Creating the Least Restrictive Online Learning Environment for Students who are Deaf*/Hard of Hearing

Creating the Least Restrictive Online Learning Environment for Students who are Deaf*/Hard of Hearing

The Impact of Learning with a Hearing Loss in the Online Classroom:

While speech delivered through a computer or tablet may be an adequate delivery method for a student with typical hearing, it creates a barrier for students who are deaf/hard of hearing. The listening effort required of students with a hearing loss is substantially greater than their peers and can result in fatigue, attention challenges and reduced retention abilities. The purpose of this article is to provide a resource of strategies to provide student access during online learning.

Some challenges to students who are hard of hearing during online learning:

  • The way speech is acoustically transmitted through a computer is not optimal for students who hear through mechanical or electrical devices.
  • When hard of hearing students have to listen to computer presented speech, they lose visual cues as well as vocal intonation/inflection cues required for their understanding.
  • While the use of closed captions is beneficial, it requires the splitting of a student’s visual attention.

These factors create gaps that the hard of hearing student needs to “fill in”, which in turn increases the required listening effort and cognitive load relative to their peers. Students who are hard of hearing, attending online classes will, without question:

  • Will have to work harder to listen and concentrate. Listening fatigue can contribute to self-doubt and stress
  • Have difficulty maintaining attention
  • Appear inattentive, distracted or frustrated at times
  • Experience difficulty following instructions
  • Hear little to none of their peers’ contributions

All of the above add to the deaf/hard of hearing student’s cognitive load.

There are, however, strategies for creating a least-restrictive online learning environment for students with a hearing loss.

* deaf – For the purposes of this article the word deaf refers to individuals who prefer to self-identify as ‘deaf’ but still use hearing technologies and spoken language to communicate.

Access to Teachers

Listening and learning virtually is just as challenging and fatiguing for students who are deaf/hard of hearing as listening and learning in the classroom through masks. The following recommendation will make it easier for your deaf/hard of hearing student to understand online lectures:

EXTERNAL MICROPHONES

One of the barriers to equal access online is the computer microphone.

  • Think of the sounds /p/ and /h/ that are just puffs of air
  • Or /s/, /f/, /t/ and /th/ that are so high pitched and soft that they just drop off before they get to the built-in microphone

Students with typical hearing may miss some sound but may still be able to ‘piece things together’. This is because they likely (unknowingly) overheard these words previously. Students with hearing loss on the other hand, do not have the same overhearing experience so their exposure, and thus ability to ‘fill in’ what they don’t hear, is essentially absent.

Unlike a built-in microphone, an external microphone is situated inches from the mouth, allowing the most important sounds for understanding speech (soft, high pitched sounds) to get to that microphone at full volume.

REDUCE BACKGROUND NOISE

Even the slightest background noise such as the low hum of a TV in the room or a fan can be enough noise to disrupt the signal of your voice and leave your deaf or hard of hearing student lost.

MAKE YOURSELF EASY TO SEE

Access to visual cues can improve understanding of spoken language for all students, but particularly for those who are deaf/hard of hearing.

Pinning the Teacher

Students can be taught to ‘pin’ their teacher on any given online learning platform so that they can see the teacher’s face

Google Meets- top image

Zoom – bottom image

Clear Image

A shadow over your face will make it difficult to read your lips.

  • Make sure to have light sources in front of you NOT behind you. Avoid sitting directly in front of a window.

Be aware of potentially distracting backgrounds. Most online platforms allow for the blurring of the background.

Internet Speed

A slow internet connection can result in a mismatch between the audio and video signal. This will cause confusion for students who benefit from watching your lips on screen.

  • Ask your students if your audio and video are in sync
  • Connect with your district IT support personnel if necessary

Teachers’ use of external microphones provides the least-restrictive online learning environment for students who are deaf/hard of hearing and is the most effective way to improve online accessibility for all online learners.

While technology is always being updated the following external microphones are currently popular with online teachers.

Bluetooth Headset/Microphone

USB Headset/Microphones

USB Microphone only (no headset)

CAPTIONING

While captioning is a complicated subject due to the variety of online delivery platforms and devices being used, many students rely on captions for complete access to spoken information. Note – benefit will vary from student to student depending on age and level of literacy. Please consult with your teacher for the deaf/hard of hearing.

In addition to remote lectures and instructions please consider captioning:

  • Multimedia Presentations (e.g. videos, movie clips)
  • Recorded lessons
  • Announcements

* Contact your Educational Audiologist for more information.

USE OF FM/DM SYSTEMS

Assuming the consistent use of properly functioning hearing aids and/or cochlear implants, plugging in a personal FM/DM system will provide the deaf/hard of hearing student with a better sound quality than listening through headphones. To achieve this your student will need:

  1. 1. Properly functioning hearing aids and/or cochlear implants
  2. 2. Access to a personal FM/DM system and receivers
  3. 3. An audio cord to connect the FM/DM transmitter to the computer, Chromebook, iPad, etc

See Listening to Electronic Devices with Hearing Technologies for specific and detailed information and instructions.

Access to Peers

Students with hearing loss typically experience difficulties understanding multiple talkers. This is true in both live and online communication environments. The following recommendation will make it easier for your deaf/hard of hearing student to follow the dialogue of multiple talkers online.

One Talker Rule

  • Enforce a one taker rule during discussions
  • Depending on the age of your students, establish control over muting participants or encourage students to mute themselves and only unmute when called upon to speak
  • Determine a procedure for student contributions (E.g. physical hand raise, typing ‘Q’ in the chat, app extensions, etc.)
  • Image – Google Meets – Nod extension

The Smaller the Group the Better

  • During breakouts, assign your deaf/hard of hearing student to partner work versus small groups
  • If small groups are necessary, try to keep the size to 3-4 students

Peer Contributions

Identifying who on screen is speaking can be tricky for a student with hearing loss. Your deaf/hard of hearing student will need time to fill in gaps and identify who is talking.

  • During discussions, ask students to identify themselves
  • Paraphrase or repeat or peer contributions
  • Visually represent student comments, questions, and answers on your screen for the whole class to see

Be aware that these challenges may result in further social isolation

Access to Materials

It is best for all materials to be made available to your student prior to the classroom lesson.

  • Share slide presentations, videos, recorded lesson, PDF docs, etc BEFORE the online lesson so that your deaf/hard of hearing student can preview the material and research words with which they may be unfamiliar
  • Provide student access to a list of upcoming keywords (e.g. list in Google Classroom)
  • Provide both print and electronic textbooks so that your student can use the glossary and preview upcoming material

Fatigue and Cognitive Load

Like their typically hearing classmates, students with hearing loss may experience what has been coined as “Zoom Fatigue”, an online learning fatigue which many of us have experienced firsthand. Unlike their typically hearing peers, students with hearing loss are not only learning by listening to computer quality sound (as opposed to live speaking) but doing so through a compromised auditory system and mechanical or electrical devices. As well, they may mishear but be unaware of their misunderstanding, adding another layer to their fatigue and cognitive load

What You Can Do To Help

  • If possible identify time to meet 1:1 with a student for support and/or provide online EA assistance
  • Check in frequently with student (privately) to ensure that they are following the lesson
  • Offer listening and learning breaks
  • Ensure that a Teacher of the Deaf/Hard of Hearing and Educational Audiologist are a part of your student’s learning team
  • Be patient and kind!

Image References

  1. 1. https://er.educause.edu/blogs/2020/8/creating-emotional-engagement-in-online-learning
  2. 2. https://www.clipartkey.com/view/iiTRbh_english-clipart-english-course-learn-online-png/
  3. 3. https://www.howtogeek.com/673264/how-to-look-better-on-zoom-and-other-video-calling-apps/
  4. 4. https://tmieducation.com/tmi-virtual-learning-portal
  5. 5. https://www.redefy.org/stories/connecting-my-high-school-experience-in-a-pandemic

About the Author: Krista Yuskow, has 20+ years of experience as an educational audiologist working with teachers and students in Edmonton, Alberta. She has extensive expertise in using assistive technology to improve student access. Krista has authored the Tech Talk section of the Teacher Tools e-magazine for several years.

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The Power of the Read-Aloud

The Power of the Read-Aloud

  • The ability to read empowers success!
  • Readers come from readers – those children whose parents themselves read and made a habit of reading daily to their child/children, have a higher interest in reading.
  • Better reading ability leads to higher education which can be tied to longer life.
  • The inability to read costs – from high school drop-out rates, to colleges that have to offer remedial reading courses, to lower paying jobs, to having fewer people in the workforce.

The ability to read is empowerment; it is self-confidence; and above all, it is independence.  Children begin their appreciation for books and stories in the arms of their parents and caregivers. By the time children are school-aged, the love of hearing/seeing stories read in the home is transferred to the classroom. It makes our job of teaching so much easier.

But for students with hearing loss, listening to stories sometimes takes more time and effort—more effort to hear and see, to process, and finally to comprehend the information presented.  It is of equal importance that we expend the time and effort to make hearing, seeing, processing, and comprehending a bit less difficult. To accomplish this:

Do

  • Familiarize yourself with the book before you read it to the child/group.
  • Read aloud/sign the title, author’s name, and illustrator’s name every time you read no matter how many times you read the same book.
  • Tell the child/group something about the writer and illustrator.
  • Take note of the text elements and adjust the emotional register of your voice/signs/body language to accompany the feelings of the characters or the intensity of the plot.

Don’t

  • Make every page in the book a time to quiz the child/group.
  • Read too fast.
  • Feel like every book has to be tied to the curriculum.
  • Use reading as a punishment.

 

How can you critique and/or improve your read-aloud skill?

Check your reading rate of speech:  You will need a timer, a book of choice, and a computer with access to a speech to text feature such as Google documents. Open a blank document, enable the speech-to-text feature, start your timer for 1 minute, and start reading at your normal rate of speech.  When 1 minute is up, stop reading, and check the word count.  I did this recently, and found that I read at 160 wpm.  Adults talk at approximately 200 words per minute, but most children only process about 125 words per minute.  It took me a few tries to get my word count down to 125 words per minute.  The slowest I felt comfortable reading was around 140 words per minute. I now know, like most adults, I need to slow down my read-aloud rate.

Check your enunciation: The speech-to-text feature is also a great tool if you want to check whether you are enunciating words properly. In Texas, we have a tendency to runallourwordstogether.  Making a conscious effort to enunciate words properly, especially target words and phrases, is difficult but it can be done.

Check your body language or signing from the viewpoint of the child/group:  Video record yourself reading and/or signing a book.  It’s best if you can record yourself at the natural time you read to your students.  Check your posture, the gestures you use, the sentence structure and signs you use.  Turn the sound down and watch the recording. Does the story flow? Are the signs correct?  Does your body language match the tone of the story? See principles of reading to Deaf children in ASL.

Check your engagement level:  With proper permission, record yourself reading to your class or student so their reactions can be seen on the video.  Are they interested? Are they engaged?  Can they hear/see you? How many times are you stopping to quiz the audience?  What kinds of questions are the students posing?  How many times are you interrupted?  An alternative to recording yourself is to ask a trusted colleague to observe you and give positive and constructive feedback. Have a short list of behaviors for the observer to focus upon.

Telling stories is an art.  With practice it can be done well.  When you think about it, there is a story waiting to be told in every subject area. Reading aloud doesn’t have to be confined to English Language Arts class.  Stories of discovery and invention in science and math, stories of victory and loss in history and sports, stories of imagination and perspective in art, stories of overcoming the odds despite disability, race, gender, and society norms – the list is endless.

I like to close my student sessions with  a story just for fun, allowing the student to choose the book from three or four I’ve brought along.  Most of the time, it’s a positive end to our time and the books are remembered well when/if  they are read again. Whatever the age of the students you serve, I encourage you to read-aloud to them.

Sources:

  • Trelease, J. (2013). The read aloud handbook (7th). Penguin Books.
  • Cole, E.B. & Flexer, C. (2016). Children with hearing loss: developing listening and talking. Plural Publishing.
  • Hart, B. & Risely, T.R. (1995). Meaningful differences in the everyday experience of young American children. Brookes Publishing.



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Accommodations – Lifeline to Equal Access

Accommodations – Lifeline to Equal Access


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

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

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


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

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

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

Auditory Learner Access Needs

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

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

Visual Learner Access Needs

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

Suggestions for Determining Appropriate Accommodations

  • Make the case. Impress upon the student’s classroom teacher and school team that accommodations are truly the student’s lifeline to equal communication access, and therefore the opportunity to obtain the same achievement as class peers. Obtain data to estimate the students’ level of access.

  • Be consistent in your approach to recommending FM/DM/HAT hearing assistance technology. The physics of sound is immutable. To receive optimized access to verbal communication in school, students who are auditory learners need to use HAT starting with school entry and continuing as long as the student is willing to comply. Even if a teacher is loud, animated and does not move around the classroom much, the student with hearing loss will still not be receiving optimal auditory input without the use of HAT.

  • Emphasize that one size does not fit all. While IDEA does not require ‘optimal’, the ADA requires equal access. This is a case where the ‘bar’ for ADA is higher than it is for IDEA. Even with HAT providing optimal auditory input, a student with hearing loss will not have normal hearing restored. Per a court case: “ADA requirements regarding students who are deaf or hard-of-hearing are different than those imposed by the IDEA.” Additional accommodations are necessary to close this gap. Because IDEA and ADA requirements are not identical, there may be some situations in which a child has accommodations as part of an IEP and also requires a 504 Plan to address the auxiliary aids and services needs per ADA.

  • Grades do not matter when it comes to accommodation needs. Children who are hard of hearing or deaf WILL need accommodations. How well or how poorly they perform in the classroom is not a determinant for whether accommodations should be provided. Some students put in many more hours of homework than their peers, often sacrificing social opportunities, to earn and maintain high academic achievement. The necessity to expend these extraordinary efforts can be a sign that discrimination is occurring. The case study provided by the ADA as part of the Frequently Asked Questions described a high achieving secondary student who had an FM system but also needed CART services so that he had full access to class discussions. If a student is not found to be eligible for an IEP, then this reflects the school team’s belief that the student will be able to experience one year’s growth in one year’s time without special support. In Deal v. Hamilton Board of Education (6th Circuit, 2004), the court ruled that “meaningful educational benefit must be gauged by the child’s potentialities.” Thus, accommodations will ALWAYS be necessary, whether via an IEP, 504 Plan or both.

    Response to
    : He seems to be doing okay academically; I don’t think we need to get him an FM/DM system.”  If a student in a wheelchair was assigned to a classroom with a narrow door would it be okay to have the student participate by sitting out in the hallway? In other words, would it be okay for him to not have to be included in a class with a door wide enough for the wheel chair because the student’s academic performance was not a concern?  Ignoring auditory inclusion needs is the same issue.
  • Consider communication needs situation-by-situation. This not only makes sense, it is another requirement of ADA. A form has been provided below to assist teams in these discussions.

  • There is no ‘set list’ for appropriate accommodations. An Accessibility Considerations handout lists examples of auxiliary aids and services. This can be used as a starting place for discussion but should not be seen as limiting accommodation choices. Auxiliary services can include teacher inservice and progress monitoring by a specialist in DHH. The federal Every Student Succeeds Act encourages specialized instructional support providers to support literacy and collaborate with classroom teachers, thus allowing special educators to work with classroom teachers on behalf of regular education students.

  • It is the school’s responsibility to ensure that the provided accommodations are effectively providing equal access to classroom communication. For students who are grade 3 and above it is suggested that they complete the Listening Inventory For Education – Revised (LIFE-R) Student Appraisal (Teacher Tools Takeout 0099, 0052, 0100) at the beginning of the year and review the results at the end of the first quarter to discuss if, with the accommodations, the student feels as though access has improved. Routine classroom observations and performance monitoring can also be helpful to determine the effectiveness of the accommodations being provided.


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Assessment Must Go On! Tailored Identification of Access & Educational Needs

Assessment Must Go On!

Tailored Identification of Access & Educational Needs

 

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

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

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

A 2018 US court case1 emphasized that students with hearing loss must receive an eligibility assessment that identifies areas of suspected need secondary to hearing loss with sufficient intensity to satisfy in depth evaluation. The special factors considerations2 also need to be applied throughout the evaluation process. The IDEA law is consistent about looking at educational performance needs when considering a student’s eligibility for specialized instruction and support.  Educational performance is not equivalent to academic performance. While academic performance needs to be considered, it is no more important to consider than the other areas specified by IDEA which are functional, behavioral, social needs and any other performance considerations relevant to the specific child.

Our students with hearing loss often have differences/needs that, added together, cause academic performance to erode over time. Even ‘good’ students with hearing loss can qualify IF there is someone on the multidisciplinary team who truly understands the impact of hearing loss on development AND uses appropriate assessments to use to tailor the evaluation process to the risk areas of students with hearing loss. One strong research finding4 was that normative test scores overestimate the abilities of children who are hard of hearing as they are unlikely to reflect the level of effort that students are expending to maintain competitiveness with peers. We must consistently communicate with our school teams that students with hearing loss are not language disordered. Language, social, and reading delays occur secondary to lifelong decreased access to communication.

 

The defined purpose of IDEA3: To ensure that all children with disabilities have available to them a free and appropriate education that emphasizes special education and related services designed to meet their unique needs and prepare them for further education, employment and independent living. Performance of the expanded core skills needed for full participation (self-advocacy, communication repair, knowledge about hearing loss, amplification independence, etc.) are necessary for a student to be fully prepared to function as an adult. These are NOT standard areas of evaluation for other students with special needs, but they must be considered as part of a tailored assessment for students who are deaf or hard of hearing.

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

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

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

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

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

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

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

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

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

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

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

 

Suggestions for performing assessment of comprehension of spoken information

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

Although testing is performed in a few weeks’ time, evaluation isn’t just about a snap shot, it is about performance over time.

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

Educational programs must be reasonably calculated to enable a child to make progress appropriate in light of the child’s circumstances. In the case of students with hearing loss, the expectation would be to provide full access to school communication and specialized instruction to fill in learning gaps PLUS support typical/expected levels of progress in the classroom. Therefore, evaluation must be tailored to identify the access, learning, and functional performance needs of every student with hearing loss so that they can progress equal to their cognitive peers, regardless of online or onsite instruction.

 

 

References

  1. 1. Ninth Circuit Court of Appeals, June 1, 2018, S.P. v. East Whittier City School District: https://successforkidswithhearingloss. com/wp-content/uploads/2019/01/Court-case-RE-need-for-thorough-assessment-highlighted.pdf
  2. 2. IDEA section 300.324(2)(iv): Consider the communication needs of the child, and in the case of a child who is deaf or hard of hearing, consider the child’s language and communication needs, opportunities for direct communications with peers and professional personnel in the child’s language and communication mode, academic level, and full range of needs, including opportunities for direct instruction in the child’s language and communication mode.
  3. 3. The 2004 IDEA Commentary provides an overall ‘setting the stage’ for the IDEA law; on this webpage.  
  4. 4. Epilogue: Conclusions and Implications for Research and Practice. Ear and Hearing, 36, 92S-98S. Sole reliance on norm-referenced scores may overestimate the outcomes ofCHH. When the children who are hard of hearing (CHH) were compared with the norm-referenced group on various measures, the differences were small. However, when compared the CHH to a sample of CNH who were matched on age and SES, the size of the effect of HL on language doubled to two thirds of a standard deviation. These results question the sole reliance on comparison to norm-referenced test scores for judging eligibility. Standardized test scores may overestimate CHH as they are unlikely to reflect the level of effort that students are expending (cognitive and perceptual resources) to maintain competitiveness with peers in secondary schooling, where the cognitive demands increase. We need to closely monitor the outcomes of CHH including comparing their performance relative to neighborhood grade-mates. Many CHH in the OCHL study represent the best-case scenario. We might expect that a sample with greater diversity on these dimensions would not perform as well as the OCHL cohort.

 

 

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

 

 

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Focusing on Vocabulary Building

Focusing on Vocabulary Building

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

Did you know…?

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

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

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

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

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

 

Resources:

 

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Teaching Auditory Skills via Remote Learning

Teaching Auditory Skills via Remote Learning

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

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

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

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

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

Can auditory training be done via remote instruction?

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

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

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

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

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

Auditory practice can include:

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

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

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

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

Some skills that can be practiced from these curricula include:

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

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

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

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

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

 

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Access and Advocacy in an e-Learning World

Access and Advocacy
in an e-Learning World

 

With remote learning, the teacher, student and the parents need to understand how to use accessibility accommodations and why. This article includes:

  • ground rules for communication in online learning
  • recent research on the impact of face coverings on speech understanding
  • remote learning listening technology and connectivity options for students with hearing loss

Rules for Good Communication During Online Learning
to Ensure Appropriate Access for the Student with Hearing Loss

1. Noise. Everyone not speaking must be muted to reduce background noise and help everyone understand.

2. Sound quality. Teacher must use a headset with a mic, not just computer sound. Using a headset makes a big difference for all learners and is necessary for captioning accuracy, if used.

  • Recognize that for students who are hard of hearing, listening through electronics provides a degraded signal that makes online learning even harder for them than their hearing peers. 

3. Speechreading and the need to ‘pin’. Being able to see the speaker’s face as they talk contributes to understanding, especially for the student with hearing loss.

  • When share your computer screen, be sure that your face can still be seen. Students will need to learn how to “pin” the speakers so that the face stays on the screen. Some platforms have a feature where the person who is speaking becomes larger on the screen. Students will need guidance on how to use these features to improve their understanding and involvement.
  • When classmates talk during remote learning, they too must show their face.  Having their camera off and talking makes it harder for everyone to follow along.
  • If a student uses an interpreter- the interpreter will need to also be “pinned” so that they are always visible on the screen.

4. Lighting. Everyone needs to be aware of lighting while on video.  The light must be to the side or coming from in front of you, so your face won’t be in shadow.

5. Seeing words + listening = better understanding. Captions help most listeners and are typically preferred in online learning situations as they improve engagement and comprehension.

  • Captions can be a lifeline for students with hearing loss, allowing them to really comprehend what is being said online.
  • All videos that are shown must be captioned (i.e. YouTube, Loom, etc.). 

6. One at a time. Just as with face to face instruction, only 1 person at a time should be speaking.  If the entire class is showing in a small gallery view, there must be time for the student with hearing loss to locate who is talking.   

7. Don’t lose anyone. It can be harder for teachers to tell if a student is getting lost during instruction when it is provided remotely.

  • Consider using ‘check in’ techniques, like raised Yes/No paddles, the provided responses (hand up, question mark, applause), or encourage students to send a private chat message if they are lost or have a question. Teachers need to do check ins more often, especially with the student with hearing loss.
  • Students with hearing loss need to advocate for themselves is there is a problem accessing the class instruction- be it live or via distance learning. This is a key life skill for students with hearing loss as access will almost always be a challenge.

8. Extra connections for full access. Students may need support in connecting their hearing aids or FM/DM devices to their computer. 

  • Many students have Bluetooth connectivity and may be able to connect their devices to their computer potentially increasing their access to the instruction.
  • Solutions for access with hearing technology need to be tailored to each student’s devices, needs, and remote learning platform.

Written by Gail Wright, Itinerant Teacher of the Deaf/Hard of Hearing, July 2020

Remote Learning Listening Options for Deaf and Hard of Hearing Students

If students return to remote learning, or parents choose remote learning through their school districts, these are some of the available listening options for hearing technology and device connectivity. These options will differ for each child based on their personal hearing devices, listening preferences, and individual situations.

1. Listen through the computer/iPad/Chromebook’s built-in speaker.

2. Use personal headphones that the student knows work with his or her devices.

3. Use an auxiliary speaker connected directly or via Bluetooth to the computer/ iPad/ Chromebook.

4. Amplified neckloops may be obtained for students whose hearing aids or cochlear implant processors have a t-coil program already programmed in and made accessible by their audiologist.

5. Some students have hearing aids or cochlear implant processors that can use a streamer plugged into the computer/ iPad/ Chromebook via an audio cable to stream audio to the personal hearing devices.

6. Students with Cochlear Corporation N6 processors (CP910) can use a monaural or binaural personal audio cable from Cochlear Corporation. (If the audio cable is plugged into a device that is running off a battery, only the audio cable is needed. If it is plugged into a device that is plugged into a wall outlet, an isolation cable must also be used to protect the CI processor from possible electrical surges.)

7. Students whose hearing aids or cochlear implant processors have Bluetooth capabilities may be able to connect devices directly to laptops/ iPads/ Chromebooks with Bluetooth. If the computer device does not have Bluetooth, it may be possible to add a Bluetooth dongle. The students’ audiologist should have shown them how to connect Bluetooth devices to their hearing aids or implant processors.

8. When needed, students may take home their school supplied remote microphone (FM/DM) systems to access remote instruction. However, this may not be the best option for students using alternating schedules / hybrid learning if transporting the system between school and home every day is needed.

Parents, teachers, Deaf and Hard of Hearing teachers, and the educational audiologist need to work together to determine which option(s) will be best for each student.

Written by Karen M. Schaaf, Educational Audiologist, July 2020.

Troubleshooting RMHAT Issues During Online Learning

Providing students with their FM/DM hearing technology, also known as RMHAT (remote microphone hearing assistance technology) is great, but only if it works. Students and families are left with questions and frustration when the student cannot successfully hear the teacher. Below are some troubleshooting options that can be tried to get students up and learning remotely when an RMHAT issue occurs:

1. Immediate temporary fix = unplug the audio/aux cable from the computer and transmitter and place the transmitter microphone near the computer’s speaker so the lesson can continue uninterrupted

2. Try a different audio/aux cable

3. Check the Bluetooth connection if applicable

4. Restart the application and possibly the computer

5. For Phonak Roger Touchscreens, make sure “Input” was selected when the audio cable was plugged in

6. If the transmitter defaulted to muting the microphone, try unmuting

7. Check the computer’s speaker and microphone settings

 

Written by Karen M. Schaaf, Educational Audiologist, August 2020.

 

 

Download the CAVE Checklist – Communication Access in Virtual Education to help identify access issues.

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E-Learning & Coronavirus

Due to Coronavirus (COVID-19), many of us have been participating in e-learning or virtual learning for several weeks. During that time, we have all learned a lot! We have learned what works, what doesn’t work, and what needs more work. And I daresay many of us have learned how to use new types of technology! You may find the following information helpful as your wrap up your school years and plan ahead for the fall. 

MEETING LEGAL RESPONSIBILITIES:

The U.S. Department of Education Secretary Betsy DeVos recently advised Congress that there was no need to provide any waivers in meeting the needs of students receiving services under IDEA. She reiterated that students with disabilities still have the right to receive a free appropriate public education. DeVos did recommend that a waiver be made to allow toddlers receiving services under Part C have their transition timeline extended if their evaluation dates occur during this window of school closures. For those of you having virtual IEP meetings during this time, check out the Virtual IEP Meeting Tip Sheets created by several programs funded by the Office of Special Education Programs.

 

RESOURCES:

The National Association of the Deaf has released a position statement on Educating PreK-12 Deaf and Hard of Hearing Students During the COVID-19 Outbreak. They have also established a webpage dedicated to Deaf Education Resources for all age levels that might be helpful. Communication Services for the Deaf has a variety of COVID-19 resource links available for the Deaf Community, including a communication card for both deaf and deafblind individuals. In addition, the A.G Bell Association for the Deaf and Hard of Hearing has compiled a list of resources for families and educators. And for those of you who work with Spanish speaking families, you might find this resource developed by the Louisiana School for the Deaf Outreach Program useful! And an great opportunity to have a digital pen pal is available at the DHH Teacher IS in.

NON-SCREEN LEARNING OPPORTUNITIES

Across Facebook and Twitter, many families have expressed concerns about the amount of time their children are now on a screen to access their education in addition to recreational activities. As teachers plan for and parents support e-learning, it is important to remember the recommended amounts of time for virtual instruction are significantly different that those of in-person instruction. The National Board of Professional Teaching Standards guidelines recommend that “elementary students should have 1-2 hours a day of online instruction, middle school students 2-3 hours, and high school students 3-4 hours.” 

To reduce the amount of screen time required for instruction, consider giving assignments that don’t require the use of a screen. For younger learners, check out this Google Drive folder filled with non-screen Language Challenges. Special thanks to Kelsey Funk for creating and sharing this resource through the Facebook page DHH Preschool Learning at Home. Have a conversation about what you see in picture scenes. And check out the Speech Therapy Store for links to LOTS of freebies!

Read books! Check out Start With a Book for lists of books by age and topic along with activities and non-screen ideas to do at home. Or check out Reading Rockets list of ideas to do before, during, and after reading a book. More information on developing a child’s reading skills can be found at Supporting Success for Children with Hearing Loss.

Write! Keep a journal of daily activities by writing or drawing, create a lockdown diary, or establish a dialogue journal. Use magnetic letters to create words, write words in shaving cream, or create word labels for various items around the house. Draw pictures and write sentences to create a short story!

Stay active! Check out some fun sensory activities at Hearing Like Me. Go on a scavenger hunt throughout your home or in your neighborhood (here’s a scavenger hunt list for older children). Check out this resource for some outdoor activities that specifically address balance, a common issue for many children who are deaf or hard of hearing. If you have access to outdoor space, take advantage of it with these 50 Simple Outdoor Activities for Kids.

Learning is a part of our every day lives.  Break away from videos and worksheets! Encourage active learning opportunities that don’t rely on a screen. No matter what you choose to do, know that there is ALWAYS an opportunity to promote language development for our deaf and hard of hearing students. As educators, now is a prime opportunity to support parents in creating language-rich environments within their homes!

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Teacher Tools Takeout

Introducing Teacher Tools Takeout

from Supporting Success for Children with Hearing Loss

Teacher Tools Takeout is similar to Teachers Pay Teachers but focused on the unique needs of children who are deaf or hard of hearing. À la carte instructional materials ready when you need them!

  • Takeout accounts will be free for users and submitting authors. Select what you want, when you want.
  • Any files downloaded from Teacher Tools Takeout will be stored in your free account
  • The majority of instructional materials are computer fillable
  • Sort for files by ability level, age/grade range, topic category, Common Core Anchor Standard, or price
  • 300+ free downloadable materials found in the Supporting Success webpages will be in Takeout
  • Materials from some of the Supporting Success publications will be for sale à la carte within Takeout
  • For authors wishing to submit materials for sale in the Takeout store, we will begin accepting materials for review in June 2020. Direct pay of royalty upon sale. Royalty is 55% minus 3% for processing.
  • School Purchase Orders will be accepted to pay for Takeout Each teacher to be provided materials would be set up with a Takeout account and a credit for the amount desired. $25 increments for purchasing districts via POs, $25 increments can be paid for online or use the ‘pick and pay’ option.
  • Categories of instructional information for students on Teacher Tools Takeout include:
    • Advocacy-self-advocacy and self-determination instruction
    • ASL teaching materials – build vocabulary, support writing, using interpreters
    • Assessment checklists, hierarchies, observation forms, interpretation info
    • Deaf Plus – information about supporting students with additional challenges
    • Deaf Studies – deaf history, culture, role models, community
    • Hearing Loss-Student Understanding and awareness of own hearing loss
    • Hearing Technology and Management – teaching and monitoring materials
    • Language Skills – over a dozen subcategories
    • Listening Skills – instruction in basics through comprehension
    • Personal Health – safety, emergency preparedness, sexuality, etc.
    • Reading Skills – phonological awareness, using visual supports, predicting, etc.
    • Self-Concept/Identity – dealing with feelings associated with hearing loss
    • Self-Management – organization, time, study skills, etc.
    • Social Communication Skills – pragmatic language, making friends, social skills
    • Teacher Information – informing teachers/parents on all the categorical areas
    • Transition – career and employment preparedness, transition to adulthood

Teacher Tools Takeout will kick off August 1st with 1000 files and will continue to GROW.

 
Integration with Teacher Tools membership:
Takeout is a new stand-alone venture for Supporting Success that also coordinates with our long-standing Teacher Tools membership.



Each joining and renewing Teacher Tools member will receive
  • Subscription to Teacher Tools e-magazine packed with 60+ pages of instructional materials and information.
  • Over 300 downloadable files free from the Supporting Success website
  • Over 50 downloadable files offered for sale on TakeoutFREE
  • Over 50 downloadable files offered exclusively to subscribers
  • PLUS up to $10 credit to spend in the Takeout
Become a Teacher Tools member to get a big head start on collecting Teacher Tools Takeout materials!  
JOIN NOW
 
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Teacher Tools Takeout: Social Conversation

Introducing Teacher Tools Takeout

from Supporting Success for Children with Hearing Loss

Free Download: Social Conversation

To celebrate the launch of Teacher Tools Takeout, here’s a FREE article for you to download:
Click the thumbnail to start the download or you can also click here

Teacher Tools Takeout is similar to Teachers Pay Teachers but focused on the unique needs of children who are deaf or hard of hearing. À la carte instructional materials ready when you need them!

  • Takeout accounts will be free for users and submitting authors. Select what you want, when you want.
  • Any files downloaded from Teacher Tools Takeout will be stored in your free account
  • The majority of instructional materials are computer fillable
  • Sort for files by ability level, age/grade range, topic category, Common Core Anchor Standard, or price
  • 300+ free downloadable materials found in the Supporting Success webpages will be in Takeout
  • Materials from some of the Supporting Success publications will be for sale à la carte within Takeout
  • For authors wishing to submit materials for sale in the Takeout store, we will begin accepting materials for review in June 2020. Direct pay of royalty upon sale. Royalty is 55% minus 3% for processing.
  • School Purchase Orders will be accepted to pay for Takeout Each teacher to be provided materials would be set up with a Takeout account and a credit for the amount desired. $25 increments for purchasing districts via POs, $25 increments can be paid for online or use the ‘pick and pay’ option.
  • Categories of instructional information for students on Teacher Tools Takeout include:
    • Advocacy-self-advocacy and self-determination instruction
    • ASL teaching materials – build vocabulary, support writing, using interpreters
    • Assessment checklists, hierarchies, observation forms, interpretation info
    • Deaf Plus – information about supporting students with additional challenges
    • Deaf Studies – deaf history, culture, role models, community
    • Hearing Loss-Student Understanding and awareness of own hearing loss
    • Hearing Technology and Management – teaching and monitoring materials
    • Language Skills – over a dozen subcategories
    • Listening Skills – instruction in basics through comprehension
    • Personal Health – safety, emergency preparedness, sexuality, etc.
    • Reading Skills – phonological awareness, using visual supports, predicting, etc.
    • Self-Concept/Identity – dealing with feelings associated with hearing loss
    • Self-Management – organization, time, study skills, etc.
    • Social Communication Skills – pragmatic language, making friends, social skills
    • Teacher Information – informing teachers/parents on all the categorical areas
    • Transition – career and employment preparedness, transition to adulthood

Teacher Tools Takeout will kick off August 1st with 1000 files and will continue to GROW.

 
Integration with Teacher Tools membership:
Takeout is a new stand-alone venture for Supporting Success that also coordinates with our long-standing Teacher Tools membership.



Each joining and renewing Teacher Tools member will receive
  • Subscription to Teacher Tools e-magazine packed with 60+ pages of instructional materials and information.
  • Over 300 downloadable files free from the Supporting Success website
  • Over 50 downloadable files offered for sale on TakeoutFREE
  • Over 50 downloadable files offered exclusively to subscribers
  • PLUS up to $10 credit to spend in the Takeout
Become a Teacher Tools member to get a big head start on collecting Teacher Tools Takeout materials!  
JOIN NOW
 
Share This!

Teacher Tools Takeout: Cascading Impact of Hearing Loss

Introducing Teacher Tools Takeout

from Supporting Success for Children with Hearing Loss

Free Download: Cascading Impact of Hearing Loss

To celebrate the launch of Teacher Tools Takeout, here’s a FREE article for you to download:
Click the thumbnail to start the download or you can also click here

Teacher Tools Takeout is similar to Teachers Pay Teachers but focused on the unique needs of children who are deaf or hard of hearing. À la carte instructional materials ready when you need them!

  • Takeout accounts will be free for users and submitting authors. Select what you want, when you want.
  • Any files downloaded from Teacher Tools Takeout will be stored in your free account
  • The majority of instructional materials are computer fillable
  • Sort for files by ability level, age/grade range, topic category, Common Core Anchor Standard, or price
  • 300+ free downloadable materials found in the Supporting Success webpages will be in Takeout
  • Materials from some of the Supporting Success publications will be for sale à la carte within Takeout
  • For authors wishing to submit materials for sale in the Takeout store, we will begin accepting materials for review in June 2020. Direct pay of royalty upon sale. Royalty is 55% minus 3% for processing.
  • School Purchase Orders will be accepted to pay for Takeout Each teacher to be provided materials would be set up with a Takeout account and a credit for the amount desired. $25 increments for purchasing districts via POs, $25 increments can be paid for online or use the ‘pick and pay’ option.
  • Categories of instructional information for students on Teacher Tools Takeout include:
    • Advocacy-self-advocacy and self-determination instruction
    • ASL teaching materials – build vocabulary, support writing, using interpreters
    • Assessment checklists, hierarchies, observation forms, interpretation info
    • Deaf Plus – information about supporting students with additional challenges
    • Deaf Studies – deaf history, culture, role models, community
    • Hearing Loss-Student Understanding and awareness of own hearing loss
    • Hearing Technology and Management – teaching and monitoring materials
    • Language Skills – over a dozen subcategories
    • Listening Skills – instruction in basics through comprehension
    • Personal Health – safety, emergency preparedness, sexuality, etc.
    • Reading Skills – phonological awareness, using visual supports, predicting, etc.
    • Self-Concept/Identity – dealing with feelings associated with hearing loss
    • Self-Management – organization, time, study skills, etc.
    • Social Communication Skills – pragmatic language, making friends, social skills
    • Teacher Information – informing teachers/parents on all the categorical areas
    • Transition – career and employment preparedness, transition to adulthood

Teacher Tools Takeout will kick off August 1st with 1000 files and will continue to GROW.

 
Integration with Teacher Tools membership:
Takeout is a new stand-alone venture for Supporting Success that also coordinates with our long-standing Teacher Tools membership.



Each joining and renewing Teacher Tools member will receive
  • Subscription to Teacher Tools e-magazine packed with 60+ pages of instructional materials and information.
  • Over 300 downloadable files free from the Supporting Success website
  • Over 50 downloadable files offered for sale on TakeoutFREE
  • Over 50 downloadable files offered exclusively to subscribers
  • PLUS up to $10 credit to spend in the Takeout
Become a Teacher Tools member to get a big head start on collecting Teacher Tools Takeout materials!  
JOIN NOW
 
Share This!

Teacher Tools Takeout: Vocabulary Development: 4 Multiple Meaning Words

Introducing Teacher Tools Takeout

from Supporting Success for Children with Hearing Loss

Free Download: Vocabulary Development – 4 Multiple Meaning Words

To celebrate the launch of Teacher Tools Takeout, here’s a FREE article for you to download:
Click the thumbnail to start the download or you can also click here

Teacher Tools Takeout is similar to Teachers Pay Teachers but focused on the unique needs of children who are deaf or hard of hearing. À la carte instructional materials ready when you need them!

  • Takeout accounts will be free for users and submitting authors. Select what you want, when you want.
  • Any files downloaded from Teacher Tools Takeout will be stored in your free account
  • The majority of instructional materials are computer fillable
  • Sort for files by ability level, age/grade range, topic category, Common Core Anchor Standard, or price
  • 300+ free downloadable materials found in the Supporting Success webpages will be in Takeout
  • Materials from some of the Supporting Success publications will be for sale à la carte within Takeout
  • For authors wishing to submit materials for sale in the Takeout store, we will begin accepting materials for review in June 2020. Direct pay of royalty upon sale. Royalty is 55% minus 3% for processing.
  • School Purchase Orders will be accepted to pay for Takeout Each teacher to be provided materials would be set up with a Takeout account and a credit for the amount desired. $25 increments for purchasing districts via POs, $25 increments can be paid for online or use the ‘pick and pay’ option.
  • Categories of instructional information for students on Teacher Tools Takeout include:
    • Advocacy-self-advocacy and self-determination instruction
    • ASL teaching materials – build vocabulary, support writing, using interpreters
    • Assessment checklists, hierarchies, observation forms, interpretation info
    • Deaf Plus – information about supporting students with additional challenges
    • Deaf Studies – deaf history, culture, role models, community
    • Hearing Loss-Student Understanding and awareness of own hearing loss
    • Hearing Technology and Management – teaching and monitoring materials
    • Language Skills – over a dozen subcategories
    • Listening Skills – instruction in basics through comprehension
    • Personal Health – safety, emergency preparedness, sexuality, etc.
    • Reading Skills – phonological awareness, using visual supports, predicting, etc.
    • Self-Concept/Identity – dealing with feelings associated with hearing loss
    • Self-Management – organization, time, study skills, etc.
    • Social Communication Skills – pragmatic language, making friends, social skills
    • Teacher Information – informing teachers/parents on all the categorical areas
    • Transition – career and employment preparedness, transition to adulthood

Teacher Tools Takeout will kick off August 1st with 1000 files and will continue to GROW.

 
Integration with Teacher Tools membership:
Takeout is a new stand-alone venture for Supporting Success that also coordinates with our long-standing Teacher Tools membership.



Each joining and renewing Teacher Tools member will receive
  • Subscription to Teacher Tools e-magazine packed with 60+ pages of instructional materials and information.
  • Over 300 downloadable files free from the Supporting Success website
  • Over 50 downloadable files offered for sale on TakeoutFREE
  • Over 50 downloadable files offered exclusively to subscribers
  • PLUS up to $10 credit to spend in the Takeout
Become a Teacher Tools member to get a big head start on collecting Teacher Tools Takeout materials!  
JOIN NOW
 
Share This!

Language Attributes: Size and Words

Introducing Teacher Tools Takeout

from Supporting Success for Children with Hearing Loss

To celebrate the launch of Teacher Tools Takeout, here’s a FREE article for you to download:
Click the thumbnail to start the download or you can also click here

Teacher Tools Takeout is similar to Teachers Pay Teachers but focused on the unique needs of children who are deaf or hard of hearing. À la carte instructional materials ready when you need them!

  • Takeout accounts will be free for users and submitting authors. Select what you want, when you want.
  • Any files downloaded from Teacher Tools Takeout will be stored in your free account
  • The majority of instructional materials are computer fillable
  • Sort for files by ability level, age/grade range, topic category, Common Core Anchor Standard, or price
  • 300+ free downloadable materials found in the Supporting Success webpages will be in Takeout
  • Materials from some of the Supporting Success publications will be for sale à la carte within Takeout
  • For authors wishing to submit materials for sale in the Takeout store, we will begin accepting materials for review in June 2020. Direct pay of royalty upon sale. Royalty is 55% minus 3% for processing.
  • School Purchase Orders will be accepted to pay for Takeout Each teacher to be provided materials would be set up with a Takeout account and a credit for the amount desired. $25 increments for purchasing districts via POs, $25 increments can be paid for online or use the ‘pick and pay’ option.
  • Categories of instructional information for students on Teacher Tools Takeout include:
    • Advocacy-self-advocacy and self-determination instruction
    • ASL teaching materials – build vocabulary, support writing, using interpreters
    • Assessment checklists, hierarchies, observation forms, interpretation info
    • Deaf Plus – information about supporting students with additional challenges
    • Deaf Studies – deaf history, culture, role models, community
    • Hearing Loss-Student Understanding and awareness of own hearing loss
    • Hearing Technology and Management – teaching and monitoring materials
    • Language Skills – over a dozen subcategories
    • Listening Skills – instruction in basics through comprehension
    • Personal Health – safety, emergency preparedness, sexuality, etc.
    • Reading Skills – phonological awareness, using visual supports, predicting, etc.
    • Self-Concept/Identity – dealing with feelings associated with hearing loss
    • Self-Management – organization, time, study skills, etc.
    • Social Communication Skills – pragmatic language, making friends, social skills
    • Teacher Information – informing teachers/parents on all the categorical areas
    • Transition – career and employment preparedness, transition to adulthood

Teacher Tools Takeout will kick off August 1st with 1000 files and will continue to GROW.

 
Integration with Teacher Tools membership:
Takeout is a new stand-alone venture for Supporting Success that also coordinates with our long-standing Teacher Tools membership.



Each joining and renewing Teacher Tools member will receive
  • Subscription to Teacher Tools e-magazine packed with 60+ pages of instructional materials and information.
  • Over 300 downloadable files free from the Supporting Success website
  • Over 50 downloadable files offered for sale on TakeoutFREE
  • Over 50 downloadable files offered exclusively to subscribers
  • PLUS up to $10 credit to spend in the Takeout
Become a Teacher Tools member to get a big head start on collecting Teacher Tools Takeout materials!  
JOIN NOW
 
Share This!

Accommodations for the Child with Unilateral Hearing Loss

Introducing Teacher Tools Takeout

from Supporting Success for Children with Hearing Loss

To celebrate the launch of Teacher Tools Takeout, here’s a FREE article for you to download:
Click the thumbnail to start the download or you can also click here

Teacher Tools Takeout is similar to Teachers Pay Teachers but focused on the unique needs of children who are deaf or hard of hearing. À la carte instructional materials ready when you need them!

  • Takeout accounts will be free for users and submitting authors. Select what you want, when you want.
  • Any files downloaded from Teacher Tools Takeout will be stored in your free account
  • The majority of instructional materials are computer fillable
  • Sort for files by ability level, age/grade range, topic category, Common Core Anchor Standard, or price
  • 300+ free downloadable materials found in the Supporting Success webpages will be in Takeout
  • Materials from some of the Supporting Success publications will be for sale à la carte within Takeout
  • For authors wishing to submit materials for sale in the Takeout store, we will begin accepting materials for review in June 2020. Direct pay of royalty upon sale. Royalty is 55% minus 3% for processing.
  • School Purchase Orders will be accepted to pay for Takeout Each teacher to be provided materials would be set up with a Takeout account and a credit for the amount desired. $25 increments for purchasing districts via POs, $25 increments can be paid for online or use the ‘pick and pay’ option.
  • Categories of instructional information for students on Teacher Tools Takeout include:
    • Advocacy-self-advocacy and self-determination instruction
    • ASL teaching materials – build vocabulary, support writing, using interpreters
    • Assessment checklists, hierarchies, observation forms, interpretation info
    • Deaf Plus – information about supporting students with additional challenges
    • Deaf Studies – deaf history, culture, role models, community
    • Hearing Loss-Student Understanding and awareness of own hearing loss
    • Hearing Technology and Management – teaching and monitoring materials
    • Language Skills – over a dozen subcategories
    • Listening Skills – instruction in basics through comprehension
    • Personal Health – safety, emergency preparedness, sexuality, etc.
    • Reading Skills – phonological awareness, using visual supports, predicting, etc.
    • Self-Concept/Identity – dealing with feelings associated with hearing loss
    • Self-Management – organization, time, study skills, etc.
    • Social Communication Skills – pragmatic language, making friends, social skills
    • Teacher Information – informing teachers/parents on all the categorical areas
    • Transition – career and employment preparedness, transition to adulthood

Teacher Tools Takeout will kick off August 1st with 1000 files and will continue to GROW.

 
Integration with Teacher Tools membership:
Takeout is a new stand-alone venture for Supporting Success that also coordinates with our long-standing Teacher Tools membership.



Each joining and renewing Teacher Tools member will receive
  • Subscription to Teacher Tools e-magazine packed with 60+ pages of instructional materials and information.
  • Over 300 downloadable files free from the Supporting Success website
  • Over 50 downloadable files offered for sale on TakeoutFREE
  • Over 50 downloadable files offered exclusively to subscribers
  • PLUS up to $10 credit to spend in the Takeout
Become a Teacher Tools member to get a big head start on collecting Teacher Tools Takeout materials!  
JOIN NOW
 
Share This!

Information Exchange Form Supporting Child with Cochlear Implant

Introducing Teacher Tools Takeout

from Supporting Success for Children with Hearing Loss

To celebrate the launch of Teacher Tools Takeout, here’s a FREE article for you to download:
Click the thumbnail to start the download or you can also click here

Teacher Tools Takeout is similar to Teachers Pay Teachers but focused on the unique needs of children who are deaf or hard of hearing. À la carte instructional materials ready when you need them!

  • Takeout accounts will be free for users and submitting authors. Select what you want, when you want.
  • Any files downloaded from Teacher Tools Takeout will be stored in your free account
  • The majority of instructional materials are computer fillable
  • Sort for files by ability level, age/grade range, topic category, Common Core Anchor Standard, or price
  • 300+ free downloadable materials found in the Supporting Success webpages will be in Takeout
  • Materials from some of the Supporting Success publications will be for sale à la carte within Takeout
  • For authors wishing to submit materials for sale in the Takeout store, we will begin accepting materials for review in June 2020. Direct pay of royalty upon sale. Royalty is 55% minus 3% for processing.
  • School Purchase Orders will be accepted to pay for Takeout Each teacher to be provided materials would be set up with a Takeout account and a credit for the amount desired. $25 increments for purchasing districts via POs, $25 increments can be paid for online or use the ‘pick and pay’ option.
  • Categories of instructional information for students on Teacher Tools Takeout include:
    • Advocacy-self-advocacy and self-determination instruction
    • ASL teaching materials – build vocabulary, support writing, using interpreters
    • Assessment checklists, hierarchies, observation forms, interpretation info
    • Deaf Plus – information about supporting students with additional challenges
    • Deaf Studies – deaf history, culture, role models, community
    • Hearing Loss-Student Understanding and awareness of own hearing loss
    • Hearing Technology and Management – teaching and monitoring materials
    • Language Skills – over a dozen subcategories
    • Listening Skills – instruction in basics through comprehension
    • Personal Health – safety, emergency preparedness, sexuality, etc.
    • Reading Skills – phonological awareness, using visual supports, predicting, etc.
    • Self-Concept/Identity – dealing with feelings associated with hearing loss
    • Self-Management – organization, time, study skills, etc.
    • Social Communication Skills – pragmatic language, making friends, social skills
    • Teacher Information – informing teachers/parents on all the categorical areas
    • Transition – career and employment preparedness, transition to adulthood

Teacher Tools Takeout will kick off August 1st with 1000 files and will continue to GROW.

 
Integration with Teacher Tools membership:
Takeout is a new stand-alone venture for Supporting Success that also coordinates with our long-standing Teacher Tools membership.



Each joining and renewing Teacher Tools member will receive
  • Subscription to Teacher Tools e-magazine packed with 60+ pages of instructional materials and information.
  • Over 300 downloadable files free from the Supporting Success website
  • Over 50 downloadable files offered for sale on TakeoutFREE
  • Over 50 downloadable files offered exclusively to subscribers
  • PLUS up to $10 credit to spend in the Takeout
Become a Teacher Tools member to get a big head start on collecting Teacher Tools Takeout materials!  
JOIN NOW
 
Share This!

Advocacy Notes: Transition Myths

Advocacy Notes: Myths about IEPs, 504s, Higher Education Admissions & Accommodations

Myth #1. Students should be moved from an IEP to a 504 plan for senior year because it “looks better” when they apply to college. Colleges don’t  ask students applying for admissions whether or not they have a disability (they’re not allowed to), and students don’t have to tell them if they don’t want to. Therefore, IEP teams should not let a students’ plan to attend college change the kind of educational plan they’re on as seniors, or take their services away because they’re worried about how this might affect their chances of getting into college. Teams should also know that there is no reason to send students’ IEPs with their applications – colleges don’t ask for this. (Students will register for accommodations after they enroll at college, and they will send their documentation directly to the disability services office.)

Myth #2. Students should stay on their IEPs because talking about their disability will give their college applications a boost. For parents or professionals who think sending the IEP will put students at an advantage (or think the opposite – that disclosing a disability will put them at a disadvantage), read this post from my blog – Admission Deans from Yale, Muskingum Answer FAQs about the Process for Students with Disabiities.  When it comes to college applications and admissions, students and everyone working with them have a lot of concerns. Even if they know the application won’t ask if the student has an IEP or 504 plan, they worry that students’ transcripts will indicate this in some way. Case managers should ask the right person in the district whether this happens. Transcripts probably don’t state that students had an IEP or 504 plan, but no decision about students’ services should be made without making sure everyone involved has the correct information.

Myth #3. Students should be moved from an IEP to a 504 plan because 504 plans are valid at college Regular readers of my work know there is a lot of misunderstanding about 504 plans. People believe that since Section 504 covers both K-12 schools and colleges, colleges have to follow 504 plans. This is not true. Colleges do have to provide eligible students with accommodations, but this is not because the students had 504 plans. Neither 504 plans nor IEPs are valid after students graduate from high school. One cause for confusion may be that some colleges accept students’ 504 plans or IEPs as documentation (meaning proof) of the disability and may grant students the accommodations they received in high school. This can lead to an understandable misconception that colleges are following students’ 504 plans, but this is not what they’re doing. Colleges may provide the accommodations that students received in high school because the students are eligible and the accommodations are considered appropriate.

Myth #4 – High school students should be taken off of any plan for their senior year because there aren’t accommodations at college for students with learning disabilities and/or ADHD Colleges do provide accommodations for all sorts of disabilities. In some cases, students may even get more accommodations than they received in high school. No one should take away all of students’ accommodations in their senior year because of any misunderstanding about the availability of college accommodations. Ideally, though – by senior year – college-bound students should be trying to work with only the kinds of accommodations they might find available at college. (Of course, each student’s situation is different, and IEP teams must make individualized decisions based on students’ needs.) It is important is that – as early as the 8th grade meeting that writes the plan for 9th grade – all members of the team have a good understanding of what kinds of accommodations colleges typically offer. If college is a goal for students, the plan should be to provide direct instruction in learning strategies and the use of assistive technology so that by senior year, students are ready to function without the supports they’re unlikely to find at college.

     

This article can be found at https://www.wrightslaw.com/info/trans.myths.accoms.hamblet.htm

Elizabeth Hamblet is the author of From High School to College: Steps to Success for Students with Disabilities, a unique step-by-step guide and essential resource for college-bound students, their families, and the special educators and school counselors who work with them.




Click here to download this article, including author information

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Assessment of Online ACCESS

Assessment of Online ACCESS

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

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

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

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

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

Access Concerns:

  1. a. When teachers provide online instruction during which only a PowerPoint presentation or documents are visible, the student is not able to speechread. Once we go back to meeting face-to-face in schools it is likely that many school staff will wear masks. How much is the student’s access impacted without speechreading?
  1. b. When teachers instruct over an internet streaming service without using a microphone (standard mic that plugs-in to the computer or FM/DM microphone) the speech signal is degraded and adds to comprehension issues. How much is the student’s access to distance learning is impacted without the use of a microphone?

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

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

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

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

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

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

 

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

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

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

 

Suggestions for performing assessment of comprehension of spoken information

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

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

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

 

References:

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



Click here to download this article, including author information

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Teacher Tools Takeout: Does this student have a poor self-concept

Introducing Teacher Tools Takeout

from Supporting Success for Children with Hearing Loss

To celebrate the launch of Teacher Tools Takeout, here’s a FREE article for you to download:
Click the thumbnail to start the download or you can also click here

Teacher Tools Takeout is similar to Teachers Pay Teachers but focused on the unique needs of children who are deaf or hard of hearing. À la carte instructional materials ready when you need them!

  • Takeout accounts will be free for users and submitting authors. Select what you want, when you want.
  • Any files downloaded from Teacher Tools Takeout will be stored in your free account
  • The majority of instructional materials are computer fillable
  • Sort for files by ability level, age/grade range, topic category, Common Core Anchor Standard, or price
  • 300+ free downloadable materials found in the Supporting Success webpages will be in Takeout
  • Materials from some of the Supporting Success publications will be for sale à la carte within Takeout
  • For authors wishing to submit materials for sale in the Takeout store, we will begin accepting materials for review in June 2020. Direct pay of royalty upon sale. Royalty is 55% minus 3% for processing.
  • School Purchase Orders will be accepted to pay for Takeout Each teacher to be provided materials would be set up with a Takeout account and a credit for the amount desired. $25 increments for purchasing districts via POs, $25 increments can be paid for online or use the ‘pick and pay’ option.
  • Categories of instructional information for students on Teacher Tools Takeout include:
    • Advocacy-self-advocacy and self-determination instruction
    • ASL teaching materials – build vocabulary, support writing, using interpreters
    • Assessment checklists, hierarchies, observation forms, interpretation info
    • Deaf Plus – information about supporting students with additional challenges
    • Deaf Studies – deaf history, culture, role models, community
    • Hearing Loss-Student Understanding and awareness of own hearing loss
    • Hearing Technology and Management – teaching and monitoring materials
    • Language Skills – over a dozen subcategories
    • Listening Skills – instruction in basics through comprehension
    • Personal Health – safety, emergency preparedness, sexuality, etc.
    • Reading Skills – phonological awareness, using visual supports, predicting, etc.
    • Self-Concept/Identity – dealing with feelings associated with hearing loss
    • Self-Management – organization, time, study skills, etc.
    • Social Communication Skills – pragmatic language, making friends, social skills
    • Teacher Information – informing teachers/parents on all the categorical areas
    • Transition – career and employment preparedness, transition to adulthood

Teacher Tools Takeout will kick off August 1st with 1000 files and will continue to GROW.

 
Integration with Teacher Tools membership:
Takeout is a new stand-alone venture for Supporting Success that also coordinates with our long-standing Teacher Tools membership.



Each joining and renewing Teacher Tools member will receive
  • Subscription to Teacher Tools e-magazine packed with 60+ pages of instructional materials and information.
  • Over 300 downloadable files free from the Supporting Success website
  • Over 50 downloadable files offered for sale on TakeoutFREE
  • Over 50 downloadable files offered exclusively to subscribers
  • PLUS up to $10 credit to spend in the Takeout
Become a Teacher Tools member to get a big head start on collecting Teacher Tools Takeout materials!  
JOIN NOW
 
Share This!

Teacher Tools Takeout: Observational Record of Behavior of Deaf or Hard of Hearing

Introducing Teacher Tools Takeout

from Supporting Success for Children with Hearing Loss

To celebrate the launch of Teacher Tools Takeout, here’s a FREE article for you to download:
Click the thumbnail to start the download or you can also click here

Teacher Tools Takeout is similar to Teachers Pay Teachers but focused on the unique needs of children who are deaf or hard of hearing. À la carte instructional materials ready when you need them!

  • Takeout accounts will be free for users and submitting authors. Select what you want, when you want.
  • Any files downloaded from Teacher Tools Takeout will be stored in your free account
  • The majority of instructional materials are computer fillable
  • Sort for files by ability level, age/grade range, topic category, Common Core Anchor Standard, or price
  • 300+ free downloadable materials found in the Supporting Success webpages will be in Takeout
  • Materials from some of the Supporting Success publications will be for sale à la carte within Takeout
  • For authors wishing to submit materials for sale in the Takeout store, we will begin accepting materials for review in June 2020. Direct pay of royalty upon sale. Royalty is 55% minus 3% for processing.
  • School Purchase Orders will be accepted to pay for Takeout Each teacher to be provided materials would be set up with a Takeout account and a credit for the amount desired. $25 increments for purchasing districts via POs, $25 increments can be paid for online or use the ‘pick and pay’ option.
  • Categories of instructional information for students on Teacher Tools Takeout include:
    • Advocacy-self-advocacy and self-determination instruction
    • ASL teaching materials – build vocabulary, support writing, using interpreters
    • Assessment checklists, hierarchies, observation forms, interpretation info
    • Deaf Plus – information about supporting students with additional challenges
    • Deaf Studies – deaf history, culture, role models, community
    • Hearing Loss-Student Understanding and awareness of own hearing loss
    • Hearing Technology and Management – teaching and monitoring materials
    • Language Skills – over a dozen subcategories
    • Listening Skills – instruction in basics through comprehension
    • Personal Health – safety, emergency preparedness, sexuality, etc.
    • Reading Skills – phonological awareness, using visual supports, predicting, etc.
    • Self-Concept/Identity – dealing with feelings associated with hearing loss
    • Self-Management – organization, time, study skills, etc.
    • Social Communication Skills – pragmatic language, making friends, social skills
    • Teacher Information – informing teachers/parents on all the categorical areas
    • Transition – career and employment preparedness, transition to adulthood

Teacher Tools Takeout will kick off August 1st with 1000 files and will continue to GROW.

 
Integration with Teacher Tools membership:
Takeout is a new stand-alone venture for Supporting Success that also coordinates with our long-standing Teacher Tools membership.



Each joining and renewing Teacher Tools member will receive
  • Subscription to Teacher Tools e-magazine packed with 60+ pages of instructional materials and information.
  • Over 300 downloadable files free from the Supporting Success website
  • Over 50 downloadable files offered for sale on TakeoutFREE
  • Over 50 downloadable files offered exclusively to subscribers
  • PLUS up to $10 credit to spend in the Takeout
Become a Teacher Tools member to get a big head start on collecting Teacher Tools Takeout materials!  
JOIN NOW
 
Share This!

Teacher Tools Takeout: LIFE-R 5-point listening response scale

Introducing Teacher Tools Takeout

from Supporting Success for Children with Hearing Loss

To celebrate the launch of Teacher Tools Takeout, here’s a FREE article for you to download:
Click the thumbnail to start the download or you can also click here

Teacher Tools Takeout is similar to Teachers Pay Teachers but focused on the unique needs of children who are deaf or hard of hearing. À la carte instructional materials ready when you need them!

  • Takeout accounts will be free for users and submitting authors. Select what you want, when you want.
  • Any files downloaded from Teacher Tools Takeout will be stored in your free account
  • The majority of instructional materials are computer fillable
  • Sort for files by ability level, age/grade range, topic category, Common Core Anchor Standard, or price
  • 300+ free downloadable materials found in the Supporting Success webpages will be in Takeout
  • Materials from some of the Supporting Success publications will be for sale à la carte within Takeout
  • For authors wishing to submit materials for sale in the Takeout store, we will begin accepting materials for review in June 2020. Direct pay of royalty upon sale. Royalty is 55% minus 3% for processing.
  • School Purchase Orders will be accepted to pay for Takeout Each teacher to be provided materials would be set up with a Takeout account and a credit for the amount desired. $25 increments for purchasing districts via POs, $25 increments can be paid for online or use the ‘pick and pay’ option.
  • Categories of instructional information for students on Teacher Tools Takeout include:
    • Advocacy-self-advocacy and self-determination instruction
    • ASL teaching materials – build vocabulary, support writing, using interpreters
    • Assessment checklists, hierarchies, observation forms, interpretation info
    • Deaf Plus – information about supporting students with additional challenges
    • Deaf Studies – deaf history, culture, role models, community
    • Hearing Loss-Student Understanding and awareness of own hearing loss
    • Hearing Technology and Management – teaching and monitoring materials
    • Language Skills – over a dozen subcategories
    • Listening Skills – instruction in basics through comprehension
    • Personal Health – safety, emergency preparedness, sexuality, etc.
    • Reading Skills – phonological awareness, using visual supports, predicting, etc.
    • Self-Concept/Identity – dealing with feelings associated with hearing loss
    • Self-Management – organization, time, study skills, etc.
    • Social Communication Skills – pragmatic language, making friends, social skills
    • Teacher Information – informing teachers/parents on all the categorical areas
    • Transition – career and employment preparedness, transition to adulthood

Teacher Tools Takeout will kick off August 1st with 1000 files and will continue to GROW.

 
Integration with Teacher Tools membership:
Takeout is a new stand-alone venture for Supporting Success that also coordinates with our long-standing Teacher Tools membership.



Each joining and renewing Teacher Tools member will receive
  • Subscription to Teacher Tools e-magazine packed with 60+ pages of instructional materials and information.
  • Over 300 downloadable files free from the Supporting Success website
  • Over 50 downloadable files offered for sale on TakeoutFREE
  • Over 50 downloadable files offered exclusively to subscribers
  • PLUS up to $10 credit to spend in the Takeout
Become a Teacher Tools member to get a big head start on collecting Teacher Tools Takeout materials!  
JOIN NOW
 
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Teacher Tools Takeout: Resources – Identifying DHH Student Needs

Introducing Teacher Tools Takeout

from Supporting Success for Children with Hearing Loss

To celebrate the launch of Teacher Tools Takeout, here’s a FREE article for you to download:
Click the thumbnail to start the download or you can also click here

Teacher Tools Takeout is similar to Teachers Pay Teachers but focused on the unique needs of children who are deaf or hard of hearing. À la carte instructional materials ready when you need them!

  • Takeout accounts will be free for users and submitting authors. Select what you want, when you want.
  • Any files downloaded from Teacher Tools Takeout will be stored in your free account
  • The majority of instructional materials are computer fillable
  • Sort for files by ability level, age/grade range, topic category, Common Core Anchor Standard, or price
  • 300+ free downloadable materials found in the Supporting Success webpages will be in Takeout
  • Materials from some of the Supporting Success publications will be for sale à la carte within Takeout
  • For authors wishing to submit materials for sale in the Takeout store, we will begin accepting materials for review in June 2020. Direct pay of royalty upon sale. Royalty is 55% minus 3% for processing.
  • School Purchase Orders will be accepted to pay for Takeout Each teacher to be provided materials would be set up with a Takeout account and a credit for the amount desired. $25 increments for purchasing districts via POs, $25 increments can be paid for online or use the ‘pick and pay’ option.
  • Categories of instructional information for students on Teacher Tools Takeout include:
    • Advocacy-self-advocacy and self-determination instruction
    • ASL teaching materials – build vocabulary, support writing, using interpreters
    • Assessment checklists, hierarchies, observation forms, interpretation info
    • Deaf Plus – information about supporting students with additional challenges
    • Deaf Studies – deaf history, culture, role models, community
    • Hearing Loss-Student Understanding and awareness of own hearing loss
    • Hearing Technology and Management – teaching and monitoring materials
    • Language Skills – over a dozen subcategories
    • Listening Skills – instruction in basics through comprehension
    • Personal Health – safety, emergency preparedness, sexuality, etc.
    • Reading Skills – phonological awareness, using visual supports, predicting, etc.
    • Self-Concept/Identity – dealing with feelings associated with hearing loss
    • Self-Management – organization, time, study skills, etc.
    • Social Communication Skills – pragmatic language, making friends, social skills
    • Teacher Information – informing teachers/parents on all the categorical areas
    • Transition – career and employment preparedness, transition to adulthood

Teacher Tools Takeout will kick off August 1st with 1000 files and will continue to GROW.

 
Integration with Teacher Tools membership:
Takeout is a new stand-alone venture for Supporting Success that also coordinates with our long-standing Teacher Tools membership.



Each joining and renewing Teacher Tools member will receive

  • Subscription to Teacher Tools e-magazine packed with 60+ pages of instructional materials and information.
  • Over 300 downloadable files free from the Supporting Success website
  • Over 50 downloadable files offered for sale on TakeoutFREE
  • Over 50 downloadable files offered exclusively to subscribers
  • PLUS up to $10 credit to spend in the Takeout

Become a Teacher Tools member to get a big head start on collecting Teacher Tools Takeout materials!  
JOIN NOW


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School Preparedness for Students with Hearing Loss

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

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

Since Sandy Hook in 2012 there have been 2,408 Mass Shootings in the US. -Gun Violence Archive
The new active shooter rules in place at the high school level were to lock the door and not let anyone in from the hallway, even a student. Consider a deaf or hard of hearing student in the bathroom, without an FM/HATS system or interpreter, who didn’t hear the lockdown announcement. This student would ultimately be left in the hallway, locked out and vulnerable. They might hear the shots, but not which direction they are coming from. How can we help these students?

We cannot ever forget that deafness is an invisible disability.

Executive Director of the American School for the Deaf, Jeff Bravin, said in the CT Mirror, “the assumption that ‘those kids will be fine, they will follow all the other students,’ is not accurate. They need access to the same information.”
Administrators and teachers often forget that students with hearing loss have inadequate access to basic safety measures. How can I send my son to school every day, knowing that he might not hear an emergency announcement, or an officer telling him to stand down?

 

Safety must be in layers

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

A good rule of thumb

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

 

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

  1. 1. Can students access the current alerting system based on their individual communications needs identified in their IEP/504/LCP plan?
  • Consider bus, bathroom, hallways, extracurriculars, playgrounds/fields, field trips, classrooms?
  • Are you including the student in these discussions? Has the emergency plan been shared with the student? Have they tried it? Do they have suggestions?
  • Have staff members been informed of the students’ specific needs in the event of an emergency?
    • Staff means teachers, substitute teachers, administrators, resource officers, and support staff such as secretaries, lunch aides, and maintenance personnel.
  • Are students able to advocate for their communication needs in the event of an emergency?
    Example: During a 504 meeting my son told the guidance staff that announcements are very quiet in the classroom and very loud and unintelligible in the hallways-something they didn’t know.
  1. 2. Can the student verbalize? Are they too young? Do they have another disability that prevents them from speaking up? *see Lanyard in Go-Bags/Kits below
  • For students who use educational interpreters, transliterators, or captionists, what is the backup?
  • The ENTIRE school could learn basic American Sign Language:
    • Quiet, Get Down, Run, Wait, Fire
    • Identify staff who know ASL
    • Universal safety ASL means a student can transfer in and already know safety signs
  1. 3. Has your Local Education Agency (LEA) notified local emergency responders of the students who are Deaf, Hard of Hearing?
  • Where the students might be sheltering?
  • How to look for small hearing aids and cochlear implants?
    *if an officer tells a child to stand down and they don’t hear him-he WILL take the child down in an active shooter situation.
  • Fire, Police, EMT-do they know and can they use the appropriate emergency ASL signs?
  1. 4. Has the school/school district identified how emergency information will be communicated to parents with hearing loss, such as reunification plans?
  2. What technology should be upgraded in the school to enable effective emergency responses?
  • Televisions, laptops, with scrolling messages enabling ASL and closed caption announcements
  • Allow students to have their own phones available so they can receive emergency texts
  • Flashing lights, repeating announcements

Go Bags or Kits

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

Items to include:

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

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

Making change through Legislation.

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

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

 

 

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

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

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Advocacy Notes: Children with Disabilities in Virtual Schools

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

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

 

Summary:

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

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


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Advocacy Notes: Coronavirus and Legal Responsibilities

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

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

 

Preparing for a school closure due to COVID-19

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

Schools closing and not providing any educational services to students

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

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

Schools closing campuses but continuing to provide educational services to students

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

  • Schools must determine how access accommodations will be provided to ensure that students with hearing loss can receive the same opportunity to instruction as their hearing peers. Schools must decide how they would provide access via interpreters and captioning to online education.
  • Teaching staff (DHHTs, SLPs, Educational Audiologists) must decide what materials they can readily use in online or virtual education methods as they continue work on IEP goals.

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

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

If a School for the Deaf is closed

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

 

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




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E-Learning & Coronavirus (COVID-19)

E-Learning & Coronavirus (COVID-19)

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

MEETING LEGAL RESPONSIBILITIES:

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

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

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

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

RESOURCES:

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

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

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

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

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

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

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

 

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

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

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

With a little bit of planning, we can do our best to ensure that we are still providing services to our students during this uncertain time.
Supporting Success for Children with Hearing Loss has a pinned post on their Facebook page where you can share resources with each other.  Please head over there, support each other, and share away!




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Advocacy Notes: What parents should ask when looking for a program for their child

Questions parents should ask when looking for an educational program to meet the needs of their child with hearing loss

Only 1 in every 100 students with IEPs has qualified to receive specialized support due to hearing loss or deafness. As a low incidence program, the unique access and educational needs of these students requires specialized knowledge in how to appropriately meet these student’s needs. Families often lack the information needed to make informed decisions about the appropriateness of a school’s suggested program, staff, accommodations and related service support. The following questions are designed to assist families in what to ask when learning about a potential educational placement.

Program

  • Who is oversees the program at the administrative level and is it easy for families to know how that person is contacted?
  • What is the lead administrator’s level of knowledge/background in educating students who are deaf or hard of hearing?
  • Who is the building principal and how active is he or she in this program or in support of accommodating the access and educational needs of the student with hearing loss?
  • What is the principal’s knowledge/background in educational needs due to hearing loss?
  • Is the principal part of the special services team; do they show up for IEP meetings?
  • If there is an educational specialist who is representative of Special Services, who is it and how are they contacted. How are they involved in decision-making?
  • How long has the program been at this site?
  • What the program’s communication philosophy and does it match what you are seeking?
  • If it is a program in which most students with hearing loss use sign language, does it include signing with voice or is it voice off?
  • If it is a listening and spoken language (auditory/oral) program or simultaneous communication (total communication) program does it have a specific curriculum or scope and sequence that is followed for developing listening skills?
  • If the program primarily supports students who use ASL, are there interpreters and what is the level of their training and their experience in this particular setting.

Teacher of the Deaf/Hard of Hearing

  • What’s the deaf educator’s actual teaching credential? (DHH teacher)
  • Where has the teacher worked? What’s her background and level of experience in working with students who are deaf, Deaf, and hard of hearing?
  • If there are interpreters, what is their required skill and experience level?
  • What is the ratio of students with hearing loss to one DHH teacher?
  • What is the ratio of students to interpreters?
  • What ongoing professional development is available for DHH staff during the school year that is directly related to their teaching/supporting students with hearing loss?
  • In the proposed classroom, do some/most students have learning challenges in addition to hearing loss or deafness? (sometimes called Deaf plus)
  • Are the staff able to explain how they address developing language for students who are at different levels of delay in comparison to the language of age peers in same grade classrooms?
  • What is the curriculum used for your child’s level of language ability – not grade level but language level?
  • What parent support programs are in place and how can you become involved?
  • Does the school/staff allow the DHH teacher to (regularly) visit or observe a student during a typical school day? (in the classroom and/or during special education support staff sessions)
  • How are the mainstream teachers provided key information about the educational impact of hearing loss and teaching these students? Who does that inservice? When is it done?
  • How are decisions made about student readiness to be placed in an inclusive or mainstream classroom? Who makes this decision?
  • How often will you be receiving the result of program monitoring data, and from whom, so you can evaluate the effectiveness of your child’s programming and IEPs?
  • How are listening skills taught? Most of these skills cannot be taught within a mainstream class.
  • Does the DHH teacher develop listening skills 1:1 or in small groups or are there attempts to include listening development into daily teaching within the classroom?
  • Are support staff (interpreters, paraeducators, SLPs) routinely assigned to teach or reinforce development of listening skills?
  • How is progress for language and listening skill development documented?
  • How are participation, group work, language and listening skill development supported in the mainstream classroom? (e.g., seating, technology, communication repair strategies, self-advocacy skills, social skills). How is this reflected in student IEPs?
  • Is there a system that is routinely used for daily communication with the families? Is there an identified system of communication between the DHH teacher and the parent?
  • Is there homework and if so, who assigns it? If homework from the mainstream classroom requires modification, is the mainstream teacher open to that?
  • How will the mainstream teacher be selected and what is their background or experience with this population?
  • How do you as the DHH teacher receive feedback concerning a student’s performance within any mainstream classroom he/she may be in? How is that feedback documented?

IEP Team

  • Who is on the IEP team?
  • Will the family receive a draft of the IEP prior to the meeting and if so, how far in advance?
  • How much input does the family have in developing the IEP? Are they welcomed to provide information/questions?
  • Who is the school psychologist or diagnostic evaluator who will perform 3-year-evaluation? What is the background, specialized training, and experience of that person in the area of impact of hearing loss and Deafness on educational development?
  • Does the family know how to call an IEP meeting if they feel a change may be needed in the IEP?
  • How is data reported at report card time (IEP data as opposed to the mainstream report card)?

Speech and Language Pathologist (SLP)

  • What’s is the SLPs specific background in working with students who are deaf and hard of hearing and how long have they been at this site?
  • What specific training has the SLP received in listening skill development?
  • How is the SLP working with the DHH teacher to incorporate classroom objectives (concepts, vocabulary, language expansion) into your child’s SLP sessions so that both the teacher and the SLP are coordinated in working on similar goals?
  • Does the SLP coordinate with private therapists if your child is receiving outside speech/listening and language skills?
  • Is information about the focus of outside therapy sessions shared with the DHH teacher and support staff (interpreters, OT, PT, paraeducators)?
  • Does the SLP routinely use the ASL interpreters as well as the student’s hearing technology in their sessions (as appropriate to the specific student)?
  • Can the family visit/observe during SLP sessions with the student?
  • Are there homework or activities specified with families to support development at home?

Hearing Technology:

  • Do both the teacher’s and interpreters know how to support hearing technology?
  • Can everyone troubleshoot the hearing assistance technology?
  • The IDEA law requires that schools must ensure student hearing devices are functioning. Are daily checks performed to make sure hearing devices are working appropriately? If so, can the staff demonstrate how monitoring is performed? Can they provide the data sheets used for equipment checks and listening checks?
  • How immediately can the child access hearing device batteries if needed?
  • Are the mainstream classrooms set up with classroom audio systems (soundfield) and if so, are they in use in appropriate coordination with the hearing technology used by the student with hearing loss? (i.e., are classroom audio systems compatible with FM/DM/RM systems if your child requires FM/DM/RM?)
  • Is there an audiologist available to assist with auditory access and hearing technology issues? How often is the audiologist available? Can the family contact the audiologist?
  • How recent is the hearing assistance technology provided by the school (FM/DM/RM)?
  • Are staff from the school district in routine communication with the cochlear implant centers in the area to allow appropriate 2-way communication in support of students who use cochlear implants?

Joan Lockye
Teacher of the Deaf/Hard of Hearing

 

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Supporting Students Who Are Deaf Plus

Supporting Students Who Are Deaf Plus

The term “Deaf Plus” refers to having both hearing loss and another disability or eligibility that qualifies the student for special education under the IDEA. It can often be difficult for educational teams to appropriately support these students as some IEP teams will only recognize or focus on one eligibility (ie: only medical issues, only autism, or only hearing loss) and not address all needs with equity. Lack of knowledge about the impacts of hearing loss by teachers and administrators adds to this challenge. The result leaves some students and families without all of the appropriate supports and services they need in the educational setting. Just as children with hearing loss cannot know when they didn’t hear something, specialists and educators don’t know what they don’t know about a disability they have not studied.

Approximately 40% of children with hearing loss have another disability. Newborn Hearing Screening (NBHS) programs test babies for hearing loss prior to leaving the hospital. However, when children are born with other medical conditions or other disabilities that are evident at birth, their hearing loss is typically identified 2 1/2 months later than children with no other medical conditions1. Unfortunately, children who have medical conditions identified after the newborn period, including but not limited to ADHD, Cerebral Palsy, Autism Spectrum Disorder (ASD), and other physical/medical conditions that are evident at birth, are often not successfully screened for hearing loss. The children may be screened, but because they are hard to test, the results may not be taken seriously, are documented as unreliable, or are not followed up on while the medical professionals and families deal with other identified and known areas of need. Additionally, while the IDEA indicates that IEP teams should not identify children with hearing loss as being eligible for special education under the qualifying condition of Specific Learning Disability (SLD), there are professionals in the field who recognize that children can have both hearing loss and a learning disability.

Following is a comparison of the rates of some disabilities in the general population vs. children with hearing loss. Rates of Conditions Among Children Who Are Deaf/HH2

 

Type of Disability

Rates Among Children Who are Deaf/HH

Rates in the General Population

No Disabilities

60%

86%

Cognitive (ID)

8.3%

0.71%

Cerebral Palsy

0.31%

Blindness & VI

5.5%

0.13%

ADHD

5.4%

5-10%

Specific Learning Disability

8%

5-10%

Autism Spectrum Disorder

7%

1%

For children who are Deaf Plus, it is critical to have complete teams both medically and educationally. From a medical perspective, children who are Deaf Plus need to have all appropriate professionals on their team including the pediatrician, pediatric neurologist, developmental pediatrician, geneticist, ophthalmologist, otolaryngologists with knowledge of hearing loss, pediatric audiologist, and others as needed. From an educational perspective, the team needs to include at a minimum the school psychologist, speech/language pathologist (SLP), deaf/hard of hearing specialist (DHH), educational audiologist (Ed AUD), occupational therapist (OT), adaptive physical education specialist (APE), nurse, physical therapist (PT), and all other appropriate providers.

As a teacher and family advocate, have worked with students who have hearing loss plus all of the following additional special education eligibilities:

  • Autism Spectrum Disorder (AUT)
  • Cerebral Palsy
  • Visual Impairment (VI)
  • Cognitive Delays
  • ADD/ADHD
  • Down Syndrome
  • Specific Learning Disability (SLD)
  • Speech Language Impaired (SLI)
  • Emotional Disability (ED)
  • Other Health Impaired (OHI)

As an IEP team, it is our job to identify all areas of need, draft goals to address those needs, develop supports and services that are appropriate to meet the goals, and make an offer of Free Appropriate Public Education (FAPE). Eventually, the time may come that one of the most important discussions for the family and the IEP team has is to determine the primary eligibility. The team must discuss what primary issue is getting in the way of the child accessing his/her educational experience.

We know that eligibility does not drive placement or services, but we do need to always remain diligent in identifying what is the primary issue that is hindering access to their education.

If our students who are Deaf Plus are provided with language access and intervention, be it ASL, total communication, or spoken language, and if the child is closing the gap between their chronological age and their hearing age, the team may need to discuss whether hearing loss continues to be the primary eligibility. Our students will always have hearing loss. They will always be “Deaf,” “Deaf/Hard of Hearing,” or “Hard of Hearing.” This is a condition that never goes away. However, there are times when the IEP team needs to identify if the hearing loss is the primary eligibility or the secondary eligibility.

EXAMPLE: A student has hearing loss and is also on the autism spectrum. No matter if the family has chosen total communication, ASL, or spoken language with regard to the hearing loss, there may come a time when the hearing loss has been addressed; the communication needs have been addressed; the child is doing well with regard to his hearing loss; and the team needs to consider if the autism is actually the primary reason that the child is not fully accessing education. Even if the child’s deafness or hearing loss becomes the secondary eligibility, we need to ensure that the DHH Itinerant and Educational Audiologist remain respected members of the IEP team. All providers who have another area of specialty need to have the benefit of the DHH lens present to support them as they serve the student. This same discussion applies to all of the other special education eligibilities.  

 

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

 

References

  1. 1. Gallaudet Research Institute, 2005
  2. 2. http://www.infanthearing.org/ehdi-ebook/2015_ebook/9-Chapter9ChildrenPLUS2015.pdf

 

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Advocacy Notes: Special Education Meetings for Necessary Communication

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

Special Education Meetings for Necessary Communication

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

Following are the various types of IEP meetings:

Initial IEP

Annual IEP

Triennial IEP

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

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

  • Transition from preschool to Kindergarten: While compulsory education does not start at preschool, special education placement does. When it comes time to transition from preschool to Kindergarten, the IEP team will schedule the “Kindergarten Transition IEP.” Some school districts do not serve their students during preschool as they may use regionalized special education preschool programs. Therefore districts may do formal/informal observations in the preschool setting and gather data about how the child is doing, while other districts choose to conduct a full re-evaluation and make the Transition to Kindergarten the new triennial IEP meeting. Either way, the full IEP team would be expected to attend along with a general education Kindergarten teacher. The transition meeting is a wonderful way to reduce the stress and anxiety that both the family and the educators in the receiving school may have. It also allows for the district to share the various program options with the family and for the IEP team to identify any additional supports that will be needed. The district can then conduct staff training, order low incidence equipment, and make any necessary acoustic accommodations over the summer.
  • Transition from elementary school to middle school (junior high) and from middle school to high school: Elementary school is typically a time when our students have a single classroom teacher who is nurturing, safe, and responsible for teaching all academic subjects. The transition to middle school is stressful for all students as it occurs at the same time as the onset of adolescence. Our students with hearing loss may have even more anxiety as they move from one teacher to potentially 6-7 separate subject matter teachers who all need to understand their unique needs. Depending on mode of communication there will typically be additional staff training, discussion of interpreters, captioning, note-taking, and other unique supports. In the early Spring of the last year of elementary school the IEP team will begin to schedule a Transition IEP meetings which will include the current providers as well as special education representatives from the receiving middle school. This meeting is not a time to review progress on previous goals, develop new goals, or make a new offer of FAPE. The purpose of this meeting is to share the child’s eligibility, explain their unique needs, review the accommodations, and current services with the receiving team. This is when the middle school team will explain their programs and class options which may include a DHH placement, a variety of supported classes for ELA and Math, or a supported Study Skills class. The transition from middle school to high school is basically the same process and an opportunity for the receiving school to explain their programs and class options while the IEP team shares how the student is doing as well as all of their unique needs and support services as a student with hearing loss.
  • IEP Transition Planning: The IDEA (Individuals with Disabilities Education Act) requires that IEP teams begin planning with all students who have an IEP by the time they turn 16. The Individual Transition Plan (ITP) is included in the IEP document. It is typically created with a combination of student interview and interest surveys completed by the student with their IEP case carrier. The purpose of the ITP is to help students prepare to be as independent as possible following high school. The ITP includes planning and goals in the areas of Post-Secondary Education, Post-Secondary Employment, and Independent Living. As with all other portions of the IEP document, the ITP is revisited every year as a part of the annual IEP.
  • Transition from high school to adult education (18-22): Unless our students with hearing loss have another eligibility, the goal is that they will graduate from high school after their senior year. There are, however, occasions when students do not complete the high school graduation requirements and are eligible for IEP services until age 22. In these cases, the IEP team at the high school will call a Transition IEP in the Spring of the Sr. Year. The team should include a representative from the adult education program. While students continue to have academic support from age 18-22, much of the focus is on supporting students in accessing the community and independent living.
  • Transition out of high school, also known as the Exit IEP: The IEP and Special Education services end for the following reasons: the student no longer meets eligibility requirements, the student graduates from high school, or the student turns 22 years old. Each state decides the level of supports that they have available for individuals with disabilities post-high school. At this time the Americans with Disabilities Act (ADA) governs supports in college, career training, employment, and independent living. If there is a state agency that supports students with their college education, the IEP should invite a representative of the agency to the Exit IEP to facilitate the transition. I typically ensure that the students and IEP teams with whom I work begin to educate students (via IEP goals) during their junior and senior year regarding their IEP accommodations and the differences between the IDEA and the ADA so that they are knowledgeable and ready to successfully advocate for themselves in all areas of their lives.

 

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

 

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An Often Unknown Cause of Hearing Loss in Children

An Often Unknown Cause of Hearing Loss in Children

Understanding and Preventing CMV in the Educational Setting

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

 

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

What is CMV?

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

What is the size of the CMV problem?

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

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

Characteristics of CMV SNHL Hearing loss in infants/children with cCMV can be unilateral, bilateral, present at birth, late onset, fluctuating or progressive. ANY child with hearing loss could potentially have had it caused by cCMV!
Of the 1 in 200 infants infected with cCMV, approximately 10% will be “symptomatic” and have serious symptoms at birth that may include microcephaly, enlarged liver/spleen, cerebral palsy, cognitive impairment, vision loss and sensorineural hearing loss(SNHL). Another 10% – 20% of the 200 infected infants are “asymptomatic” will have or go on to develop SNHL. Using the 3.8 million births in the US in 2018 as an example again, 1900 would have had symptomatic CMV and 950-1900 would have had asymptomatic CMV that caused hearing loss. Audiological follow-up data for 860 children with congenital CMV. Dahle et al 2000, extrapolated by Walter 2017
Asymptomatic at birth, n=651 Symptomatic at birth n=209
Hearing loss 7.4% 40.7%
Unilateral 52% 33%
Bilateral 48% 67%
High frequency only 37.5% 12.9%
Delayed onset 37.5% 27%
Median age of delayed onset 44 months range (24-182) 33 months range (6-197)
Progressive 54% 54%
Fluctuating 54% 29%
 

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

 
If an infant is known to have passed the newborn hearing screen but has tested positive for CMV, the most recent JCIH statement recommends a full pediatric audiology evaluation by 3 months of age and then future monitoring “every 12 months to age 3 or at shorter intervals based on parent/provider concerns”.
Presently, most infants are not tested for cCMV at birth. Infants with obvious symptoms of cCMV are being tested, and in a few states with recent legislation, those infants who fail their newborn hearing screen are tested. If an infant is not tested for cCMV by 3 weeks of age, any positive test after 3 weeks of age may indicate an acquired infection rather than a congenital infection. It is therefore difficult to estimate what proportion of SNHL is due to congenital CMV in children outside of the newborn period.  

How is CMV spread?

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

How can we prevent CMV?

  Educators who work with young children are at greater risk of contracting CMV and can help to prevent transmission of CMV by treating all body fluids as if they are infectious. This includes:
  • Wash hands frequently with soap and water, lathering for at least 15 seconds
  • Avoid kissing a child near the nose or mouth
  • Do not put things in your mouth that have been in a child’s mouth such as a pacifier, cups, utensils or food
  • Wear gloves for all contact with body fluids, and always wash hands after removing gloves
  • Use EPA approved disinfectants to frequently clean workplace surfaces that may be contaminated with body fluids
  • Do not use diaper wipes to clean potentially contaminated workplace surfaces
  • Disinfect small toys or objects that may have been contaminated with body fluids
  Any and all children, both in the classroom and in the home, or extended family setting, may potentially transmit CMV to a woman of childbearing age or a pregnant woman. It is prudent to use good hygiene precautions in all of these settings.   Resources Click Here to download this article
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Advocacy Notes: Captioning in the Classroom

Captioning in the Classroom

 

 

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

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

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

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

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

Some of the considerations are:

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

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

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

 

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

 

Relevant References:

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

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

 

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Missing Bits Results in Syntax Deficits

Missing Bits Results in Syntax Deficits

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

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

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

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

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

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

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

 

 

Other tools for gathering functional data:

Test of Grammatical Structures (TAGS)   PRESCHOOL and ABOVE

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

FREE CID Online Course: The Art of the Structured Syntax Lesson: Assessing, Planning and Prompting
  • determine present levels of syntax skills
  • determine syntax goals for IEPs and lessons
  • track syntax development over time and
  • report syntax progress to parents and other professionals

 

Grammar Chipper Chat     GRADE K-5

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

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

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

 

 

Formal, norm-referenced testing

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

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

Oral Passage Understanding Scale (OPUS)

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

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

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

Test of Narrative Language-2 (TNL2)

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

 

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

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

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

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

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

Access is so important that the IDEA statute (20 USC 1400(c)(5)(H)) specifies “supporting the development and use of technology, including assistive technology devices and assistive technology services, to maximize accessibility for children with disabilities.”
The special considerations portion of IDEA specific to students with hearing loss requires that the IEP team must… iv) Consider the communication needs of the child, and in the case of the child who is deaf or hard of hearing, consider the language and communication needs, opportunities for direct communication with peers and professional personnel in the child’s language and communication mode, academic level, and full range of needs, including opportunities for direct instruction in the child’s language and communication mode, and (v) Consider whether the child requires assistive communication devices and services. 34 CFR 303.324(2).  Typically, students who with amplification systems must use them as part of receiving a free and appropriate public education (FAPE). Without amplification, students who are hard of hearing will not have an equal or appropriate opportunity for direct communication with peers or professional personnel. Thus the requirement that assistive devices be considered as a part of FAPE.

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

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

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Get Free Tools to Work with Children with Hearing Loss

Get Free Tools to Work with Children with Hearing Loss

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

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

Growing Up with Hearing Loss

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

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

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

My World Tool

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

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

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

Telecare for Teens and Tweens

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

The Ida Institute

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

References

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

  1. [2] Ear Foundation study https://www.earfoundation.org.uk/research/research-categories/current-research/transitioning-for-european-young-people-using-telecare-tools

 

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Advocacy Notes: Reading Progress for DHH Plus

Progress in Light of Circumstances – A Right for Every Student

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

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

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

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

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

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

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

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

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

Appropriate:

Accommodations to optimize access to school communication

Assessment to identify the learning needs unique to students with hearing loss

Intensity of specialized instruction tailored to meet these unique needs by a knowledgeable teacher with specialty in working with students with hearing loss

Continuous progress monitoring to measure progress in closing learning gaps

Revising IEP services and accommodations/supports to support GROWTH.

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

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

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Self-Advocacy as a Stand-Alone Service?

IEP Individualized Education Program Teaching Words 3d Render Illustration
Too often we hear, “He has good grades, so he won’t qualify for special education.” It is true that there must be a relationship between a child’s disability and school performance to qualify for services, however, IDEA specifies educational performance, not grades. There are characteristics associated with having a hearing loss that impact school performance, like missing or misunderstanding more communication than their peers. This is the basis for ongoing language and vocabulary issues and underlies the need for self-advocacy. Accommodations cannot close all ongoing communication gaps. It truly is necessary to teach self-advocacy skills to enable students to fully participate in the classroom and act appropriately when they know they have not fully received or understood information.

The ‘bread and butter’ of itinerant support to students with hearing loss is often considered to be ensuring communication access, supporting language development to allow expected academic progress, and self-advocacy skills training. While access relates to ADA requirements, and supporting language is linked to academics, training in self-advocacy is too often considered to be non-academic and therefore not necessary.

Students do not know what they didn’t hear because they didn’t hear it – yet they are held accountable for receiving and fully understanding this information.

If a student who was low vision was continually knocking into people, desks, and classroom walls due to the inability to clearly see everything, a vision specialist would likely be called in to assist the student in developing appropriate orientation and mobility skills. A student with hearing loss often incompletely hears, misses spoken information, or misunderstands what is said. Self-Advocacy training is to a student with hearing loss what orientation and mobility training is to a student with visual impairment.
Full participation in the classroom requires that a student recognize when a communication breakdown occurs, and self-advocate for their listening and learning needs. Students who are deaf or hard of hearing must have the knowledge and skills to access accommodations and support in any setting and as an integral part of an independent adulthood. Ideally, students would have instruction in self-advocacy from preschool through grade 4 (about age 10). As they reach the tween and teen years, focus should change on supporting the student’s ability to problem-solve communication issues as part of their self-determination of future goals.

The Iowa Core Curriculum states, “students who are deaf or hard of hearing have specialized needs not covered in the general education curriculum. Hearing loss adds a dimension to learning that often requires explicit teaching, such as information gained through incidental learning. It has been estimated that for persons without hearing loss, 80% of information learned is acquired incidentally. No effort is required. Any type of hearing loss interrupts this automatic path to gain information. This incidental information must be delivered directly to students who are deaf or hard of hearing.

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

Legal Considerations

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

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

Not hearing everything in the classroom does have an adverse educational effect on the ability to fully comprehend, learn at the same pace as others, and fully participate in all school activities.
IDEA has indicated that a child’s disability condition must have an adverse educational effect to be considered eligible for specialized services. Note – IDEA did not say the child must have poor grades. Self-advocacy skills, if the student knows how and when to appropriately use them, facilitate full participation and greater levels of comprehension, thereby allowing full access to the general education curriculum.

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

Self-Advocacy

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

Self-Determination

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

From the US Office of Civil Rights:

We need to encourage students to understand their disability.
  • They need to know the functional limitations that result from their disability.
  • Understand their strengths and weaknesses. Be able to explain their disability to others.
  • Be able to their difficulties in the past, and what has helped them overcome such problems.
  • This should include specific adjustments or strategies that might work in specific situation.
  • They must practice explaining their disability, as well as why they need certain accommodations, supports, or services.
U.S. Department of Education, Office for Civil Rights, Transition of Students With Disabilities to Postsecondary Education: A Guide for High School Educators, Washington, D.C., 2007

He does not know what he did not hear.

This reality underlies the requirement to teach self-advocacy, specifically teaching the student about what he does hear, does not hear and under what conditions, and how to use situational awareness to recognize when he likely missed information. Some knowledge of hearing loss teaching and assessment resources:
  1. 1. Advocacy in Action Self-Advocacy Curriculum
  2. 2. Audiology Self-Advocacy Checklist – Elementary School  Middle School  High School
  3. 3. Building Skills for Success in the Fast-Paced Classroom
  4. 4. ELFLing
  5. 5. Monkey Talk Self-Advocacy Game
  6. 6. Phonak Guide to Access Planning
  7. 7. Recorded Functional Listening Evaluation Using Sentences (FLE)
  8. 8. Rule the School Self-Advocacy Game
  9. 9. Steps to Success Sequence of Skills for Students who are Deaf/Hard of Hearing

Teaching Hearing Device Use and Troubleshooting

Some knowledge of hearing device use teaching and assessment resources:
  1. 1. Race to the Brain Game
  2. 2. Advocacy in Action Self-Advocacy Curriculum
  3. 3. Building Skills for Independence in the Mainstream
  4. 4. SEAM – Student Expectations for Advocacy & Monitoring Listening and Hearing Technology (PDF)
  5. 5. Steps to Success Scope and Sequence of Skills for Students who are Deaf/Hard of Hearing

Teaching Self-Advocacy Strategies

Some knowledge of self-advocacy skills teaching and assessment resources:
  1. 1. Advocacy in Action Self-Advocacy Curriculum
  2. 2. Building Skills for Independence in the Mainstream
  3. 3. Building Skills for Success in the Fast-Paced Classroom
  4. 4. COACH: Self-Advocacy & Transition Skills for Secondary Students who are Deaf/Hard of Hearing
  5. 5. Guide to Self-Advocacy Skill Development: Suggestions for Sequence of Skill Attainment (PDF)
  6. 6. Monkey Talk Self-Advocacy Game
  7. 7. Phonak Guide to Access Planning
  8. 8. SCRIPT 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 ongoing instruction in self-advocacy skills needs, including hearing device independence for students who are hard of hearing, as part of the IEP or 504 Plan.

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Advocacy Notes: The Right to 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.   Click here to download this Article
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Eligibility – Even with Good Grades

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

A recent US court case1 made it clear that students with hearing loss must receive an eligibility assessment that identifies areas of suspected need secondary to hearing loss must be evaluated with sufficient intensity to satisfy in depth evaluation. The special factors considerations2 also need to be applied throughout the evaluation process. Furthermore, the LEAD-K3 movement has spotlighted the need for appropriate, tailored assessment of children who are deaf or hard of hearing.  The big question from the field of education for children with hearing loss is ‘What assessments should we be using?’
If the creators of IDEA wanted to make it clear that good grades = no IEP they would have clearly done so – but they did not.
The IDEA law is consistent about looking at educational performance needs when considering a student’s eligibility for specialized instruction and support. Educational performance is not equivalent to academic performance. While academic performance needs to be considered, it is no more important to consider than the other areas specified by IDEA which are functional, behavioral, social needs and any other performance considerations relevant to the specific child. If a school team only considers grades for eligibility then they are using a sole criterion, which goes against the IDEA requirement that eligibility determinations be made with consideration of at-risk areas as determined by the suspected area of disability. Our students with hearing loss may ‘look fine’ in the classroom, yet we realize that there are usually subtle differences/needs that, added together, cause academic performance to erode over time. Even ‘good’ students with hearing loss can qualify IF there is someone on the multidisciplinary team who truly understands the impact of hearing loss on development AND uses appropriate assessments to use to tailor the evaluation process to the risk areas of students with hearing loss. Teachers of the deaf/hard of hearing and educational audiologists should have/receive the training needed to feel comfortable in assessment. The defined purpose of IDEA4: To ensure that all children with disabilities have available to them a free and appropriate education that emphasizes special education and related services designed to meet their unique needs and prepare them for further education, employment and independent living. Performance of the expanded core skills needed for full participation (self-advocacy, communication repair, knowledge about hearing loss, amplification independence, etc.) are necessary for a student to be fully prepared to function as an adult. These are NOT standard areas of evaluation for other students with special needs, but they must be considered as part of a tailored assessment for students who are deaf or hard of hearing.  
Download an updated version of Resources for Identifying DHH Student Needs: Eligibility Assessment and Beyond that reflects some of the information discussed in Steps to Assessment and additional recent tests not included in that book.
LIST OF RECOMMENDED ASSESSMENTS: The list includes recommendations for both functional and formal assessments for ages 3-5 years and school-age students. In evaluations, it is appropriate to look closely at social/emotional, self-advocacy, and the possibly subtle phonological/morphological awareness and ‘Swiss cheese’ language skills that impact comprehension and reading fluency. Low average language results reflect the impact of hearing loss, not capability. So often for our students, qualification for specialized instructional services hinges on the results of language assessment. A study5 found that 40% of students with hearing loss have a capacity for higher language levels beyond what test scores indicate. Further6, language learning for students with hearing loss occurs on average at 70%, or just above 2/3, of the rate of children with normal hearing. It is appropriate to anticipate that most children with hearing loss upon school entry will have some delay in expressive and/or receptive language, with greater degrees of hearing loss predicting greater levels of language delay. Also, the nature of hearing loss causes incidental language to be missed whenever a child is further away from about 3-6 feet of the speaker. This typically results in ‘spotty’ or ‘Swiss cheese’ language rather than solid overarching language delays. A student may therefore score higher than his or her actual functional language ability, based on the actual questions asked during the assessment and the individual’s particular vocabulary or conceptual knowledge. One strong finding from the robust 2015 Outcomes of Children with Hearing Loss Study7 was that normative test scores overestimate the abilities of children who are hard of hearing as they are unlikely to reflect the level of effort that students are expending to maintain competitiveness with peers. Although 80%8 of children born deaf in the developed world receive cochlear implants, the success rate with cochlear implants is highly variable and cannot be assumed to ever ‘fix’ all language development issues, even for children with the best outcomes. We must consistently communicate with our school teams that students with hearing loss are not language disordered. Language, social, and reading delays occur secondary to lifelong decreased access to communication.
Title II of the American’s with Disabilities Act requires that schools ensure that communication for students who are deaf and hard of hearing is as effective as communication for others through the provision of appropriate aids and services, thus affording an equal opportunity to obtain the same result, to gain the same benefit, or to reach the same level of achievement as that provided to others.
EVERY student with hearing loss who is going through initial assessment needs to have cognitive testing in order to accurately and appropriately estimate if/how much the hearing loss has impacted development based on the student’s ability compared to peers with typical hearing.9 Students with hearing loss (DHH-only) experience delays secondary to access issues. It is important to know the cognitive ability of each student with hearing loss as their communication access needs must be accommodated so that they reach the same level of achievement as their cognitive peers. Although testing is performed in a few weeks’ time, evaluation isn’t just about a snap shot, it is about performance over time. Case in point, we received a call from a parent of a 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 there is evidence of 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. 1. Ninth Circuit Court of Appeals, June 1, 2018, S.P. v. East Whittier City School District: https://successforkidswithhearingloss. com/wp-content/uploads/2019/01/Court-case-RE-need-for-thorough-assessment-highlighted.pdf
  2. 2. IDEA section 300.324(2)(iv): Consider the communication needs of the child, and in the case of a child who is deaf or hard of hearing, consider the child’s language and communication needs, opportunities for direct communications with peers and professional personnel in the child’s language and communication mode, academic level, and full range of needs, including opportunities for direct instruction in the child’s language and communication mode.
  3. 3. LEAD-K: Language Equality and Acquisition for Deaf Kids. https://successforkidswithhearingloss.com/wp-content/uploads/2019/01/Court-case-RE-need-for-thorough-assessment-highlighted.pdf
  4. 4. The 2004 IDEA Commentary provides an overall ‘setting the stage’ for the IDEA law; on this webpage.
  5. 5. Language underperformance in young children who are deaf or hard-of-hearing: are the expectations too low? Journal of Developmental & Behavioral Pediatrics. September 19, 2017. Results2 focused on children with hearing loss who have language levels within the average range on standardized measures. Researchers identified a mismatch between the cognitive level children test at and the expectations for their language skills. In examining the abilities of their 152 young child subjects they found that at least 40 percent have a capacity for higher language levels – beyond what their language test scores indicate.
  6. 6. The Effect of IQ on spoken language and speech perception development in children with impaired hearing. Cochlear Implants International, (11)1, June, 370-74. A 2010 study3 found that children were learning language at approximately 2/3 of the rate (or 70% of the rate) of their normally hearing peers. Subjects were 62 children ages 5-12 years who used oral communication and attended oral early intervention or school settings. Children in preschool learned language at a faster rate than children attending primary school. On average, children attending preschool were learning at 0.78 of the rate for normal hearing children as compared to a rate of 0.67 for students in primary school. Speech perception scores did not plateau until children had, on average, the language ability of a typically hearing 7-year-old.
  7. 7. Epilogue: Conclusions and Implications for Research and Practice. Ear and Hearing, 36, 92S-98S. Sole reliance on norm-referenced scores may overestimate the outcomes ofCHH. When the children who are hard of hearing (CHH) were compared with the norm-referenced group on various measures, the differences were small. However, when compared the CHH to a sample of CNH who were matched on age and SES, the size of the effect of HL on language doubled to two thirds of a standard deviation. These results question the sole reliance on comparison to norm-referenced test scores for judging eligibility. Standardized test scores may overestimate CHH as they are unlikely to reflect the level of effort that students are expending (cognitive and perceptual resources) to maintain competitiveness with peers in secondary schooling, where the cognitive demands increase. We need to closely monitor the outcomes of CHH including comparing their performance relative to neighborhood grade-mates. Many CHH in the OCHL study represent the best-case scenario. We might expect that a sample with greater diversity on these dimensions would not perform as well as the OCHL cohort
  8. Language acquisition for deaf children: Reducing the harms of zero tolerance to the use of alternative approaches. Harm Reduction Journal, 2012, 9-16. Today, 80% of children born deaf in the developed world are implanted with cochlear devices. Due to brain plasticity changes during early childhood, children who have not acquired a first language in the early years might never be completely fluent in any language. If they miss this critical period for exposure to a natural language, their subsequent development of the cognitive activities that rely on a solid first language might be underdeveloped, such as literacy, memory organization, and number manipulation.
  9. Addressing the Need for Appropriate Use of Norm-Referenced Test Instruments. Supporting Success, December 2017.
  Karen L. Anderson, PhD, Director, Supporting Success for Children with Hearing Loss; 2019 Early March Update. This information is not intended as legal advice.  http://successforkidswithhearingloss.com Sign up to receive Bimonthly Updates from Supporting Success. Click here to download this article.
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Advocacy Notes: Family Wants ASL Interpreters

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

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

Academic learning is driven by communication access.

This statement needs to be restated repeatedly and remembered constantly! The premise of providing a free and appropriate public education (FAPE) begins with the assumption that the student will be exposed to – and be able to perceive – school instruction. Job #1 in FAPE, especially for students with hearing loss, is to ensure access to instruction. As clarified by the US Supreme Court in 2017, schools need to provide instructional services and supports necessary for the student to make meaningful progress in the regular curriculum in light of the child’s circumstances. Minimal achievement gains are not enough. For students with hearing loss who have no other learning issues, the child’s primary circumstance is a lack of full communication access as the cause of past and present learning issues.
iv) Consider the communication needs of the child, and in the case of the child who is deaf or hard of hearing, consider the language and communication needs, opportunities for direct communication with peers and professional personnel in the child’s language and communication mode, academic level, and full range of needs, including opportunities for direct instruction in the child’s language and communication mode, and (v) Consider whether the child requires assistive communication devices and services. 34 CFR 303.324(2)
Special education law has specifically recognized the critical nature of communication access for students who are deaf or hard of hearing via the Special Considerations Section of IDEA. This provides a communication driven, child-centered appropriate in creating an education program that is driven by the child’s right to fully and effectively access communication that makes benefitting from education possible. This emphasis on equal access to communication is also specified within the Americans with Disabilities Act in which schools must ensure that communication is as effective for students with hearing loss as it is for peers. The decision about the appropriateness and necessity of providing classroom ASL interpreters needs to be guided by the discussions of the IDEA Special Considerations. The following questions should be some of those that are answered by the student’s IEP team as the special consideration factors are discussed:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In the case of a child who was raised in an ASL environment that did not include an emphasis and consistent work to develop LSL skills it can be assumed that just having hearing aids on did not allow the child to develop spoken language at an adequate rate to allow him or her to be able to comprehend and compete with age peers within a typical classroom setting without an ASL interpreter. Based on language levels in ASL and LSLS, key decisions would likely be:
  • What intensity of direct intervention in listening skills is necessary to result in LSL fluency within one (Two? Three?) academic year? Daily intensive intervention by a skilled LSL provider may be likely as the child will not be exposed many hours to good spoken language models outside of school. The sooner the student can rely on listening as the primary access to classroom learning the sooner the expense of having an interpreter can be eliminated.
  • What is the plan for the interpreter, classroom teacher, and classroom aide (if any) to work together to facilitate the student’s communication during instruction, incidental language exposure, and peer-to-peer communication? When would LSL be used? When would ASL be used?
  • What are the communication benchmarks to look for during progress monitoring that will signal a switch from full interpretation of all class communication to using ASL to scaffold what the child does not understand when presented information by spoken language only? This is an incremental stepwise process.
  Ultimately, what educational program will allow the child to access communication at a level that there will be meaningful academic progress?   Click here to download this article.
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Pre-teaching Vocabulary and Vocabulary Instruction

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

Free resource provides invaluable information for teachers working with multiple grade levels:

https://www.lead4ward.com

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

Tips for vocabulary instruction:

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

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

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

Which vocabulary words?

  • Tier 1 words are words students are likely to know (happy, mom)
  • Tier 2 words appear in many contexts and across content areas (equal, state)
  • Tier 3 words are content-specific (chromosome, biosphere)
While some of our students may have to be taught Tier 1 words before moving on, targeting vocabulary instruction for Tier 2 words may be the best use of your time for students in the general education setting.   These are words that will be seen and heard frequently and across subjects. Taking advantage of pre-teaching these words in multiple contexts and forms (with applicable prefixes and suffixes) will address higher order thinking skills as well. There are many sources for Tier 2 word-lists, such as this free resource that appears on  Teachers Pay Teachers:  https://www.teacherspayteachers.com/FreeDownload/FREEBIE-Vocabulary-Targets-Word-List-K-5-Tier-2-Words-2095007 Other sources for vocabulary instruction include Cracking the Grammar Code 4 Book set with a Vocabulary Enhancement Simple Picture Glossary Supplement (Homelvig & Rugg); Latin and Greek Roots: Teaching Vocabulary Using Hands-On Activities and Common Objects (Stokes); 100% Curriculum Vocabulary-Primary and Secondary Editions (Eggleston & Larson). See complete catalog.
Pre-teaching vocabulary is NOT tutoring – it is specialized instruction.
Systematic vocabulary instruction including pre-teaching is essential not only for increased knowledge of the world around  our students, but also for increased confidence in reading, writing, and comprehension.  

Sources:

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

 

What program is most appropriate for a preschooler with cochlear implants?

  While this question needs to be answered on an individual basis, a 2004 court case provides important insights into what an appropriate program is – and is not. The many factors that influence a child’s success with a cochlear implant include1:
  • Age of onset of deafness
  • Age at time of implantation
  • Consistency of device use
  • Bilateral/bimodal device use
  • Educational environment
  • Family support & follow up
  • Residual hearing
  • Etiology of hearing loss
  • Additional special needs
Before a school can provide an appropriate educational program, it must be established the level to which the child has made auditory progress since the time of implantation. With appropriate early intervention, including work with the family and child to develop auditory skills, the following progress is expected2: Lack of appropriate intervention, follow through by families, other health/development issues, and problems with equipment function will all slow down expected development. For a performance checklist for development of complex listening skills, see Activities for Listening and Learning. In general, an educational environment that supports good use and continued auditory development using cochlear implants will have someone who knows how to support and maintain the CI, educators with a knowledge base about the impact of hearing loss on learning and how to best support performance, an optimal auditory environment via appropriate classroom acoustics and use of remote microphone technology (FM/DM system), and intervention to continue auditory development. Relevant court case3: In 2004 the question about appropriate programming for preschoolers with cochlear implants was deliberated in Florida. The child received a cochlear implant at age 30 months and was receiving intensive services to promote listening and spoken language. At age 3 the family wanted the child to attend an auditory oral school for children who are deaf and hard of hearing so that rapid growth would continue in her listening and spoken language development. The school was offering placement in a varying exceptionalities (VE) class of students who are all developmentally delayed as there was no preschool class specially designed to teach children with hearing loss to listen and speak without using sign language. Neither the VE teacher nor the classroom aides had experience working with deaf children, nor did the available speech language pathologists. There was a special education teacher who had not worked with any oral deaf children. There was also an itinerant teacher of the deaf/hard of hearing who had some experience using sign language with students who had cochlear implants in secondary school grades, but no experience with a child who had a cochlear implant and required auditory skill development. With close collaboration with the oral deaf school staff, an IEP was developed and the child began attending a pre-kindergarten VE class, even though she had no developmental delays unassociated with hearing loss. It was subsequently revealed that the child was receiving speech articulation services instead of intensive training to develop her ability to access and process sound through the auditory channel. The family rejected the placement and unilaterally returned the child to the oral deaf school. Findings: The district was found to have violated provide a free and appropriate public education (FAPE) as the IEPs developed by the school did not address the student’s need to learn how to hear, comprehend, and communicate in her mode of communication, thus not providing her with FAPE. The court found that the school’s proposed placement would not provide the student with FAPE because: (1) a VE classroom is inappropriate because the student needs an educational program in a setting designed to allow meaningfully access to the educational process through an oral mode of communication, (2) the district professionals lack the necessary knowledge, training, and experience to implement the IEP, (3) the VE placement does not provide for necessary parent training, ongoing audiology support and hearing device troubleshooting services, (4) the VE placement will not adequately develop the student’s auditory brain structure, and thus her ability to hear and speak, during the narrow window of opportunity before the student is 5-6 years of age, (5) the VE placement fails to provide the student with the opportunity to achieve the goal of being mainstreamed by kindergarten or first grade.  

Resources

  1. 1. Setting Appropriate Expectations and Communication Goals with a Cochlear Implant. https://advancedbionics.com/content/dam/advancedbionics/Documents/libraries/Tools-for-Schools/Educational_Support/presentations/Expectations_for_Cochlear_Implantation/ExpectationsforCochlearImplantation_Notes.pdf
  2. 2. Tools for Toddlers: TRACKING AUDITORY PROGRESS in children with cochlear implants. https://advancedbionics.com/content/dam/advancedbionics/Documents/libraries/Tools-for-Toddlers/early-intervention-professionals-teachers-therapists/Tracking-Auditory-Progress.pdf
  3. 3. N. vs St. Johns County School Board. https://successforkidswithhearingloss.com/wp-content/uploads/2019/10/Court-case-need-for-appropriate-preschool-program-for-child-with-CI.pdf
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Auditory Skill Practice – a MUST for Hard of Hearing Students

Despite the technological leaps made in Hearing Assistive Technology Systems (HATS), devices like hearing aids and cochlear implants do not “fix’ the listening challenges of students with hearing loss. Incomplete auditory access usually interferes with auditory skill development therefore, children who are hard of hearing benefit from practice with listening skills1. It is up to the professionals who understand hearing loss to provide listening strategy intervention for students who are hard of hearing. Too often, however, teachers who work with these students don’t feel they have enough knowledge about which auditory skills are appropriate to practice and how those skills develop. New information recently added to the Supporting Success website can answer many of your questions: Listening (Auditory Skills) Development pages.

Why practice auditory skills?

Listening is essential to communicating. Many who write about the contribution of listening skills to school success cite a study by Wilt2, which analyzed how time spent communicating is broken into different activities. Wilt found that people listen 45% of the time they spend communicating, 30 % of communication time was speaking, 16%  reading, and 9 % writing. Listening practice can improve listening skills.   Sweetow3 reviewed dozens of studies of auditory training and found that improvements in communication strategies—and often in sentence recognition—can be expected. When using a synthetic training approach, participants listen to spoken language, often at the sentence level, and learn to use visual cues, context and knowledge of language to understand the information. Listening practice is underrepresented in most general education curricula. Listening can be challenging for many students, and even more difficult  for students with hearing loss.  If our students are to have improve their access to communication in the classroom, discussing listening challenges and practicing listening skills must happen during their time with professionals who understand hearing loss. Q: How can we find time to assess and practice auditory skills? A: Apply the Speech Perception Lens to every lesson.        Auditory speech perception is the set of skills needed to understand spoken language through listening. Improvement of speech perception can lead to better comprehension and production of spoken language. If you wonder where to find the time in your daily schedule to add auditory practice, each month the Listening Strategies article in Teacher Tools provides new ready-to-use cross-curricular activities for auditory practice while also addressing common curriculum goals.

Four abilities4 comprise speech perception. Listed in order of complexity:

  • Detect or hear sounds
  • Discriminate, or recognize how spoken utterances (e.g., phonemes, words, sentences) are different from each other
  • Identify, or attach meaning to, spoken utterances, and
  • Use all that auditory information to comprehend discourse such as phrases, sentences and conversations
Incorporating auditory speech perception practice into lessons that are aligned with academic objectives can take full advantage of the time the D/HH professional spends with a student, while also targeting auditory skill sets for students with hearing loss.
If a teacher examines the task being asked of a student in a given lesson, she can determine what listening skills will be required for successful completion of the task. Taking this perspective can be likened to looking at the lesson through a “speech perception lens.”

Use the Speech Perception Lens for Error Analysis

Step One: Analyze the auditory task. To examine auditory tasks, looking at the first column of this table to find the complexity level of the spoken message to which the student will listen. For an early reader, a lesson on sound-letter matching will ask the student to listen to a phoneme. In a small group or partner discussion, the student will be listening to discourse. Next, determine how the student will be responding. If the student is simply indicating that she heard something, a rare task in an educational setting, the task is one of detection. If the student is expected to repeat what was heard, the task is identification. Most educational tasks require the student to demonstrate comprehension by making a choice. The choice may be within a given set of possible answers, or it may be an open choice based on information learned. The student who hears the phoneme /m/ and is expected to point to the letter m or write it,  is showing comprehension of a phonemic relationship. The student who listens to a classmate’s opinion and then responds to show agreement or disagreement is showing comprehension of a sentence or discourse, depending on the length of the classmate’s statement. Step Two: Know the essential features of vowels and consonants.  Vowels vary from one another based on the location in the vocal tract in which they resonate.  Vowels which resonate near one another sound similar. Consonants, however, vary based on the way in which they are produced – whether they are nasal (like /n/), require a stopping of breath (like /t/), or produce a sound caused by friction of air passing through a restricted space (like /s/).  Errors are more likely to happen when listening to sounds that are produced in the same way, like /s/ and /z/.  Read more here.

The Bottom Line: Do Something!

Professionals who work in a one-to-one or very small group session with students who have hearing loss can provide guided practice using materials from the student’s academic curriculum. In these sessions, the adult will be able to determine the possible reasons for an error and help the student find strategies to avoid that type of error in the classroom. New lessons and strategies for listening success can be found in the monthly Teacher Tools magazine.

References:

  1. 1. Ferguson, M. A., & Henshaw, H. (2015). Frontiers in psychology6, 556.
  2. 2. Miriam E. Wilt(1950) A Study of Teacher Awareness of Listening as a Factor in Elementary Education, The Journal of Educational Research, 43:8, 626-636, DOI: 1080/00220671.1950.10881817
  3. 3. J Am Acad Audiol.2005 Jul-Aug;16(7):494-504. Efficacy of individual auditory training in adults: a systematic review of the evidence.
  4. 4. Erber, N.P. (1982). Auditory training. Washington DC: AG Bell Association for the Deaf
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The Necessity of Classroom Observation

Classroom observation is a critical part of assessment and performance monitoring. It provides the opportunity to collect data on how the student with hearing loss is functioning in the classroom in comparison to typical peers. Specifically, we need to observe behavior using what we know about how the hearing loss impacts speech perception, listening, learning, language, participation, behavior and overall social interaction.
Why do students with hearing loss specifically need to be observed?
Eligibility for specialized instruction and supports is based on information from academic, developmental and functional sources. IDEA does not specify that students must show academic needs (as in having poor grades) – it specifies showing adverse impact on educational performance, which is broader than just academics.
Who is the professional that needs to observe?
Teachers of the deaf/hard of hearing, educational audiologists, and speech language pathologists with a specialty in DHH all bring the following ‘lenses’ to their observations. In some places this input by the student’s classroom interpreter or transliterator is also sought. These “lenses” of observation are different from others on the assessment/IEP team. 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 utilize social language in the integrated 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 when the peers contributed to the instructional delivery?
  • How did the student access the general education curriculum when technology was utilized?
  • Did the student demonstrate appropriate progress in the general education curriculum?
This focus of student assessment is different from other school staff that do not have DHH expertise.
What needs to be observed?
Download the Observational Record of Behavior as an example of specific behaviors to focus on during observation and how they can be rated while you observe.
The information under each of the “lenses” provide a good start to what the observer needs to have in mind when beginning the classroom observation. One example of a form to use has been provided (see box). The Access to Curriculum Assessment Inventory1 is a highly recommended process to follow to obtain observation information. It is critical to not only note behaviors, but to 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 Marianne’s 45 -minute civics class on October 12, she attended to the interpreter 44% of the time. The longest interval of attending was 5 minutes.”
LATENCY – elapsed time between an event and the expected behavioral response
  • “In the morning it takes William 7 minutes to follow instruction after the teacher gives a direction. In the afternoon it takes William 4 minutes to follow instruction after the teacher gives a direction.”
How can observation data be reported?
In chapter one of Building Skills for Success in the Fast-Paced Classroom1 steps were provided describing how to conduct a systematic classroom observation through the DHH lens. An extensive report of findings from a real student classroom observation using this systematic process can be downloaded here. The names have been changed to protect identities. Excerpts from the report:
  • Of the 17 questions or items reviewed, Sam was able to answer five correctly (29%). Much of this information was review, not new. Sam was surprised when told the British were from England, not France, they lost the war and that the Continental Army was made up the colonists/Americans and they/we won the war in America, not in France.
  • The pace, level of complexity in relation to new concepts and vocabulary and language loaded curriculum in all areas at his current grade level highlight Sam’s difficulty to access and internalize new information at the same rate as his grade level peers. … Without a concerted effort and plan for intervention, the gap that is seen at the fifth-grade level will only continue to increase.
Identifiable adverse educational effects caused by the hearing loss
Students with hearing loss have access issues, as hearing technology does not ‘restore’ normal hearing ability, especially when listening at a distance, in noise, and to softly spoken or quickly spoken speech. Functional information by means of classroom observation, teacher checklists, and student checklists, will often reveal that students with hearing loss:

1)     Hesitate in starting work after instruction

2)     Participate less in the classroom (less often, less appropriately)

3)     Have challenges comprehending verbal instruction, class discussions, small group work, and partner projects as compared to peers.

4)     May interact less and/or more immaturely with peers

In grades preschool through fourth grade this translates into the need to develop awareness of (a) when information is being missed (he doesn’t know what he didn’t hear because he didn’t hear it – but he is continually held accountable for knowing this information anyway), (b) different ways to respond when information is missed (communication repair), (c) appropriate ways and when to self-advocate, and then (d) in the tween/teen years, how to apply problem-solving to challenging situations for self-determination.    
  1. 1. Access to Curriculum Assessment Inventory can be found in Building Skills for Success in the Fast-Paced Classroom, page 27-58 or purchased as part of the Teacher Inservice Combo from Supporting Success.
  2. 2. Anderson, K. & Arnoldi, K. (2011). Building Skills for Success in the Fast-Paced Classroom. Supporting Success for Children with Hearing Loss Publications. Pages 14-19.
  Click here to download this article.
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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   Click Here to Download this Article
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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   Download this Article
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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:   Download this Article
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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   Additional Resources Click here to download this article.
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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.   Click Here to Download this Article
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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.   Click Here to Download this Article
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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.   Click Here to download 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. Download this Article
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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.   Download this Article
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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   Click here to download this article.
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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.   Download this Article
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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)     Download this Article  
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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