Transitioning to Oral or Mainstreaming programs - DEAF/HOH Seminar Massachusetts Dept of ESE August 11, 2009 - Holy Cross College

The following are notes from a presentations by Terrell Clark of Children's Hospital Boston I am attending today. Many of these notes apply not just to Deaf/Hard of Hearing students but to all students with disabilities and to students who have multiple disabilities including hearing impairment.

Meeting the Needs of Students who are Deaf and HOH Book
2003 revision nation effort 40 people contributed - original 1994
guidelines not mandates or rules (best practices)

LRE - 1994 "Thou Shalt Not Exclude"
Yet...

• you need to understand unique language, social, communicative, tech needs of Deaf/hoh when making placement decisions
• parents MUST be informed (by law - IDEA) of all placement choices
• parents placements should be taken into consideration before making final decision (by law - IDEA)
  
• (Mass has no public/state school for Deaf/hoh, but has some private, some collaborative and some public schools (with tuition options) Deaf/hoh programs)

Students preferences and choices must be considered in IEP development - i.e. for instruction, services, setting. (After age 14 student should be given the choice of IEP participation. This is up to the parent until age 18. After 18 student must be included.)

Evaluation must guide IEP/

Eval must include:

• reason for referral
• education levels of performance
• educational needs
• evaluation/date results of direct intervention
• evaluation and information from parent
• summary/finding of interpretation of results
• recommendations to the IEP team

Determination of Communication Mode:

• audiological, communication skills, speech and language assessments
• are competences sufficient for child to access language via audition?
• will additional visual supports enhance performance?
• do demonstrated competencies show need for access to language learning via visual modality? (not just sign language - text, powerpoints, pictures, etc.)
  

Interpreters

• Teams must be knowledgeable about evaluation and managing a classroom placement that requires an interpreter.
  
• There are many implications and times it is not exactly appropriate (3 year old with 50 signs, interpreter who is not qualified, child who does not understand sign, etc.).

• Interpreter does not replace a qualified teacher of the Deaf.

• Students need guidance to manage the social interactions using an interpreter

• Student's access to education is directly corrected to quality of interpreting services.

Self-advocacy vs. Self-embarrassment

• Why do we ask students whoa re Deaf/hoh to ask for clarification etc. in large groups/discussions when often times they don't even know they missed anything? Are we asking them to self-advocate or embarrass themselves?
• Who's responsibility is it to create a learning environment conductive to learning for ALL students?

Note: If Deaf/hoh kids could learn spoken language from speaking models they would... 90% of kids who are Deaf/hoh live in speaking home with speaking models. There is a gain to having an authentic peer gain/match. Student who are Deaf/hoh in a school placement must have full language/communication access, high academic standards, authentic peers interactions, social communication and participation in activities during and outside of school, physical and communication access.

TEAMS must ensure that communication access is supported in the:

• classroom
• whole school
• family

Audiograms, gains from Hearing Aids and Cochlear Implants are important but alone are not an indicator of how student can use hearing for understanding. Program must reflect needs.

Decisions are child led, not device driven!

Decisions/planning should consider:

• demonstrated preferences and competencies
• may require gradual transitional process
• amount of educational and communicative support needed and available to child

As the years pass kids with cochlear implants, who are of average intelligence, will be/are fully included, especially those who are implanted early. They learn sign at 7-9 months, get implanted at 12-14 months and by 24 months have spoken language. By 36 months they are typically on track. Decisions are child led, not device driven. Children getting implants later have a much different outlook. Child led, not device driven.

Social networks, connecting kids with implants with other kids with implants, etc. is very important - authentic peer groups. The psychosocial support can help increase resilience.

Kids should be grouped with age-appropriate peers who share language and communicate preferences.

The TEAM should ensure the CULTURAL needs of students who are Deaf/hoh are met. (The issue psychologically isn't capital D Deaf vs. deaf, but is the issue of feeling like you belong versus feeling "other" or like an outsider.)

Considerations for direction instruction:

• language skills must be within two years of instructional level (very important!)
  
• "Deaf friendly" environment
• ability to use an interpreter
• availability of qualified/certified interpreter
• remember interpreter lag
  
• accommodations must be able to integrated into the classroom experience

Cochlear Implant Technology

• the early the implantation the more the benefit (jokingly after age 3 is geriatrics to get an implant)
  

• In Mass 5 cochlear Implant Centers (3 in Boston, 1 in Worcester, 1 in Springfield)
• Increase in numbers of kids getting them
• Critical services
• monitor equipment
• consultation on amplification and classroom acoustics
• provision of auditory habilitation

Question re: Cochlear Implants and older students

• implanting older kids who have progressive hearing loss (they once heard, and speak) is accepted (post-lingual deafness)
  
• implanting older kids who never heard is not very helpful

Question re: cochlear implants and students with other disabilities

• originally implants only offered to deafened adults
• then deaf children age 2 and older
• now deaf children age 1 and older
• deaf children with other disabilities were ruled out
• rules were loosened a little, but goal of implants was still speech understanding and production
• some parents fought and were able to win the chance for kids without the likely capability to produce speech to be implanted (based on access)
• some kids with PDD are still not seen as candidates based on the likeliness that implants will be a very negative experience because of increase auditory sensitivity/SI issues

Deafness/HOH and Literacy

• were very poor but are improving
• formerly people made decisions based on there theoretical camps rather than research and reality (i.e. ASL ruins kids must use SEE, sign ruins kids must use aural/oral) actual problem has been we didn't identify hearing loss until after age 2 and vital brain plasticity and language learning period was missed
• early identification of hearing loss (newborn screening) and early intervention (sign by 6 months, parent teaching, EI until 36 months) lead to entrance to preschool at correct developmental level and maintenance of that in school
• home birthed kids must be screened at first dr visit!!!
  
• NOTE: if EI fails these kids are behind for life (in MASS NOV 12-13 EI conference on Deaf and HOH in Boxboro check www.childrenshospital.org/nextsteps there is a session on deafblind too).
  
• There also seems to be an issue with kids not being identified early in newborn screening (deafened in infancy) and then assumed to be "late talkers" and parents told not to worry about it until "after two" and then the window is mostly missed for language
  
• landscape of literacy is changing due to early ID and technology
  
• implants
• digital hearing aids
• sound fields
• FM
• ALD
• visual supports

Children with Cochlear Implants/Hearing Aids and other technology who Sign Guidelines for Transition to Inclusion
Things to think about:

• oral receptive and expressive language
• written English skills
• social emotional
• academics
• self concepts
• attention
• age group considerations
• how are skills evaluation?