Too Many Students to Serve?

The majority of itinerant teachers of the deaf/hard of hearing 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’.

Fewer new educators of the deaf are graduating and a large number of teachers who have been in the field 20+ years will be retiring soon. Providing appropriate levels of service and support to our students and their mainstream teachers is increasingly challenging.

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

 

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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!

 

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We Want Him to be “Normal”…

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. There are actions that can be taken to reduce the social and self-esteem consequences of being a ‘one and only’.

 

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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.

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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?’

 

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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

 

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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.

 

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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’.

 

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“Special Considerations” and LRE for Students who are DHH

Early January 2019

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. Communication accessibility comes first!

 

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

December 2018

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. 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.

 

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Inclusion – Factors that Make it or Break it

Late November 2018

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.

 

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Reducing the Impact of Stigma and Teasing

Early November 2018

About 30% of all 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. A recent study was conducted on peer victimization of children with hearing loss who wore hearing devices, communicated orally, and were educated in the mainstream classroom that identified a victimization rate of 50%. Dealing with stigma and teasing or bullying can have far-reaching effects on school performance and self-concept.

 

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Identifying Student’s Functional Issues in the Classroom

Late October 2018

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.

1IDEA Eligibility Determination – Section 300.304(b)(1)

 

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More Tips For Itinerant Teachers

Early October 2018

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

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

Tips and tricks learned through the years:

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

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Technology Monitoring Is Necessary For Hearing Device Users

Late September 2018

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

Challenge 1: Well-Fit Hearing Devices

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

What Can YOU Do?

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

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

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

Challenge 2: Ensuring that Hearing Devices are Functioning

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Tips For Itinerants – Getting Started In A New School Year

Early September 2018

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

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

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

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

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

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Dear Classroom Teacher: You Have A Student With Hearing Loss

August 2018

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

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

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

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

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

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

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Evaluation Considerations – Low Average ≠ ‘Okay’

May 2018

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

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

Using Norm-Referenced Tests to Determine Eligibility

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

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Determining Annual Yearly Progress

Late April 2018

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

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

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

Disadvantages of High-Stakes Testing for Students with Hearing Loss

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

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Self-Advocacy Instruction – Necessary for Full Participation

Early April 2018

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

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

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

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Teen Transition – A Necessary Part of Future Success

Late March 2018

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

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

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

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

2. Are the postsecondary goals updated annually?

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

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

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

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

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

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

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

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Progress Monitoring – Gains Equal to Peers?

Early March 2018

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

We need to not only strive to close language and learning gaps, we need to simultaneously support our students in keeping up with the day-to-day learning in the classroom. We MUST monitor progress to know if full access is truly occurring and to ensure that our students are keeping pace with classroom expectations. Without appropriate support, the trajectory of educational performance shown above is all too likely. Students who are deaf or hard of hearing with no other learning issues – with full access to school communication – CAN progress at the expected rate IF they are receiving the appropriate intensity of focused support.

Monitor and Compare – Progress from Year-to-Year

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

Continue Reading the Early March 2018 Update

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