Early Intervention with Children who are Deaf and Hard of Hearing: Teaming to Meet the Needs of Babi

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Early Intervention with Children who are Deaf and
Hard of Hearing Teaming to Meet the Needs of
Babies and Their Families

• Georgia State University Spring 2002 UNHSI
  Training
• Susan R. Easterbrooks, Associate Professor/Deaf
  Education
• Dept of Educational Psychology and Special
  Education

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Purpose of the Workshop

• To familiarize participants with the areas of
  information they will need to understand and be
  able to explain regarding the needs of babies who
  are deaf and hard of hearing and their parents.
• To encourage a collaborative response within the
  19 health districts to the challenges of
  screening and intervention.

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Screening 101

• Prevalence of Hearing Loss
• 2 to 3 per 1000 at birth
• Prime time for language/speech development
• Early ID and intervention are imperative
• 6 months is a key target
• Auditory pathway is most stimulable
• 2 years is too late for most

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A Little History

• 1990 Rhode Island
• 1993 NIH Consensus
• 1993-98 NIH 5 year multicenter research
  project sets screening protocols, studies and
  recommends data tracking, funds 17 states
• 1998 Yoshinaga-Itano publishes landmark study
• 1999 Walsh bill passes Congress
• 2000 UNHSI bill passes in GA
• Today Over 40 states provide screening
• GA screens 95 of all MBU/NICU babies

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Justification

• Screening technologies are easy to use, and are
  capable of sensitivity and specificity
• Infant hearing loss not detectable clinically
• Intervention works if begun early enough
• Where intervention is available, results are
  dramatic
• Screening is cost-effective

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Herer, G. (2002). Universal newborn hearing
screening update. Paper presented at the annual
convention of the Council for Exceptional
Children. April 3-6. NY, NY

• Childrens National Medical Center/Holy Cross
  Hospital
• Mother-Baby Unit/ NICU
• Four years of screenings
• 32,295 babies screened
• 99.1 screened
• 98.4 passed before discharge
• 80 non-passers returned for screening
• 72.4 passed re-screen
• 81.6 re-screen failures returned for ABR
• 77.4 of ABRs have hearing loss
• N 72

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• 51.4 of identified babies had risk factors,
  48.6 did not
• Important to screen MBU, not just NICU
• Less than 2 of well newborns and less than 4 of
  NICU babies required a post-discharge rescreen
• 38.9 bilateral S/N loss
• 23.6 bilateral conductive loss
• 23.6 unilateral S/N loss
• 13.9 unilateral conductive loss
• ½ had risk factors only 24 came from NICU

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Summary

• We are now screening babies routinely for hearing
  loss, and we are identifying most children very
  early.
• Intensive intervention is required to meet the
  needs of these babies and their families.
• Teams need to collaborate to make sure that
  families receive all necessary support.

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What kind of support is needed?

• At time of screening
• Objective information about the process of
  screening
• Objective information about the chances of having
  a hearing loss (1 per 1000)
• Objective information about the number of
  screening failures who do/do not have losses
  (3/4 pass 2nd screening 3/4 who fail 2nd
  screening have hearing loss)
• Information that beginning treatment in the first
  6 months can make the difference between a
  lifetime of dealing with the loss or
  significantly reduced effects of a loss. There is
  no time to waste in finding out the diagnosis and
  starting treatment.
• Therefore, if the child fails the screening,
  chances are s/he will not have a hearing loss,
  but it is not worth jeopardizing the childs
  future to ignore the possibility.

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• Yoshinaga-Itano Study
• Children whose hearing loss was identified by 6
  months of age had significantly better scores
  than those identified after 6 months of age
• In those children with normal cognitive
  abilities, this statistical difference was
  independent of age, gender, ethnicity,
  communication mode, degree of hearing loss,
  socioeconomic group, or the presence or absence
  of other disabilities

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What kind of support is needed?

• In the early days
• Emotional
• Fear
• Shock/denial
• Sadness/grief
• Informational
• Importance of screening
• Importance of intervention
• Importance of follow-up
• Terminology

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As the diagnosis sinks in, they need information
on

• Importance of early intervention
• Available service providers
• Developing appropriate interactions with baby
• Coming to terms with the hearing loss
• Remains a challenge for many years

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When families have settled in to the new
information, they need to be made aware of
challenges regarding.

• Choosing and dealing with professionals
• Using a hearing aid
• Understanding a variety of technologies
• Understanding a variety of medical terminology
• Especially for children with other risk factors
• Choosing a communication approach
• Dealing with siblings, extended family, friends
• Understanding the unique contributions of the
  Deaf culture
• !!! Promoting communication development !!!

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You may be attempting to address these in the
face of.

• denial from the family
• few service options to recommend
• families who do not place the same value on
  education as you do
• Deaf families who may not place the same value on
  listening as you do
• families in the middle of other crises
• A child whose other problems seem to take
  precedence over the hearing loss

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How do you meet their needs?

• Recognize that we all have the same needs
• Love/belonging success/control fun/information
  freedom from/freedom to
• Recognize that you cannot make someone do
  anything that they will choose what they will do
• Recognize that the best you can do is provide
  them with information, information, and more
  information so that they can make effective
  choices

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What are the major categories of information they
will need to know about?

• How to cope emotionally
• One day at a time
• Asking for help
• From the team
• Parent to parent
• Seeking information
• Medical
• Services
• terminology
• Financial
• How to work this all in to their larger family
  constellation.
• Audiology, hearing aids, cochlear implants, and
  other technology
• Communication options
• Deaf culture
• WHAT TO EXPECT
• Resources, resources, and more resources

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The Key to Success Collaboration

• Meeting your team mates
• Who are they?
• With which aspects are each of you comfortable ?
• Return to previous slide
• Identify team strengths
• Identify team needs