1. 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

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

10. 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

12. 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

14. 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

16. How lasting is the effect?

17. 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

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

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

21. 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

22. 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

23. 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

24. 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

25. PREDICTORS OF OPTIMAL LANGUAGE AND LITERACY

26. 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

27. STRONG EMOTIONAL AVAILABILITY LEADS TO BETTER VOCABULARY DEVELOPMENT LOWER PARENTAL STRESS IS RELATED TO BETTER LANGUAGE

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

29. 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

30. 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

31. 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

32. 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

33. 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

34. 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

35. 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

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

37. 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

38. 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)

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

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

41. 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

42. 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

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

44. 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

45. 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

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

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

48. NECAP: NATIONAL EARLY CHILDHOOD ASSESSMENT PROJECT: DEAF AND HARD OF HEARING ASSOCIATION OF UNIVERSITY CENTERS ON DISABILITY: CENTERS FOR DISEASE CONTROL

49. 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.)

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

51. Assessments Completed 259 assessments completed (not including Colorado) 162 children assessed 1 to 4 times each Colorado: 225 assessments per year

52. Participant Characteristics (excluding Colorado) Bilateral loss = 249; Unilateral loss = 10 Auditory Neuropathy = 7 English-speaking home = 239; Spanish-speaking home = 20 No additional disabilities = 229; Have additional disabilities = 30 Boys = 140; girls = 119

53. Degree of Hearing Loss

54. Participant Criteria for Language Outcomes Analysis Bilateral hearing loss English-speaking home No other disabilities that would affect speech or language development

55. States Represented in Current Language Outcomes Analysis Arizona Colorado Idaho New Mexico (previous participant) Texas Utah (previous participant) Wisconsin Wyoming  Note: CA and IN just initiated NECAP; no data yet

56. Language Outcomes Analysis: Participant Characteristics Chronological age Range = 6 to 40 months Mean = 21 months Boys = 130; Girls = 140 Number of assessments = 270

57. Assessment 1: Minnesota Child Development Inventory (1992) 8 areas of development assessed Language, Motor, Social, Self Help, Pre-Literacy Parent report Parents respond “yes” or “no” to a variety of statements about their child Example: “Has a vocabulary of 20 or more words” Scales adapted to reflect abilities in both spoken and sign language

58. Assessment 2: MacArthur-Bates Communicative Dev. Inventories Assesses spoken and sign vocabulary Expressive and receptive for younger children Expressive vocabulary for older children Parent-report instrument

59. Determining Language Quotient  Language Age/Chronological Age x 100  If LQ = 100, Language Age = CA  If LQ < 100, Language Age < CA  If LQ > 100, Language Age > CA  LQs of 80+ are within the normal range compared to hearing children

60. Median Language Quotients

61. Percent of Scores in the Average Range (LQ = 80+)

62. Minnesota CDI: Median Language Quotients

63. MacArthur-Bates: Median Vocabulary Production Quotients

64. Conclusions Almost 80% of children scored within the average range on the Minnesota Expressive Language subtest On average, children in all states scored more poorly on cognitive-linguistic items (Minn Lang Comp) compared to more superficial language items (Minn Exp Lang)

65. Conclusions Acquiring an age-appropriate lexicon is a challenge for many children with 43% demonstrating significant delays Differences in language outcomes are apparent between some states As more assessments are collected, factors predictive of better language outcomes will be identified

66. Colorado Individual Performance Profile: Criteria for Placement decisions

69. Describe the student's current service delivery system. Do NOT include the services of an educational interpreter when counting these hours to identify a category of services below. __1_Indirect Service: Monitor (No IEP, 100% of time in general education); check here if student has a 504 Plan___. __2_Indirect Service: Consultation (IEP, 100% of time in general education classroom) __3_Direct Service: (>60% of time in general education classroom), 1-4 hours of instructional services per week from a licensed teacher of the Deaf/HH or combination of teacher of Deaf/HH or other special education team __4_Direct Service: (21-60% of time in general education classroom), 1-2 hours instructional services daily from a licensed teacher of the Deaf/HH or combination of teacher of Deaf/HH & other special education team; may be team or co-taught __5_Direct Service: (<21% of time in general education classroom), 3 or more hours per day of instructional services from a licensed teacher of the Deaf/HH or combination of teacher of Deaf/HH & other special education team; student is still receiving his/her academic instruction in the general classroom a portion of the school day; may be team or co-taught __6_Direct Service: (Separate Facility), all instruction from a licensed teacher of the Deaf/HH and other special education professionals in hearing services ___Other:Please explain___________________________________________________________ ___CSDB students only: ___day student___residential

70. Comparison of CSAP Reading Score to Level of Service

71. CSAP Reading Performance Growth 2004 vs 2005  Reading grades 3-10  N=751 students  Adequate Yearly Progress or 1 years growth in 1 year  40% made 1 years growth  40.8% made > 1 years growth  18.7% made < 1 years growth

72. Deaf Child’s Bill of Rights

73. http://www.cde.state.co.us/cdesped/downlo ad/pdf/dhh-DeafChildBillRts.pdf

74.  that each child’s “unique communication mode is respected, utilized, and developed to an appropriate level of proficiency”,  that teachers and other providers who work with children who are Deaf or Hard of Hearing are specifically trained for this population, including proficiency in the primary language mode of the children with whom they work,  that an education with a sufficient number of language mode peers with whom direct communication is possible and who are of same age and ability level is available, Deaf Child’s Bill of Rights

75.  that each child’s “unique communication mode is respected, utilized, and developed to an appropriate level of proficiency”,  that teachers and other providers who work with children who are Deaf or Hard of Hearing are specifically trained for this population, including proficiency in the primary language mode of the children with whom they work,  that an education with a sufficient number of language mode peers with whom direct communication is possible and who are of same age and ability level is available,

76.  that parent involvement and, where appropriate, people who are Deaf and Hard of Hearing, determine the extent, content, and purpose of educational programs,  that children who are Deaf and Hard of Hearing benefit from an education in which they are exposed to Deaf and Hard of Hearing role models,  that programs provide direct and appropriate access to all components of the educational process, including but not limited to recess, lunch, and extra-curricular activities, Deaf Child’s Bill of Rights

77.  that parent involvement and, where appropriate, people who are Deaf and Hard of Hearing, determine the extent, content, and purpose of educational programs,  that children who are Deaf and Hard of Hearing benefit from an education in which they are exposed to Deaf and Hard of Hearing role models,  that programs provide direct and appropriate access to all components of the educational process, including but not limited to recess, lunch, and extra-curricular activities,

78.  that programs provide for the unique vocational needs, including appropriate research, curricula, programs, staff, and outreach,  that the least restrictive environment for each child who is Deaf or Hard of Hearing takes into consideration the legislative findings and declarations of this law, and  that due to the unique communication needs of children who are Deaf and Hard of Hearing, the development and implementation of state and regional programs would be beneficial. Deaf Child’s Bill of Rights

79. SUMMARY Set a Goal Measure the Baseline Develop a Plan Institute the Plan Measure the progress

80. FOR THE SAKE OF OUR CHILDREN: WE CAN ACHIEVE OUR GOAL