Teaching Learners with Multiple Special Needs: Deaf

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Tuesday, August 11, 2009

Improving Auditory Access to the Curriculum through Technology

notes on a presentation by Charlotte Mullen MA-CCC-A Audiologist Children's Hospital - Waltham

Mass ESE Deaf/HOH Seminar August 11, 2009 Holy Cross College

This discussion is about students who are Deaf/HOH and use audition to learn in the classroom - other modalities may be used but this is about kids who use audition - amplification or implants.

Why are their more Deaf/HOH kids in the mainstream?

newborn hearing screening

41 states, PR, DC mandate - MA included -- homebirths can be an issue, accidental homebirths usually tested planned home births usually not
age of ID down from 2.5 to infancy
mild ID also now ID at infancy down from kindergarten (age 5)
screen by 1 month, diagnosed by 3 months, amplification and treatment by 6 months will stay on normal developmental course
thus incidence of hearing loss is the same but placement in public schools is up and placement in private schools is down

cochlear implants happening as early as 12 months, thus students ready for mainstream education in pre-school or kindergarten

Goal of amplification and implants is to allow students to use audition for instruction because 60%+ of learning in schools is auditory.
Consideration must be made for socialization as well as academics.

Factors that affect a child's auditory performance:

degree of hearing loss
type of hearing loss (where in the ear the loss is coming from)
age of diagnosis was made and intervention began
stability of hearing loss (static, progressive, fluctuating)

Note: Good speech does not mean good hearing!

Question re: aided audiogram

no longer done because of new digital hearing aide technology, the aided audiogram only tells you what the hearing aide is doing for soft sounds which is really how well the hearing aide is working, not the ability to hear

What to take from the Audiological Evaluation

An overall description of the child's degree of hearing impairment
Unaided word recognition scores
A description of what the child is able to hear with their amplification device (hearing aids, cochlear implant(s), combo)
how do they do on the single word level, in sentences, in conversations, how do they do in quiet, how do they do in noisy places, how do they do with visual cues
if the audiological report does not include a description of the child's ability to hear and understand speech under different conditions a new referral may need to be made

Simulation of Spelling Test with Hearing Loss
List One My Guesses at the Words severe loss with aides
(note: the blank ones I could not hear at all)
1.
2.
3.
4. move
5.
6. loud
7. twist
8. say
9. bite
10. beet

List two (same list) moderate loss with aides
1. pill
2. pap
3. pump
4. move
5. wise
6. back
7. sit
8. froze
9. purse
10. juice

List three (same list) normal hearing

1. fill
2. catch
3. thumb
4. knee
5. wise
6. bath
7. fish
8. shows
9. bed
10. juice

(My comments --- wow! The only word I got all three times was move! That's 10 percent! The first list - which I could not understand really at all was like a kid with severe hearing loss WITH hearing aides! The second list was moderate loss WITH hearing aides! This makes me feel terrible for all my moderate HOH kids with aides AND other disabilities trying to function in my room. I need to do so much more for these students!!! Teachers of the Deaf are so so so important! they need to be on the teams for these kids, actively involved and there to point out what we speducators need to be doing!)

IDEA says every school/LEA is required to ensure that hearing aids worn in school by children with hearing impairments and Deafness are functioning properly (Section 300.113 (a) and (b))

someone must be appointed to check the equipment and make sure it is working (CHECK ADAPTED LEARNING I HAVE POSTED A HEARING AID CHECK LIST)
there MUST be a back up person to check
there MUST be a back up plan if it does not work

Classroom Considerations

distance between speaker and listener

average conversational speech is 3-4 feet
every doubling of distance speech is decreased by 6 decibels

background noise

classrooms are noisy places
heaters, air conditioners, lights, etc - old buildings can be very noisy
kids making noise (kid with ADD and nylon wind pants, all the kids turning to page 93 and the teacher keeps talking)
noise from outside the classroom - street, playground, hallway, cafeteria, gym, low flying planes, sirens, car alarms, lockers, printers, projectors etc
noise type makes it easier or harder to ignore but noise is noise, noise may exceed the loudness of teachers voice effecting ability to be hear (and leading to teacher vocal strain, increasing teacher sick time)
speech to noise ratio ASHA and acoustical society of America recommend speech be 15 dB higher than background words... but it needs to be higher
open classrooms/open schools are a real problem
as are modified large spaces (redone/sub divided gyms or auditoriums)
modular classrooms are noisy with HVAC on top and thin walls

acoustics and reverberation

you want some, but not too much reverberation
surfaces near teacher should be hard
soft, absorbant surfaces should be else where
acoustical tiles (reduces reflection of noise does not reduce noise through ceiling)
quietclassrooms.org is a good place for more info

preferential seating

in front of wear the teacher gives the majority of instruction - where the teacher actually is, not his or her desk
away from obvious noise
away from not obvious noise (fish tank, hampster cage, kids who are involuntarily noisy, etc)

consider professional help

an acoustical engineer can be higher to measure ambient background noise and reverberation (about $2,000-3,000 - but you will save that in ligation)
put the wrong things in place you can make it worse
they can locate noise sources and give suggestions

tips

get an area rug, it can follow a kid through the years (send out to be cleaned every year)
chair socks (standard tennis balls have latex and you might lose a finger cutting them)
Quiet Feet felt pads go on chair legs
plastic chair glides that are felt on the bottom
reduce reflective surfaces, curtains, quilts, carpets, blankets, flags, blankets

Paying for Modifications

sped funds
building funds
21st century green high performing schools facility act HR3221 goes before senate in fall
stimulus money

Who should address classroom modifications?
Chapter 433 of the Acts of 2004 (Mass Law) Assistive Technology (not Deaf/HOH - all)

What was being used then (2004) (number of educators using):

comm boards (79)
FM systems (75)
PECS (73)
Alphasmart (64)
Voice Output Device (49)
TTS readers (18)
Other (31)

Who does the training on Classroom Mod and Amplification Systems in Schools (in descending order)

SLP
Don't Know
Other
Clinical Audiologist
Some IEP Member
Teacher

Is the person doing the training comfortable?
about 50/50 yes/no!!!!!

In other states, an Educational Audiologist is a standard member of the TEAM for a student who is Deaf/HOH.

Make recommendations
Manages equipment/tech
Not consistent mechanism in MA
Only 2 or 3 in public school systems in MA (OMG!!!!)
(Side Note CB, teacher of the Deaf/HOH I worked with at Old Job, I appreciate you more than ever!!!)
Scope of Practice - Based on professional scopes of practice ion audiology (AAA, 2004,; ASHA 2004), the audiologist is the ONLY ONE qualified to deal with the technology for learners who are Deaf/HOH
Under IDEA Educational Audiology, teacher of the deaf and speech-language pathologists are sperate roles/scopes of practice (as are severe sped teachers for that matter)
Educational Audiologists are members of the IEP team (or legally should be!)

Amplification Options for the Classroom

just hearing aides
just cochlear implants
ALD (assistive listening devices)

individual FM systems

designed to overcome effects of distance, noise and room acoustics
teacher wears microphone and FM transmitter
child wears attachment on hearing aide or implant
FM signal goes directly into hearing aide/implant
no matter where teacher moves her voice can be heard
teacher voice always louder than background noise
two manufacturers - Otocon (used to be Phonic Ear) and Phonac
two kinds of hearing aide/implant receivers - clip on (called "shoe" or "boot") and all-in-one -- schools like the shoes
to find out what you need talk to audiologist
do I have to buy something new? maybe not. what do you have? discuss with audiologist
FM systems usually last 5-6 years (even if you are careful they get dropped, wear and tear etc)
companies offer services contract that allow you to send systems back in the summer for cleaning and upgrade and will replace a boot or shoe one time in the life time of a device for a boot or shoe replacement for $100 instead of $800
rechargeable batteries (in transmitter) are only good for 12-18 months
before the student uses a system it MUST be evaluated by an audiologist - purchase the system from a local dispensing audiologist (who will charge more, but will do the evaluation part too and will fix any problems and will trouble shoot any issues)
adult with normal hearing must monitor the system daily (aides/implant and FM) ask different questions daily
FM does not preclude the need for other services
older kids may not want to wear or carry

Soundfield FM

amplifies whole room
if the room has poor acoustics this will make it worse
can be added to personal FM

Teaching Tips

secret signal to redirect attention
rephrase when kids ask questions, comment, give answers
use visuals
give handouts, outlines
use powerpoint and SMART Boards, etc
in Foreign Lang remember listening labs and websites do not have any visual cues
many Deaf/HOH require a foreign lang exemption
some schools allow ASL as alternative to foreign lang
may require a note taker
think about social impliications of handing off a personal FM every period to teachers
if you are taking notes you can't be looking for facial cues/lip reading
if you don't have a note taker at least compare notes
use carbonless notebook paper
use notesharing websites
if the child can type allow use of laptop or alphasmart
be creatice with technolgy - give kids powerpoints, share SMART notes, use web 2.0

CART

Computer Aided Realtime Translation
Instant translation of spoken word to English text
in classroom or done remotely
uses stenotype machine, laptop and special software

C-Print and Typewell

content based transcriptions
requires a laptop with special software
trascriber trained but not as much as CART
C-Print has new graphic program

Captions

most things can be captions
harder online
scripts available if not captioned (but not as useful)
if you can't give visual access, don't use it

Extracurricular Activities

accommodations and modifications also apply to school activities sponsored after school

ESY

extended school year also needs to be using these things

Key Take Home Points

reduce background noise
minimize reverb
quieter classrooms
lunch buddy (don't eat in cafe)
allow normal conversation in library
be creative with classroom tech

Why do these things?

to allow full access
it is the law

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