Determining Appropriate Service Delivery for Students With Hearing Loss

Determining appropriate service delivery to improve outcomes means matching instruction, communication supports, and staffing to the unique needs of each student with hearing loss. When services fit the student well, schools can improve access, language growth, and academic progress.

Regardless of the move to full inclusion and the shortage of teachers of the deaf/hard of hearing, school teams remain obligated to the student to identify areas of educational need, appropriate IEP goals, the amount of service time needed, by whom, and in what setting.

In the March 22, 2017, US Supreme Court decision, Chief Justice Roberts wrote, “…IDEA demands more. It requires an educational program reasonably calculated to enable a child to make progress appropriate in light of the child’s circumstances.” If a child is not fully included, school officials must look at the child’s unique needs and required level of specialized instruction before developing an IEP that is “pursuing academic and functional advancement.” If a child is 6 months behind expected achievement levels, an itinerant DHH teacher cannot maintain a year’s growth and also make up the level of delay with only twice-per-week 30-minute sessions of service. Providing an inappropriate amount of educational support will not result in the needed level of student outcomes, nor will it make teachers of the DHH appear effective.

“Kids in the middle” refers to students who may not be served in delivery models that consist of direct services from a teacher of the deaf and hard-of-hearing. Therefore, the resulting services may or may not adequately address the communication, social, and academic needs of these students. Central to the concept of special education is the idea that the Individual Education Planning Team will collaboratively determine the special and general education services a student needs based on the goals and objectives developed for him or her. This process is meant to ensure that each student will receive services tailored specifically to his or her unique set of needs. With the recent clarification by the US Supreme Court, it is anticipated that school teams will once again consider the amount and intensity of services necessary to allow students with hearing loss to progress at a rate typical of hearing peers. Our goals should focus on helping students become effective communicators, competent readers, and knowledgeable consumers of goods and services.

One result of the Supporting Success survey last April to identify the roles and responsibilities of itinerant teachers of the deaf/hard of hearing indicated that 25% of respondents used matrices to guide their discussions in the determination of the level of service delivery. With increased pressure to ‘serve less, more remotely’ under the assumption that the student will learn as well when teachers of the DHH services are minimized, many teachers and districts are exploring or implementing the use of service delivery matrices.

It is important to preface this discussion by recognizing that a service delivery matrix can only be a guide to decision-making, assisting in team discussions, and not the final word in appropriate levels of service. The focus needs to remain on “what the student needs to catch up and keep pace.”

Hearing loss results in learning needs that are unique, including some areas of need that cannot be effectively addressed in a mainstream classroom. For the teacher(s) of the DHH who would like to begin the conversation of using a service delivery matrix, the following handouts may be a helpful addition to discussions with administration:

• Why Involve the Teacher of the Deaf/Hard of Hearing on the Assessment Team and the IEP?
• Role Comparisons: Supporting Students Who are Deaf or Hard of Hearing
• Considerations for Assessment & Service Provision for Children with Hearing Loss

Below are examples of matrices that are already in use. Some are DHH-specific, while others are not. Some take into account the social, technological, accommodations, and self-advocacy needs of students, and others do not.

Use of a service delivery matrix may provide the evidence base needed for justification of appropriate levels of service to meet student needs – academic, class participation, and expanded core skill development. 

Example Matrices for Determination of Level of Service Delivery

• Educational Impact for Students Who Are Deaf or Hard of Hearing. The Michigan Department of Education – Low Incidence Outreach has produced an exceptionally helpful tool that has recently been made computer-fillable. It is suggested that persons be interested in monitoring their website for the new fully accessible version to be released.
• Hearing Itinerant Services Rubric. Many varying factors are considered within the 3-page matrix. Individual child issues or circumstances need to be carefully considered, as well as the rubric recommendations. Thanks much to SEDOL in Illinois for sharing this 2014 resource.
• Service Delivery Guide for Educating Students Who Are Deaf and Low Functioning was developed by Region 4, Houston, Texas, in 2016. As the title indicates, this matrix is different from the others, as it is specific to students who are Deaf-plus.
• Matrix of Services was developed by the Florida Department of Education Bureau of Exceptional Education and Student Services in 2017 as guidance to indicate the intensity of support required to meet the needs of students identified as exceptional. It is not DHH-specific. Be sure to download the large Matrix of Services Handbook that provides detailed explanations of all domains for appropriate use. Note: This large file may take extra time to access.

Key factors for service delivery decisions:

• Communication access.
• Educational performance.
• Listening environment. Language needs.
• Device use and management.
• Classroom placement.
• Staffing and support services.
• Family priorities and student goals.

Frequently Asked Questions About Service Delivery for Students with Hearing Loss

What does service delivery mean for students with hearing loss?
Educational service delivery refers to the specific framework through which specialized instruction, communication accommodations, assistive technologies, and therapies are provided. Rather than a one-size-fits-all model, appropriate service delivery is customized to ensure a student who is deaf or hard of hearing (DHH) has equitable access to the curriculum.

What distinct service delivery models are available for DHH students?
Depending on the student’s unique language and academic needs, an Individualized Education Program (IEP) team can select from several standard service frameworks:

• Direct Instruction (Pull-Out): Individual or small group specialized instruction provided by a Teacher of the Deaf and Hard of Hearing (TODHH) outside the general education room.
• Co-Teaching / Inclusive Support (Push-In): The specialist works directly inside the general education classroom alongside the mainstream teacher to modify instruction in real time.
• Consultative Services: The TODHH or Educational Audiologist monitors progress and collaborates with general education staff, rather than working directly with the student.
• Related Services: Coordinated auxiliary support, including speech-language pathology (SLP) sessions or audiology equipment monitoring.

What key factors determine appropriate service delivery and placement?
To improve academic and communication outcomes, IEP teams must base service decisions on comprehensive data rather than administrative convenience. Key data points include the following:

What professionals should be involved in service delivery planning?
Because hearing loss impacts both acoustic access and language development, a multi-disciplinary team is legally required under IDEA. This planning matrix should always include the parents, a certified Teacher of the Deaf and Hard of Hearing, an Educational Audiologist, a Speech-Language Pathologist (SLP), the general education teacher, and a school administrator.

What is the Least Restrictive Environment (LRE) for a student with hearing loss?
The Least Restrictive Environment is not simply a physical location; it is defined by where the student has full communication access. For some DHH students, this means full inclusion in a mainstream classroom with real-time remote CART captioning or an interpreter. For others, it may require a specialized self-contained room or school for the deaf where they can communicate directly with fluent peers and instructors.

Can an educational service delivery plan change over time?
Yes. Service delivery should be a dynamic process reviewed at least annually during IEP meetings. As a student develops stronger independent self-advocacy skills, masters technical device connections, or faces greater vocabulary demands in higher grade levels, the intensity and type of service delivery must be adjusted to match their changing needs.

Additional Resources:
Issues: Determining Service Delivery
Push-In Services for Students in the Mainstream
Student Services: One Size Doesn’t Fit All
Too Many Students to Serve?

2018 © Karen L. Anderson, PhD, Late November Update, Supporting Success for Children with Hearing Loss http://successforkidswithhearingloss.com This information is not intended as legal advice.

You can download the original article here.

Originally published: Jan. 2018
Last updated: June 2026