normed assessment) but it can significantly affect academic achievement.

Auditory Learner Access Needs

A Functional Listening Evaluation conducted on (DATE) indicated that XXX is a student with an educationally significant hearing loss, which limits access to the curriculum. XXX’s hearing aids do not restore normal hearing and thereby do not provide sufficient access to classroom content. XXX’s comprehension is also significantly challenged in the presence of background noise at levels typical of a classroom. Hearing Assistive Technology (§300.5 under IDEA), recommended by an educational audiologist (a related service provider under IDEA; §300.34) is required in order for this student to access curriculum and to receive a free and appropriate public education (FAPE). Specifically, the following Hearing Assistive Technology is recommended to supplement her hearing aids: …. *

Students who are hard of hearing do not have normal hearing restored by hearing aids or cochlear implants. Under typical classroom listening conditions they will ALWAYS have to put forth more effort, to ultimately perceive fragmented communication. With more effort put toward listening, there are fewer cognitive resources available for the student to recognize all of the words, comprehend them and integrate them into their knowledge base. This is why a student with hearing loss typically requires information to be repeated 3 times when a typically hearing student would need to have it presented only once. While a student may ‘communicate normally’ in a 1:1 conversation across a small table in a quiet room (3 feet), that ability is not predictive of how accurately the student will be able to listen at a distance (class discussion) and in the presence of typical levels of classroom noise. Similarly, hearing thresholds on an audiogram are also not predictive of speech perception as only 39% of the ability to understand speech in noise can be predicted from hearing thresholds. Hearing assistance technology (HAT), specifically personal FM/DM systems, are the ONLY means to optimize the auditory signal a student receives.   
(*Based on information from Kym Meyer, Educational Audiologist)

Visual Learner Access Needs

The academic information received by visual communicators is totally reliant upon the skills of their sign language interpreter or cued speech transliterator. A 2005 study evaluated 2100 educational interpreters in the US using the Educational Interpreters Performance Assessment. The results found that about 60% of the interpreters evaluated had inadequate skills to provide full access. The study suggested that many students receive interpreter services that seriously hinder reasonable access to class curriculum and social interaction. A 2009 study focused on the accuracy of translation as measured by number of key science words included in a CART transcript or in videos of sign interpretation. “Best” interpreters /CART providers were selected who knew the study was about accuracy were selected. Participants transcribed or signed three science videos by NASA. The accuracy interpreters for the three videos was 81%, 80.1%, 62.7%. The accuracy of the CART providers was 98.5%, 96.9%, 97.2% resulting in an average accuracy of 75% for interpreters and 97% for CART transcription.  The bottom line is that sufficient “through the air” access to verbal instruction and classroom communication cannot be assumed because an interpreter or CART is provided in the classroom.

Suggestions for Determining Appropriate Accommodations

• Make the case. Impress upon the student’s classroom teacher and school team that accommodations are truly the student’s lifeline to equal communication access, and therefore the opportunity to obtain the same achievement as class peers. Obtain data to estimate the students’ level of access.
  
  
• Be consistent in your approach to recommending FM/DM/HAT hearing assistance technology. The physics of sound is immutable. To receive optimized access to verbal communication in school, students who are auditory learners need to use HAT starting with school entry and continuing as long as the student is willing to comply. Even if a teacher is loud, animated and does not move around the classroom much, the student with hearing loss will still not be receiving optimal auditory input without the use of HAT.
  
  
• Emphasize that one size does not fit all. While IDEA does not require ‘optimal’, the ADA requires equal access. This is a case where the ‘bar’ for ADA is higher than it is for IDEA. Even with HAT providing optimal auditory input, a student with hearing loss will not have normal hearing restored. Per a court case: “ADA requirements regarding students who are deaf or hard-of-hearing are different than those imposed by the IDEA.” Additional accommodations are necessary to close this gap. Because IDEA and ADA requirements are not identical, there may be some situations in which a child has accommodations as part of an IEP and also requires a 504 Plan to address the auxiliary aids and services needs per ADA.
  
  
• Grades do not matter when it comes to accommodation needs. Children who are hard of hearing or deaf WILL need accommodations. How well or how poorly they perform in the classroom is not a determinant for whether accommodations should be provided. Some students put in many more hours of homework than their peers, often sacrificing social opportunities, to earn and maintain high academic achievement. The necessity to expend these extraordinary efforts can be a sign that discrimination is occurring. The case study provided by the ADA as part of the Frequently Asked Questions described a high achieving secondary student who had an FM system but also needed CART services so that he had full access to class discussions. If a student is not found to be eligible for an IEP, then this reflects the school team’s belief that the student will be able to experience one year’s growth in one year’s time without special support. In Deal v. Hamilton Board of Education (6th Circuit, 2004), the court ruled that “meaningful educational benefit must be gauged by the child’s potentialities.” Thus, accommodations will ALWAYS be necessary, whether via an IEP, 504 Plan or both.
  
  Response to: “He seems to be doing okay academically; I don’t think we need to get him an FM/DM system.”  If a student in a wheelchair was assigned to a classroom with a narrow door would it be okay to have the student participate by sitting out in the hallway? In other words, would it be okay for him to not have to be included in a class with a door wide enough for the wheel chair because the student’s academic performance was not a concern?  Ignoring auditory inclusion needs is the same issue.

• Consider communication needs situation-by-situation. This not only makes sense, it is another requirement of ADA. A form has been provided below to assist teams in these discussions.
  
  
• There is no ‘set list’ for appropriate accommodations. An Accessibility Considerations handout lists examples of auxiliary aids and services. This can be used as a starting place for discussion but should not be seen as limiting accommodation choices. Auxiliary services can include teacher inservice and progress monitoring by a specialist in DHH. The federal Every Student Succeeds Act encourages specialized instructional support providers to support literacy and collaborate with classroom teachers, thus allowing special educators to work with classroom teachers on behalf of regular education students.
  
  
• It is the school’s responsibility to ensure that the provided accommodations are effectively providing equal access to classroom communication. For students who are grade 3 and above it is suggested that they complete the Listening Inventory For Education – Revised (LIFE-R) Student Appraisal (Teacher Tools Takeout 0099, 0052, 0100) at the beginning of the year and review the results at the end of the first quarter to discuss if, with the accommodations, the student feels as though access has improved. Routine classroom observations and performance monitoring can also be helpful to determine the effectiveness of the accommodations being provided.

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Assessment Must Go On!

Tailored Identification of Access & Educational Needs

 

Despite the challenges of the COVID pandemic, schools remain responsible for offering an equal educational opportunity to students with hearing loss. To do so we must identify and address access issues in online learning situations, along with tailoring assessment to identify a student’s full range of needs. Big questions from the field of education for children with hearing loss include ‘What assessments should we be using?’ and in these trying times, “How can we assess during COVID”

Equal access was already a challenge! The Title II ADA requirement that schools are required to ensure that communication for students who are deaf and hard of hearing are as effective as communication for others [ADA Title II 28 C.F.R. 35.160 (a)(1)] was already a tall order for students who are hard of hearing since it is a fact that no hearing devices in current existence restore normal hearing ability. Even in a classroom setting the provision of hearing assistance technology, interpreter services, and captioning still are often not sufficient to close the access gap. As seen within the CAVE Checklist (Communication Access in Virtual Education) there is no one solution to provide access to students who are hard of hearing or deaf, whether instruction is provided online/remotely or face-to-face. The challenges everyone experiences communicating with masks has underscored the awareness and sensitivity to the challenges of persons who rely on speechreading to boost understanding. Our students require the involvement of a DHH specialist to assist in identifying the access solutions that maximize understanding in whatever instructional situations they face.

If the creators of IDEA wanted to make it clear that good grades = no IEP they would have clearly done so – but they did not.

A 2018 US court case¹ emphasized that students with hearing loss must receive an eligibility assessment that identifies areas of suspected need secondary to hearing loss with sufficient intensity to satisfy in depth evaluation. The special factors considerations² also need to be applied throughout the evaluation process. 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.

Our students with hearing loss often have 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. One strong research finding⁴ 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. 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.

 

The defined purpose of IDEA³: 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.

Go to Teacher Tools Takeout to download Resources for Identifying DHH Student Needs: Eligibility Assessment and Beyond lists of functional and norm-referenced tests.

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.

For students with hearing loss to experience equal access, we need to identify barriers first.

Perform a modified Functional Listening Evaluation procedure in an online teaching situation

We know that students with typical hearing respond with 90+% accuracy when listening in noise, even when the noise level is equal to the speech presentation level. It is reasonable to assume that the degradation in sound that occurs when a teacher’s voice is presented over an internet streaming service (like Zoom) will not significantly decrease the speech perception and auditory comprehension ability of students with typical hearing.

For equal access students with hearing loss should be able to perform with at least 90% accuracy during online learning presentations. Ideally, you will have performed the FLE under classroom conditions and have the percent scores under different listening conditions that can be compared to the following.

Suggestions on how to perform this functional check of listening accuracy during online learning:

a. Download and print out the Common Children’s Phrases.
b. Prepare to present Children’s Nonsense Phrases within the Common Children’s Phrases There are 8 lists of 20 items. You can place a + or o next to each sentence to record responses.
c. LIST 1: Use a microphone plugged into your computer as you present and encourage the student to watch your face. Even a standard SmartPhone headset will work with most media devices to improve speech signal clarity. This simulates the best listening condition.
d. LIST 2: Turn off your webcam or do not allow the student to watch your face. Continue to use your microphone. This simulates listening when the teacher is presenting a PowerPoint presentation while livestreaming and her face is not visible.
e. LIST 3: Unplug your microphone and present the list of words in the speechreading condition. These results will indicate how important it is for the student to have the teacher always use a microphone during online learning.
f. LIST 4: Present the nonsense phrases without using the microphone or allowing speechreading. Too many students are currently expected to learn in this situation. With the data you’ve now obtained you can demonstrate the level of barrier to understanding posed by not using a microphone and/or not allowing speechreading.
g. LIST 5 and 6: If you have a mask with a transparent inset available, repeat the conditions with and without using the microphone. This will provide you with some data as to just how important it is for a teacher to use a transparent mask once we return to school, and the potential barrier posed to having the teacher’s face viewed in this manner.

Check comprehension of what the student can hear (or see)

Schools have not been excused from conducting assessment or gathering progress monitoring data. Norm-referenced tests have strict administration protocols. That said, modifications can be made as long as they are referenced in the test report with the caveat that use of the norms may not be as accurate as if the original administration protocol was used.

For the purposes of students who are deaf or hard of hearing we really want to know how students perform on auditory (or sign interpreted) comprehension tasks relative to their typical class peers. Results will reflect (1) the degree to which hearing loss is posing as a barrier to comprehension along with (2) the impact of any language issues the student may experience. This is true whether the student is face-to-face in a quiet room, or in an online learning situation.

 

Suggestions for performing assessment of comprehension of spoken information

a. Gather comprehension data using the Oral Passage Understanding Scale (OPUS) for grades K-12. This test only takes 10-15 minutes to complete. It identifies how well a person can integrate and apply knowledge of use of words and word combinations, grammar and inferential meaning.
b. Gather comprehension data using the Listening Comprehension Test 2 for grades 1-6 or the Listening Comprehension Test Adolescent for grades 7-12. This test assesses comprehension of main idea, listening for details, vocabulary, reasoning and understanding messages. It takes about 30 minutes to administer.
c. Conduct an Informal Evaluation of Auditory Comprehension of Information with and without Accommodations. This functional assessment procedure refers to how to conduct comparison testing in a typical classroom environment (or simulated classroom noise vs. quiet). Adapt the procedure to online learning by reading a story and answering comprehension questions with and without a microphone, with and without speechreading, speechreading through a mask, with and without captioning, etc.
d. For hard of hearing students DO NOT ALLOW SPEECHREADING as this is an inconsistent listening condition.
e. If a HAT (FM/DM system) is typically used with the student be sure to use it while performing comprehension assessments.
f. If captioning is typically used during instruction it can be used while performing the assessments.
g. For students who are Deaf and use an interpreter, if at all possible, have the interpreter the student uses in the classroom setting interpret what you say during testing. Allow the student to view your face and the interpreter so the student’s ‘triangle of communication’ is as typical as possible.

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: a child had an IEP in kindergarten and grade 1 and was then dismissed. By the end of grade 4 reading scores had decreased. The school team wasn’t concerned because the student  ‘wasn’t very bad yet. When looking at eligibility, dig into prior testing and see if there is evidence of declining percentile ranking in test results over time. For example, in grade 2 the child scored 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.

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, regardless of online or onsite instruction.

 

 

References

1. 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. 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. 3. The 2004 IDEA Commentary provides an overall ‘setting the stage’ for the IDEA law; on this webpage.  
4. 4. 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.

 

 

Karen L. Anderson, PhD, Director, Supporting Success for Children with Hearing Loss; 2020 Early Oct Update.
This information is not intended as legal advice.  http://successforkidswithhearingloss.com 
Sign up to receive Bimonthly Updates from Supporting Success.

 

 

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Focusing on Vocabulary Building

Vocabulary building strategies are some of the most important tools an educator can have in her teaching toolbox, and teaching students to break apart words (morphology) is one of those strategies no teacher should be without.  Quoting the film The Firm, “it’s not sexy, but it’s got teeth!” 

Did you know…?

• Approximately 60% of English words are of Greek or Latin origin
• Twenty prefixes make up 97% of prefixed words in printed school English, and just four of those (un-, re-, in-, dis-) make up the first 58%
• Words with inflectional endings (plurals, possessives, s-v agreement, tense markers) account for most words students see/read
• By middle school, a student needs to have learned approximately 9,000 word families to comprehend academic reading texts

The ability to manipulate and analyze words is a critical skill for reading success. As teachers, we know that. A vocabulary goal is likely written into many IEPs. Whether signed, spoken, or both, word knowledge is what sets apart good readers.  However, the task of learning the number of words being used each week is daunting for a student with language delays.  In addition, a teacher can feel completely overwhelmed by the expansive number of words she is required to teach that student, knowing those language delays are present. Using time wisely is imperative and prioritizing which words and word parts are of the most importance becomes crucial.

Where to begin? I found myself beginning by choosing the most obscure words in a text, thinking that they needed the most emphasis. Now I know this was not the best way to go about teaching vocabulary. A better way for teachers to use their time and skill is to teach the highest frequency words and word parts first.  For example, since the prefixes un-, re-in-, and dis- make up roughly 58% of all prefixed words, this is a great place to start. With inflectional endings such as plurals and possessives making up most of the words students see and read, they are another great place to begin. 

As for word lists of the most commonly used content area vocabulary, https://lead4ward.com/resources/ is very helpful and provides lists by grade. I am also excited that Supporting Success has added two new resources for effective vocabulary instruction: Academic Vocabulary for Middle School Students by Greene and Coxhead, and the Vocabulary Handbook, by Diamond and Gutlohn. Each book includes excellent research-based lists for content areas and strategies for teaching the words our students really need to know to comprehend increasingly complex subject matter. Need help knowing exactly where to start? The Academic Vocabulary book includes a free downloadable Vocabulary Size Test to use with your students. The Vocabulary Handbook includes a pre/post-test for students to test their knowledge.

Another great resource for vocabulary instruction is Latin and Greek Roots, by Stokes. If you like hands on activities, Latin and Greek Roots has multiple activities using minimal preparation and common objects. Here you will find a fun way to teach words and word analysis.  What are you waiting for?  Seize the day! 

 

Resources:

• Easterbrooks, S.R. & Beal-Alvarez, J. (2013). Literacy Instruction for Students who are Deaf and Hard of Hearing. New York: Oxford University Press.
• Greene, J.W. & Coxhead, A. (2015). Academic Vocabulary for Middle School Students: Research-based Lists & Strategies for Key Content Areas. Baltimore, Maryland: Paul H. Brookes Publishing Co., Inc.
• Diamond, L. & Gutlohn, L. (2019). Vocabulary Handbook. Baltimore, Maryland: Paul H. Brookes Publishing Co., Inc.
• Stokes, P.D. (2012). Latin and Greek Roots: Teaching Vocabulary Using Hands-on Activities and Common Objects. Austin, Texas: PRO-ED, Inc.

 

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Teaching Auditory Skills via Remote Learning

The COVID-19 pandemic has forced educators worldwide to adjust their methods of teaching, moving from direct classroom instruction to virtual teaching. While these adjustments have proved challenging, teachers everywhere are providing instruction in reading, math, writing and more, through remote learning techniques. They are being creative so that various curricula can be used to meet the needs of the students. Those serving students who are deaf and hard of hearing learning listening and spoken language skills have an added component to consider: how to best do auditory skills teaching in a virtual environment?

What is the first step for developing auditory skills with remote techniques?

Starting any session with LING sound test is a smart idea to yield information about how the child is hearing across the speech spectrum. Conceptually, LINGs are done in order to map the stability of a student’s access to sound over the course of a treatment, between sessions and for troubleshooting. Keeping the structure of a LING check at the beginning of a session can be a good checkpoint that ensures the student is wearing devices and they are powered on.

There are multiple factors that affect audibility in the remote learning environment, such as: speaker fidelity, internet bandwidth, distraction, distance from the speaker and noise/reverberation in the listening environment. Due to these factors outside of the child’s behavior, doing the LINGs in a virtual session may produce unpredictable or inaccurate outcomes. If the child misses a LING during a virtual session it may be that the volume of the computing technology is not appropriate orbackground noise is interfering and needs to be addressed.

If the student doesn’t have anyone facilitating the session with them, educators can do the LINGs virtually with the understanding that the outcome may not be a true indicator of access to sound. Otherwise, empower the caregiver(s). This is a great time to build caregiver capacity for doing the LINGs at home, to obtain caregiver feedback on the student’s access to sound, and to talk to the caregiver about optimal acoustics. Educators may send the CID quick tip video on LINGs, spend a session (or part of one) coaching the caregiver(s) on how to do the LINGs in person with the child or, if you can, demonstrate as a first step.

Can auditory training be done via remote instruction?

Auditory skills teaching programs are offered widely by device manufacturers and other sources to encourage computer-based learning (visit your student’s device manufacturer’s website to see what they offer).  These remote learning programs are valuable tools, and they are designed and validated for computer-based learning.

Other auditory skills curricula were designed to be done face-to-face given the inherent advantage of being in the same space with the student. The purposeful engagement between the learner and the teacher toward auditory goals can be somewhat challenging during remote instruction. When we engage students in auditory skills tasks, we typically have control over a variety of factors (e.g. background noise, proximity of the student, integrity of the auditory signal). The control over these factors helps make the training verifiable. Working with students remotely takes away our control of these factors, which makes engaging in formal auditory skills teaching a challenge with non-computer-based curricula.

While using non computer-based curricula, educators should note on the rating forms that skills were worked on during virtual learning, as a referent that the skills may develop in a modified timeline. It may be useful, in the time of a pandemic, to pause the goal of formal skills training, and to consider this a great time for auditory practice.

What is auditory practice and how does it fill the need typically carved out for auditory skills learning?

Auditory practice is a way in which students can still be encouraged to practice their listening skills while in a less than optimal listening environment. It is a way to practice new listening strategies, encourage self-advocacy skills and determine what methods are effective for your student. The goal of auditory practice is to enhance listening and discriminating skills regarding the student’s own auditory environment. While we use captions throughout our lessons as a support for our students, during auditory practice, you might consider pausing them. Remember to turn them back on before transitioning to the next subject.

Auditory practice can include:

• Introducing or re-familiarizing strategies for listening and self-advocacy skills.
• Planning auditory lessons with students, including detection or hearing in noise (based on skill level).
• Identifying sounds in the student’s environment and localizing sounds.
• Using the time to build on the depth of auditory skills for one ear at a time.
• Teaching the student (and caregiver) to find a quiet listening spot. Small rooms with little reverberation are best. This includes carpeted rooms or those with soft furnishings/curtains.
• Reminding the student to ask for repetitions if needed or to use other repair strategies such as repeating what they heard (e.g., “I heard you say …,” “Could you repeat what you said after ‘___’”) and asking for specific clarification.
• Building strategies for supplementing listening with devices, such as streaming via Bluetooth.

Are there elements of formal auditory skills curricula we can use with remote learning auditory practice?

The goals and objectives within auditory skills curricula (such as CID’s SPICE and SPICE for Life) can be used to develop goals, and many of the activities within the manuals can be adapted to a remote platform by using the curricula’s resources and rating forms to track progress.

If a child is doing well following along in the session, providers could use parts of SPICE/SFL as auditory practice. Providers typically have previous knowledge of the student’s present levels. Keep in mind that error patterns, especially unusual ones from the provider’s perspective, may be a biproduct of the remote learning environment and should be taken into consideration. Elements of these curricula, however, could be coached and practiced in a remote learning environment, perhaps with the help of a caregiver.

Some skills that can be practiced from these curricula include:

• listening to a story and answering questions about it
• engaging in a conversation (practice communication repair strategies)
• recalling a set of spoken words (avoid working on plural s/z and past tense d/t as these morphemes are especially difficult to perceive through technology)
• following directions to draw a picture (e.g., “draw a round face with two blue eyes.”)

Remember, any summaries or statements about the skill or activity would need to include a caveat that these were observed during remote learning. It is feasible that the provider could encourage the caregiver(s) to find props, pictures and/or supplies in the home (or send via email as a link, PowerPoint, or GoogleDoc) that are relevant to the child’s skill level. The provider could then coach the caregiver toward eliciting student practice. The CID SPICE for Life, for example, does include Home Practice pages in the Resource Manual that may be shared with parents.

What are some ways that we can ensure students have optimal access to sound when engaging in remote leaning?

• Identify what technology is available to the student and if there are options for setting the student up with other equipment (e.g., Bluetooth speaker, streamers, direct connections or a hard-wired speaker to plug into the technology for louder, clearer sound).
• Contact an audiologist with any sound-related questions.
• Strategize for a device-listening check at the start of the day – either via LINGs (see above) or having the caregiver use monitor earphones/stethosets to listen
• Make sure fresh batteries are in place. Using technology for wireless connectivity drains device batteries faster than usual.
• Charge streamers or FM/DM systems nightly.
• Use dehumidifiers for the devices so that they are working optimally.
• Maximize the volume on computing technology as needed for best sound. There may be enhancements to download to increase the volume. The caregiver or student may be able to use a free sound-level meter app on a mobile phone to check if volume is increased. These are great skills to develop for self-advocacy.

Daily computer-based learning is now a reality for students. Although this may not be ideal for students with hearing loss, it is an opportunity to build their capacity for listening with technology. Teaching them ways their device(s) can be tiered with technology, focusing on self-advocacy skills and engaging them in real-world listening situations are skills that will be beneficial, even when typical classroom learning resumes.

 

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Assessment of Online ACCESS

The world of education has shifted sharply once we began our societal response to the COVID-19 pandemic. Yet, we remain responsible for offering an equal educational opportunity to students with hearing loss. To do so we must identify and address access issues in online learning situations. Some current issues for our students who are DHH are:

• Concerns about equal access in distance learning
• Teaching practices to enhance or limit access
• Ways to gather information that shows a student’s level of access

Equal access was already a challenge! The Title II ADA requirement that schools are required to ensure that communication for students who are deaf and hard of hearing are as effective as communication for others [ADA Title II 28 C.F.R. 35.160 (a)(1)] was already a tall order for students who are hard of hearing since it is a fact that no hearing devices in current existence restore normal hearing ability. Even in a classroom setting the provision of hearing assistance technology, interpreter services, and captioning still are often not sufficient to close the access gap.

Encouragement is not the same as effective solutions. A 3/21/20 Supplemental Fact Sheet¹ from the US Department of Education clarified that special education and related services can be provided through distance instruction and that many disability-related modifications and services, like captioning and sign language interpreting, may be effectively provided online. The Fact Sheet encouraged parents and educators to collaborate creatively to use high-and low-tech strategies to meet the needs of students with disabilities. This encouragement resulted in a steep learning curve by all teachers, and especially those who work with students who have access issues due to hearing or vision limitations.

All instruction must be fully accessible to students who are deaf and hard of hearing.

Access Concerns:

1. a. When teachers provide online instruction during which only a PowerPoint presentation or documents are visible, the student is not able to speechread. Once we go back to meeting face-to-face in schools it is likely that many school staff will wear masks. How much is the student’s access impacted without speechreading?

1. b. When teachers instruct over an internet streaming service without using a microphone (standard mic that plugs-in to the computer or FM/DM microphone) the speech signal is degraded and adds to comprehension issues. How much is the student’s access to distance learning is impacted without the use of a microphone?

For students with hearing loss to experience equal access, we need to identify barriers first.

Perform a modified Functional Listening Evaluation procedure in an online teaching situation

We know that students with typical hearing respond with 90+% accuracy when listening in noise, even when the noise level is equal to the speech presentation level. It is reasonable to assume that the degradation in sound that occurs when a teacher’s voice is presented over an internet streaming service (like Zoom) will not significantly decrease the speech perception and auditory comprehension ability of students with typical hearing.

For equal access students with hearing loss should be able to perform with at least 90% accuracy during online learning presentations. Ideally, you will have performed the FLE under classroom conditions and have the percent scores under different listening conditions that can be compared to the following.

Suggestions on how to perform this functional check of listening accuracy during online learning:

1. a. Download and print out the Common Children’s Phrases.

1. b. Prepare to present Children’s Nonsense Phrases within the Common Children’s Phrases There are 8 lists of 20 items. You can place a + or o next to each sentence to record responses.

1. c. LIST 1: Use a microphone plugged into your computer as you present and encourage the student to watch your face. Even a standard SmartPhone headset will work with most media devices to improve speech signal clarity. This simulates the best listening condition.

1. d. LIST 2: Turn off your webcam or do not allow the student to watch your face. Continue to use your microphone. This simulates listening when the teacher is presenting a PowerPoint presentation while livestreaming and her face is not visible.

1. e. LIST 3: Unplug your microphone and present the list of words in the speechreading condition. These results will indicate how important it is for the student to have the teacher always use a microphone during online learning.

1. f. LIST 4: Present the nonsense phrases without using the microphone or allowing speechreading. Too many students are currently expected to learn in this situation. With the data you’ve now obtained you can demonstrate the level of barrier to understanding posed by not using a microphone and/or not allowing speechreading.

1. g. LIST 5 and 6: If you have a mask with a transparent inset available, repeat the conditions with and without using the microphone. This will provide you with some data as to just how important it is for a teacher to use a transparent mask once we return to school, and the potential barrier posed to having the teacher’s face viewed in this manner.

 

Check comprehension of what the student can hear (or see)

Schools have not been excused from conducting assessment or gathering progress monitoring data. Norm-referenced tests have strict administration protocols. That said, modifications can be made as long as they are referenced in the test report with the caveat that use of the norms may not be as accurate as if the original administration protocol was used.

For the purposes of students who are deaf or hard of hearing we really want to know how students perform on auditory (or sign interpreted) comprehension tasks relative to their typical class peers. Results will reflect (1) the degree to which hearing loss is posing as a barrier to comprehension along with (2) the impact of any language issues the student may experience. This is true whether the student is face-to-face in a quiet room, or in an online learning situation.

 

Suggestions for performing assessment of comprehension of spoken information

1. a. Gather comprehension data using the Oral Passage Understanding Scale (OPUS) for grades K-12. This test only takes 10-15 minutes to complete. It identifies how well a person can integrate and apply knowledge of use of words and word combinations, grammar and inferential meaning.

1. b. Gather comprehension data using the Listening Comprehension Test 2 for grades 1-6 or the Listening Comprehension Test Adolescent for grades 7-12. This test assesses comprehension of main idea, listening for details, vocabulary, reasoning and understanding messages. It takes about 30 minutes to administer.

1. c. Conduct an Informal Evaluation of Auditory Comprehension of Information with and without Accommodations. This functional assessment procedure refers to how to conduct comparison testing in a typical classroom environment (or simulated classroom noise vs. quiet). Adapt the procedure to online learning by reading a story and answering comprehension questions with and without a microphone, with and without speechreading, speechreading through a mask, with and without captioning, etc.

1. d. For hard of hearing students DO NOT ALLOW SPEECHREADING as this is an inconsistent listening condition.

1. e. If a HAT (FM/DM system) is typically used with the student be sure to use it while performing comprehension assessments.

1. f. If captioning is typically used during instruction it can be used while performing the assessments.

1. g. For students who are Deaf and use an interpreter, if at all possible have what you say when administering the test be presented by the interpreter the student uses in the classroom setting. Allow the student to view your face and the interpreter so the student’s ‘triangle of communication’ is as typical as possible.

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.

Read more information on tailoring assessment procedures to the needs of students with hearing loss.

 

References:

1. 1. March 21, 2020 Supplemental Fact Sheet Addressing the Risk of COVID-19 in Preschool, Elementary, and Secondary Schools While Serving Children with Disabilities
2. 2. The Effect of IQ on spoken language and speech perception development in children with impaired hearing. Cochlear Implants International, (11)1, June, 370-74.

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A Connecticut mom of a student with hearing loss shares her journey into establishing greater awareness for the need for emergency preparedness when children are hard of hearing or deaf. Read more for: – Key issues regarding students who are DHH and school safety – When planning should occur – Possible emergencies and appropriate responses

In 2018, I read a Clarke School article titled “Keeping our Students Safe.” It asked the question, How are you keeping deaf/hard of hearing students safe during school lockdowns and emergencies?  I immediately asked my son if he had a safety plan in school that addressed his hearing loss. His response was a no. I researched the Connecticut school safety guideline that is required by the Department of Homeland Security. The only proactive suggestion was that students with functional disabilities should have a buddy system in place. Did the school consider hearing loss a functional disability? Did my son ever have a buddy in place? No.  Now he was in high school making the buddy system was unrealistic.

Since Sandy Hook in 2012 there have been 2,408 Mass Shootings in the US. -Gun Violence Archive

The new active shooter rules in place at the high school level were to lock the door and not let anyone in from the hallway, even a student. Consider a deaf or hard of hearing student in the bathroom, without an FM/HATS system or interpreter, who didn’t hear the lockdown announcement. This student would ultimately be left in the hallway, locked out and vulnerable. They might hear the shots, but not which direction they are coming from. How can we help these students?

We cannot ever forget that deafness is an invisible disability.

Executive Director of the American School for the Deaf, Jeff Bravin, said in the CT Mirror, “the assumption that ‘those kids will be fine, they will follow all the other students,’ is not accurate. They need access to the same information.”

Administrators and teachers often forget that students with hearing loss have inadequate access to basic safety measures. How can I send my son to school every day, knowing that he might not hear an emergency announcement, or an officer telling him to stand down?

 

Safety must be in layers

Not every safety recommendation will fit every student or a school’s current capability. Technology doesn’t always work in an emergency. If you have multiple layers of communication, then the likelihood of your student being safe in an emergency increases exponentially. In the IEP/504 Plan you can request a school in-service communication needs and safety training BEFORE the school year begins. This can be done through the teacher of the deaf or deaf services agency. Often emergency drills are done the first week of school, not on the first day. This year on the first day of school, the high school cafeteria caught on fire. Confused freshmen were late exiting the building, not knowing where to go or what to do in their new surroundings. The pre-school year meeting is often held in August and can also make sure all technology is in good working condition. Often schools forget to set up these in-services, even when they are in the IEP/504 plan. Be proactive in early August to identify when this in-service training will be taking place.

A good rule of thumb

Your student is an individual and there is no one size fits all safety plan. If a student has a communication need specified in their IEP or 504 Plan then this need should be reflected in the safety plan. Plans should be simple, uncomplicated and not rely solely on technology. For example, if the IEP says the student must receive all announcements in writing, the safety plan must specify an effective means to quickly announced emergency information, which may or may not be the same as specified as an accommodation in the IEP.

 

Questions to answer for ALL POSSIBLE EMERGENCIES, fire, weather, water, active shooter/threat.

1. 1. Can students access the current alerting system based on their individual communications needs identified in their IEP/504/LCP plan?

• Consider bus, bathroom, hallways, extracurriculars, playgrounds/fields, field trips, classrooms?
• Are you including the student in these discussions? Has the emergency plan been shared with the student? Have they tried it? Do they have suggestions?
• Have staff members been informed of the students’ specific needs in the event of an emergency?
  • Staff means teachers, substitute teachers, administrators, resource officers, and support staff such as secretaries, lunch aides, and maintenance personnel.
• Are students able to advocate for their communication needs in the event of an emergency?
  Example: During a 504 meeting my son told the guidance staff that announcements are very quiet in the classroom and very loud and unintelligible in the hallways-something they didn’t know.

2. 2. Can the student verbalize? Are they too young? Do they have another disability that prevents them from speaking up? *see Lanyard in Go-Bags/Kits below

• For students who use educational interpreters, transliterators, or captionists, what is the backup?
• The ENTIRE school could learn basic American Sign Language:
  • Quiet, Get Down, Run, Wait, Fire
  • Identify staff who know ASL
  • Universal safety ASL means a student can transfer in and already know safety signs

3. 3. Has your Local Education Agency (LEA) notified local emergency responders of the students who are Deaf, Hard of Hearing?

• Where the students might be sheltering?
• How to look for small hearing aids and cochlear implants?
  *if an officer tells a child to stand down and they don’t hear him-he WILL take the child down in an active shooter situation.
• Fire, Police, EMT-do they know and can they use the appropriate emergency ASL signs?

4. 4. Has the school/school district identified how emergency information will be communicated to parents with hearing loss, such as reunification plans?
5. What technology should be upgraded in the school to enable effective emergency responses?

• Televisions, laptops, with scrolling messages enabling ASL and closed caption announcements
• Allow students to have their own phones available so they can receive emergency texts
• Flashing lights, repeating announcements

Go Bags or Kits

These are classroom safety bags that can be easily put together with donated items from community organizations. This can be projects sponsored by PTA’s, boy or girl scouts, Exchange or Rotary clubs. The bags can be the inexpensive string bags that companies give out. Reach out to local companies and hearing technology companies for donations.

Items to include:

• Extra batteries for hearing aids and cochlear implants
• Chargers for hearing technology devices
• Waterproof container for technology/batteries
• Flashlight with extra batteries for to enable communication via signing/lip reading
• Pen/pencil/paper/dry erase board for writing important communications that the student cannot hear.
  *teachers need to whisper during active shooter scenarios or cannot be heard over a loud alarm.
• Communication Cards with appropriate ASL signs, words, or pictures.
  *My school is using colored cards that signal different emergencies.
• Emergency Lanyards for young students and/or those who are nonverbal
  • include name, communication mode, and parents contact information.
• Copy of School Emergency Form

Use these guidelines as tools. Parents of deaf and hard of hearing students are often at odds with school district over services. Cooperation is necessary so the whole team can thoughtfully create safety plans.

Making change through Legislation.

The situation of the unpreparedness of protecting our students with hearing loss in emergency situations spurred me on to help introduce and fight for CT legislation through the Governor’s Advisory Board for the Deaf and Hard of Hearing. On the last day of the CT Legislative session, June 2019, at 2 minutes to midnight, the State of Connecticut Public Act 19-184 was passed. It states “Every student identified as Deaf, Hard of Hearing or Deaf-Blind will have an Emergency Communication Plan as part of their Language and Communication Plan”

The Language and Communication Plan is filled out at the beginning of a Connecticut IEP or 504 meeting. It is a checklist and guide that addresses the special language and communication needs of deaf and hard of hearing students. https://portal.ct.gov/-/media/SDE/Special-Education/Language_and_Communication_Plan.pdf?la=en

 

 

The guidelines in this article were made possible through thoughtful work sessions with the Connecticut Coalition on Education of Deaf and Hard of Hearing Students and my son’s incredible teacher of the deaf, Rebecca Rabinsky-Ankrom and her teacher network. The Pennsylvania Department of Education guidelines were referenced.

Susan Yankee, is a member of the CT Governor’s Advisory Board for the Deaf and Hard of Hearing, the Coalition on Education of Deaf and Hard of Hearing Students, Disability Rights CT Partners in Policymaking graduate, and a mom to a hard of hearing high school student.

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Success in mainstream classrooms when you have a hearing loss is often a substantial challenge for our students. Even in 2016 the option of meeting the needs of students with disabilities in virtual school learning programs was considered.  A letter from the US Department of Education defined a school’s responsibilities to students with disabilities enrolled in virtual learning settings. The letter affirmed that virtual schools must carry out the requirements of IDEA just as they must in physical schools.

Link to the August 5, 2016, Office of Special Education Dear Colleague Letter: See the new video from the Office of Civil Rights on online learning accessibility.

 

Summary:

300. 1. The requirements of IDEA apply to State Education Agencies (SEAs) and Local Education Agencies (LEAs), regardless of whether a child is enrolled in a virtual school that is a public school of the LEA or a public school that is constituted as an LEA by the State.
301. 2. Accordingly, the SEA is responsible for ensuring that all LEAs, including virtual schools that operate as LEAs, implement the requirements of IDEA. If a virtual school is a public school of an LEA, the LEA is the entity that would generally be responsible for ensuring that the requirements of Part B are met by that virtual school for children with disabilities participating in the virtual school’s program.
302. 3. Each SEA also must have policies and procedures that ensure that children with disabilities who attend virtual school LEAs and virtual schools that are part of LEAs are included in all general State and district-wide assessment programs, including assessments described in section 1111 of the Elementary and Secondary Education Act of 1965, with appropriate accommodations and alternate assessments, where necessary and as indicated in their respective individualized education programs (IEPs). 34 CFR-§300.160.
303. 4. Where a virtual school is a public school operated by the LEA in which the parent resides, that LEA generally would be responsible for making FAPE available to an eligible child with a disability. LEAs retain this responsibility even if they choose to contract with virtual schools to provide educational services to children with disabilities.
304. 5. In addition to the requirements discussed above, we highlight below some particular requirements under IDEA that responsible LEAs must meet in order to ensure the provision of FAPE to children with disabilities in virtual schools. These LEA responsibilities include, but are not limited to:
305. 6. ensuring that each eligible child with a disability has FAPE available to him or her in accordance with 34 CFR-§§300.101 and 300.17
306. 7. implementing the evaluation and eligibility requirements in 34 CFR-§§300.300-300.311;
307. 8. carrying out the IEP requirements in 34 CFR-§§300.320 through 300.324, including those governing IEP content, IEP Team participants, parent participation, when IEPs must be in effect, consideration of special factors, the development, review, and revision of IEPs, secondary transition services and participation in State and districtwide assessment programs; and
308. 9. implementing the requirements in 34 CFR-§§300.114 through 300.117, regarding education in the least restrictive environment, including ensuring the availability of a continuum of alternative placements to provide special education and related services.

The educational rights and protections afforded to children with disabilities and their parents under IDEA must not be diminished or compromised when children with disabilities attend virtual schools that are constituted as LEAs or are public schools of an LEA

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Advocacy Notes: Legal Requirements for Providing Services to Children with Disabilities During the Coronavirus Disease Outbreak

The CDC has issued guidance to help administrators of public and private childcare programs and K–12 schools plan for and prevent the spread of COVID-19 among students and staff. Many decisions have been made by governments and school districts to close school campuses.  The US Department of Education has provided an FAQ document to assist in understanding the legal responsibilities of schools to provide services under IDEA during this health crisis.

 

Preparing for a school closure due to COVID-19

IEP teams may, include distance learning plans in a child’s IEP that could be triggered and implemented during a closure due to a COVID-19 outbreak. Such contingent provisions may include the provision of special education and related services at an alternate location or the provision of online or virtual instruction, instructional telephone calls, and other curriculum-based instructional activities, and may identify which special education and related services, if any, could be provided at the child’s home. Creating a contingency plan before a COVID-19 outbreak occurs gives the child’s service providers and the child’s parents an opportunity to reach agreement as to what circumstances would trigger the use of the child’s distance learning plan and the services that would be provided during the dismissal.

Schools closing and not providing any educational services to students

If the school does not provide educational services to general education students, then it is not obligated to provide services to students with disabilities during the same period of time. Once school resumes, the school must make every effort to provide the services specified on the IEP.

• Decisions must be made about how teachers of the deaf/hard of hearing and educational audiologists will be able to increase the service time spent with students once school resumes, to make up for the time lost during school closure, as the service time specified on the IEP remains a responsibility that the school must make every effort to provide.

Schools closing campuses but continuing to provide educational services to students

If the school is providing educational opportunities to the general student population during school closure, the school must ensure that students with disabilities also have equal access to the same opportunities. Schools must ensure that each student with an IEP or 504 Plan is provided special education and related services specified on the IEP or 504 Plan, to the greatest extent possible.

• Schools must determine how access accommodations will be provided to ensure that students with hearing loss can receive the same opportunity to instruction as their hearing peers. Schools must decide how they would provide access via interpreters and captioning to online education.
  • Note: Teacher Tools membership materials provide a wealth of digital instructional materials.
• Teaching staff (DHHTs, SLPs, Educational Audiologists) must decide what materials they can readily use in online or virtual education methods as they continue work on IEP goals.
  • Note: Streamer captioning is an option for secure captioning services.

If a child is sick with COVID-19 while schools remain open

Students with IEPs who must stay home for more than 10 school days due to a medical problem need homebound services. A placement change would need to be made on the IEP. The IEP goals would remain the same. The IEP Team would determine the method of instruction most applicable for the student to benefit. If the child does not receive homebound services, the school must determine if compensatory services may be needed to make up for any skills that may have been lost. For children with disabilities protected by Section 504 who are dismissed from school during an outbreak of COVID-19 because they are at high risk for health complications, the decision to dismiss must be based on his or her individual risk for medical complications and not on perceptions of the child’s needs based merely on stereotypes or generalizations regarding his or her disability.

If a School for the Deaf is closed

The school must determine whether each child could benefit from online or virtual instruction, instructional telephone calls, and other curriculum-based instructional activities to the extent available. If the child does not receive services during the school closure, the school must determine if compensatory services may be needed to make up for any skills that may have been lost.

 

Note: This information is not to be construed as legal advice. Bulleted points represent information added by the author. Refer to the full Department of Education document for more information.

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E-Learning & Coronavirus (COVID-19)

Due to concerns with the rapid spread of Coronavirus, also known as COVID-19, schools and universities across the country are shutting down their campuses and moving to e-learning or virtual learning.  In light of this, the following resource information  could be helpful as you consider how to provide instruction to your students who are deaf or hard of hearing. 

MEETING LEGAL RESPONSIBILITIES:

An important resource regarding our legal responsibilities to provide services to students with disabilities has been released by the U.S. Department of Education. In summary, if general education services are being provided during school closures, Part B and Part C special education services should continue. 

The NAD video explains the seriousness of the virus to share with students, including the commonly used ASL sign for coronavirus.

While not easy, it is important to remember that while schools are in session, even remotely, we are still obligated to provide accommodations, auxiliary aids, and services as stated in the IEP so students can still access their education.  The Council for Exceptional Children, and the National Association of the Deaf has shared some excellent information regarding access during remote learning, as well an Education Advocacy letter that reminds us of our legal obligations when providing online courses and examinations. 

The Center for Deaf and Hard of Hearing Education has some #DeafEdTips on E-Learning Accessibility.  It has lots of good reminders and additional resources for both deaf educators and general education teachers.

While more focused on post-secondary access, the National Deaf Center (NDC) has some helpful tips for educators as they switch to online learning.

RESOURCES:

As schools switch to online learning, many education companies are offering FREE subscriptions to their services.  An open access Google Drive document with links to all of those possibilities can be found here.  For those who need to focus on auditory listening, HearBuilder has some resources. Also, check out this Leprechaun Listening Story using ScreenCastify and EdPuzzle. Speech and Language Pathologists, check out this document for ideas.

Some ASL resources can be found at ASL Teaching Resources. ASL videos are available on various YouTube channels: Educational Resource Center on Deafness, Rocky Mountain Deaf School, ASLized!, and Aunt Alice’s ASL TV. Check out additional virtual activities through this LiveBinder.  And lastly, have students create books at Book Creator!

Described and Captioned Media Program (DCMP) is a great resource too. Teachers can assign videos for students to watch and then do follow up assignments. All content is captioned, and audio described and FREE.

Supporting Success Teacher Tools e-magazines are full of ready-to-use materials with your students. Members can download pages to use immediately that can be shared and discussed in an e-format with students.

The Ability Challenge has created a Slack community forum for educators to discuss the provision of special education services and supporting learners with diverse needs during online instruction. 

Snapplify offers a library of 50 000+ free e-books. Teachers can sign up for free and also claim exclusive teacher benefits. Excellent to send free e-books to your kids and get them to read while they are at home! You can also share your resources on the platform. Easily integrates with Microsoft and Google for education.

Did you know that Zoom has the capability to add captions during live video sessions that can be recorded?  You can type the closed captions directly via Zoom or you can integrate a third-party service, like Streamer^TM automated captioning that is available from Supporting Success for Children with Hearing Loss that can add captions in real-time. Streamer is typically 98+% accurate (with the speaker using a microphone) for only $9.97/month (email questions to streamer-support@success4kidswhl.com). Other videoconferencing resources and their caption abilities are available from See Hear Communication Matters (they also have a lot of e-learning resources, including virtual field trip sites on their Facebook page!)  

 

EXPLAINING CORONAVIRUS TO CHILDREN: When trying to explain coronavirus to children, it can be difficult to know what to say.  Two resources to share with families:

• A kid friendly video explaining coronavirus, with captions and a transcript, can be found at Brain Pop.
• A FREE, downloadable coronavirus social story can be found at The Autism Educator.

In addition to Supporting Success for Children with Hearing Loss Facebook page, there are MANY deaf educator Facebook groups that are discussing these topics and sharing resources. MANY resources and ideas are being shared on these pages. If you are a Facebook user, search for them and join the discussion!  While not education specific, The Daily Moth has a Facebook page that provides frequent updates in ASL on current events that you or your students might find helpful. 

With a little bit of planning, we can do our best to ensure that we are still providing services to our students during this uncertain time.

Supporting Success for Children with Hearing Loss has a pinned post on their Facebook page where you can share resources with each other.  Please head over there, support each other, and share away!

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TOPIC: We seem to have so many different meetings that we are asked to attend with the school district. What is the purpose for are all of the different special education meetings? What is a Transition meeting?

Special Education Meetings for Necessary Communication

Many families know that they have an IEP meeting once a year. However, the variety of IEP meetings that and are held, when they can be held, and who can request an IEP is not always clear to families or teachers. One type of IEP meeting that can be confusing to many families is the Transition IEP, and the confusion is heightened by the fact that some school districts will use the transition IEP to change the Triennial IEP date. 

Following are the various types of IEP meetings:

Initial IEP

Annual IEP

Triennial IEP

Amendment IEP which is any IEP meeting held between the annual IEP meetings and can be requested by either the district or the family at any time. One amendment meeting is the Transition IEP.

Transition meetings can be very confusing. IEP teams meet for a variety of transitions throughout the educational process, and these meetings are all typically scheduled in the Spring. Following is a discussion and overview of the various types of transition meetings:

• Transition from preschool to Kindergarten: While compulsory education does not start at preschool, special education placement does. When it comes time to transition from preschool to Kindergarten, the IEP team will schedule the “Kindergarten Transition IEP.” Some school districts do not serve their students during preschool as they may use regionalized special education preschool programs. Therefore districts may do formal/informal observations in the preschool setting and gather data about how the child is doing, while other districts choose to conduct a full re-evaluation and make the Transition to Kindergarten the new triennial IEP meeting. Either way, the full IEP team would be expected to attend along with a general education Kindergarten teacher. The transition meeting is a wonderful way to reduce the stress and anxiety that both the family and the educators in the receiving school may have. It also allows for the district to share the various program options with the family and for the IEP team to identify any additional supports that will be needed. The district can then conduct staff training, order low incidence equipment, and make any necessary acoustic accommodations over the summer.

• Transition from elementary school to middle school (junior high) and from middle school to high school: Elementary school is typically a time when our students have a single classroom teacher who is nurturing, safe, and responsible for teaching all academic subjects. The transition to middle school is stressful for all students as it occurs at the same time as the onset of adolescence. Our students with hearing loss may have even more anxiety as they move from one teacher to potentially 6-7 separate subject matter teachers who all need to understand their unique needs. Depending on mode of communication there will typically be additional staff training, discussion of interpreters, captioning, note-taking, and other unique supports. In the early Spring of the last year of elementary school the IEP team will begin to schedule a Transition IEP meetings which will include the current providers as well as special education representatives from the receiving middle school. This meeting is not a time to review progress on previous goals, develop new goals, or make a new offer of FAPE. The purpose of this meeting is to share the child’s eligibility, explain their unique needs, review the accommodations, and current services with the receiving team. This is when the middle school team will explain their programs and class options which may include a DHH placement, a variety of supported classes for ELA and Math, or a supported Study Skills class. The transition from middle school to high school is basically the same process and an opportunity for the receiving school to explain their programs and class options while the IEP team shares how the student is doing as well as all of their unique needs and support services as a student with hearing loss.

• IEP Transition Planning: The IDEA (Individuals with Disabilities Education Act) requires that IEP teams begin planning with all students who have an IEP by the time they turn 16. The Individual Transition Plan (ITP) is included in the IEP document. It is typically created with a combination of student interview and interest surveys completed by the student with their IEP case carrier. The purpose of the ITP is to help students prepare to be as independent as possible following high school. The ITP includes planning and goals in the areas of Post-Secondary Education, Post-Secondary Employment, and Independent Living. As with all other portions of the IEP document, the ITP is revisited every year as a part of the annual IEP.

• Transition from high school to adult education (18-22): Unless our students with hearing loss have another eligibility, the goal is that they will graduate from high school after their senior year. There are, however, occasions when students do not complete the high school graduation requirements and are eligible for IEP services until age 22. In these cases, the IEP team at the high school will call a Transition IEP in the Spring of the Sr. Year. The team should include a representative from the adult education program. While students continue to have academic support from age 18-22, much of the focus is on supporting students in accessing the community and independent living.

• Transition out of high school, also known as the Exit IEP: The IEP and Special Education services end for the following reasons: the student no longer meets eligibility requirements, the student graduates from high school, or the student turns 22 years old. Each state decides the level of supports that they have available for individuals with disabilities post-high school. At this time the Americans with Disabilities Act (ADA) governs supports in college, career training, employment, and independent living. If there is a state agency that supports students with their college education, the IEP should invite a representative of the agency to the Exit IEP to facilitate the transition. I typically ensure that the students and IEP teams with whom I work begin to educate students (via IEP goals) during their junior and senior year regarding their IEP accommodations and the differences between the IDEA and the ADA so that they are knowledgeable and ready to successfully advocate for themselves in all areas of their lives.

 

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

 

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An Often Unknown Cause of Hearing Loss in Children

Understanding and Preventing CMV in the Educational Setting

Author: Brenda Balch, M.D., AAP EHDI Chapter Champion for CT

 

The leading cause of sensorineural hearing loss is heredity, but many people don’t realize that the second most common cause of SNHL in children is due to Congenital Cytomegalovirus or cCMV. It is also the most common congenital viral infection in the United States and resulting hearing loss may be preventable. CMV can cause wide variation in hearing loss, including progressive loss.  

What is CMV?

  Cytomegalovirus is a herpes virus that causes minimal to no symptoms in most people. In the U.S, by age 40, most of us have evidence of a past infection. CMV becomes a concern in primarily two scenarios – in a pregnant woman or in a severely immunocompromised individual. Most women are unaware of CMV and the risk of infection during pregnancy.  

What is the size of the CMV problem?

  cCMV is the most common congenital viral infection in the United States. Approximately 1 out of every 200 infants are infected with CMV prior to birth. With 3.8 million births in the US in 2018 we can assume that 19,000 children were infected with CMV.

Of those who are infected, how many children end up with hearing loss?

Characteristics of CMV SNHL Hearing loss in infants/children with cCMV can be unilateral, bilateral, present at birth, late onset, fluctuating or progressive. ANY child with hearing loss could potentially have had it caused by cCMV!

Of the 1 in 200 infants infected with cCMV, approximately 10% will be “symptomatic” and have serious symptoms at birth that may include microcephaly, enlarged liver/spleen, cerebral palsy, cognitive impairment, vision loss and sensorineural hearing loss(SNHL). Another 10% – 20% of the 200 infected infants are “asymptomatic” will have or go on to develop SNHL. Using the 3.8 million births in the US in 2018 as an example again, 1900 would have had symptomatic CMV and 950-1900 would have had asymptomatic CMV that caused hearing loss. Audiological follow-up data for 860 children with congenital CMV. Dahle et al 2000, extrapolated by Walter 2017

	Asymptomatic at birth, n=651	Symptomatic at birth n=209
Hearing loss	7.4%	40.7%
Unilateral	52%	33%
Bilateral	48%	67%
High frequency only	37.5%	12.9%
Delayed onset	37.5%	27%
Median age of delayed onset	44 months range (24-182)	33 months range (6-197)
Progressive	54%	54%
Fluctuating	54%	29%

 

CMV is so common! Can’t we test for it before it causes hearing loss and other problems?

 

If an infant is known to have passed the newborn hearing screen but has tested positive for CMV, the most recent JCIH statement recommends a full pediatric audiology evaluation by 3 months of age and then future monitoring “every 12 months to age 3 or at shorter intervals based on parent/provider concerns”.

Presently, most infants are not tested for cCMV at birth. Infants with obvious symptoms of cCMV are being tested, and in a few states with recent legislation, those infants who fail their newborn hearing screen are tested. If an infant is not tested for cCMV by 3 weeks of age, any positive test after 3 weeks of age may indicate an acquired infection rather than a congenital infection. It is therefore difficult to estimate what proportion of SNHL is due to congenital CMV in children outside of the newborn period.  

How is CMV spread?

  Cytomegalovirus is primarily spread through saliva, mucous and urine. Infants and young children are commonly shedding the virus. Small children have behaviors that are more likely to lead to the transmission of CMV. Women of child bearing age should be aware of the risks of congenital CMV and methods of prevention. Women who are pregnant or planning on becoming pregnant can take precautions that may reduce their risk of exposure to CMV. Clinical studies with antivirals for CMV and trials for a CMV vaccine are ongoing.  

How can we prevent CMV?

  Educators who work with young children are at greater risk of contracting CMV and can help to prevent transmission of CMV by treating all body fluids as if they are infectious. This includes:

• Wash hands frequently with soap and water, lathering for at least 15 seconds
• Avoid kissing a child near the nose or mouth
• Do not put things in your mouth that have been in a child’s mouth such as a pacifier, cups, utensils or food
• Wear gloves for all contact with body fluids, and always wash hands after removing gloves
• Use EPA approved disinfectants to frequently clean workplace surfaces that may be contaminated with body fluids
• Do not use diaper wipes to clean potentially contaminated workplace surfaces
• Disinfect small toys or objects that may have been contaminated with body fluids

  Any and all children, both in the classroom and in the home, or extended family setting, may potentially transmit CMV to a woman of childbearing age or a pregnant woman. It is prudent to use good hygiene precautions in all of these settings.   Resources

• https://cdc.gov/cmv/index.html
• JCIH 2019 position statement

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Captioning in the Classroom

 

 

My child can’t keep up with what is said, but the school said that they wouldn’t provide captioning…

Why would captioning be needed? Hearing loss decreases the amount of speech that is perceived, especially in large group listening environments like classrooms. Even with the most up to date hearing technology, normal hearing – or 20:20 hearing – is not restored. This puts students who are hard of hearing at high risk for increasing gaps in vocabulary and challenges keeping up with what their abilities would predict them to be able to perform in school.

Legal Case: Providing captioning of verbal communication that occurs in school is one way that we can use to close the typical ‘listening gap’ of students who are hard of hearing who have sufficient language and reading fluency skills to benefit from captioning services.  In 2013, two high school students who with hearing loss brought a suit against the Tustin Unified School District. The students had IEPs under IDEA but were not provided captioning services as part of their educational plans. The findings of the case were that, while IDEA and ADA are similar statutes, “the ADA requirements regarding students who are deaf or hard-of-hearing are different than those imposed by the IDEA.” Under ADA the district had an obligation to provide effective communication under Title II of the ADA.

Digging Deeper into this Case: The two high school students wanted a word-for-word transcription so that they could fully understand the teacher and fellow students without undue strain and consequent stress. In both of these cases, the school district denied the student requests but offered other accommodations. In the case of student K.M., even though the teachers felt that the student participated in classroom discussions comparably to peers, she emphasized that she could only follow along in the classroom with intense concentration, leaving her exhausted at the end of each day. The other student, D.H. felt that she needed captioning in order to have equal access in the classroom, even though she was making good academic progress. The school’s finding that “D.H. hears enough of what her teacher and fellow pupils say in class to allow her to access the general education curriculum” and “did not need CART services to gain educational benefit” was sufficient to meet their obligations under IDEA as the IDEA does not require that services be provided to maximize achievement, but this finding was insufficient for fulfilling the effective communication obligation under ADA. Public entities must furnish appropriate auxiliary aids and services where necessary to afford an individual with a disability an equal opportunity to participate in, enjoy the benefits of, as service, program, or activity conducted by a public entity. Furthermore, in determining what type of auxiliary aid and service is necessary, a public entity shall give primary consideration to the requests of the individual with disabilities.

Considerations – Will the student be able to benefit? Just as with other accommodations, captioning will not necessarily meet the communication needs of every student with hearing loss. Families and school teams should consider whether a student has the skills necessary to benefit from word-for-word captioning. Information and a checklist to help guide these considerations can be found here. The Placement and Readiness Checklists (PARC) includes within the suite a Captioning/Transcribing Readiness Checklist.

Some of the considerations are:

• Reading fluency rate of 100-130 words per minute, which is the average speaking rate. This is typical of an average rate for a 4^th grade student.
• Language ability and/or language processing ability to comprehend text that appears at a rate of 100-130 words per minute.
• Tolerance for delay. CART transcription by a captionists has a 2-3 second delay. Automated captioning systems have a delay of about 1 second.
• Tolerance for error. An accuracy rate of 98% has been found to be adequate for captioning services. Whether automated captioning or CART services, there will be some inaccuracies due to difficulty to transcribe words that are not said loudly enough, or clearly enough, for fully accurate captioning.
• Ability to split attention from 2-way communication to 3-way. Attention and focus in needed by the hard of hearing listener to be aware of when a comprehension issue occurs, access the captioning, and revert back to listening and speechreading.
• Student motivation to utilize captioning if it is provided.
• In the case of remote CART or automated captioning, teacher willingness to use the microphone appropriately, and ensure use of the microphone in student discussions, so that accurate captioning can be provided.

Students who do not have the language ability or reading fluency to benefit from captioning at the typical speaking rate could benefit from captioning that is not word-for-word, such as TypeWell or C-Print. 

Is the student really benefitting from having captioning available? A communication accommodation is only effective if it truly allows the user better comprehension during communication. No one communication accommodation is a perfect fit for all communication situations. This page has some ideas for gathering pre-test and post-test information to assist in determining the degree the student is benefitting from captioning. The page includes Assessing Auditory Comprehension with and without Accommodations which provides a process for gathering this data.

 

Summary: Due to typical gaps in listening comprehension, students who are hard of hearing often can benefit from having captioning available to them in the secondary grades. Families and school teams should consider if the student has the ability to benefit from captioning. If it appears this is possible or likely, a trial period to gather data supporting level of benefit should occur. Successful use of captioning relies on student ability and motivation, teacher compliance, and appropriate use of transcript and/or transcription technology. High quality automated captioning systems, such as Streamer^TM, allow students and families to trial use of captioning in home communication environments and are a good way to prepare a student for eventual use of captioning in the school setting.

 

Relevant References:

https://onlinelibrary.wiley.com/doi/abs/10.1002/dei.262

https://www.ncbi.nlm.nih.gov/pubmed/21941878

 

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Missing Bits Results in Syntax Deficits

Students with hearing loss, whether hard of hearing or deaf, are at high risk for deficits in syntax due to their imperfect perception of the English language. Word endings, tense, and other grammatical features are often lost when these ‘bits and pieces’ are not perceived. Extra direct instruction in grammar and syntax is usually necessary for students with hearing loss, as their missing bits often result in poorer comprehension – whether of conversation or the written word. These deficits can be glaring when a student turns in a written assignment.

The challenge: Effectively teaching grammar and syntax is a daunting task. Hearing peers largely absorb correct syntax through listening alone and have a good handle on it as they begin to develop reading skills. As early as kindergarten, typical students following the general education curriculum should be able to (with adult assistance) speak/sign, read, and write a grammatically correct sentence as simple as “I like pizza.” to as complex as “My brother rides his red bike around the park after school.” By the fourth grade, typical students should be able to speak, read, and write sentences as simple as “I like pepperoni pizza from Pizza Hut.” to as complex as “Jason, Kim and I rode in my mother’s dark blue Suburban to the movies on Friday night where we saw three of the most popular students in our school.”  By middle school, typical students are responsible for the intricate content of novels. They are often given a prompt or topic as a writing assignment and a few ideas at which point they are on their own to generate the rest. Where typically hearing and developing students gradually absorb syntax with minimal extra instruction, students with hearing loss often have to work hard to keep up with this rate and complexity of typical development.

What we need to know about syntax skills whether students use spoken language or a sign system:

• Can the student speak/sign a sentence with a subject and a verb?
• Use tense markers?
• Use singular and plural forms? Many times, the /s/ on the end of plural words is not heard. The same can hold true for the possessive ‘s. If the student uses ASL, plural is shown by repeating the sign, such as CHAIR-CHAIR-CHAIR for “chairs”
• Use articles and determiners? (the, a, that, this, etc.).
• Are there any descriptive words being used? Prepositions?
• For ASL users, is the student using classifiers? Nonmanual markers?

Assessment: As with other areas of instruction, it always helps to start with the basics – identifying the student’s challenges. As part of a functional assessment for syntax, taking language samples is a great way to take inventory of what a student knows. Use a smart phone to record a student as you read a book together or discuss a topic. Try to obtain about 50 utterances, which may take more than one session with some students. After doing recorded language samples several times, you will begin to feel adept at listening and looking for patterns in the student’s language. Other assessment methods are provided as follows.

Does the language make sense? (Is it sequential?)

When language samples have been analyzed, gaps can be determined as can targets for instruction.  Whatever your method for obtaining data whether it is language sampling, formal tests, or functional assessments suggested below, syntax is an important piece of the reading and  comprehension puzzle and must be assessed!

 

 

Other tools for gathering functional data:

Test of Grammatical Structures (TAGS)   PRESCHOOL and ABOVE

Part of the Preschool Language Pack, the CID Teacher Assessment of Grammatical Structures (TAGS) is a series of three rating forms developed to evaluate a child’s understanding and use of the grammatical structures of English. The rating forms provide a representation of grammatical structures for children with hearing loss who develop grammatical structures in smaller increments and at slower rates compared to children who are typically developing. This starter kit is a guide to using the CID TAGS system for teaching and tracking receptive and expressive language development in oral children who are deaf and hard of hearing. It can also be used to evaluate sentence structure for children who use sign language. The TAGS rating forms enable teachers to:

FREE CID Online Course: The Art of the Structured Syntax Lesson: Assessing, Planning and Prompting

• determine present levels of syntax skills
• determine syntax goals for IEPs and lessons
• track syntax development over time and
• report syntax progress to parents and other professionals

 

Grammar Chipper Chat     GRADE K-5

These materials allow you to explore 16 of the grammatical structures found on most language assessments (i.e., CELF, TOLD). Each grammar area has 20-30 color-coded question cards with a sentence prompt on one side and images on the reverse side. The student fills in the missing word on the question side using the pictures as cues. A functional assessment can be performed using these cards. A subset of cards in each of the 16 areas (i.e 3-4 cards) can be shuffled together and presented in random order to the student. Additional cards can be presented in the areas in which there are errors to verify that there is a lack of functional use (up to 10 cards per problematic area). Refer to Brown’s Stages to assess or intervene in sequence of development. A valuable means to pinpoint issues and monitor progress in syntax learning.

Cracking the Grammar Code  GRADE 5 – ADULT
Within the 149-page FREE downloadable  Syntax Skill Pretests and Simple Skill Activities
sample book, there are pretests teachers can use to identify students’ skill levels. Each pretest has a rubric to diagnose specific skills in the broader category. The pretests and answer keys are provided for the following syntax skill areas: Nouns, Articles, Conjunctions, Verbs, Pronouns, Adjectives-Adverbs-Prepositional Phrases, Finding the Subject, and Subject-Verb agreement. A passing score is 80% on any of these functional assessments. If your student does not pass various parts of the pretest the specific lesson to start on within the Cracking the Grammar Code workbooks is provided.

Download the Free Syntax Skill Pretest book and start assessing your students ASAP!

 

 

Formal, norm-referenced testing

There are a number of test instruments typically administered by speech language pathologists that will assess a student’s level of syntax development. If a student has received an evaluation by a speech language pathologist in the previous 6 months it is often useful to review those results for insights into specific areas of syntax deficit that have already been identified.

Teachers of the deaf/hard of hearing often perform assessments related to students’ listening comprehension ability, specifically the ability to recall and understand information presented by others. Two popular assessments for this purpose also provide some information about student syntactic understanding or use. While not an extensive investigation into syntax, if a TDHH is performing one of these tests anyway, it may provide a starting place to focus additional syntax assessment, for example with the Cracking the Grammar Code free syntax skill pretest book.

Oral Passage Understanding Scale (OPUS)

For ages 5.0 to 21 years, the Oral Passage Understanding Scale is a measure of listening (auditory) comprehension. It evaluates a person’s ability to listen to passages that are read aloud and recall information about them. This ability is key to success in the classroom and social situations. It also measures memory skills, which are integral to listening comprehension. OPUS identifies how well a person can integrate and apply knowledge in three structural categories of language:

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

Measuring higher-level comprehension skills, including inference and prediction, yields more detailed information beyond simply whether or not the individual can comprehend. These skills require deeper processing abilities.

Test of Narrative Language-2 (TNL2)

For ages 4.0 – 15-11, the TNL2 provides a format that shortcuts the typical lengthy language sample analysis process. No transcription is necessary. Children’s answers to the comprehension questions and their stories can be reliably scored from audio recordings (use your Smart Phone!). The instructions are scripted and clear examples are used for scoring. The TNL should be of great benefit in identifying students who have adequate language, but issues using their language ability for ongoing interactions in an age-appropriate manner.

 

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TOPIC: I’ve asked the school to check a student’s hearing aids and FM/RM system daily and they refuse. 

Documenting Daily Amplification Use is Legally REQUIRED in the U.S.

Per IDEA Sec. 300.113. (a) Each public agency must ensure that hearing aids worn in school by children with hearing impairments, including deafness, are functioning properly. (b) (1) Each public agency must ensure that the external components of surgically implanted medical devices are functioning properly.

A court case from June 2015 has raised the bar for what educators who specialize in DHH must know and do. In this case, the school district team had included use of an FM system on a student’s IEP. The educational audiologist fitted and verified the FM for the specific student’s use and trained the teacher in its use. The FM system was then made available to the student. The court found the school district negligent in providing FAPE because there was no record that the FM/HAT devices was provided to the student daily. Read more. This finding strengthens the need for daily hearing aid monitoring and data collection.

Access is so important that the IDEA statute (20 USC 1400(c)(5)(H)) specifies “supporting the development and use of technology, including assistive technology devices and assistive technology services, to maximize accessibility for children with disabilities.”

The special considerations portion of IDEA specific to students with hearing loss requires that the IEP team must… iv) Consider the communication needs of the child, and in the case of the child who is deaf or hard of hearing, consider the language and communication needs, opportunities for direct communication 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, and (v) Consider whether the child requires assistive communication devices and services. 34 CFR 303.324(2).  Typically, students who with amplification systems must use them as part of receiving a free and appropriate public education (FAPE). Without amplification, students who are hard of hearing will not have an equal or appropriate opportunity for direct communication with peers or professional personnel. Thus the requirement that assistive devices be considered as a part of FAPE.

We know that not all families want their child to gain the attention needed to perform hearing device monitoring. We also know that in the US, there needs to be documentation that the student’s hearing devices are functioning properly. Thus, we truly need to inform families of these requirements. An example of Amplification Monitoring Consent Form has been included in the Hearing Aids and FM/DM pages of the Supporting Success website.

Since hearing devices can malfunction at any time, to truly ensure that they are functioning properly we ultimately need to teach the student how to be responsible for their own hearing aid monitoring. See Building Skills for Independence and Advocacy in Action for instructional materials to strengthen hearing device independence skills for students.

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Get Free Tools to Work with Children with Hearing Loss

The Ida Institute, a nonprofit working to advance person-centered hearing care, offers free pediatric tools and resources to support educators and hearing care professionals in understanding the perspectives of children with hearing loss and give the them stronger voices as they advocate for their own needs.

The World Healthcare Organization reports that while the most obvious effect of childhood hearing loss is on language development, it also impacts literacy, self-esteem, social skills, academic achievements, employment opportunities, emotional and psychological well-being, and can bring on feelings of isolation, loneliness and depression^[1].

Growing Up with Hearing Loss

Growing Up with Hearing Loss uses videos, questions, and suggestions to inform and inspire children and their parents and to prompt them to think about communication needs and skills development.

To help manage the key transitions in a child’s life, the institute developed Growing Up with Hearing Loss. The resource offers easy-to-follow strategies for developing independence, good decision-making, and self-awareness during each developmental stage.

Lisa Kovacs, Director of Programs at Hands & Voices, an advocacy group for parents of children with hearing loss, has used Growing Up with Hearing Loss in an online module for teens. She said some of the benefits are that the resource “targets self-determination skills in different ages and stages of a child’s journey starting at age three until the time the child becomes a young adult. Strong self-determination leads to competent self-advocacy skills, which will support students as they transition into either the workforce or post-secondary education.”

My World Tool

Use My World to recreate their day in a home, playground, or classroom setting by populating the spaces with friends, family, and the things they enjoy. Then, they can use the environments to help articulate their challenges, thoughts, and feelings about living with hearing loss.

Ida’s popular My World tool resembles a game in both its digital and physical versions, making sessions more relaxed and enjoyable for kids. The free My World app is downloadable from iTunes and the Play Store. Research has shown that working with children in a play setting can ease anxiety and improve their sense of self, adaptive functioning, and family functioning.

Jacqueline Dahlen, a teacher consultant for the deaf and hard of hearing in Alberta, Canada, uses Ida’s My World app with her students. “I like the interactive nature of the app which allows the student to place or move objects in space to represent their listening environments,” she says. “The students enjoy selecting their avatar and I like the different listening environments to choose from. It sparks discussions with students from the visuals created.”

Telecare for Teens and Tweens

Ida Telecare for Teens and Tweens tools encourage students to reflect on their needs and help them to take greater control of their hearing health and become better advocates for themselves.

The Ida Institute has also developed a suite of telehealth tools which includes Ida Telecare for Teens and Tweens. A study² on the Telecare for Teens and Tweens tools by the Ear Foundation showed the tools encourage young people (study participants were ages 11-17) to participate in their hearing care and that sharing their experiences promotes social participation and discussions of hopes and concerns in an empowering way. The study concludes, “This approach fosters self-determination, self-management, and self-advocacy thereby increasing the potential for positive long-term outcomes.”  

The Ida Institute

“Our tools and resources help children and young people think about and express their needs,” says Ida’s Associate Director, Ena Nielsen. “This helps professionals learn what is most important to the child and their family so they can focus on what matters most.” You can learn more about these and other Ida tools and resources on their website at idainstitute.com/tools  

References

[1]. WHO, Childhood Hearing Loss: Strategies for prevention and care https://www.who.int/docs/default-source/imported2/childhood-hearing-loss–strategies-for-prevention-and-care.pdf?sfvrsn=cbbbb3cc_0

2. [2] Ear Foundation study https://www.earfoundation.org.uk/research/research-categories/current-research/transitioning-for-european-young-people-using-telecare-tools

 

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Progress in Light of Circumstances – A Right for Every Student

I don’t think my child is making progress in reading…

Our question from the field: At a recent IEP meeting it seemed as though my child who has both hearing loss and other learning issues hasn’t made any progress in learning to read in the last year. I KNOW he can learn. The school didn’t seem surprised nor did they suggest any changes in the program….  

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 increasingly 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?

The IEP should be reasonably calculated to enable a child to make progress appropriate in light of the child’s circumstances.

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.  

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 disordered learning. 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.  

A recent research study* focused on the reading performance of students who were deaf/hard of hearing and had additional learning issues. The majority of the 214 students in this study had either intellectual or multiple disabilities as their primary disability while about 10% had DHH as their primary.  Over the 6-year period the 314 students took an alternate reading assessment an average of 3.72 times between grades 3-11. When comparing the performance of the 214 DHH+ students with the performance of other students with significant disabilities taking the same alternate reading assessment, the DHH+ students had overall poorer performance and growth rates. Most of these students increased their performance on the alternate state reading standards as they progressed in grade level. The percentage of ‘proficient’ increased, while the percentage of ‘emerging’ decreased during the 6-year period. The fact that the study found students who are DHH+ had lower proficiency scores than other students with significant disabilities on their state alternate assessment underscores how the addition of hearing loss to a child with complex needs is multiplicative, not additive. The need for interdisciplinary teaming to untangle and respond to the unique and complex needs of students who are DHH+ is essential. Like all students, those who are DHH+ CAN LEARN!  

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.

* Donne, V, Hansen, M.A.,  & Zigmond, N. (2019). Statewide alternate reading assessment of students who are deaf/hard of hearing with additional disabilities. Communication Disorders Quarterly, 40(2), 67-76.

For a review of this study, refer to the January 2020 Teacher Tools e-magazine Knowledge is Power article by Holly Pedersen.  

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Too often we hear, “He has good grades, so he won’t qualify for special education.” It is true that there must be a relationship between a child’s disability and school performance to qualify for services, however, IDEA specifies educational performance, not grades. There are characteristics associated with having a hearing loss that impact school performance, like missing or misunderstanding more communication than their peers. This is the basis for ongoing language and vocabulary issues and underlies the need for self-advocacy. Accommodations cannot close all ongoing 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.

The ‘bread and butter’ of itinerant support to students with hearing loss is often considered to be ensuring communication access, supporting language development to allow expected academic progress, 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.

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.

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.

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.

The Iowa Core Curriculum states, “students who are deaf or hard of hearing have specialized needs not covered in the general education curriculum. Hearing loss adds a dimension to learning that often 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.

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 was developed.”

Legal Considerations

In determining whether a child has educational performance needs that require specialized support IDEA specifies that team must: iv) Consider the communication needs of the child, and in the case of the child who is deaf or hard of hearing, consider the language and communication needs, opportunities for direct communication 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… 34 CFR 303.324(2). Hearing loss of any degree impacts and reduces the amount of communication students fully receive.

The American’s with Disabilities Act is a discrimination law that, in summary, requires schools to ensure that students with hearing loss have communication that is as effective as it is for others. If not, auxiliary aids and services must be provided to “level the playing field” or allow equal access. Since we KNOW that there is no amplification that fully closes the ‘listening gap’ for students in a classroom and we KNOW that incidental language will be missed, and we KNOW that classroom or group discussions are especially challenged then the FACT that students with hearing loss will not perceive information as fully as hearing peers will be one of their (full range of) needs.

Not hearing everything in the classroom does have an adverse educational effect on the ability to fully comprehend, learn at the same pace as others, and fully participate in all school activities.

IDEA has indicated that a child’s disability condition must have an adverse educational effect to be considered eligible for specialized services. Note – IDEA did not say the child must have poor grades. Self-advocacy skills, if the student knows how and when to appropriately use them, facilitate full participation and greater levels of comprehension, thereby allowing full access to the general education curriculum.

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. Race to the Brain Game
2. 2. Advocacy in Action Self-Advocacy Curriculum
3. 3. Building Skills for Independence in the Mainstream
4. 4. SEAM – Student Expectations for Advocacy & Monitoring Listening and Hearing Technology (PDF)
5. 5. 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 ongoing instruction in self-advocacy skills needs, including hearing device independence for students who are hard of hearing, as part of the IEP or 504 Plan.

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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.   Click here to download this Article

Tailored Assessment for Students with Hearing Loss: Identifying Needs to Support Eligibility for Specialized Instruction

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 need 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?’

If the creators of IDEA wanted to make it clear that good grades = no IEP they would have clearly done so – but they did not.

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.  

Download an updated version of Resources for Identifying DHH Student Needs: Eligibility Assessment and Beyond that reflects some of the information discussed in Steps to Assessment and additional recent tests not included in that book.

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.

Title II of the American’s with Disabilities Act requires that schools ensure that communication for students who are deaf and hard of hearing is as effective as communication for others through the provision of appropriate aids and services, thus affording an equal opportunity to obtain the same result, to gain the same benefit, or to reach the same level of achievement as that provided to others.

EVERY student with hearing loss who is going through initial assessment needs to have cognitive 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 with typical hearing.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 there is evidence of 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. 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. 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. 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. 4. The 2004 IDEA Commentary provides an overall ‘setting the stage’ for the IDEA law; on this webpage.
5. 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. 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. 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.

  Karen L. Anderson, PhD, Director, Supporting Success for Children with Hearing Loss; 2019 Early March Update. This information is not intended as legal advice.  http://successforkidswithhearingloss.com Sign up to receive Bimonthly Updates from Supporting Success. Click here to download this article.

If the family wants an ASL interpreter is the school required to provide one?

Question from the field: We have two students who were raised by Deaf families in ASL environments. Both have moderate to severe hearing loss with access to speech via amplification. The students are preschool and in grade 1. Neither are fluent in listening and spoken language (LSL). The district doesn’t want to provide interpreters because the students can ‘hear’. One student is not fluent enough in LSL to access verbal instruction. The other student has significant LSL skills but still reports frequent frustrations with access and comprehension.

Academic learning is driven by communication access.

This statement needs to be restated repeatedly and remembered constantly! The premise of providing a free and appropriate public education (FAPE) begins with the assumption that the student will be exposed to – and be able to perceive – school instruction. Job #1 in FAPE, especially for students with hearing loss, is to ensure access to instruction. As clarified by the US Supreme Court in 2017, schools need to provide instructional services and supports necessary for the student to make meaningful progress in the regular curriculum in light of the child’s circumstances. Minimal achievement gains are not enough. For students with hearing loss who have no other learning issues, the child’s primary circumstance is a lack of full communication access as the cause of past and present learning issues.

iv) Consider the communication needs of the child, and in the case of the child who is deaf or hard of hearing, consider the language and communication needs, opportunities for direct communication 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, and (v) Consider whether the child requires assistive communication devices and services. 34 CFR 303.324(2)

Special education law has specifically recognized the critical nature of communication access for students who are deaf or hard of hearing via the Special Considerations Section of IDEA. This provides a communication driven, child-centered appropriate in creating an education program that is driven by the child’s right to fully and effectively access communication that makes benefitting from education possible. This emphasis on equal access to communication is also specified within the Americans with Disabilities Act in which schools must ensure that communication is as effective for students with hearing loss as it is for peers. The decision about the appropriateness and necessity of providing classroom ASL interpreters needs to be guided by the discussions of the IDEA Special Considerations. The following questions should be some of those that are answered by the student’s IEP team as the special consideration factors are discussed:

1. How effectively is the student able to access/comprehend using his or her communication mode(s)?

2. What appears to be the level of comprehension in different situations (i.e., quiet vs noisy class)?

3. If the child uses both sign and spoken language the team needs to understand how, when, where, why and who the child communicates with each language modality. Spoken language may be adequate for routine activities but not sufficient for the student to (fully) comprehend teacher instruction.

4. How will the student access the inferential learning opportunities that hearing children are exposed to daily? What about peer-to-peer interactions, such as group work or class discussion?

5. What hearing technology does the student use and the level of benefit? Do the hearing aids plus an FM/DM device allow the student to close their comprehension gap fully? What is his ‘listening gap’?

6. What is the student’s language level in comparison to the teacher’s instructional language level? Does comprehension of instruction increase from one communication modality over another?

7. What is the student’s ASL vocabulary development level in comparison to their spoken language development level? (Refer to the White Paper on Estimating Access for more information)

8. What level of facilitation will be needed for the student to be able to meaningfully communicate with peers and adults?

When a child can be observed to ‘hear’ it is logical – but incorrect – to assume that they can understand.

Data must be collected to determine how and when either ASL or LSL is the most effective means of communication for a student who has some skills in both. Data drives informed decision-making.

Learning a new language takes exposure and TEACHING when there are delays due to access issues.

There are two important pieces of knowledge that have been gained from research on language learning by children who receive cochlear implants that are applicable to question from the field.

a. Children who develop language via signing and then are implanted will more quickly learn listening and spoken language. As they are exposed and taught LSL, their previous language experience works as a scaffold to support verbal language learning. The better the ASL language level, the faster the rate of spoken language development once consistent hearing and appropriate LSL instruction are provided.

b. It takes time! Access to sound does not magically result in knowledge of spoken language. Knowledge must be learned. A child who is 5 years old or older who is implanted and heavily reliant on signs takes a minimum of 12 months of appropriate, knowledgeable, and intensive instruction in listening and spoken language before a major improvement in language can be expected. Not age equivalent comprehension – but beginning to rely on spoken language in some situations for understanding.

In the case of a child who was raised in an ASL environment that did not include an emphasis and consistent work to develop LSL skills it can be assumed that just having hearing aids on did not allow the child to develop spoken language at an adequate rate to allow him or her to be able to comprehend and compete with age peers within a typical classroom setting without an ASL interpreter. Based on language levels in ASL and LSLS, key decisions would likely be:

• What intensity of direct intervention in listening skills is necessary to result in LSL fluency within one (Two? Three?) academic year? Daily intensive intervention by a skilled LSL provider may be likely as the child will not be exposed many hours to good spoken language models outside of school. The sooner the student can rely on listening as the primary access to classroom learning the sooner the expense of having an interpreter can be eliminated.
• What is the plan for the interpreter, classroom teacher, and classroom aide (if any) to work together to facilitate the student’s communication during instruction, incidental language exposure, and peer-to-peer communication? When would LSL be used? When would ASL be used?
• What are the communication benchmarks to look for during progress monitoring that will signal a switch from full interpretation of all class communication to using ASL to scaffold what the child does not understand when presented information by spoken language only? This is an incremental stepwise process.

  Ultimately, what educational program will allow the child to access communication at a level that there will be meaningful academic progress?   Click here to download this article.

Many students who are hard of hearing or deaf enter school with limited vocabularies and language experience, whether their communication modality is spoken or signed.  Given these constraints, vocabulary instruction is an essential and ongoing component of our work with students.  The sheer breadth and depth of information presented in a general education setting is often overwhelming, however, pre-teaching vocabulary can be an effective strategy in helping students integrate new words and concepts into their “bank of knowledge”. Various factors come into play when pre-teaching vocabulary is identified as an accommodation and/or specialized instruction.  Pre-teaching vocabulary requires close collaboration with classroom teachers. Lesson plans may be difficult to obtain, finding signs for many specialized topics can be a challenge, and time limitations make deciding which vocabulary is the most important to teach is equally challenging.

Free resource provides invaluable information for teachers working with multiple grade levels: https://www.lead4ward.com

Teachers of the Deaf and Hard of Hearing must have curriculum expertise for multiple grade levels, including staying abreast of the words and concepts being taught. One resource created by Texas educators is https://www.lead4ward.com. Concepts and vocabulary introduced in each grade, along with previous concepts to be mastered are included for all core subject areas from kindergarten to high school. This academic vocabulary can be extremely helpful in planning your pre-instruction.

Tips for vocabulary instruction:

1. Scaffolding– Learning the meaning of a new word may be more effectively taught when students can relate new words to prior knowledge. Effective teachers relate new vocabulary to what a child is likely to already know rather than to a dictionary or glossary definition. For example, when teaching the word ‘severe,’ the student may learn it better when it is related to a personal experience (e.g. a severe injury) than to a story about the weather. For some students with hearing loss, teaching the word injury will be required while learning the word severe. 2. Explicit Instruction – Put away your assumptions about what you think the student knows and teach to be sure the student can say/sign the word, recognize it in print and in visual representation, discuss the word’s multiple meanings, and use it in its various contexts. 3. Discussion – For deeper understanding, discussion is paramount. The term “discussion” is not to be confused with “questioning.” Discussion, in a group setting, involves questions or comments going from student-to-student with the teacher acting as a facilitator where questioning usually goes from teacher-to-student, back to teacher, and then to another student, with content being more strictly controlled by the teacher. Discuss:

a. the definition b. multiple meanings c. produce synonyms and antonyms d. practice using the word in reading and writing, and e. provide examples and non-examples of appropriate use of the word.

4. Visual/graphic organizers– Visual/graphic organizers show relationships between words and make information easier to manage. Our students need to be able to identify attributes and categorize words in various ways.

The ability to organize words and information makes word retrieval easier.

Some types of visual organizers include Venn diagrams, flow charts, KWL charts, sequential organizers, semantic maps, and graphs.  Without word organization, students end up with a “laundry basket” of new words rather than a file cabinet. And isn’t it easier to retrieve something from a file cabinet than a laundry basket? 5. Repetition, repetition, repetition – Repetition is necessary for students to master vocabulary words. Along with repeated exposure, seeing and using a new word or phrase across content areas and activities will help deepen word knowledge. Up to 12 exposures may be necessary to develop deep understanding of a new word, and students who struggle with reading may need additional opportunities (Easterbrooks & Beal Alvarez, 2013).

Which vocabulary words?

• Tier 1 words are words students are likely to know (happy, mom)
• Tier 2 words appear in many contexts and across content areas (equal, state)
• Tier 3 words are content-specific (chromosome, biosphere)

While some of our students may have to be taught Tier 1 words before moving on, targeting vocabulary instruction for Tier 2 words may be the best use of your time for students in the general education setting.   These are words that will be seen and heard frequently and across subjects. Taking advantage of pre-teaching these words in multiple contexts and forms (with applicable prefixes and suffixes) will address higher order thinking skills as well. There are many sources for Tier 2 word-lists, such as this free resource that appears on  Teachers Pay Teachers:  https://www.teacherspayteachers.com/FreeDownload/FREEBIE-Vocabulary-Targets-Word-List-K-5-Tier-2-Words-2095007 Other sources for vocabulary instruction include Cracking the Grammar Code 4 Book set with a Vocabulary Enhancement Simple Picture Glossary Supplement (Homelvig & Rugg); Latin and Greek Roots: Teaching Vocabulary Using Hands-On Activities and Common Objects (Stokes); 100% Curriculum Vocabulary-Primary and Secondary Editions (Eggleston & Larson). See complete catalog.

Pre-teaching vocabulary is NOT tutoring – it is specialized instruction.

Systematic vocabulary instruction including pre-teaching is essential not only for increased knowledge of the world around  our students, but also for increased confidence in reading, writing, and comprehension.  

Sources:

• Price, L. (2014). Visualizing vocabulary: Improving word association & retrieval skills [.pdf]. Retrieved from https://successforkidswithhearingloss.com/ Webcast available from The Online Itinerant.
• Knoors, H. & Marschark, M. (2014). Teaching deaf learners. New York: Oxford University Press.
• Easterbrooks, S.R. & Beal-Alvarez, J. (2013). Literacy instruction for students who are deaf and hard of hearing. New York: Oxford University Press.
• Gambrell, L.B. & Morrow, L.M. (2013). Best practices in literacy instruction (5^th). New York: Guilford Press.
• Schirmer, B.R. (1994). Language and literacy development in children who are deaf. New York: Macmillan.
• Hart, B.O. (1963). Teaching reading to deaf children. Washington, D.C.: Alexander Graham Bell Association for The Deaf, Inc.

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