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THE TIME IS NOW

A Steep Hill to Climb: Identifying the Literacy Crisis for Deaf and Hard of Hearing Students Christine Yoshinaga-Itano, Ph.D. Professor University of Colorado, Boulder. THE TIME IS NOW. NO CHILD LEFT BEHIND: INCLUDING THOSE WHO ARE DEAF OR HARD OF HEARING.

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THE TIME IS NOW

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  1. A Steep Hill to Climb: Identifying the Literacy Crisis for Deaf and Hard of Hearing StudentsChristine Yoshinaga-Itano, Ph.D. Professor University of Colorado, Boulder

  2. THE TIME IS NOW

  3. NO CHILD LEFT BEHIND: INCLUDING THOSE WHO ARE DEAF OR HARD OF HEARING

  4. Early Hearing Detection and Intervention • Sensitive Periods of Brain Development • An opportunity to develop language in the typical time frame, achieving milestones at the same time as children with normal hearing.

  5. Critical Milestones with the goal of age appropriate language • Screening before 1 month • Identification before 3 months • Amplification within 1 month from identification • Intervention before 6 months

  6. What needs to happen to meet these goals?

  7. COLLABORATION AND COORDINATION • INTER-AGENCY: BREAKING DOWN THE BARRIERS • INTER-DISCIPLINARY, MULTI-DISCIPLINARY, TRANS-DISCIPLINARY INTERACTION • ACCOUNTABILITY AND DATA MANAGEMENT • FIDELITY OF THE SERVICES PROVIDED • HIGHLY QUALIFIED PROVIDERS

  8. THE OUTCOME OF MEETING EHDI MILESTONES

  9. OPTIMAL OUTCOMES ARE POSSIBLE • AT ALL AGES FROM BIRTH • FOR CHILDREN OF FAMILIES WHO HAVE CHOSEN SIGN LANGUAGE AS THEIR PRIMARY MODE OF COMMUNICATION • FOR CHILDREN OF FAMILIES WHO HAVE CHOSEN SPOKEN LANGUAGE AS THEIR PRIMARY MODE OF COMMUNICATION • FOR CHILDREN IN FAMILIES FROM ETHNIC MAJORITY CULTURE • FOR CHILDREN IN FAMILIES FROM ETHNIC MINORITY CULTURES • FOR FEMALES AND FOR MALES

  10. OPTIMAL OUTCOMES • FOR ALL CHILDREN WHO ARE DEAF OR HARD OF HEARING – MILD, MODERATE, SEVERE, PROFOUND • FOR CHILDREN IN FAMILIES WHOSE MOTHERS HAVE A HIGH SCHOOL EDUCATION OR LESS • FOR CHILDREN IN FAMILIES WHOSE MOTHERS HAVE GREATER THAN A HIGH SCHOOL EDUCATION • FOR CHILDREN IN FAMILIES ON MEDICAID • FOR CHILDREN IN FAMILIES WHO DO NOT RECEIVE MEDICAID • FOR CHILDREN WITH HEARING LOSS ONLY • FOR CHILDREN WITH HEARING LOSS AND ADDITIONAL DISABILITIES

  11. FAILURE IS NOT AN OPTION IF APPROPRIATE SERVICES ARE NOT PROVIDED, THE LACK OF APPROPRIATE SERVICES CREATES AN ENVIRONMENTALLY-CAUSED DISABILITY AS SERIOUS AS A COGNITIVE DEVELOPMENTAL DELAY

  12. How lasting is the effect?

  13. Longitudinal study of children birth through 84 months (7 years) • Age appropriate vocabulary skills • Age appropriate receptive syntax skills • Primary predictors: account for 72% of the variance of the language outcome at 84 months of age. • Non-verbal cognitive development • Amount of language the child is exposed to in the home • Language development at 3 years of age • Degree of hearing loss • Age of identification and initiation of early intervention • Maternal level of education

  14. MCDI-EL and TACL-3 (Baca, 2009)

  15. Some delays still exist • Articulation • Pragmatic language development – the socially appropriate use of language • Expressive syntax

  16. ASSURING QUALITY • ADOPT BEST PRACTICE STANDARDS OF CARE AND IMPLEMENT AN ACCOUNTABILITY SYSTEM • DEVELOP A DATA MANAGEMENT SYSTEM: FOLLOW FROM AGE OF IDENTIFICATION – EHDI DATA BASE HAS THAT POTENTIAL • AGE OF IDENTIFICATION, THE AGE OF ACCESS TO LANGUAGE/ INTERVENTION START IS CRITICAL • LONGITUDINAL DEVELOPMENT • ONLY WAY TO GUARANTEE THAT ALL CHILDREN WHO ARE DEAF OR HARD OF HEARING ARE INCLUDED

  17. ASSURING QUALITY • QUALIFICATIONS OF THE EARLY INTERVENTION PROVIDER • WITH ADDITIONAL QUALIFICATIONS FOR BOTH LISTENING AND SPOKEN LANGUAGE AND FOR SIGN LANGUAGE • DEVELOP AND IMPLEMENT A MECHANISM FOR PROVIDERS TO IMPROVE THEIR SKILLS AND KNOWLEDGE • DOCUMENT DEVELOPMENTAL PROGRESS, PROVIDE FEEDBACK TO FAMILIES AND PROVIDERS • IMPLEMENT A STATEWIDE PROTOCOL, COMMON ASSESSMENT TOOLS THAT WILL BE USED WITH ALL CHILDREN AND FAMILIES

  18. ASSURING QUALITY • ASSURE MEANINGFUL INVOLVEMENT OF PARENTS OF CHILDREN WHO ARE DEAF OR HARD OF HEARING AT ALL LEVELS OF THE SYSTEM • ASSURE MEANINGFUL INVOLVEMENT OF DEAF AND HARD OF HEARING ADULTS AT ALL LEVELS OF THE SYSTEM • DEVELOP AND IMPLEMENT LEADERSHIP TRAINING • DESIGN AND IMPLEMENT A SYSTEM OF SERVICES

  19. ASSURING QUALITY • DEVELOP AND IMPLEMENT STRATEGIES FOR FAMILIES WHO DO NOT SPEAK ENGLISH IN THE HOME • DEVELOP AND IMPLEMENT STRATEGIES FOR FAMILIES WHOSE CHILDREN HAVE ADDITIONAL DISABILITIES • DEVELOP AND IMPLEMENT STRATEGIES FOR FAMILIES FOR DIVERSE CULTURES AND DIVERSE SOCIO-ECONOMIC BACKGROUNDS • DEVELOP SYSTEMS THAT PROVIDE EQUITABLE CARE WHEREVER THE FAMILY AND CHILD LIVE IN THE STATE

  20. PREDICTORS OF OPTIMAL LANGUAGE AND LITERACY

  21. EMOTIONAL AVAILABILITY • MATERNAL/PATERNAL BONDING • PARENTAL STRESS • RECIPROCAL EMOTIONAL AVAILABILITY IN THE COMMUNICATION BETWEEN PARENT AND CHILD • SCAFFOLDING: KNOWING WHEN TO SUPPORT JUST ENOUGH FOR THE CHILD TO SUCCEED IN WHAT S/HE IS ATTEMPTING • STRATEGIES FOR DEALING WITH FRUSTRATION AND ANGER

  22. STRONG EMOTIONAL AVAILABILITY LEADS TO BETTER VOCABULARY DEVELOPMENTLOWER PARENTAL STRESS IS RELATED TO BETTER LANGUAGE

  23. A POWERFUL PREDICTOR OF VOCABULARY DEVELOPMENT: AMOUNT OF PARENT TALK TO THE CHILD

  24. Total Number of Parental Words • Accounts for an 11.07% of the language outcome at 84 months and 14.04% of the rate of language development from 4 to 7 years

  25. High Maternal Level of Education • Number of Parent Words not included • High Maternal level of Education accounts for 10.81% of the variance of the language outcome at 84 months and 7.48% of the variance of the rate of language development from 4 to 7 years

  26. Maternal Level of Education + Number of Parental Words • Accounts for 16.38% more variance of the language outcome at 84 months and 13.71% of the rate of language development from 4 to 7 years

  27. Both Maternal level of education and Number of Parental Words are predictors of language at 84 months • Maternal level of education emerges as a significant predictor of language outcome between 48 and 84 months of age • Number of parental utterances in the birth through 48 month age group is a significant predictor of language outcome at 84 months of age and rate of language growth from 4 to 7 years of age

  28. Relationship Maternal Level of Education and Number of Parental Words • Amount of variance accounted for by the variables High Maternal Level of Education and Number of Parental Words spoken to the Child appear to be accounting for overlapping variance • Number of Parental Words accounts for more variance

  29. EOWPVT differences by Maternal Level of Educational Level (Baca, 2009) • 35 month language age difference at 84 months of age between group with mean age level for mothers with educational level less than 12 years (HS grad) as compared to group for mothers with educational level 16 years or greater (college) 55.75 months versus 91.33 months

  30. THE IMPACT OF MATERNAL LEVEL OF EDUCATION CAN BE OVERCOME WITH EXCELLENT INTERVENTION • Colorado studies indicate that Maternal level of education does not predict language outcomes of children with hearing loss – birth through 36 months

  31. VOCABULARY DEVELOPMENT IS THE MOST SIGNIFICANT PREDICTOR OF LITERACY FOR CHILDREN WHO ARE DEAF OR HARD OF HEARINGJUST AS IT IS FOR CHILDREN WITH NORMAL HEARING

  32. EMERGENT LITERACY • Early sources: • Emergent Literacy - Construction of knowledge about the uses and nature of written language • Story telling • Experiences with children’s books • TV

  33. NARRATIVE DEVELOPMENT • Literary devices • Narrators • Distinct voices of characters • Setting • Identities of characters • Shifts in time or place • Connectives (relationships between events in stories)- (relationships between previous and upcoming events) cohesion • Storytelling is both social and cognitive • Increasing sophistication in pragmatic uses, i.e. (because)

  34. META-LINGUISTIC AWARENESS • Knowing what to do in failures of communication • Conscious awareness of adjustments • Re-wording – vocabulary changes • Changing syntax

  35. WHY EMERGENT LITERACY, NARRATIVE DEVELOPMENT, METALINGUISTIC KNOWLEDGE ARE SO CRITICAL FOR CHILDREN WHO ARE DEAF OR HARD OF HEARING

  36. Study Participants • Normal Hearing Group • N=109 • Age Range: 2-7 years • Normal hearing and cognition • Hearing Loss Group • N=126 • Age Range: 3-7 years • All Levels of hearing loss • Normal cognition

  37. Children with Normal Hearing • 44% (20 of 45) of the items were mastered using complex language by 3 years of age • 95.5% (43 of 45) of the items were mastered by 4 years of age • 98% by 5 years • 100% by 6 years

  38. Final Items to Master for NH group • Provides information on request • Name, date of birth, address (2 of 3 items) • Makes promises

  39. Children with Hearing Loss • 6.6% (3 of 45) of the items were mastered with complex language by six years of age • 69% (31 of 45) of the items were mastered by 7 years of age

  40. Items not Mastered by 7yrs (HL Group) • Provides information on request • Repairs incomplete sentences • Ends conversations • Interjects • Apologies • Request clarification • Makes promises • Ask questions to problem solve • Asks questions to make predictions • Retells a story • Tells 4-6 picture story in right order • Creates original story • Explains relationships between objects-action-situations • Compares and contrasts

  41. Percentage of Items Mastered by Age for NH and HL groups

  42. The proportion achieving 50% or more of the items with complex language

  43. NECAP: NATIONAL EARLY CHILDHOOD ASSESSMENT PROJECT: DEAF AND HARD OF HEARINGASSOCIATION OF UNIVERSITY CENTERS ON DISABILITY: CENTERS FOR DISEASE CONTROL

  44. STATE COMMITMENTS TO DEVELOP SYSTEMS TO COLLECT STANDARD ASSESSMENT DATA FROM ALL CHILDREN WHO ARE DEAF OR HARD OF HEARING • Assessment Components • Demographic form • Release of audiologic information • Minnesota Child Development Inventory • MacArthur-Bates Communicative Development Inventories • Additional assessments on request (e.g., play, listening skills, speech intelligibility, etc.)

  45. Participating States • Arizona • California • Colorado • Idaho • Indiana • Texas • Wisconsin • Wyoming • Nebraska • Oregon

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