Advocacy Notes: Responding to Bullying

My student is being bullied
but the school isn’t taking it seriously!

Question from the field: My student is being bullied but the school isn’t taking the situation seriously. What can I do?

Students with hearing loss often struggle in social situations due to a variety of situations. They may not have the level of language sophistication as their peers. They may mis-hear or misunderstand, or they may have a lack of access to what is being said by their peers. All of these can lead to bullying and teasing by peers including systemic bullying. It is critical that the school administration and staff understand your concerns.

As with the greater population of students, our students with hearing loss may be bullied in a variety of ways and circumstances. However, there are built in conditions that can make them feel singled out and isolated even when there is no bullying. If there is bullying on top of this, we must address it and help non-DHH professionals understand the needs of our students.

Real-Life Examples

Playground bullying situation:

My daughter was the first mainstreamed DHH student in our neighborhood school when she was in 2nd grade. Unfortunately, due to the need for CI revision surgery she started the school year in the general education class completely “off the air.” Early on in the school year she found herself being bullied by a group of boys on the playground. My 8-year-old daughter who could not hear anything at the time ended up surrounded by a group of boys taller than her, pushing her, saying things to her that she did not hear. The image of my little girl in that position is still paralyzing.

Mean girl” bullying situation:

These students of mine are fully mainstreamed and have the benefit of not being the only student in their classes with hearing loss. Unfortunately, they told me at the beginning of 8th grade that all of 7th grade they were teased and humiliated by the “popular” students. They shared that when teachers were syncing their classroom equipment, students would make derogatory comments about their hearing loss that their teachers never heard. Additionally, in Physical Education class the “popular” students would take the teacher mic, walk away, and give commands into the mic like, “turn in a circle,” and “jump up and down.” The students felt like they were treated like pets. When asked why they didn’t say anything to an adult, they shared that they were  afraid that if they stood up for themselves, they would not be liked. None of this is actually the case, but that is how our students feel.

Classroom bullying situation:

This student was mainstreamed starting in Kindergarten. Her primary needs focused on self-advocacy. Unfortunately, the year she finally started to advocate for herself she was met with such push back that she ended up in tears at home every night for 2 months. When she advocated for a change of seat due to a peer who caused auditory distraction, her teacher shut her down and told her no. The peer then began to openly bully her and bring the other classmates into it. When she advocated for her accommodations she was told by her teacher that she needed to “do better.”

Deaf plus bullying situation:

This student has a hearing loss as well as physical and medical conditions that limit him. Some of his peers were verbally calling him names related to the fact that he is hard of hearing and also made derogatory comments about his physical condition. Luckily for us, he told his parents and didn’t hold it in. We were able to go to the administration immediately.

Middle school bullying situation:

Back to my daughter…. we had several situations of bullying due to the fact that she was the first oral deaf student and cochlear implant user in our town in the mainstream with no previous path to follow. In 8th grade she had an oral language facilitator assigned to her in order to facilitate communication in the educational setting. This person was and accommodation for her as an oral student the same way a sign language interpreter would facilitate communication for a student who uses ASL. Unfortunately, when the language facilitator left her alone in PE she was physically beat up by 3 boys because she “talked funny.”

What can be done to reduce victimization of students with hearing loss?

The first step is to inform and involve the parents, if they are not already aware. Every school now has clear policies about bullying. Find the bullying policy and be clear about how the student’s situation fits the definition of bullying per the school policy and the prevention and cessation practices already delineated. Once the administration clearly understands that a true bullying situation is occurring, try to increase their understanding of the extra vulnerability of students with hearing loss and the need to go above and beyond the action items spelled out in policy to truly address victimization of students who are deaf or hard of hearing.

These activities can include:

  • Peer in-services: Proactively, the best way to create a circle of support around our students is to do peer in-services at the beginning of each year. I like to explain how amazing their peer with hearing loss is as a person dealing with a challenge. Answer all of the peer’s questions to take the mystery out of it, and at the same time give the peers a sense of ownership in understanding that in noisy situations when there is not teacher using an FM/DM system, their friend is going to have a harder time hearing. Make the inservice age appropriate and new every year. The requirement for peer inservice can be added into the IEP as an accommodation.
  • Grade level in-services: Some schools will do grade level presentations either directly related to the student with hearing loss and their unique circumstance or more of a focus on tolerance, empathy, and understanding differences. Kids are amazing!! They will almost always recognize that we all have something that makes us feel different and this helps to promote empathy for our students with hearing loss as well as for all of their peers.
  • Intervention in the moment: If there is bullying in the moment, pull the 2 students together and ask the student with hearing loss what they heard. This gives you the opportunity to work on communication repair and at the same time you are able to teach the typically hearing peer about how they may have been misunderstood or not heard at all. You can respond to the cause of bullying in the moment without ever directly addressing the typical peer.
  • Staff training: Talk with the school administration about the nuances of how hearing loss, listening in noise, and language issues can affect our students in social communication. You may want to ask for an opportunity to speak at a regularly scheduled staff meeting. This way you will be able to address the general education teachers as a group and get them on board with addressing bullying of students and add a focus on hearing loss specifically.
  • DHH Itinerant push-in services: If the teacher of the deaf/hard of hearing is currently only providing pull-put services, adding some push-in services in order to observe in class can lead to opportunities for intervention. Observe during regular instruction, specialist instruction (ie: Art, Music, etc.), and during unstructured times (i.e., PE, recess, lunch, etc.).
  • Goals for communication repair and self-advocacy: As this month’s Update topic emphasizes, about a quarter of typically hearing students are victimized whereas over half of students with hearing loss typically experience some type of bullying. While being bullied is not the fault of the student with hearing loss, you can prepare them to deal with the likelihood of being victimized by adding goals for communication repair strategies and self-advocacy. This way you can work directly with your student on how to handle situations in which they are being bullied.

 

Melinda Gillinger, M. A.
Special Education Consultant
Director of Parent Outreach/Advocacy for Supporting Success for Children with Hearing Loss
Melinda@success4kidswhl.com

 

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Bullying / Teasing Happens!

 

October is National Bullying Prevention Month.

Gallaudet researchers found that 812 deaf and hard of hearing students in eleven U.S. schools reported instances of bullying at rates 2-3 times higher than reported by hearing students.  It is obvious that bullying is a serious problem.  What is not always so clear is how parents, teachers, and deaf/hard of hearing students can work together to resolve it.

The Problem:

The incidence of bullying in the deaf or hard of hearing student population is a significant, even startling, reality. A 2018 study1 found that adolescents with hearing loss endured significantly higher incidence of bullying versus the general population (50.0% vs. 28.0%), particularly for exclusion (26.3% vs. 4.7%) and coercion (17.5% vs. 3.6%). Children younger than 12 years with hearing loss reported lower rates of bullying (38.7%) than adolescents with HL, but rates did not differ significantly.

“I thought more children and adolescents with hearing loss would report getting picked on, but I did not expect the rates to be twice as high as the general population,” said Dr. Andrea Warner-Czyz, study author.

In 20162, the story of a deaf high school student in Nebraska was reported on television news.  Students had taken his backpack during a lunch period and dumped it in a toilet.  Contained inside were his tablet, school supplies, homework, debit card, and his cochlear implant.  The student, Alexis Hernandez, reported: “Those students think it’s ok to bully a deaf student, but it’s not.  It’s not OK to bully someone who is disabled, deaf, or hard of hearing.  Or anyone for that matter.”

Another study3 found that students who had lower language abilities were more vulnerable to victimization if they lacked understanding of their own emotions and levels of anger, sadness, and fear. As students with hearing loss have a greater risk for difficulty in being able to identify and describe emotional states4, recognizing that these challenges may contribute to victimization has important implications for intervention.

Bullying can be5:

  • verbal: name-calling, insulting, teasing, ridiculing
  • emotional/indirect: ignoring or deliberately excluding, spreading rumors or nasty stories, turning friends against the child, laughing at them or talking about them behind their back, taking, hiding or damaging their personal belongings, drawing unkind pictures of the child, using a feature of the child’s disability to bully them, e.g. deliberately making loud noises near a deaf child who is known to find loud noises unpleasant, creeping up on them from behind to scare them, deliberately making a noise when the teacher is giving instructions.
  • physical: any physical contact which would hurt such as hitting, kicking, pinching, pushing, shoving, tripping up, pulling out hearing aids.
  • manipulation/controlling behavior: using the child’s vulnerability as a way of controlling them or making them do something the bully wants them to do.
  • cyberbullying: using electronic media (internet, mobile phones) to bully someone. This includes bullying through text messages, instant messaging, email, chat forums, online games and social networking websites.

Solutions:

Once we recognize what forms the behavior takes, what possible solutions are available for our students who are vulnerable?

Incorporate routine screening for bullying via direct questions6:

  1. 1. Ask the child about friends. A response of “none” or “few friends” deserves additional prompting (Why do you think that is?).
  2. 2. Inquire if the child avoids going to school and request more information on the assistance the child has accessed.
  3. 3. Ask the child directly if he or she has experienced bullying. If the child answers “yes,” ask follow-up questions and refer the child to school and community resources.

Address developing skills to reduce victimization in the student IEP6:

Issues related to peer victimization can also be included on individualized education plans or 504 plans. For example, educational plans can specify informing teachers and classmates about hearing loss. Plans can also include a safe environment statement designating a “home base” where a student can go when feeling unsafe and/or a “safe person” with whom a student can discuss difficult situations. Additionally, education plans could include strategies to reduce vulnerability and improve response to bullying by targeting social pragmatic skills (e.g., taking turns and asking questions; reading facial expressions and body language) via one-on-one instruction, role playing, or social stories. Organizing a social skills group can help children develop social competencies in a supportive environment. Clinicians can also help patients address assertiveness and/or self-advocacy, with specific training to identify and report bullying, say “no” to stop the situation, and request assistance from a trusted source.

For teachers:  provide ongoing education to keep students aware that the bullying they may be experiencing – or doing to others – is unacceptable.  Give your students a safe and open communication pathway for reporting incidents of bullying.  Recognize that bullying will most often happen when you are not watching – In the lunchroom, the bathrooms, the playground, the hallways.  Just because you did not see it does not mean it did not happen!

Be a listener. Be supportive.   Report incidents to your school administration as promptly as possible.

For parents:  talk to your child about feelings – openly and often.  They need to know that when things go wrong, you will be there to support them.  Stay closely involved with

school administrators and teachers.  Does the staff understand about hearing loss?  Really understand?

About cyberbullying:  This form of bullying may be the most insidious and dangerous of all. While our deaf and hard of hearing students find invaluable and positive connections online, the potential for negative interactions has increased disproportionately.

How can we be proactive about cyberbullying?  By being fully aware of what websites are being used.  If we as adults continue to make excuses about our lack of skill or disdain for social media, we are inadvertently providing limitless opportunities for our children to be vulnerable to cyberbullying.

Recognize, React, and Raise Awareness

October month is dedicated to Bullying Prevention but teachers and parents of deaf and hard of hearing children are fully aware that the need to protect vulnerable students is ongoing. Find a wealth of resources to stop bullying in your family or classroom or school in the following websites.

 

 

Resources for Teachers and Parents

References

  1. 1. Warner-Czyz, A. D., et. al. (2018) Effect of hearing loss on peer victimization in school-age children. Exceptional Children. https://medicalxpress.com/news/2018-04-children-loss-bullying.html . Download from: https://successforkidswithhearingloss.com/wp-content/uploads/2019/09/Children-with-hearing-loss-face-more-bullying-2018.pdf
  2. 2. 2016 news: https://www.newschannel5.com/news/national/burke-high-school-investigating-bullying-incident-after-it-goes-viral
  3. 3. Van den Bedem, N.P., et al, (2018). Victimization, bullying, and emotional competence: Longitudinal associations in (Pre)Adolescents with and without developmental language disorder, Journal of Speech, Language, and Hearing Research, 61, 2028-2044.
  4. 4. Goberis, D., Beams, D., Daples, M., Abrisch, A., Baca, R. & Yoshinaga-Itano, C. (2012). The Missing Link in Language Development of Deaf and Hard of Hearing Children: Pragmatic language development. Seminars in Speech and Language, (2012), 33:4, 297-309.
  5. 5. Bullying Advice for Parents of Deaf Children. National Deaf Children Society in the UK. Download from: https://successforkidswithhearingloss.com/wp-content/uploads/2019/09/Bullying-Advice-for-Parents-of-Deaf-Children-NDCS-UK.pdf
  6. 6. Warner-Czyz, A. D. (2018). Peer victimization of children with hearing loss. The Hearing Journal, October. Download from: https://successforkidswithhearingloss.com/wp-content/uploads/2019/09/Peer_Victimization_of_Children_with_Hearing_Loss.4.pdf

 

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Advocacy Notes: Why do the Ling Sound Test

Why Should the Ling Sound Test be done at school?

Question from the field: Can you please clarify the reason for the LING sound test. Why do families want us to do this at school, and how can we implement this without stressing out the general education teachers?

The reason we do a daily listening check is purely and for the sole purpose of ensuring that our students’ personal and classroom technology is working and that they have full and clear access to their instruction.

The Ling Sounds let us know how our students are both accessing and discriminating sounds across the speech spectrum. The purpose of conducting this listening check is not for us to check the student’s personal listening abilities, and it is not a time for us to work on their auditory skills or IEP goals.

As Carol Flexer teaches us, we do not hear with our ears. We hear with our brains. “Hearing loss is a doorway problem… there is some type and amount of obstruction in this ear doorway that prevents auditory data from the environment to reach the brain where learning the meaning of that auditory information occurs. Hearing aids and cochlear implants break through the doorway to allow access, stimulation, and development of auditory neural pathways.”1 We do the daily Ling sounds listening check in order to ensure that the child has clear access through their technology (personal and classroom) to their brain prior to starting each day.

 

The LING Sound Check:

WHAT?

The Ling Sounds were identified by Daniel Ling. They are “ah” “oo” “ee” “s” “sh” and “m” We know that when a child can detect all 6 of these sounds, they have access to sounds from 250 Hz to 8000 Hz. When they can discriminate all 6 of these sounds, we know that they are ready to learn.

WHY?

We as educators are responsible for our students’ access to their instruction in the educational setting. We must ensure that before instruction starts, we are aware of any auditory limitations that the student may have on any given day. By doing the daily listening check, we may identify confusion of low frequencies such as “oo” and “m” or difficulty with high frequency information such as “s” and “sh.” We may see a pattern of difficulty that is reflective of equipment issues that has nothing to do with the child’s effort or how much he or she is paying attention. For example, if a child is not clearly able to perceive the “s” sound they could be unable to differentiate between cat, cap, cast, calf, etc. If the access issue is not as simple as a battery or that the child has a cold that day, then the information is shared with the teacher as well as the family who may then decide to follow up with their clinical audiologist.

WHO?

For most teams the general education classroom teacher will not be the one to conduct the listening checks as they have many other students and responsibilities at the beginning of each school day. This is not necessarily a task or responsibility that we want to add to the general education teacher’s load. We do want them to understand what it is and why we do it. Teams will typically identify a primary person on the school site who will be trained how to conduct the listening checks as well as training some back up personnel on campus. Examples of staff who may conduct the listening checks are a SPED teacher, SLP, classroom aide, school nurse or health tech, or a 1:1 aide. This is a good discussion to have as a team so that the Teacher of the Deaf and Educational Audiologist can train the appropriate team members.

WHEN?

It is important that the listening checks be done prior to instruction at the start of school. It only takes a few minutes and should always be done before instruction begins.

WHERE?

The listening checks must be done in a quiet location. It may be in a classroom before the other students enter, the nurse’s office, outside of the classroom after the students have all left the playground, or wherever the team identifies as an appropriate location with minimal auditory distractions or interference.

HOW?

In my experience the listening checks are done as follows:

  • The student is facing away from the adult. Most teams will assess at ear level, 3 feet, and 6 feet.
  • The adult says the 6 Ling sounds and sometimes includes silence.
  • It is imperative that the sounds are never done in the same order from one day to the next as our students are masters at knowing what comes next
  • The person conducting the listening check will put a check mark ✅ if the child gets the sound correct on the first attempt, “2nd,” if they get it correct the second time, and document2 the sound the child says (ie: “m” for “oo”) if they said it wrong.

WHAT NOT TO DO:

Do not ever do the following while conducting a Ling sound listening check:

  1. 1. Continue to repeat the sound until the student gets it right.
  2. 2. Turn the child to face us if they are saying the wrong sound.
  3. 3. Let the student know that they missed a sound. We want to say, “Listen again” and “Great job” and send them off to class. Remember that are checking the equipment and access, not the student.

The reasons we do the daily Ling sound listening checks are so that the we can confirm the equipment is working, so the educators know the student is ready to learn, and to inform the family if the equipment is not working in case they need to follow up with their clinical audiologist. Our students should not feel like they have failed or done anything wrong as this is not a time when we are working on their skills or IEP goals.

 

Melinda GilLinger, M. A.
Special Education Consultant
www.melindagilLinger.com

 

  1. 1. How to Grow a Young Child’s Listening Brain, Carol Flexer, PhD, CCC-A, LSLS Cert. AVT 6/26/2018
  2. 2. Suggested resource to document the Ling Six Sound Check: https://www.teacherspayteachers.com/Product/The-Ling-6-Sound-Check-1729553
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Determining Listening Challenges

Speech perception and listening accuracy cannot be assumed by looking at the audiogram – it must be assessed. Teacher’s voices, room acoustics, and classroom management vary so identifying listening challenges – and specific accommodations – needs to be done for students who are hard of hearing each school year. New information about the Listening Inventory For Education – Revised will help guide consideration of what typical listening challenges look like for students with normal hearing, so that we can better quantify these challenges for students who are hard of hearing.

 

Why challenged listening?

The primary difference between students with hearing loss and their typically hearing peers is that they do not access speech as fully. This reality is often unrecognized by school staff who ‘know’ that the child can hear them just fine. While all children under the age of 15 years have an immature auditory cortex, and therefore greater challenges listening as accurately as adults, those with hearing loss are more impacted.

Classrooms are often noisy and the person the child needs to hear is often more than 3 feet from the hearing aid microphones. While individuals can detect sound occurring beyond 3 feet, to truly perceive sounds like s, f, t, p (as in cat, cap, cast, calf) speech must be within the student’s listening bubble, or the range of hearing within which speech can be fully heard. 

For most classroom communication students who are hard of hearing must work harder to listen, resulting in fewer cognitive resources available to process what was said so that it can be comprehended and remembered. Because they expend more effort to listen and pay attention, they experience greater listening fatigue as compared to typically hearing peers. Greater effort for less comprehension, at a higher level of fatigue, all play a role in reducing the pace of learning and an increasing gap in achievement across school years. Refer to the Cascading Impact of Hearing Loss handout for more information.

How well a student is able to perceive speech in a classroom will impact educational performance. These impacts are often overlooked or misunderstood by school staff as they review whether it is necessary to evaluate a student with hearing loss to determine eligibility for sufficiently intensive specialized services and accommodations.

Almost 5 years ago (November 2014) the US Department of Education and US Department of Justice clarified that, under Title II of the ADA, 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)] through the provision of appropriate aids and services “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” [ADA Title II 28 C.F.R. 35.130 (b)(1)(iii)]. (Read more about ADA.)

To determine if communication is “as effective as others” we need to apply what is known about typically hearing children.

Functional Assessment

Performance under typical school conditions is necessary to assess either directly with the Functional Listening Evaluation (FLE), or indirectly, with checklists like the Children’s Home Inventory of Listening Difficulties (CHILD) or the Listening Inventory For Education-Revised (LIFE-R).

The Functional Listening Evaluation has become a mainstay in the field of DHH education and is commonly performed by educational audiologists and teachers of the deaf/hard of hearing. The FLE is a means to estimate how well a student is able to access verbal instruction, and to what degree speechreading, distance and noise effect performance.

90-95% = Typical Hearing Average

The FLE can be performed with a variety of age-appropriate stimuli including single words, phrases, nonsense phrases and sentences depending upon if the desired information is about the precision of speech perception (words/nonsense material) or to estimate access to classroom communication (phrases for young children, sentences for grade 1 and above). A steady source of background noise and a means to control the loudness of the noise in comparison to the presenter’s voice is needed to perform the FLE in a valid manner. The Recorded FLE Using Sentences was created to simplify and add consistency to FLE administration. See the 2-minute video demonstration of using the Recorded FLE Using Sentences on YouTube. A free 10-minute classroom noise file can be downloaded from this Supporting Success webpage for instructional use or to aid in assessment. Collected data (1999)1 on children age 3 to 17 with typical hearing listening in quiet and noise found that the typical score listening in quiet averaged 95+% and in noise 90+%, regardless of age and without the use of visual cues.

The Listening Inventory For Education was revised in 2012 (LIFE-R) resulting in a suite of checklists for students, classroom teachers and parents. Most frequently used is the LIFE-R Student Appraisal which is a self-report measure for students grade 3, or age 8, and above. Students must consider each of the 15 school listening situations and decide the how difficult it is for them to hear and understand. Via this rating, a potential score of 100% is possible on the LIFE-R Student Appraisal.

72% = Typical Hearing Average

Two recent research studies provide helpful insight into interpretation of LIFE-R results. In 20181, researcher in Belgium translated the LIFE-R verbatim into Dutch and it was completed by 187 secondary students with normal hearing. Even though a score of 100% is possible, the typical listening situations in a classroom can be challenging for students with normal hearing as well as those with hearing loss. The average score for students with normal hearing was 72% with the most difficult listening situations being when classmates were noisy or when listening to responses during class discussion. The first ten questions on the LIFE-R relate directly to instructional classroom situations, in which students score significantly higher than the five questions related to social or group listening situations.

57% = DHH Average

A second study2 analyzed the data collected from use of the online LIFE-R over a period of 4 years (no identifying information), resulting in 3500-5000 responses, depending on the question analyzed. In every listening situation, students with severe to profound hearing loss showed greater hearing difficulty than all other groups, including cochlear implant users. The total average score for all 15 listening situations across students of different grades, hearing technology and hearing levels was 57%. Of the data analyzed, 509 had grade level indicated. Students in grades 3-6 reported poorer listening (53%) than those in grade 7-9 (61%) for all 15 situation responses. The most challenging situation was trying to listen to the teacher when other students were making noise, while difficult for all respondents, was even more so for the younger students. The second most difficult scenario was listening in a large room or school assembly.

If a student with hearing loss scores less than 90% on the FLE, or less than 72% on the LIFE-R it is evidence that communication is not as effective as peers and that auxiliary aids and services MUST BE PROVIDED to close this gap.

 

Formal Assessment

When students are present in classrooms it is assumed that they will hear and understand instruction. Hearing loss impacts this basic assumption and the question “to what degree is this student impacted” must be addressed. Although it is expensive to purchase norm-referenced tests, it is necessary to have the ability to collect data that is relevant to children with hearing loss in both a norm-referenced and functional performance (informal) format. The following are felt to be the best tools available to gather this information to identify areas of weakness, which make results advantageous to eligibility discussions and planning.

  • Developmental Test of Auditory Perception (DTAP): age 6-18. Takes 30 minutes to administer via CD. Results in language and non-language auditory perception index scores and background noise and no background noise index scores. The DTAP and FLE are a powerful combination to provide evidence of the impact of hearing loss on access to communication.
  • Assessment of Story Comprehension (ASC): Pre-K and K, age 3-5 years. Takes 3 minutes to administer and 1 to score. Teacher reads a story and student answers literal and inferential questions.
  • Oral Passage Understanding Scale (OPUS): age 5-21 years. Takes 10-20 minutes. Teacher reads a passage and student answers questions. It identifies knowledge and use of words, word combinations, syntax, and use of language in which meaning is not directly available from the words used. Yields more information than simply whether the individual can comprehend; deeper processing abilities.
  • Listening Comprehension Test – 2 / Listening Comprehension Test – Adolescent: ages 6-11 and 12-18 years. Takes 35 minutes to administer. Results are a good predictor of how well a student will be able to function in the mainstream classroom. Subtests are listening for the main ideas, details, reasoning, vocabulary and understanding messages. Results can readily be used to develop intervention goals.

 

References

  1. 1. Bodkin, K., Madell, J., & Rosenfield, R. (1999). Word recognition in quiet and noise for normally developing children. American Academy of Audiology Convention, Miami, FL – Poster session.
  2. 2. Krijger, L. DeRaeve, K. L. Anderson & I. Dhooge (2018). Translation and validation of the Listen Inventory for Education Revised into Dutch. International Journal of Pediatric Otorhinolaryngology, 107, 62-68. Online article.
  3. 3. Nelson, K. Anderson, J. Whicker, T. Barrett, K. Munoz, & K. White (2019). Classroom Listening Experiences of Students who are DHH using LIFE-R. Submitted manuscript.
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Advocacy Notes: Key Things for Classroom Teachers to Know

What are the key things that classroom teachers need to know in order to support my students?

 

Question from the field: I have students whose IEPs call for staff inservice training prior to school starting or within the first couple of weeks. Some use hearing aids and others use cochlear implants, but they are all placed in general education classrooms. Knowing that the general education teachers have limited time, what are the key things that they need to know in order to support my students?

Starting each school year with a staff inservice training sets the stage for success. This is a great question with which many Teachers of the Deaf (TOD) and Educational Audiologists struggle.

The 2 most important things to remember when providing trainings to staff who will be working with our students with hearing loss in the general education setting are:

1. Always share the WHY behind what you are asking them to do for the student. Once teachers understand WHY they need to use the teacher transmitter or pass-mic, WHY students need strategic preferential seating, and WHY we ask for pre- and post-teaching, most begin proactively thinking about what else they can do to support the student.

2. Everyone who will influence the success of the student needs to be at the training. It is critical that all staff who will interact with our students attend the training to hear the information from the TOD, AUD, or expert conducting the training. Asking teachers who attend the training, but are not experts in this field, to pass on the information is not fair to the student, the teacher who has just learned everything about the new student, or the teacher who missed the training.

 

General education teachers have shared with me that the following were things that they did not know and helped them to better serve the student with hearing loss:

  • Difference between hearing aids and cochlear implants: It is important for people outside of this field to understand that cochlear implants are not the same as hearing aids. Additionally, there are still teachers and administrators who believe that cochlear implants restore normal hearing or believe that the students are no longer deaf.
  • Understanding the audiogram: I explain the audiogram not from the technical perspective that clinical and educational audiologists understand it, but rather in order for teachers, coaches, and service providers to understand the speech spectrum and where the critical features of linguistic information occur. It is also very important for everyone to understand the unique loss and history of the student they will be serving. Many general education teachers and providers who have previously served students with hearing loss are under the impression that this means they understand what all students with hearing loss will need. Knowing the individual child’s loss, the technology they use, and their history helps everyone have a better school year.
  • Incidental hearing/Incidental learning: It is critical for everyone to have an understanding of how our students may have gaps in their knowledge of language and concepts that their typically hearing peers know and how that can lead to misunderstandings in both their academics and social interactions.
  • Hearing Assistive Technology (HATS): Hearing assistive technology is a term that encompasses the low incidence equipment in the IEP such as the personal FM/DM system, classroom sound field system, and pass-mic for access to peer input. After explaining what a student has in his/her IEP, it is very helpful to share the Hearing Loss in the Classroom video1.

 

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

 

1. Hearing Loss in the Classroom video, J. Madel, Sept. 2010

 

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Surface Learning is Not Enough – the Need for Deeper Understanding

 

In most classrooms, new information is presented in a lecture format supplemented by reading material, until students build surface knowledge of the topic. Interaction activities such as classroom discussion, small group work, and partner problem-solving are used to solidify surface knowledge and to move students to a deeper level of understanding1. Therefore, how well students are able to converse in the classroom setting truly impacts their move toward deeper understanding and learning at the expected pace.

 

It is faulty to assume that:

(1) a student will ‘catch up’ once they enter school,
(2) just because a student has ‘okay’ language at school entry that he/she will be able to keep up with class expectations across the academic years, and
(3) non-DHH-specific specialized services provided with less intensity than needed for a student to close gaps and to keep up will be sufficient to counteract the access issues caused by hearing loss.

On the way to deeper understanding: For students with hearing loss, keeping pace in moving to a deeper level of understanding can be very challenging. 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 language 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.

 

Filling the gaps. Due to prior knowledge deficits 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 peer activities that are meant to move them to deeper understanding. “Closing the language gaps” is not something that is a nice extra touch to provide to our students if there is a teacher of the deaf/hard of hearing available – it is a necessary accommodation for equal access to learning.

Filling in the gaps in prior knowledge is necessary if a child is to be able to develop the surface learning needed prior to developing deeper understanding. Without this surface learning, a deeper understanding similar to that of class peers is not possible.

Added to typical knowledge deficits is the reality that reduced precision listening ability caused by hearing loss very often delays literacy skill development and slows reading fluency. Teaching vocabulary, when the student does not have sufficient phonological awareness skills, will not develop the reading fluency needed for comprehension, especially in the secondary grades.

 

Conversational inequalities. Research2 has indicated that during one-on-one conversations in a quiet setting, students with hearing loss have conversational skills equivalent to their hearing peers. This includes skills for initiating a conversation, maintaining a dialogue over several turns, shifting the topic, and terminating the conversation. In a typical mainstream classroom, there are many choices for communication partners along with background noise, reverberation, and listening at distances beyond 3 feet. These conditions all interfere with speech perception of students who are hard of hearing.

 

Students with hearing loss make 25% fewer overall communication attempts than their hearing peers. They also often seem unaware that their peers had tried to initiate conversation and do not attempt to maintain a conversation. When they attempt to maintain a conversation, they generally use one-to-two-word phrases to maintain communication and do not add new information.

 

A teacher repeating key information from class discussions cannot ‘level the playing field’ for our students.

Students with hearing loss frequently try to maintain the conversation by bringing up a topic that is unrelated to the conversation. In other words, they are not aware enough of the content of the conversation to contribute information, so they bring up a new topic. Thus, when classroom activities move to peer interaction as a way to facilitate deeper understanding it is often very challenging for students with hearing loss to participate successfully. As can be inferred by the research, in quiet settings performance in conversation equal peers. Therefore, it is the unequal acoustic access in the classroom that results in conversational challenges for students who are hard of hearing. This provides a powerful argument for the use of hearing assistance technology that will improve perception of peer voices in 1:1 or group settings.

 

Moving to a quieter area for discussion will not ensure full participation by the student with hearing loss. Including him or her in a group that sticks to the topic will heighten the value of the activity for the learner with hearing loss and improve the deepening of understanding.

Challenges repairing communication breakdowns. Another aspect of conversation relates to what a person does when they do not fully understand what another person has said. One study3 found that persons with hearing loss have difficulty when a shift in topic is made during conversation. The more predictable the conversation, the fewer the likelihood of communication breakdowns. If a student is sitting with a group of peers who maintain their focus on the problem-solving task, the level of understanding is likely much higher than if the student was in a group who wandered off topic repeatedly. The teacher needs to be aware of this issue when pairing our students with different partners or groups.

 

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 necessary for

deep learning to occur. Providing the appropriate access technology is a necessity if we are to allow deeper learning to occur within the classroom. Selecting appropriate group partners and honing communication repair skills is also critical to achieving at the same rate and to the same level as peers.

 

References:

  1. 1. Fisher, Frey, Hattie (2016) Visible Learning for Literacy Grades K12: Implementing the Practices that Work Best to Accelerate Student Learning. Corwin/SAGE, Thousand Oaks, California
  2. 2. Duncan (2001). Conversational skills of children with hearing loss and children with normal hearing in an integrated setting. The Volta Review, 101(4), 193211.
  3. 3. Caissie (2002). Conversational topic shifting and its effect on communication breakdowns for individuals with hearing loss. TheVolta Review, 102(2), 4556

 

Some products to check out related to this topic:

 

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Preparing for Success: What Classroom Teachers Need to Know About Students with Hearing Loss

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

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

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

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

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

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

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

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

What Teachers Can DO to Help a Student with Hearing Loss

 

How to identify a communication breakdown

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

Classroom Tips for Teachers – Speaking

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

Classroom Tips for Teachers – Engaging

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

Classroom Tips for Teachers – In the Classroom

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

How a Teacher can Manage Peer Conversations

 

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

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

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

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

 

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

 

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Advocacy Notes: My Supervisor Says I Can’t Advocate for My Students!

Advocacy Notes:

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

 

 

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

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

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

 

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

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

In pdf   Complaint   Analysis by Wrightslaw

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

 

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

 

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Fall 2019 Catalog

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Too Many Students to Serve?

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

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

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

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

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

 

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

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

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

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

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

 

References:

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

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

 

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

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

  • Spoken Language – developing the use of spoken language in the primary language of the family and/or education system using the mouth and vocal cords
  • American Sign Language (ASL) – a complete language system that uses signs with the hands combined with facial expression and body posture. ASL includes visual attention, eye contact and fingerspelling.
  • Manually Coded English (MCE) – the use of signs that represent English
    words. Many of the signs are borrowed from ASL, but use the word order, grammar, and sentence structure of English.
  • Cued Speech – a system of hand signals to help the listener with hearing loss identify the differences in speech sounds that are difficult to discriminate through listening.
  • Conceptually Accurate Signed English (CASE)/Pidgin Sign English (PSE) – a mix of ASL signs used in English word order.
  • Simultaneous Communication – used in order to speak out loud while signing using CASE or PSE.
  • Bilingual-Bicultural (Bi-Bi) – typically the use of ASL as the student’s first language and primary mode of communication while learning to read and write in English.

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

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

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

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

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

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

  • For an 8th grade student, the school district allowed the student to take his Roger DM system on the Spring Break trip to Washington DC.
  • I had a 16-year-old student who regularly participated in her own IEP meetings, so the school provided both her FM system and CART services during the IEP meetings.
  • I have had multiple preschool students whose schools were inserviced so that they understood the role and benefit of the ASL interpreter and/or FM systems. They consistently provided these supports during field trips and walks through the neighborhood outside of the classroom.
  • Finally, I had an 18-year-old student with a cochlear implant who uses spoken language. Her school provided 2 note-takers to travel with her on a school trip from California to Hawaii so that she could access the lectures held on hikes and on top of volcanoes.

 

References

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

 

 

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Learning Progress Equal to Peers?

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

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

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

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

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

 

Compare Progress from Year-to-Year

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

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

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

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

Needed Supports for Keeping Pace in the Classroom

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

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

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

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

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

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

Considerations for Monitoring Progress

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

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

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

Monitoring Progress of Expanded Core Skills

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

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

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

 

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

 

References:

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

 

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Advocacy Notes: No FM Provided

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

 

Why FM/DM Systems?

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

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

 

HATS includes any of the following components2:

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

 

Timing is Essential for FAPE

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

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

 

The Barrier of Lack of Audiology Expertise

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

 

Be Empowered to Advocate

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

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

 

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

 

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We Want Him to be “Normal”…

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

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

What does this approach mean for the student?

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

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

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

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

Setting the stage for rejection of hearing devices

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

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

  • Before he enters kindergarten if possible, prepare the child that he will be asked questions
    • Other kids probably haven’t seen a child using hearing aids and won’t know what they are
    • He will be asked questions about what the hearing devices are and why he uses them
    • Other children may want to handle the devices and he needs to be able to discourage this appropriately, so they are not broken
    • People do not understand what it means to have a hearing loss.
  • Work with the child to develop an understanding of what a hearing loss is, and what that means
    • He knows he is the kid in the family that wears hearing aids but is likely to not have a clear understanding of why.
    • Use materials like the CHILD checklist questions and the My World tool (soon to be an app!) to discuss how the hearing loss means he has a smaller ‘listening bubble’ and challenges listening in noise, at a distance, and when people talk fast or have accents.
    • The hearing aids help him – A LOT! Unless he understands what it means to have a hearing loss and how the hearing aids help him, he won’t be able to explain it to others when they ask or to advocate for himself when he knows he will have a hard time hearing and understanding.
    • Inservice the class peers
      • Whether the child wants to play a role in talking about hearing and listening with his classmates or not, an adult needs to set the stage for student acceptance (teacher, parent, DHH specialist)
      • Discuss the importance of hearing and being a good listener in the classroom. What happens if someone can’t hear as well as others? Some children are born with ears that do not work as well as other peoples and they use hearing aids. Etc.
      • It is especially hard to understand in noise and when someone is talking at a distance. This makes it seem like the person could be ignoring you, but that is not true.
      • Read a book to the class, like Eggbert the Slightly Cracked Egg roughly for preschool through grade 2, Friends, Like You for grades 2-5, and El Deafo for grades 3-6.
      • Discuss how to be respectful when talking to others. Get their attention first, etc.
      • Demonstrate the use of the DM system. Allow the child to ‘shine’ as the teacher steps away and quietly asks a question that the rest of the class cannot hear but the child using the DM system can answer.
      • Answer questions – the classmates will be curious!
  • He WILL be teased. What should he do?
    • While some children will ask about the hearing devices because they are curious, others will tease the child. Discuss teasing:
      • Why do children tease?
      • Is he the only one who gets teased? Only kids with hearing aids get teased?
      • How should he avoid bullying situations?
      • Practice responses to typical questions and teasing situations
    • Refer to Building Self-Confidence and Resilience to Maximize Acceptance for materials on teaching for resilience to teasing
  • Make regular connections between DHH peers is critical for success
    • Children who connect with others who have similar hearing loss and device use will be more self-confident and resilient to peer pressure. Holding regular group meetings digitally (i.e., Skype, Zoom, etc.) among students to meet instructional goals for self-advocacy is an effective way to increase student success – socially, emotionally, and academically!

 

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Advocacy Notes: Early Intervention

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

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

 

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

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

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

Download this OSEP letter.

 

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

 

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

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

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

Download this OSEP letter.

 

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Early Intervention Materials on Tap

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

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

 

Summary of OCHL Findings:

  • 15% of the children had unstable hearing that declined over the study period
  • Over half of the children had hearing aid fittings that did not meet prescriptive targets and 35% of the total had below average audibility due to poor hearing aid fit; only 65% of the children had adequate aided audibility of speech
  • The majority wore their hearing aids at least 8 hours per day, with young children wearing just a few hours, increasing wear time gradually until they achieved more usage in preschool
  • 10-15% had declining or limited hearing aid wear
  • Children with mild to severe hearing loss, on average, showed depressed language levels compared with peers with normal hearing who were matched on age and socioeconomic status; amount of language delay increased with greater severity of hearing loss
  • Better audibility with hearing aids was associated with faster rates of language growth in the preschool years.
  • Children fit early with hearing aids had better early language achievement than children fit later. Any degree of hearing loss, even mild loss, can place children at risk for learning issues. The risk can be minimized with early and aggressive intervention.

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

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

 

Early Intervention “Curriculums”

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

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

 

EI Resources for Families Choosing to Use ASL

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

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

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

 

EI Resources for Families Choosing to Use Listening and Spoken Language

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

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

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

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

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

 

Early Intervention Materials

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

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

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

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

Achieving Effective Hearing Aid Use in Early Childhood

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

The Developing Child with Unilateral Hearing Loss

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

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

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

Social-Emotional Evaluation/Assessment Measure (SEAM)

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

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

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

 

APPS!

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

 

References

  1. 1. White, K. R. (2018). Demographic Considerations in Serving Children who are Hard of Hearing or Deaf. Journal of Early Hearing Detection and Intervention, 3(2), 14-17.
  2. 2. Ear and Hearing, November/December 2015, Volume 36, Supplement 1 Conclusions article
  3. 3. Advocacy Facts. NCHAM handout.

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Advocacy Notes: Due Process

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

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

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

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

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

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

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

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

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

 

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

 

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

 

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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 needs to be applied throughout the evaluation process. Furthermore, the LEAD-K3 movement has spotlighted the need for appropriate, tailored assessment of children who are deaf or hard of hearing.  The big question from the field of education for children with hearing loss is ‘What assessments should we be using?’

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

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

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

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

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.

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

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

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

Title II of the American’s with Disabilities Act requires that schools ensure that communication for students who are deaf and hard of hearing “are 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.

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

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

 

References

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

 

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Advocacy Notes: Addressing Reading and Literacy in the IEP

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

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

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

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

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

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

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

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

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

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

Sample Goals:

  • VocabularyBaseline: STUDENT displays some difficulty when listening in environments with background noise and/or multi-talker babble. STUDENT is able to demonstrate discrimination of close-set vocabulary and short passages in the presence of background noise with 65% accuracy. Goal: By DATE, STUDENT will be able to demonstrate discrimination of close-set vocabulary and short passages in an environment with background noise or multi-talker babble with 80% accuracy as measured by teacher charted data.
  • Reading comprehensionBaseline: STUDENT is able to answer who was in the story with 70% accuracy. She is struggling to retell basic details about the story when prompted with 45% accuracy. Goal: By DATE, STUDENT will be able to answer basic who, what, when, and where questions about a story that has been read to her with 80% accuracy in 3 out of 4 trials as measured by teacher created assessments and work samples
  • Higher order thinking skills (HOTS)Baseline: After reading grade level passages, STUDENT is able to demonstrate mastery of basic WH questions with 80% accuracy. However, when asked to respond to questions that do not involve concrete details (ie: make predictions, inferences, and identify cause and effect, (s)he is only able to respond with 44% accuracy. Goal: By DATE, after independently reading a grade level passage, STUDENT will demonstrate an understanding of HOTS (ie: prediction, inference, and cause and effect) by responding to open-ended questions with 80% accuracy as measured by work samples and teacher charted data.

 

References

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

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

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

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

  • Phonemic awareness: Reliant on ability to perform fine auditory discrimination, including high frequency hearing
  • Phonics: Reliant on ability to clearly hear the sound/letter associations to be able to compare/contrast
  • Vocabulary development: Reliant primarily on incidental learning and exposure through having been read to by family
  • Reading fluency, including oral reading skills: Requires appropriate intonation, pronunciation, ‘instant’ phonics recognition, understanding of syntax and punctuation, knowledge of wide range of vocabulary, etc.
  • Reading comprehension strategies: Relies on understanding story grammar, being able to take the perspectives of other (Theory of Mind), broad vocabulary, understanding of multiple meaning words, figurative language, idioms, etc.

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

  • Reading comprehension difficulties of children with hearing loss may be poorer than predicted from word-reading skills. There is a need to examine BOTH the word reading and reading comprehension for stories that are within the child’s word-reading ability.
  • Children with hearing loss may be especially poor at integrating their outside knowledge with information in the texts. They are likely to benefit from guidance when answering inference questions to help them use more efficient comprehension strategies and encourage them to incorporate different sources of information.

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


Comprehension instruction should be aimed at teaching students:1

  • Word meanings and the meaningful parts of words (morphology).
  • How to infer word meanings from context and structure.
  • How to untangle the complex syntax of sentences.
  • How to interpret the cohesive links across a text.
  • How to identify and interpret the organizational plan or structure of a text and how to use this organization as a memory aid.
  • How to interpret an author’s tone.
  • How to use (and not overuse) one’s knowledge to help make sense of a text.
  • How to summarize text information effectively.
  • How to monitor one’s comprehension — recognizing whether understanding is taking place and taking appropriate action if it is not.
  • How to rehearse text information so that it is remembered/learned.
  • How to interpret the graphic elements of texts (e.g., illustrations, charts, graphs, tables).
  • To develop the reading stamina required for understanding longer texts.
  • To recognize what a text says and what it does not.
  • How to compare and combine information appropriately from multiple texts.

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

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

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

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

 

Good versus Poor Readers: Before, During, and After Reading2

GOOD READERS POOR READERS

Before Reading

-Use test features (e.g., headings, illustrations) to get a sense of what they will read and help themselves set a purpose for reading.

-Set goals and ask questions that will help them be selective in the focus of their reading.

-Consider what they already know about the topic.

-Observe how text is organized, which prepares them to make connections between and among concepts.

-Begin reading without a purpose for reading.

-Do not consider (or do not have) background knowledge about the topic.

-Do not recognize how text is organized and therefore do not have a plan for how to approach reading it.

-Lack motivation or interest in reading.

During Reading

-Read fluently (quickly and accurately) and use word identification strategies to decode unfamiliar words.

-Use strategies (i.e., context clues, prior knowledge) to figure out the meaning of vocabulary and concepts.

-Recognize and use text structures to make connections between the meanings of sentences and/or concepts.

-Ask and answer questions while they are reading.

-Make predictions about what will happen next and evaluate their predictions as they read further.

-May make mental images of what they are reading to help them visualize what they read.

-Identify the main ideas as they read to determine what is important, what is supportive, and what is less important.

-Monitor their reading by recognizing comprehension problems and using fix-up strategies to repair their understanding.

-Have difficulty decoding words, particularly multisyllable words, resulting in slow labored reading that detracts focus from comprehension. Laborious reading is also likely to result in frustration and a desire to just “get it done.”

-Have limited vocabulary and lack strategies to figure out new words.

-May not have background knowledge of the topic of the text, which impedes their ability to make connections between the text and what they already know.

-Do not recognize text structures.

-Move through the text, even if they do not understand what they have read.

-May be easily distracted because they are not actively engaged with the text.

-Are not aware when comprehension has broken down and/or lack strategies to repair comprehension problems when they do.

After Reading

-Reflect on content that was read.

-Summarize important points from the reading.

-Draw inferences.

-May go to other sources to clarify concepts they did not understand.

-Believe success is a result of effort.

-Do not use strategies to reflect on reading.

-Cannot summarize important points.

-Do not seek out information to help them understand what they read.

-Think success is a result of luck or some other external variable rather than strategic effort.

 

References

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

 

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Advocacy Notes: Eligibility for Fully Mainstreamed, High Functioning Students with Hearing Loss

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

 

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

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

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

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

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

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

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

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

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

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

 

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

 

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

 

 

References

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

 

 

Author: Melinda Gillinger, M. A.

Special Education Consultant

www.melindagillinger.com

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Hearing Loss and Sarcasm: The Problem is Conceptual NOT Perceptual

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

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

The ability to understand the different types of sarcasm gains importance when we recognize how useful verbal irony is in our social lives. When all academic and work settings are considered, about 8% of conversational turns among adolescents and adults ironic 3,4. Being able to successfully use irony is associated with social competence, popularity, and peer leadership skills5,6. Irony is used to express a wide range of pragmatic functions, including:

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

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

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

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

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

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

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

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

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

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

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

A deficit in verbal irony is indicative of broader issues

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

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

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

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

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

 

The good news – WE CAN HELP CHILDREN IMPROVE!

When thinking about how to support social competence and pragmatic language then, it is sometimes most profitable to address Theory of Mind (the concepts behind the social skills). And here is the good news: research indicates that although persons with hearing loss often evidence severe challenges in Theory of Mind, they can also benefit greatly from appropriate Theory of Mind interventions in a short period of time10, 11.

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

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

 

 

References

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

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

 

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

Author: Melinda Gillinger, Advocacy Consultant

 

2 questions from the field – same answer:

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

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

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

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

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

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

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

 

Step by Step Guide:

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

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

 

IFSP

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

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

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

IEP

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

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

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

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

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

 

Melinda Gillinger, M. A.

Special Education Consultant

www.melindagillinger.com

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Only One Ear CAN be a Big Deal

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

Terminology

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

The Heart of the Resulting School Problems for Students with UHL

  • Poorer ability to listen and localize sound in noisy environments.
  • Even a very low level of noise is likely to interfere with listening, especially when speech is presented toward the poor ear and noise is toward the typically hearing ear.
  • The amount of difficulty localizing and processing speech in noise increases with degree of hearing loss.
  • These children require speech to be at a higher signal-to-noise ratio if they are to perform similar to normal hearing peers (NH).
  • It may take longer for these students to localize the speaker. Some children may benefit from seeing the talker (young children) however the effort required to localize who is speaking may impact the ability to comprehend what was said.
  • Children are not always aware that they experience more difficulty listening than peers with NH.

 

Summary of Research Findings

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

 

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

  • The first 2-word phrase occurs at 18 months for UHL versus 15 months for NH.
  • Delays in auditory behavior were found in 21% of UHL versus in 4% of NH.
  • Delays in preverbal vocalizations were found in 41% of UHL versus only 2.6% of NH.
  • Preschoolers ages 4-6 years were found to have delayed language development and have poorer scores on the Children’s Home Inventory of Listening Difficulties (CHILD) checklist.
  • Early childhood: the mean total language score = 91.78, almost 10% lower than ‘average’. Converting this difference to age equivalence results in language delays of 6 months for children with UHL. These language findings were not correlated with the severity of the loss or side of UHL.
  • Lower scores have been found for syntax, morphology, vocabulary for children with SSD.
  • Lower scores on oral language skills, especially oral composite scores (standard score (SS) of 90 vs 99, which was a significant difference).
  • Impact of cognitive ability: children with UHL who had a higher IQ (90+) had higher oral skills. Their oral skills improved over time (ages 6-12 years). Children with lower IQ (90 or less) did not improve or improved at a much slower rate in their oral skills over time. Lower IQ UHL students who were on IEPs had oral skills that improved over time whereas those who were not on IEPs decreased in their oral skills relative to age peers over time. (Longitudinal study 2013).
  • Academic difficulties are apparent to the teacher: Comparisons of SIFTER checklist scores for students with UHL compared to NH indicated significant differences across SIFTER content areas: Academics – 8 vs 11, Attention – 7.8 vs 12, Communication – 8 vs 11, Class Participation – 9 vs 12.5, School Behavior – 11.5 vs 13.5.
  • Quality of life: On the HEAR-QL checklist, children with UHL scored substantially lower than NH (as in scores of 72-80 compared to NH scores of 95).
  • Speech/Language Summary: UHL is associated with language delays in young children and school-aged children. There is improvement over time, especially for children with 90+ IQs and those with 90 IQs or less who were on IEPs. Children with UHL do not catch up to the language level of their siblings over time. Risk factors for language delays include: Profound UHL, lower IQ, poverty, maternal education, male.
  • Educational Consequences Summary: Children with UHL have an increased risk of grade failure, increased risk to be on IEPs, increased academic weaknesses per teachers, high rates of speech therapy (~50%). Language delays in infancy through adolescence may widen with age and do NOT disappear. Verbal IQ differences may widen with age and do NOT disappear.

 

Effort and Fatigue Issues for UHL (Ben Hornsby)

  • Fatigue can look like tiredness, sleepiness in the morning, inattentiveness and distractibility, mood changes (irritability, frustration), changes in classroom contributions, difficulty following directions.
  • Listening-related fatigue may be associated with factors that increase perceived effort. UHL or BHL can increase listening difficulties, which increases listening effort, increases risk for fatigue. This may impact the individual’s evaluation of the effort-reward ratio, meaning when a listening problem is detected the student may initially increase their effort so that they can understand. When, too often, they are not successful in understanding despite the greater effort committed, they can learn that trying harder ‘isn’t worth the effort’.
  • As language ability (i.e., as determined by a CELF score) improves, evidence of fatigue secondary to UHL is reduced. Better language = less risk for fatigue.
  • Children with UHL who have the largest asymmetry between their ears report the most overall fatigue. SSD likely to have greater fatigue than mild/moderate UHL.
  • Adults with UHL were 5 times more likely to report severe fatigue than adults with no hearing loss.

 

Amplification Findings for UHL

  • Younger children (6-9 years) who received their first hearing aid by age 5 showed benefit in localizing sound when they were using the hearing aid in their poor ear (UHL, not SSD). Older children (10-14 years) who received a hearing aid at age 7 or older indicated that the hearing aid was detrimental to localization. Providing early ‘balanced’ hearing to children with usable hearing in the poor ear prior to age 3 provides the best results. Early intervention success was linked to bilateral ‘balanced’ hearing. If a hearing aid is going to be fit, it should happen prior to age 3. Waiting until kindergarten will likely result in rejection (2010).
  • Retrospective parent survey results: 72% of parents felt their child improved or greatly improved using a hearing aid in the poorer ear in various listening situations. Of this group of parents, 100% were happy they chose to have their child fit with a hearing aid and 50% expressed that they wished a hearing aid were fit sooner (2002).

Elizabeth Fitzpatrick Phonak presentation:

  • At diagnosis, the degree of hearing loss for 154 children with UHL was 31% mild loss, 19% moderate loss, 19% moderate-severe loss, 9% severe loss, 15% profound loss, 7% high frequency loss.
  • Based on 337 children, only 21% received amplification shortly after diagnosis. Most take a year or more to get their first hearing device. Average age of diagnosis was 13.9 months; average age at amplification was 42.9 months.
  • Of those who received hearing aids, 37% of children with UHL did not use them. (2010)

Erin Picou Phonak presentation:

  • This researcher studied whether CROS aids improve speech recognition and comprehension in the classroom. Findings indicated that in comparison to FM use, the benefit of a CROS hearing device is most notable in multi-talker situations with peers who are not using the remote FM microphone. Benefits were most apparent for speech from the ‘bad side.’

Douglas Sladen Phonak presentation:

  • Cochlear implants for students with SSD: The most improvement in speech understanding is in the first 3 months after implant activation. Words/sentence scores prior to implantation are about 5% correct. After 3 months they are 35 and 55%, after 6 months they are 40 and 60%, and 12 months post-activation scores are 45 and 65%.
  • CI for SSD can improve speech understanding but may have a negligible impact on listening effort.

Intervention for Students with UHL and SSD

  • Seating: When possible, the classroom should be arranged in a U-shape, with the child’s poor hearing ear facing away from the students.
  • Amplification options:
    • Roger FM – microphone should be passed during small group activities and discussions (i.e. Touchscreen has automatic omnidirectional mics when in group)
    • FM/DM (i.e. Roger Focus) receiver is placed in the typical ear
    • Soundfield (CADS) amplification is an option but this does not improve access during noisy group activities. CADS + FM/DM is a good option, but the teacher may have to use 2 microphones.
    • Even with optimal amplification, we cannot assume students are fully accessing communication or that they understand and process what they hear.
  • Direct teaching:
    • Language, syntax, and listening comprehension should be assessed for intervention needs.
    • Students need to learn to use their hearing devices and monitor/troubleshoot appropriately.
    • Students need to learn self-advocacy skills, including communication repair strategies.
    • Students are at risk for identity, self-concept, and social/pragmatic communication skills. They need to connect with other students with UHL to develop a healthy self-concept.

 

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

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

 

Our question from the field:

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

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

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

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

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

NOTE:

The IDEA defines the IEP team as “a group of individuals composed of” the following members https://sites.ed.gov/idea/statute-chapter-33/subchapter-II/1414:

1. The parents of a child with a disability
2. Not less than 1 regular education teacher of such child (if the child is, or may be, participating in the regular education environment)
3. Not less than 1 special education teacher, or where appropriate, not less than 1 special education provider of such child
4. A representative of the local education agency who is qualified to provide or supervise the provision of, specially designed instruction to meet the unique needs of children with disabilities; is knowledgeable about the general education curriculum; and is knowledgeable about the availability of resources of the local education agency
5. An individual who can interpret the instructional implications of evaluation results, who may be a member of the team described
6. At the discretion of the parent or the agency, other individuals who have knowledge or special expertise regarding the child, including related services personnel as appropriate

Whenever appropriate, the child with a disability

A few years back a district in Montana had two students with cochlear implants who use spoken language move to their schools. Their district hired a TOD from out of state for the purpose of serving these students. In California, as more and more students are being placed in their neighborhood schools in inclusive classrooms, thereby increasing the need for DHH Itinerant services, one of the regionalized county programs also reached out of state and brought in an appropriately trained TOD. Another way to facilitate that a TOD is on board is for the family to request an assessment with a TOD in writing. The district is then required to either provide the assessment or formally and in writing deny the request. (specialeducationguide.com)

While the SLP and Educational Audiologist are highly trained individuals with knowledge and expertise, unless they have 2 degrees, they are not Teachers of the Deaf. Even among Teachers of the Deaf there are critical variables in training, knowledge, and expertise depending on the student’s language. Each of these three specialists is important, and each is needed on the IEP team in order to appropriately serve and support both the student with hearing loss as well as to support the general education teachers/staff who do not have the unique lens of the TOD.

 

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

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“Special Considerations” and LRE for Students who are DHH

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

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

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

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

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

Note:

The recent Optimizing Outcomes for Students who are Deaf or Hard of Hearing Educational Service Guidelines (NASDSE, September 20181) and the still relevant policy guidance on Deaf Students Education Services (US Department of Education, 19922) are both valuable resources in helping to answer this question.

Full-Inclusion as a Driver: With the push toward full inclusion in the classroom, including limiting pull-out for specialized instruction, school teams may seek to provide an interpreter in the situation above as a way to address communication needs in the inclusive environment. However, for the varying communication needs of students with hearing loss, an interpreter may be an inappropriate solution, or only a part of a solution, to meet these communication needs. As made clear from the following paragraph2, school teams must thoroughly understand a student’s communication needs, how to provide the least restrictive educational environment and the appropriately intensive specialized instruction in light of those communication needs.

Meeting the unique communication and related needs of a student who is deaf is a fundamental part of providing a free appropriate public education (FAPE) to the child. Any setting which does not meet the communication and related needs of a child who is deaf, and therefore does not allow for the provision of FAPE, cannot be considered the LRE for that child. A full range of alternative placements as described at 34 CFR 300.551(a) and (b)(1) of the IDEA regulations must be available to the extent necessary to implement each child’s IEP. There are cases when the nature of the disability and the individual child’s needs dictate a specialized setting that provides structured curriculum or special methods of teaching. Just as placement in the regular educational setting is required when it is appropriate for the unique needs of a child who is deaf, so is removal from the regular educational setting required when the child’s needs cannot be met in that setting with the use of supplementary aids and services.” 2

To consider these language and communication special factors, the IEP team should ask1:

  • What is the child’s primary language and mode of communication?
  • What communicative needs and opportunities does the child have? Can he comprehend what is said in school?
  • Does the child have the skills and strategies necessary to meet those communicative needs and take advantage of communication opportunities? (social, self-advocacy)
  • Can the child fulfill his or her need to communicate in different settings? (listening in noise, social situations)
  • Does the child communicate appropriately and effectively, and if not, why not? (full participant in class?)

Strategies to Obtain Information About Communication Needs

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

    1. 1. What is his most effective communication mode of communication? The PARC checklists should help to tease this out (PARC Instructional Communication Access Checklist, followed by the appropriate grade level readiness checklist).
    1. 2. What is his degree of delay compared to the language level of typical peers? An extensive language assessment must be performed, including listening comprehension. If providing an interpreter is being discussed, then assessment needs to be performed to determine his development level with both languages. Assessments that provide age expectations for learning ASL can be found in this document.
    1. 3. Is there reason to believe that there is a cognitive component that is further impairing language growth (nonverbal IQ measure by someone skilled in DHH cognitive assessment)? When provided appropriately intensive services focused on oral language development was rapid progress made? Given intensive ASL instruction, not just interpreter services, does he pick up language at a rapid rate?
    1. 4. What intensity of services are required for him to learn language at a pace of more than one month of development for one month of time? The school team can complete this matrix that assists teams in teasing out student communication, skill level, impact of hearing loss on education and resulting service intensity needs. This is a situation where it is highly likely that a full-day inclusive classroom setting is the most restrictive placement for a student to receive FAPE.
    1. 5. What service providers are need for him to develop language quickly? A teacher of the deaf/hard of hearing and/or speech clinician with extensive training in oral education of students with hearing loss is likely necessary to reach the eventual goal of age-appropriate language.

 

 

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

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The Power of an Appropriate Program of Special Education Support

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

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

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Self-Advocacy Skill Development is Required for Full Participation in the Classroom

 

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

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

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

 

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

Self-Advocacy

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

Self-Determination

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

 

From the US Office of Civil Rights:

We need to encourage students to understand their disability.

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

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

 

He does not know what he did not hear.

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

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

Teaching Hearing Device Use and Troubleshooting

Some knowledge of hearing device use teaching and assessment resources:

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

Teaching Self-Advocacy Strategies

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

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

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

 

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Inclusion – Factors that Make it or Break it

Every parent and teacher want children with hearing loss to be successful in the classroom, both academically and socially. There are benefits to including students with disabilities in their neighborhood schools and having them be fully included in mainstream settings. Yet, students with hearing loss have unique needs that are often overlooked or minimized due to the low incidence nature of this learning challenge. The purpose of this article is to examine the factors that result in successful inclusion and those that are barriers to success.

A research study from 20061 delved into the ingredientsfor success for students with hearing loss. While the article focused on students who were orally educated, many of the factors also apply to students who are visual communicators in the inclusive education environment.

The findings resulted from a series of focus groups with young people with hearing loss, their parents, and itinerant teachers of the deaf and hard of hearing. The findings support that successful inclusion requires a commitment from various sources and respectful partnerships among the school team, including parents.

Low Incidence, but More Children than You May Think – Increasing numbers of infants with hearing loss continue to be early identified within the United States, however the most recent data (2016) indicates that, of more than 65,000 infants failing newborn hearing screening, over 16,500 (25%) were lost to follow up and did not go through the diagnostic process. Approximately 10% of babies failing hearing screen are identified with hearing loss. Thus, it can be surmised that more than a thousand babies who were lost to follow up each year will enter school with hearing loss without the benefit of early intervention. Of the 2016 babies identified with hearing loss for whom early intervention data was reported, almost 20% never received early intervention services. While early hearing loss detection and intervention (EHDI) in the US has been a huge success in the last 20 years, it is clear that we continue to have a significant proportion of children with congenital hearing loss who are unidentified, and/or receive no timely intervention despite failing newborn hearing screening. Add to this number the children with progressive or otherwise acquired hearing loss who passed newborn hearing screening. These children too are likely to have gone without timely early intervention resulting in a developmental impact that is a educational crisis. It has been reported that approximately 7% of children in school have some degree of unilateral or bilateral hearing loss, or 25 times as many children in school with hearing loss as there are at birth.

Educational Impact – Due to this and other factors, children with hearing loss can often have significant language delay (i.e., more than 6 months), resulting in their difficulty not only catching up in their areas of delay, but also keeping pace in the inclusive classroom for which significant communication access barriers are an everyday reality. The goal of an appropriate educational placement is to match the needs of the student to the continuum of services available in a school or school district. The strong move to full inclusion within the US has reduced the number of day school, center-based and resource room settings specific to students with hearing loss, creating a landscape that increasingly looks ‘one-size-fits-all’ – the inclusive setting.

It is critical for parents, school teams, and especially specialists in the education of children with hearing loss to fully understand what is required for these children to succeed in their neighborhood schools. Inclusion focuses on acceptance rather than exclusion of children with disabilities in the classroom, school and community. It is being accepted as having overall beneficial effects. For more information on inclusion benefits and the specific serious considerations for students with hearing loss refer to the October 2017 Supporting Success Update article, Is the Inclusion Model Good for Students with Hearing Loss?

Predictors of Successful Inclusion

These predictors have often focused on the individual characteristics of the students themselves. It has been common to place pressure on the students themselves, holding them primarily responsible for their own success or failure within the mainstream. The characteristics include:

  • Early identification of hearing loss
  • Early and consistent use of amplification (in the case of visual learners it would be early and consistent use of fluent, vocabulary rich ASL skills or other form of visual communication)
  • Early family-oriented infant and preschool programming
  • High level of parental involvement in early childhood
  • Knowledgeable development of auditory and spoken language skills (in the case of visual learners, knowledgeable development of visual communication skills)
  • Early placement into regular school (between age 3-6) with support services as required
  • Reading/writing ability commensurate with peers
  • High levels of speech intelligibility
  • Good organizational skills
  • Proactive, determined to succeed and enthusiastic about learning
  • Taking responsibility for their own educational success by keeping up with homework, planning/reading ahead, and requesting help as necessary
  • Advocating for their own needs including active problem-solving skills to address their communication and learning challenges
  • Being outgoing, having a good sense of humor, and being open to discussing and explaining the hearing loss to others

What is success?

There are a variety of ways in which ‘success’ has been defined, including:

  • Academic achievement
  • Receptive/expressive language
  • Performance on standardized measures of learning

These elements do not ensure that a student will be able to make a successful adjustment to adult living. Success in inclusive settings needs to be defined in terms of social development, along with communication and academic achievement.

Elements necessary for success include:

  • the need for detailed planning and close examination of educational alternatives based on the abilities and needs of the individual child prior to classroom placement
  • in-depth in-service training for teachers and other professionals
  • ongoing support of students and teachers in facilitating inclusion and
  • the importance of psycho-social considerations in planning for successful educational placements

Barriers to Success

  • Classroom teachers who lack information, preparation, and/or interest in understanding the effects of hearing loss on communication development and academic performance
    • Teachers unwilling to invest the additional time and effort required to teach the student effectively
    • Teachers who have negative attitudes toward inclusion generally or towards integrating students with hearing loss in particular
    • Teachers who are unwilling to maintain communication with parents or solicit their involvement
    • Underestimating the potential abilities of students with hearing loss; having reduced expectations with respect to learning or social behavior
    • Drawing excessive attention to the student’s hearing loss
    • Teacher unwillingness to use assistive technology and learn adapted teaching strategies in order to make information more accessible to students with hearing loss
  • Itinerant teachers who
    • are inflexible in scheduling individual sessions according to the student’s class schedule
    • set limits for the student, such as opposing enrollment in foreign language or music classes
    • spotlight the student with hearing loss by drawing excessive attention to their hearing challenges
  • Peer barriers
    • Were perceived as acting either as barriers to the inclusion of the student, lacking in sensitivity to hearing loss and the needs of these peers including overemphasizing the hearing loss and making the students feel conspicuous
    • Having new peer groups frequently throughout their school career, resulting in the need to constantly disclose the hearing loss and deal with peer reactions, questions, comments
    • Resentment towards the child with hearing loss due to perceived favoritism or reduced classroom demands
    • Peers who tease the students or intentionally exclude them from social activities during school, especially in later elementary years through high school
  • Administrative barriers
    • Lack of openness to a team approach to inclusion, including parents as partners
    • Lack of consistency in services provided
    • Placement in classrooms with large student-teacher ratios
    • Lack of budgetary consideration for the purchase of assistive hearing/communication technology and acoustic modifications
    • Lack of commitment to funding resource support services for both teachers and students
  • Parent barriers
    • Unfamiliarity with the educational system
    • Lack of advocacy skills or unwillingness/inability to take the time needed to advocate with the school and/or work with their children at home
    • Abdicating responsibility for the child’s learning once they enter school, rather than maintaining an ongoing involvement in their child’s educational progress
  • Additional barriers posed by the student with hearing loss
    • Being shy and lacking assertiveness, which reinforces unwillingness to participate socially and academically

 Facilitators to Success

  • The role of the itinerant teacher was the most frequent and important facilitator to inclusion mentioned across all groups (teachers, parents, students)
    • Developing individualized programs to promote language, social and academic skills
    • Sensitizing classroom teachers and peers to issues related to hearing loss and use of classroom hearing/communication technology
    • Consulting regularly with classroom teachers
    • Coordinating school-based services and programs
    • Encouraging families as well as the students to take responsibility for the proper functioning of hearing aid technology
    • Supporting skill development and situations that promote student independence
    • Respecting student opinions related to selection of elective classes and having input into use of assistive technology in class
  • Cooperative Principals who support the roles of support professionals
    • Support role of the itinerant teacher
    • Support and encourage the classroom teacher’s efforts to facilitate the student’s effective learning
    • Support budgetary considerations to promote success of students with hearing loss
    • Promoting a team approach to case management that emphasizes the inclusion of parents
    • Provision for the continuity of services from support professionals over several years
    • Establishing an atmosphere of acceptance within the school
    • Developing a strong volunteer network in the school
    • Sensitivity to the need for a reduced teacher-student ratio in the classroom
  • Classroom teachers who have positive attitudes toward the concept of inclusion
    • Flexibility toward assignments and testing
    • Open to suggestions by the itinerant teachers
    • Open to use of classroom hearing/communication technology
    • Facilitative teaching strategies (i.e., facing the class while teaching, writing notes and assignments on the board, providing class notes, speaking at a slightly slower rate, facilitating the use of buddies and notetakers in class, providing hands-on opportunities for learning)
    • Communicating regularly with parents
    • Sensitive to the needs of students with hearing loss
    • Attitude wherein they “feel like they can make a difference” in the education of the child with hearing loss
    • Individual attention
  • Classroom hearing/communication technology used consistently and appropriately
    • Technology is readily accessible to teachers/student
    • Technology is up-to-date
    • Technology is maintained in good working order
    • Technology is not forced upon the student
  • Peers who
    • are perceived as acting as facilitators to the inclusion of the student, with sensitivity to hearing loss and the needs of these peers without making them feel conspicuous
    • are willing to act in the role as notetaker
    • are willing to act as communication, academic, and social interpreters for students with hearing loss
    • attend the same school and classes with the student over time, establishing long-term relationships with a body of peers who know the student, his needs, and accept the student for who he is
  • Parents who have an assertive attitude and actively advocate to obtain essential services for their children in a school setting
    • Become aware of educational policies/procedures relating to placement and evaluation of progress
    • Membership on local school board or parent committees
    • Attending program review committees
    • Building a positive relationship with the itinerant and classroom teachers and administrators
    • Helping with homework, follow up on topics and concepts discussed in class, and ongoing intensive work on the language (and speech) development of their children

Students with Hearing Loss who are English Language Learners

A recent article2 on students with hearing loss who are English language learners (DHH EL) identified the lack of appropriate assessments and resources specifically designed for students who are DHH EL. Service providers must adapt resources from other sources or develop their own resources to meet the needs of these students. The article states that collaboration between the general education teacher, EL teachers, and special education teachers should focus on a) identifying specific content and/or skills that can be taught or reinforced by EL teachers and/or special education teachers; b) ensuring that instruction in these concepts and/or skills will be consistent across teachers and programs, and c) preventing gaps, redundancies, and/or conflicts in instruction.

Summary

Full inclusion of students with hearing loss is becoming more common. It is important for specialists in the education of students with hearing loss to recognize the internal and external factors that facilitate student success in these settings, and also the barriers to this success. Successful inclusion requires commitment from numerous sources. The provision of adequate support systems of students, teachers, and parents is an essential component of inclusion. It is facilitated when there is a partnership between knowledgeable families, professionals and children. Students with hearing loss themselves cannot be held solely responsible for the success or failure of their integrated experiences. The majority of barriers to successful inclusion are associated with the lack of knowledge, negative attitudes, and insensitivity of other key players in the inclusion process.

 

References

  1. Eriks-Brophy, A., Durieux-Smith, A., Olds, J., Fitzpatrick, E., Duquett, C., and Whittingham, J. (2006). Facilitators and Barriers to the Inclusion of Orally Educated Children and Youth with Hearing Loss in Schools: Promoting Partnerships to Support Inclusion. The Volta Review, 106(1), 53-88.

Becker, S.J. & Bowen, S.K. (2018). Service Providers’ Perspective on the Education of Students Who are Deaf or Hard of Hearing and English Learners. American Annals of the Deaf, 163(3), 356-373

 

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Reducing the Impact of Stigma and Teasing

Peer Victimization and Hearing Loss

More than ¼ of school-aged children experience bullying or peer-victimization. The risk of this negative treatment increases for children who have lower social competence, presence of special needs, or overall seem “different” from their peer group.

In general, adolescents who do not “fit in” experience twice the rate of peer victimization than the general population. Adolescents with special needs are most frequently teased, gossiped about, and socially excluded.

Children with hearing loss have a higher risk of peer victimization due to the visibility of their hearing devices, poorer speech perception, articulation/ pronunciation differences, delays in language skills, social difficulties, and difficulty making and maintaining peer relationships. A 2012 study reported the incidence of peer victimization for children with hearing loss ranging from 17-67% dependent upon the degree of difference perceived by typical peers.

A recent study1 was conducted on peer victimization of children with hearing loss who wore hearing devices, communicated orally, and were educated in the mainstream classroom. The study included 56 children ages 12-18 years. Their mean age for hearing device fitting was 3.3 years and they averaged 10.8 years of experience using their hearing devices. These participants completed a series of questionnaires exploring their communication competence, social competence, temperament, and level and type of peer victimization.

The results of this study found that adolescents who used hearing devices reported significantly higher rates of victimization than those in the general population (50% versus 28%). Compared to the general adolescent population, adolescents with hearing loss reported the following prevalence: teasing (25.8% versus 18.8%), rumors (21.1% versus 16.5%), and social exclusion (26.3% versus 4.7%), and coercion (17.5% versus 3.6%). Males and females experienced victimization at similar rates, but the type of victimization varied with males having higher rates of coercion and females having higher rates of social exclusion.

The bullied and non-bulled groups of students with hearing loss did not differ on measures of communication competence, social competence, temperament, or behavior. Children from families with lower socioeconomic states and parenting styles characterized by abuse or overprotection have higher victimization rates, whereas those who have supportive family relationships are more protected against the impact of bullying.

Peer victimization demands attention from both parents and professionals.

Stigma and Hearing Loss

Among adults not pursuing hearing care, 21% described hearing aids as “too embarrassing”, 15% described them as “unattractive”, and 14% claimed hearing aids were “too noticeable”. These all represent the perceived stigma of having a hearing loss. Stigma can be divided into two types:

External or environmental stigma – messages that people with hearing loss receive from other people, such as impatience, embarrassment, discomfort, or anger related to increased communication difficulty with the person who has the hearing loss. Examples of environmental stigma for children could include a teacher looking annoyed when a child drops of the HAT microphone, being ignored by classmates during group work, or any type of teasing or other peer-victimization. Home examples could include being excluded from family conversations, being discouraged to use hearing devices in public “so people don’t know,” or being yelled at for not following a parent’s instructions because the direction was not heard.

Internal stigma – negative messages that people with hearing loss tell themselves that are triggered by the embarrassment, vulnerability, shame, and/or fear they feel as they anticipate or experience increased communication challenges. Examples of internal stigma for children could include eating lunch alone because it is too hard to understand what peers are saying in the noisy environment, not wanting to participate in class discussions because of experiences providing an answer to a question different than the one asked, or not requesting clarification or repetition of information missed auditorily because they don’t want to “stick out.”  A home example includes the child isolating himself from family activities or acting out behaviorally because he cannot readily understand what is being said and has received impatient or angry responses when asking for clarification.

 

Strategies to Reduce the Impact of Stigma and Peer-Victimization

Dealing with stigma and teasing or bullying can have far-reaching effects on school performance and self-concept.  Students who expect that negative consequences will occur when they self-advocate or use their hearing devices are much more likely to reject use of their devices and not fully participate in the general education curriculum. There are some strategies in common, and some different when helping children develop resilience in dealing with these issues.

Addressing Victimization and Stigma

1. Issues related to stigma and peer victimization can be included on IEPs or 504 plans, for example:

a. Specify the need to inform teachers and classmates about hearing loss to reduce negative responses to the student and/or hearing devices.
b. Provide a safe environment statement designing a “home base” where a student can go when feeling unsafe or a “safe person” with whom a student can discuss difficult situations.
c. IEPs can include strategies to reduce vulnerability and improve response to bullying by targeting response to bully and social pragmatic skills, via 1:1 instruction, role playing, or social stories.
d. IEPs can target self-advocacy and communication repair skill development, including addressing assertiveness. Work on changing “I can’t” statements to “I can” to improve resilience when negative situations occur.
e. IEPs can target the student’s knowledge of their hearing loss and hearing devices, including understanding their most challenging listening situations, what they or others can do to improve their communication effectiveness. Students should learn and practice how to describe their hearing loss, including how to respond to questions about their hearing loss and hearing devices.

2. Identify if the student is one of the approximately 50% of students with hearing loss who are victimized. Ask the child directly if they have experienced bullying and if so, what kind (coercion, social exclusion, physical harm, gossip, teased). When is the victimization happening? In the classroom? Hall? Bus stop? How pervasive is this treatment? Help them understand that many, if not most, students experience some type of peer victimization at some point during their school years. They are not alone.

Resilience on Orange Puzzle on White Background.

3. Education about WHY students become bullies, what they get out of bullying someone, and what keeps a bully coming back for further bad treatment will help the student understand that they are not the only victims. This also goes for groups who exclude or coerce students, not only teasing situations. In the IEP include a goal to teach the specifics of what NOT to do in each of these situations, along with appropriate responses.

4. Use the Kool Kidz Vidz available on Teacher Tools to expose ‘one and only’ students who use hearing devices in their schools to other students with hearing loss who have had the same experiences with stigma from hearing loss. The discussion points provided with each Kool Kidz Vid make these easy ‘go to’ materials with a potential for high impact.

5. Connecting students who use hearing devices with one another may have the most powerful effect on reducing the impact of stigma and bullying by strengthening self-concept, self-confidence to self-advocate, while reducing feelings of isolation. IEP goals for self-advocacy can be met via group work (face-to-face or virtually) with DHH peers using devices. Students who come into contact with DHH peers are less likely to reject use of their hearing devices. As a group:

a. Discuss all types of peer victimization with a pair of DHH peers or a larger group of DHH peers. Encourage discussion of which types of negative treatment have been experienced.
b. Discuss both external and internal stigma along with individuals having the power to overcome negative messages as part of their journey figuring out who they are and who they want to become (goals for after high school).
c. Talk about the perception of “different” and how this increases the risk for victimization. Help students work through the concept that it is the hearing loss that makes them different and this cannot be changed. Hearing devices help them behave more normally (less “different”) because they can hear, comprehend, and respond in social situations better than if they were not using hearing devices.

Resources used for this article:

Peer Victimization of Children with Hearing Loss, A. D. Warner-Czyz, Hearing Journal, Oct, 2018.

Incorporating Stigma Counseling into Audiology Practice, H. Cohen & N. M. Williams, Hearing Journal, Sept, 2018.

 

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Can You Guess the Big 5?

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

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

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

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

 

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

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

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

 

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

Ages 6-11, Grades 1-6 or Adolescent version: Ages 12-18, Grades 6-12
35-40 minutes to administer

Subtests: Main Idea, Details, Reasoning, Vocabulary, Understanding Messages. The Listening Comprehension Tests focus on:

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

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

 

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

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

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

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

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

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

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

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

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

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

PLSI has 3 subscales:

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

 

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

 

5. How does s/he process language?

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

Phonological Processing Index:

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

Auditory Memory Index:

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

Listening Comprehension Index:

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

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

 

 

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Identifying Student’s Functional Issues in the Classroom

The evaluation process requires1 that a variety of assessment tools and strategies are used to gather relevant functional, developmental, and academic information about the student to determine if there is a disability that is adversely affecting educational performance. We also must develop a statement about the student’s present level of academic achievement and functional performance. Classroom observation provides the opportunity to collect data on how the student with hearing loss functions in the classroom in comparison to typical peers. Using the ‘deaf lens’ during observations, systematically considering performance, and obtaining teacher checklist information all help to paint the picture of functional performance and identify issues.

Classroom Observation

We need to observe student behavior using what we know about how hearing loss impacts speech perception, listening, learning, language, and overall social interaction. Classroom observation is a critical part of evaluation and planning to appropriately meet student access accommodation and educational performance needs.

The following “lenses” are what professionals with expertise in the education of students who are deaf or hard of hearing bring to the assessment/IEP team that is different from other educational professionals.

Communication Lens

  • How much instruction does the student understand?
  • What is the student’s level of classroom interaction?

Participation and Social Language Lens

  • What strategies or compensatory skills does the student utilize?
  • What does the student do when there are learning breakdowns?
  • How does the student understand and use social language in the inclusive classroom setting?
  • Are the student’s use and understanding of social language developing appropriately?

Curriculum Lens

  • What strengths and gaps in access were observed when the teacher delivered the instruction?
  • What strengths and gaps in access were observed during peer discussions and group interactions?
  • How did the student access the general education curriculum when technology was used?
  • Does the student demonstrate progress similar to their cognitive peers in the general education curriculum?

It is critical to not only note behaviors, but also collect specific data. The following are examples:

Frequency – number of times, or how often, a student behavior occurs.

“Tyler turned to watch his peers offering oral responses 2/9 times, or 22% of the time.”

Duration – total amount of time a student is engaged in a specific behavior.

“During a 45-minute class, Sally attended to the interpreter 60% of the time. The longest interval of attending was for 5 minutes.”

Latency – elapsed time between an event and the expected behavioral response.

“Gerald hesitated before following teacher directions in 4 out of 5 instances observed. In comparison to peers, his hesitation ranged from 15 seconds to 2 minutes longer to begin an activity than a sample of 5 surrounding peers.”

Click here to download the Classroom Observation Record of Behavior

 

Focused Consideration of Access Needs

Universally, students with hearing loss have greater difficulty accessing verbal communication in both large and small group instruction within the typical classroom environment. It is not a question of IF a student needs accommodation, it is a question of verifying WHEN, under what conditions, WHICH accommodations are necessary to level the access playing field. Schools are required2 to ensure that communication for students who are deaf or hard of hearing is as effective as communication for others to afford an equal opportunity to reach the same level of achievement as that provided to others. Functional hearing is necessary to identify and cannot be revealed by an audiogram or speech and language evaluation. Results of a Functional Listening Evaluation in combination with data from a classroom observation is an effective way to start a discussion with the school team about the necessity of providing effective accommodations to improve communication access. Refer to the White Paper on Estimating Access for more information.

Click here to download the Accessibility Considerations Worksheet

 

Gathering Information from Classroom Teachers

Teachers spend more time with the student than any other educational professional. It is necessary to obtain their thoughts about the student’s function in comparison to class peers. By providing checklists targeted to identifying issues related to hearing loss, classroom teachers also become more aware of the subtle impacts of hearing loss on performance and may be more open to team discussions of student needs. Examples of teacher checklists are:

  • Screening Instruments For Targeting Educational Risk

Original forms can be downloaded from this webpage. Updated forms that are computer fillable are available in the Teacher Inservice Combo and Documenting Skills for Success.

  • Listening Instrument For Education – Revised (LIFE-R) Teacher Appraisal

The Teacher Appraisal can be downloaded. There are two pages to the appraisal. The first page is the Teacher Appraisal of Listening Difficulty and focuses on student attention and class participation. The second page is the Teacher Checklist: Self-Advocacy and Instructional Access. The DHH professional can choose to request that the teacher fill out only one page, based on the information they desire to collect.

  • Placement and Readiness Checklists (PARC): General Education Inclusion Readiness Checklist

This checklist can be downloaded. It may work best for the DHH professional to sit down with the teacher in an interview format to complete this checklist. Alternately, the DHH professional can complete the checklist after classroom observation and/or from their knowledge from working with the student and then invite the teacher to review and discuss the student’s performance. This PARC checklist is a reliable and valid tool to identify the readiness skills of students who are deaf or hard of hearing in grades kindergarten through 7. A study found that the mean ratings for DHH students were significantly lower than for their hearing peers.

 

Gathering functional information about educational performance is every bit as important as considering academic performance1. The communication access issues of our students require them to work harder, expending more energy, often to receive less information than their typically hearing peers. Functional performance issues require appropriate access accommodations. They may also warrant instruction in self-advocacy skills, social interaction, or other aspects of the Expanded Core Curriculum that need specific and direct teaching.

 

1 IDEA Eligibility Determination – Section 300.304(b)(1)
2 Americans with Disabilities Act: ADA Title II 28 C.F.R. 35.160(a)(1) and Title II 28 C.F.R. 35.130 (b)(1)(iii).

 

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More Tips For Itinerant Teachers

Itinerant teachers must be ready for anything. Many itinerant teachers have evolved into their role, rather than trained for it.  The transition from classroom teacher to traveling teacher meant altering my expectations and constantly redefining my role in my students’ education. Frustrating as it may seem at times, I find the role of itinerant teacher to be the most fulfilling.

Just as “deaf children are not hearing children who cannot hear”, itinerant teachers are not simply classroom teachers with cars.  Itinerants are also consultants, technology experts, cultural attaches, collaborators, and communicators. Itinerants know that planning and preparation are essential; we also know that all the best planning and preparation can be thwarted by traffic, weather, illness, changing schedules, miscommunication, fire drills, field trips, and heaven forbid—car trouble. Supporting our low incidence students so that their needs can be met in the inclusive classroom takes knowledge, heart, and stamina.

Tips and tricks learned through the years:

Show, don’t tell.  When it comes to discussing the educational impact of hearing loss, it can be more effective to show, rather than tell. A five-minute video or a few seconds of an audio clip demonstrating what a child’s hearing level sounds like can be more effective than anything I have to tell them or any handout I can provide. These demonstrations are very helpful when you are asked the inevitable question, “So what or how much can he/she actually hear?”

Pace yourself. It is the beginning of a new year, and we teachers are all regaining our stride after the summer break.  Avoid the temptation to save time by distributing a year’s worth of knowledge on hearing loss to school staff in one sitting. In my experience, this information goes unread, buried under piles of other paperwork, or lost. Weekly tips for teachers is a great resource for sending important tidbits that can be digested easily and quickly.

Be succinct. Whatever you have to say or show teachers or administrators, make it short, and make it specific. Be respectful of your schedule and theirs.

Be prepared to check hearing technology. As an itinerant teacher of the deaf/hard of hearing I am used to transporting a multitude of supplies. One thing I try never to be without is my bag of hearing technology paraphernalia. I have a small bag with monitor earphones, a “wand”, extra batteries of all sizes, a hearing aid stethoscope, alcohol wipes, a hearing aid multi-use tool, FM lapel mike clips, and scissors.  It has repeatedly saved time for me and my students.

Keep accurate records.  This is much easier said than done, but it is so important. I am often asked when I last saw a student; What was said at the meeting with __’s teacher?; Have I talked to the interpreter, parent, audiologist about….?, What did you find when you assessed….?; What are is ___’s reading level, strengths? What data are you basing your decision to…? and the list goes on. Data is the driving force for all we do. It is not only essential; it is difficult to refute.

Collaborate in small groups. Itinerant teachers have knowledge about issues affecting learners who are deaf or hard of hearing. General education teachers have knowledge of their grade-level counterparts. Finding time to collaborate can be extremely difficult, but it is worth the effort.  When discussing a particular student or group of students, I find that discussion by two to three educators in a group can produce great results. More than four people at the table, and collaboration can become a tedious, overwhelming experience.

Develop a routine. Paperwork such as lesson plans, reports, and mileage can quickly become a monumental task when not done in small steps and when it is fresh on your mind.  I strive to take good notes as I am visiting a classroom or seeing a student and not wait “until I have time” to do it. Details have a tendency to be forgotten when I wait until the end of a session or the end of the day. As for mileage, choose a day to input mileage at the end of each week. You will thank yourself when the end of the month arrives.

Make use of driving time.  So much of our day can be consumed by driving. I recently began calculating my average daily time on the road. I have found (and have data to prove it) that I can spend an average of 90 minutes per day traveling between campuses. This time can be made useful for all sorts of tasks such as making phone calls (hands free), confirming that students are present at your next campus, mentally preparing for my next assignment, or as a time to reflect.

Make things easy on yourself. Fill up your gas tank on Sunday. Keep a stash of edibles in your car. Input all the phone numbers of the schools you currently visit and could potentially visit in your cell phone contact list. I also have hearing aid and FM system helpdesks, my school’s administration, transportation, and IT support in my phone contact list. With their permission, I also collect as many teacher’s phone numbers as possible. This is a great help when I need to send a message to someone quickly.

Develop a rapport. Learn the names of all the receptionists, principals, educators, janitors, and support staff with whom you come into contact. This comes from introducing yourself and being seen or heard periodically throughout the school year(s). These are the people who can help you help students and in turn can make your life so much easier.

These are tips gleaned from years of past successes and failures. Tools and resources for itinerant teachers are evolving and improving daily, giving us better ways to communicate and help our students reach their full potential. Itinerant teachers dedicate much of their adult lives to improving the futures of students with hearing loss. It is a passion and an incredibly satisfying vocation. Providing support to students who are deaf and hard of hearing as an itinerant teacher is an experience I continue to enjoy.  Wishing YOU a great year ahead!

Resources

Arnoldi, K. (2014). The accessible general education classroom: strategies to support student success. Retrieved from https://webcasts.successforkidswithhearingloss.com/accessible-classroom/

Foster, S. & Cue, K. (2008). Roles and responsibilities of itinerant specialist teachers of deaf and hard of hearing students. American Annals of the Deaf 153(5), p. 435-449.

Kluwin, T.N., Morris, C.S., & Clifford, J. (2004). A Rapid ethnography of teachers of the deaf. American Annals of the Deaf 149(1), 52-72.

Luckner, J. An introduction to educating children who are deaf/hard of hearing: Itinerant teaching. Retrieved from http://infanthearing.org/ehdi-ebook/

Luckner, J. & Ayantoye, C. (2013). Itinerant teachers of students who are deaf or hard of hearing: practices and preparation. Journal of Deaf Studies and Deaf Education 18(3), p. 409-423. Doi:10.1093/deafed/ent015

Dorn, B. (2018). Five strategies for itinerant teacher of deaf and hard of hearing students. Odyssey 19, p. 16-21.

Marschark, M. (2014). Deaf children are not hearing children who can’t hear.  Retrieved from http://www.raisingandeducatingdeafchildren.org/2014/07/01/deaf-children-are-not-hearing-children-who-cant-heartm/


This article was written by itinerant teacher of the deaf/hard of hearing, Brenda Wellen. Brenda has a wealth of experience in working with students with hearing loss and school staff. She began as an aide in a Deaf Education self-contained classroom (5 years). Her first assignment as a teacher of the deaf/hard of hearing was a middle school self-contained classroom for 5 years after which she moved to an elementary self-contained classroom for 8 years, then back to middle school for 3 years as the students were gradually mainstreamed and the job transitioned into itinerant services. She has provided itinerant services for 9 years, working with all ages of children with roles as a parent-infant advisor, itinerant for D/HH students from 3-22, and as a “Supporter” for a adult with hearing loss who is a former student. Brenda is an invited contributor for Bimonthly Update articles.

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Advocacy Notes – Early October 2018

Can a 504 Plan be ENOUGH Support?

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

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

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

Appropriate educational services can include:

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

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

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Technology Monitoring Is Necessary For Hearing Device Users

The job of hearing devices is to improve the audibility of speech, allowing students to perceive much more of verbal instruction and all other spoken communication more fully. By funneling more audible speech information into the brain, the student is able to access more of the curriculum. For our hard of hearing students, hearing devices can be considered the gateway to their educational and social success. For the impact of hearing loss to be minimized optimally, students who are hard of hearing need well fit hearing aids or implants, the devices need to function appropriately, and the student needs to be willing to use the devices in school, and preferably all waking hours. Each of these can be a significant challenge that is a barrier to student success.

Challenge 1: Well-Fit Hearing Devices

One of the results of the 2015 Outcomes of Children with Hearing Loss Study1 was that well-fit HAs reduce risk and provides some degree of protection against language delay. Greater aided audibility is associated with better language outcomes in preschool. HAs are well-fit when speech is made as audible as possible by closely matching gain to prescriptive targets, the latter of which is dependent upon the child’s degree and configuration of HL. Another finding of this broad study was that 31% of children who are hard of hearing had hearing aids that were not fit to optimize speech perception. Just because a child is wearing hearing aids does not mean that he is perceiving speech as optimally as possible. Results indicated that optimized audibility made positive contributions to children’s language and auditory development, even for the children with mild hearing loss. Children receiving the most benefit from their HAs (i.e., greatest aided audibility after controlling for the influence of unaided hearing) demonstrated a positive language growth pattern, showing steady improvement in standard scores from age 2 to 6 years. In contrast, children receiving the lowest benefit from hearing aids showed no change in standard scores over the same time period. By 6 years of age, there was a cumulative difference between these groups of two thirds of a standard deviation. In addition, aided audibility was positively associated with multiple measures of word recognition in quiet from ages 2 to 6 years and in noise for 7- to 9-year-olds. Children with greater aided audibility had better auditory development outcomes and speech recognition abilities than children with lower aided audibility across a wide range of ages and outcome measures. These conclusions support the inclusion of aided audibility in the model as a factor that moderates the impact of HL on children’s outcomes.

What Can YOU Do?

1. Obtain consent from the families of students on your caseload to be in touch with their audiologists. Having routine consent to contact the audiologist about the child’s hearing levels and amplification devices will save time if questions arise about how well the child appears to be perceiving speech.

2. Invest the time to identify a child’s level of access to speech under typical school conditions. There is no replacement for the critical information obtained by doing a Functional Listening Evaluation. Students with typical hearing score 95%+ in quiet and 90%+ in noise If a student has been trained to routinely respond to Ling sound audibility checks, take the time to perform the ELFLing, which systematically identifies the ability to perceive the Ling sounds at different distances. If you only have a few minutes, at least do the Iowa Medial Consonant Test, which is a fast check of audibility for specific consonant sounds. If a child has 25-70 dB hearing levels and has worn hearing aids for some time, then a 100% score is expected.

3. Hearing aids should be fit so that students with hearing loss of 70 dB or better can perceive all of the speech phonemes in quiet from 3 feet without watching the speaker’s face. If you have a student who does not seem to be able to do this, bring the issue to the attention of the family and audiologist. If hearing devices are the gateway to learning, removing any barrier to that gateway can only benefit the student’s performance.

Challenge 2: Ensuring that Hearing Devices are Functioning

It is a cruel reality that 50% of children’s hearing aids malfunction on any given day2. In the US, IDEA specifies4 for children with IEPs, schools must ensure that the hearing devices worn by students with hearing loss are functioning. This requirement underscores the value of working hearing devices and their necessity if a student with hearing loss is to receive a free and appropriate public education, while the ADA focuses on the discriminatory nature of denying full access to classroom communication. With an effective hearing aid monitoring program in place hearing aid malfunction rates can drop to less than 1%2.

Although the law provides no specifics on who, how or how often hearing device monitoring will occur, there is clear intent that the school bears the responsibility to ensure that this monitoring occurs. This need for monitoring and data gathering was reinforced by the outcome of a 2015 court case5 that ruled that a school violated the IDEA record keeping clause (34 CFR 76.731 ) by not keeping a daily log of whether or not the student was provided daily access to the FM/DM system required by the IEP, and if the student used the FM/DM system each day.

In order to verify that the hearing device monitoring activity has occurred, the school needs to have a record of data that provides evidence of hearing device monitoring, including the daily presence and use of the FM/DM system if this communication access accommodation is included on the IEP.

What Can You/Your School District Do?

1. Include teaching hearing aid independence skills to students as a goal on the IEP or as part of ADA accommodations on the 5043 Plan. Hearing devices can malfunction at any time. ONLY the student – with training – is able to immediately identify when a problem arises, and is in the best position to troubleshoot the device and/or request assistance.6 See SEAM skill hierarchy from Building Skills for Success in the Fast-Paced Classroom or refer to Building Skills for Independence in the Mainstream for teaching independence skills6.

2. Have administration knowledge and support of the legal requirement to perform regular monitoring and necessary data collection. Without clear support from the principal, classroom teachers often view hearing aid monitoring as a ‘good thing to do if they have time’ rather than a required activity.

3. Require that a teacher of the deaf/hard of hearing or educational audiologist meet with classroom teachers and provide instruction in how to monitor hearing device function, including involving the student in monitoring, and delineate expectations for necessary data gathering.

4. Provide clear expectations for data collection processes/forms to be used, how often data needs to be collected (i.e., daily), where it needs to be kept, and who is ultimately responsible for ensuring that monitoring and data collection occurs.

Challenge 3: Students Who Don’t Use Their Hearing Devices

While it may seem funny to turn to a child not wearing their hearing aids and say, “Your brain is in your pocket! Oh no!” it is true that about 25% of students do not (consistently) use their hearing aids7. Rejection of hearing aids can be due to lack of support from home. If the family is not supportive of the child using hearing aids, the student may feel as though they are being disloyal to what parents want by wearing their hearing aids at school. If the family does not want amplification to be used, it should not be included on the IEP and there needs to be a clear understanding of reduced academic achievement expectations and risk for social and/or behavior issues.

What Can You Do?

1. Children can often reject their hearing aids when malfunction issues frequently occur as they learn they cannot rely on hearing better via the technology8. Instruction in hearing aid use, monitoring, and troubleshooting is necessary for equal access to education6.

2. Feeling good about cool hearing aid technology is a good foundation for confidence. Items like hearing aid charms, hearing aid fairy wings, or Ear Gear ‘hearing aid outfits’ can catch the attention of peers in a positive way. With positive experiences, students with hearing loss will be better prepared emotionally to deal with the teasing that seems to be a natural part of late elementary and middle school. Share these ideas with families.

3. As students enter 3rd grade and beyond, having no preparation for resilience to teasing by peers too often results in students rejecting amplification secondary to social rejection concerns, even if they know that the amplification is important for learning. Most students with hearing loss are in their neighborhood school with no other peers who use hearing devices. Developing an identity as a person with hearing loss is not possible without feeling a part of a group of okay kids who happen to have hearing loss and use hearing devices. Connections with other students who use hearing devices, or at a minimum, viewing and discussing Kool Kidz Vidz10 can help students develop a healthier identify and resilience to being a ‘one and only’.

4. The direct involvement of a teacher of the deaf/hard of hearing to instruct students in self-advocacy skills and connect them to similar peers is needed if rejection of hearing devices due to social reasons is to be minimized.6,9 As students reach the secondary grades, they need to be fully involved in problem-solving11 their access challenges and making decisions about their use of hearing devices.

Summary

Hearing devices are the gateway to optimal school performance for students who are hard of hearing. There is both logical and legal reasons for teachers of the deaf/hard of hearing and school districts to fully support appropriate hearing device use and the skill building needed for students to feel confident when wearing their devices.

References

1. Moeller, MP, Tomblin, JB, et. al, (2015). Outcomes with Hearing Loss Study, Ear and Hearing, 36: 1S-3S, November/December.

2. Langan, L. & Blair, J.C. (2000). “Can You Hear Me?” A Longitudinal Study of Hearing Aid Monitoring in the Classroom. Journal of Educational Audiology (5), 34-36.

3. Summary of ADA information related to students with hearing loss.

4. IDEA Sec. 300.113. (a) Supporting hearing aid monitoring (b) (1)  Supporting cochlear implant processor monitoring.

5. Detroit City School District., 115LRP 31115 (SEA MI 06/12/15). Written summary of court case findings.

6. Instructional materials for 43 separate goals for hearing device independence can be found in Building Skills for Independence in the Mainstream.

7. 2017 Supporting Success for Children with Hearing Loss Survey: Children Rejecting Hearing Devices: Who, Why, When? Findings for 88 respondents representing a combined caseload of 1863 students.

8. Franks, JL (2008). Why do students with hearing impairment resist wearing FM amplification? Master’s Thesis, Eastern Michigan University.

9. Building Self-Confidence & Resilience to Maximize Acceptance of Hearing Devices: Guide to Building Awareness and Skills to Facilitate Daily Use of Hearing Devices Early Childhood Through High School.

10. Kool Kidz Vidz are part of the membership benefits of Teacher Tools. There are 13 brief videos by students with varying degrees of hearing loss and hearing devices, including discussion questions.

11. COACH – Self-Advocacy & Transition Skills for Secondary Students who are Deaf or Hard of Hearing

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Tips For Itinerants

The beginning of the school year means scheduling, organizing and inservicing – oh my! For itinerant teachers, one of the biggest tricks to starting the school year is getting to everyone in a timely manner to educate them on their student – hearing loss and its impact on learning, accessibility, and technology needs. At best, this can be overwhelming and difficult as one tries to do this with an entire caseload of students, spread around different levels and different schools and, for many of us, even different cities! Couple that with the general education teacher’s beginning of the year schedule, to-do list, and general overwhelm. It can be a recipe for failure! One thing to remember: Inservicing is an ongoing process. It does not happen once at the beginning of the year and then not again until next school year. The beginning of the year is only an introduction – effective inservicing should be ongoing.

How can you get important information to everyone in a timely manner in a way that people can absorb it? How does one efficiently provide ongoing inservicing and support in an already tight schedule? Consider sending a video that can be emailed and accessed when convenient and revisited when needed. This can be an introduction to a topic or need, letting an individual know you’ll be back and will follow up, or can be a short inservicing or follow up on its own. At the beginning of the year, a video can be used to introduce yourself and give immediate “Need To Knows” to teachers, administration and others.

Below is a list of possibilities in using such technology throughout the school year:

  • Introduce yourself to staff, families, administration, and new students.
    Send student reminders about skills they are working on, upcoming visits, or just to check it.
  • Create tutorials such as “Hearing Loss 101” or “How to Use an FM System.” These can be made once, saved in your account, and sent however often you need to send them.
  • Have students create their own teacher inservices about their hearing loss and their needs. While some students are not yet comfortable approaching a teacher to advocate for themselves or to explain their needs, often times they are more comfortable making a video.
  • Interview students and “introduce” them to other DHH students so students realize they are not alone in their hearing loss. (Of course get parent permission before you share their video with others.)
  • Sign language tutorials for parents, teachers, and the students themselves
    Show and tell of what a student is currently working on. This can support the general education teacher as well as families in knowing current skills and expectations as well as help them support skill development in the general education classroom and at home.
  • Troubleshooting tutorials for the FM system and other technology.

Of course this is not an exhaustive list. There are many more ways to utilize video technology in building capacity in working with your students as you work to enlist the village.

Consider the use of the Chrome add-on LOOM (useloom.com). This easy to use free Chrome add-on simply requires an easy download, a laptop or desktop computer and a webcam. You then record your message which is saved in your Loom account. It takes about 30 seconds to download and save the video. A link is then given for a specified recipient to access your recording. To show you how easy it is to create and share videos in Loom, I have provided a short visual tutorial. View a LOOM video version describing how to create a video here.

 

To get Loom on your desktop or laptop (unfortunately, it is not yet available on your tablet or smartphone), go to www.useloom.com. You need a google account to access this add-on. After you have downloaded Loom, you are ready to record a video.

From here on out, you will notice that you now have an icon on the top of your tool bar. This icon looks a little like a flower. From almost any webpage (there are a few exceptions), you may click on that icon and Loom will automatically launch. There is no need to sign in to your account each time or even go to a special webpage.

At this point, you will have the opportunity to choose how you want to use Loom. You may utilize the camera only, your computer screen only, or both. It depends on your goal as to which one you will use. If you are making a tutorial from something on the web, then you probably want to view the screen. For example, suppose you want to review key vocabulary and concepts from a science video for a student who signs and read lips. You have the ability to capture the science video and as well as yourself, emphasizing key concepts and vocabulary during the video. On the other hand, suppose you want to do a trouble shooting tutorial for staff for when the FM isn’t working. In a situation such as this, you would only need the camera and not the computer screen. Therefore, you would want to utilize the camera only. Click on your choice of recording style and click “record now.” Loom will give you a countdown prior to recording.

Link is ready to share!

Once you have completed your video, Loom downloads it into your account in about 30 seconds. From there, you can send it out immediately if you so choose. However, you also have some fantastic options prior to sharing it. For example, you can mark spots in the video for quick reference. For instance, if you are sending home a book for a family to read with their child, and have recorded signs for vocabulary and concepts, you can mark where each sign is shown in the video. Simply pause the video, type the desired word, and hit return.

Loom automatically saves the spot in the video at the exact time you have referenced it. The viewer can click on the word on the side, and the video will automatically jump to the right spot. Videos may also be trimmed if desired. When you are ready to send the link to others, you can either automatically send it from Loom, or you can copy the link and send it yourself in an email.

This Chrome add-on can save you hours of emailing and travel time, reduces the need to go to a classroom for quick check-ins and reduces emergency visits to fix a “broken” hearing aid that simply needed a new battery.

It can also provide more education, ongoing support and feedback for families, staff and even students. This allows you to have more quality time when face-to-face, providing a stronger and more consistent impact as you work to raise up a village that can support your DHH students.

When you need to be 4 places at once and there is no time in your schedule, this Chrome add-on is a life saver. If you need to connect with 10 teachers in a single day and educate them on your student – hearing loss and its impact on learning, accessibility, and technology, by using an add-on like Loom you can do it, no problem!

For more tips and tools for those who work with DHH students, check out the professional trainings available at The Online Itinerant’s website at www.TheOnlineItinerant.com.

By Stefanie Kessen, The Online Itinerant for Supporting Success for Children with Hearing Loss, © 2018

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Dear Classroom Teacher: You Have A Student With Hearing Loss

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

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

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

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

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

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

INTRODUCE THE STUDENT HEARING ISSUES AND NEEDS VIA EMAIL

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

USING THE TEACHER INSERVICE COMBO TO MAKE AN IMPRESSION!

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

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

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

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

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

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

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

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

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

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Advocacy Notes – August 2018

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

Speech Language Results and Observation Alone are Insufficient

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Evaluation Considerations – Low Average ≠ ‘Okay’

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

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

Using Norm-Referenced Tests to Determine Eligibility

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

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

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

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

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

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

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

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

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

References

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

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

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Advocacy Notes

Grade Retention

Question from the field:

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

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

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

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

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

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

Example:

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

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

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Determining Annual Yearly Progress

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

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

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

Disadvantages of High-Stakes Testing for Students with Hearing Loss

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

Is RTI the Same as Progress Monitoring?

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

Challenges in Collecting Valid Data on Students with Hearing Loss

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

Common Progress Monitoring Procedures

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

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

Are Standardized Test Scores Enough as a Measure of Achievement?

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

What Additional Data Should be Gathered?

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

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

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

References

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

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

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

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

PePNet Test Equity Summit Highlights. (2008).

PePNet Test Equity Summit Highlights. (2008).

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

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

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Advocacy Notes

The Power of an Appropriate Program of Special Education Support

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

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

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

Where is the Silver Lining in this Case?

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

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

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

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

Appropriate:

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

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

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Self-Advocacy Instruction – Necessary for Full Participation

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

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

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

Components of Self-Advocacy

Following are basic questions that students with hearing loss typically require instruction in so that they can understand their hearing needs and respond appropriately.

Self-Advocacy

1. What does it mean to have a hearing loss?

2. Why do I have problems understanding (relate to hearing loss and language issues)?

3. How does my hearing loss affect me (school, socially)?

4. When do I have problems understanding what people say?

5. How important are my hearing devices?

6. How do I know when my hearing devices are not working?

7. What should I do when they are not working?

8. What can I do when I know I have not heard what was said (specific self-advocacy & communication repair strategies)?

Self-Determination

9. How much am I willing to have the hearing loss impact how well I do in school (planning/future goals)?

10. When is it critical for me to disclose my hearing loss (problem solving)?

11. What are my legal rights to access, supports, and services?

From the 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 explain 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 situations.
  • 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. Advocacy in Action Self-Advocacy Curriculum

2. Audiology Self-Advocacy Checklist – Elementary School  Middle School High School (PDF)

3. Building Skills for Success in the Fast-Paced Classroom

4. ELFLing

5. Monkey Talk Self-Advocacy Game

6. Phonak Guide to Access Planning

7. Recorded Functional Listening Evaluation Using Sentences (FLE)

8. Rule the School Self-Advocacy Game

9. Steps to Success Scope and 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. Advocacy in Action Self-Advocacy Curriculum

2. Building Skills for Independence in the Mainstream

3. SEAM – Student Expectations for Advocacy & Monitoring Listening and Hearing Technology

4. Steps to Success Scope and Sequence of Skills for Students who are Deaf/Hard of Hearing

Teaching Self-Advocacy Strategies

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

1. Advocacy in Action Self-Advocacy Curriculum

2. Building Skills for Independence in the Mainstream

3. Building Skills for Success in the Fast-Paced Classroom

4. COACH: Self-Advocacy & Transition Skills for Secondary Students who are Deaf/Hard of Hearing

5. Guide to Self-Advocacy Skill Development: Suggestions for Sequence of Skill Attainment (PDF)

6. Monkey Talk Self-Advocacy Game

7. Phonak Guide to Access Planning

8. Rule the School Self-Advocacy Game

9. SCRIPT 2nd Ed: Student Communication Repair Inventory & Practical Training

10. Steps to Success Scope and Sequence of Skills for Students who are Deaf/Hard of Hearing

11. What’s the Problem Game      

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

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Teen Transition – A Necessary Part of Future Success

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

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

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

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

2. Are the postsecondary goals updated annually?

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

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

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

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

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

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

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

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

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

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

Teaching Transition Skills

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

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

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

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

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

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

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

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

Transition for Students Who are “Low Functioning Deaf”

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

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

A Step Toward Post-High School Readiness

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

References

 

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Advocacy Notes

Who is Responsible for Providing FAPE?

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

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

Educational Benefit

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

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

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

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

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

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

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

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

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

Resources

Wrightslaw article: Who is responsible for providing FAPE?

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

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

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Progress Monitoring – Gains Equal to Peers?

Hearing loss is a barrier that limits access to ongoing communication in the environment. For students who are hard of hearing this means that they do not perceive 90% or more of speech, especially if it occurs beyond the 3-6 foot range. Decreased speech perception translates into decreased comprehension, especially of novel words and new information. For students who are deaf and visual communicators, most only receive communication from their classroom interpreter with little meaningful conversation or information exchange directly with peers. Progress through the curriculum at the same rate as class peers with typical hearing assumes that the student has received the same information as those peers. It’s all about access!

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.

Monitor and Compare – Progress from Year-to-Year

Review your student files semi-annually for young children and annually for school-age students. Specifically, look at norm-referenced test results, like the high-stakes tests or language evaluations. Have the student’s percentile scores stayed constant? With your focused intervention and appropriate supports, has the student’s percentile scores improved? Or, like the figure above depicts, has the student experienced inappropriate access issues 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 48th percentile, at the 38th percentile in grade 3, and at the 30th percentile in grade 5. 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 certainly raises the question about adequate yearly progress and if the access accommodations and 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.

Infants and Toddlers

An integral part of early intervention services includes monitoring the growth in skill development for young children with hearing loss. If a child was identified at birth and received amplification/intervention within a couple of months, then the goal is one month of development per one month of age. If the hearing loss was identified and amplification/intervention not provided until 3 months or later, then the goal is more than one month of growth per one month of age. If a child with a delay only gains 6 months of development in a 6-month period then he or she will never catch up to age peers by school entry.

The following are resources that can be used by interventionists/parents to track skill growth over time.

Communication Development Monitoring – checklists for parents of children ages 8-36 months to complete every 6 months to track expressive vocabulary growth as compared to typically developing peers. Checklists can hang on refrigerator as a reminder to families about words appropriate for them to include in daily conversations. It will also be handy to mark when a word has been learned. Graphs for boys and girls show growth via percentile ranks. Scoring examples are also posted to assist in identifying the growth in months for every 6-month period.

Auditory Skills Checklist 1   Auditory Skills Checklist 2– Approximately 85% of children with hearing loss have hearing loss of 70 dB or better. Of the approximately 15% who have 71-110+ dB hearing loss, about half receive cochlear implants. Finally, based on one state’s 2013 data (NC), of the families who chose a communication option, 92% chose spoken language for their children. Only 2% chose ASL and 6% chose simultaneous communication. Fewer than 1% chose Cued Speech. Based on this, it is clear that for the vast majority of children, growth in auditory skill development is very, very important to their future success and should be diligently tracked from infancy.

ASL Development for those families and children who use sign language, skill development should also be monitored. Information on this webpage includes an extensive developmental checklist for ASL skills. Once a child is in kindergarten the ASL Content Standards below should be used as a guide to development.

Pragmatics Checklist – as children transition from early intervention it is critical to determine language performance in all areas. Pragmatics is often overlooked. Pragmatics, or social communication, will not develop at a typical rate, or in the same way for children with hearing loss unless addressed. It is typical for a 7-year-old with hearing loss to have the pragmatics skills of a 3-year-old!

Hearing aid use and independence is a concern, even for our youngest children with hearing loss. Families need to develop confidence in monitoring hearing devices and supporting full time use. Strategies for Keeping Hearing Aids On and Achieving Effective Hearing Aid Use in Early Childhood are resources to assist in these goals.

School Age

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

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