Education

Placement Options

• Infant (birth to 3)
• Preschool ( 3 to 5)
• School-Age Students

Infants (birth – 3)
It is important that a strong foundation begin during infancy. Parents need to seek out centers that can provide a solid beginning, since these are the critical years in a child’s listening, language, and speech development. Families are encouraged to use resources online and request training when personnel are unfamiliar with hearing loss.

Due to newborn hearing screenings and increased public awareness of hearing loss, children are being diagnosed at or soon after birth. When an infant is diagnosed with a hearing loss, early intervention services need to start immediately. The child’s pediatrician, ENT, or audiologist can provide the local Early Intervention numbers or they can be found on the state’s website on-line. By contacting EI, you will be assigned to a local coordinator who will arrange for evaluations that are needed to determine appropriate services. This generally takes 1-3 months. Provided in conformity with an IFSP (Individualized Family Service Plan), a multidisciplinary team performs evaluations and helps develop this plan, along with the family. The types of services recommended are:

• Speech – provided by an Auditory-Verbal Therapist (AVT) or speech pathologist (SLP) knowledgeable in hearing loss. Beginning speech provides listening therapy with verbal stimulation.
• Teacher of the Deaf (TOD)– a certified TOD can instruct families on hearing loss and how to care for hearing aids/cochlear implants at home, as well as providing instruction on good listening and language techniques.
• Audiology – a pediatric audiologist tests and fits hearing aids or recommends cochlear implants.
• Additional services as needed (occupational therapy, physical therapy, feeding therapy, vision training)

• Home or other natural environment – a Teacher of the Deaf (TOD) goes to the home, daycare, or other designated place to educate and support the family and child and explain hearing issues. Families or caregivers are instructed on the care of hearing aids/cochlear implants, and how to maximize listening and beginning language development.
• Center-based services – Parents bring their infants or the children are bussed to a special school where a combination of services and support are provided
  
  • Individual or small group instruction by a TOD, where beginning communicative and social interaction take place.
  • Individual speech-language-auditory therapy by a therapist knowledgeable about hearing loss and how to provide this specific type of therapy.
  • Support from a trained psychologist/social worker
  • Parent groups
  • Audiological support
  
  In addition, it is a good idea to enroll toddlers in programs with their normal hearing peers, such as “Mommy and Me,” “Gymboree,” story time at the local library or other programs offered in the community. This is a way to interact with hearing peers using age appropriate language and social skills. Because these private activities are an expense for parents, families who do not have funding should encourage play dates and family interactions. The goal is to expose the deaf or hard of hearing child to appropriate language models, so any opportunity to do this is positive.

Preschool (3-5)
There are various preschool options for children with hearing loss, not all of which are available in every district. There are traditional preschools, as well as preschool programs in schools/programs for the deaf. The key is getting proper guidance when transitioning to preschool (from IFSP to IEP). Assessing each child is important. Then the IFSP team and hearing aid/cochlear implant center can help determine abilities and areas of concern. Choosing an appropriate preschool is easier to decide once assessments and input from all providers are reviewed. Evaluations are determined and performed by designated sites. These evaluations should include audiology, speech-language,psychological, social history, educational, and gross/fine motor skills. The following are preschool options:

• Mainstream preschool – This is usually close to home and is private pay. Related services occur in the preschool class, or in a different room/site. The services include SEIT (Special Education Itinerant Teacher)/Teacher of the Deaf, speech, or others. If these services are in the classroom, they are called push in. If they are in a separate location they are called pull out. Push in service is usually appropriate for a child in a mainstream preschool. The TOD is the liaison to the classroom teacher, home, speech pathologist and center. The TOD may work in a small group with the child with hearing loss, sit next to the child, or facilitate language in small group interaction. Language, vocabulary, appropriate/consistent use of amplification and communication skills are the primary areas looked at on this level. Pull out services may occur less often, but can help the child understand vocabulary and concepts missed in class. Auditory skills are also addressed during these sessions. The greatest problem in a mainstream preschool is acoustics, since most classrooms are noisy and poorly designed. In order to hear the speaker (teacher), a personal FM or some other sound field FM is recommended, depending on the classroom environment and the unique needs of the child. A personal FM system consists of a microphone worn by the teacher and FM receivers attached to the child’s hearing aids or cochlear implants. The speaker’s voice is heard directly through the receivers. With a sound field system, the speaker’s voice is heard through some type of speaker system placed near the child or around the classroom. An educational audiologist can help determine the appropriate equipment. The TOD can also help to monitor and maintain this equipment after an educational audiologist has set it up.
• Preschool classes within schools/programs for the deaf – Due to technological advances including more effective hearing aids and cochlear implants, many of these programs are auditory/oral. Teachers work with children using auditory/oral techniques, to help them listen and speak. These programs have wonderful acoustics in the classroom, small class size, an audiologist on staff, speech services on-site, and good collaboration. Some of these programs use sign language as support or in the form of total communication. Therefore, it is important to observe these classes prior to enrolling a child to insure that there are appropriate language models and a true auditory/oral approach
  
  • Those programs that have some ability to mainstream are preferable
  • There are programs that have “reverse mainstreaming,” where hearing children attend classes with those who have hearing loss. They are excellent language models in the classroom, and the children have all the related services and FM equipment provided and monitored by the school.
  • There are other programs that divide the week into 2 parts-- half self-contained in the school for the deaf, and the other half mainstreamed in a private preschool. The TOD acts as a liaison, observing the children in the mainstream setting and offering on-site training. FM equipment is also provided.
  • The last option is a full day, self-contained class within a school/program for the deaf. If children attend these, good language models may not be available. Observing this setting is important. Attending after school activities is helpful for children in self-contained programs. Activities such as dance, gymnastics, or sporting events may be fun for the children, help develop skills, and provide positive language models. Family gatherings and play dates should be encouraged as well. Some of these children have greater language delays or other learning issues, and a self-contained setting is needed.
  Again, the professionals can guide families to make the correct choice.

• General education classes – Children who have developed skills on the same level as their hearing peers will return to a traditional class. There are usually 20-25 children within the class and one teacher. The child will need FM equipment, related services, modifications, and accommodations
• Inclusion/blended/collaborative class- These classes have various names, but are similar in design. They all have a classroom teacher, along with a special education teacher (not a TOD), and a teacher assistant(s). The amount of time the special education teacher spends in the classroom varies, but it is typically 1-3 hours per day. The class itself has a ratio of regular education students to special education students. The ratio varies according to district. The positive aspect of this class is the fact that 3 or even 4 adults may be in the class at the same time, giving greater support to the child with hearing loss, as well as the other special education students. Observing the class is helpful to insure that the needs of the other classified children do not conflict with the needs of the deaf/hard of hearing child.
• Self-contained class – Children who are unable to partake in a general education or inclusion class may benefit from a special education class within the local school. There are usually 12-15 students in the class, with a full time special education teacher and teacher assistant. The children receive the benefit of greater individualization. Behavior may be an issue in these classes, so observation is necessary to be sure the child will fit in.

Other Related Services

All students in the general education settings need related services, staff training, assistive technology, testing accommodations, and classroom modifications. Some of the related services can be provided within the classroom itself following the push-in model, while others need to be provided in a separate location. Some of the services are:

• Teacher of the Deaf (TOD) – Services are usually given three to five times a week, and may be push in or pull out. As academics become more difficult and language complex, as well as a fast-paced communication becomes interactive, the pull out model is preferable. During pull out sessions, the TOD can preview and review academic material for the child, as well as explain vocabulary and concepts that were difficult to understand in class. Communication with the classroom teacher is important, including consult sessions, or notebook/email. During consult sessions, the TOD and classroom teacher have a specific time slot built into their schedules to discuss new vocabulary, concepts, or review books to be taught in the near future. Notebook or email communication can provide similar information using a written format. It is imperative that the TOD knows what is being taught in the classroom, and where difficulties occur, in order to reinforce these in a one on one setting.
• Speech – Services are usually provided two to five times a week, usually in a pull out manner. Children may be seen in a small group for pragmatics, but they also need to be seen for individual sessions. Knowledge about equipment including listening checks, analyzing phoneme errors with cochlear implants and hearing aids, and providing listening as part of the school therapy program is important. If a speech-language pathologist is not familiar with hearing loss and its ramifications, it will be necessary for him/her to receive training about this subject. There are many conferences/workshops that can be attended, as well as educational outreach directly to the school districts. Sometimes school districts contract out with local speech pathologists who understand deafness and know auditory-verbal techniques, or who are certified AVTs
• Resource Room – This is a service provided by a special education teacher. It addresses support in fundamental academic skills and is provided in a small group setting. Some children receive this service when additional support is needed in academic subjects. Students are pulled out for this service, which adds to the time out of the classroom. Usually the TOD is a person who works on academics and knows how to modify/teach language specifically for children with hearing loss.
• Occupational Therapy (OT) and Physical Therapy (PT) –These services are scheduled if the child has been evaluated and requires OT or PT. Sensory integration may be part of OT services. OT and PT are usually pull out sessions, although OT may be provided in the classroom. PT is always provided outside the classroom.
• Teacher assistant/aide – This is an individual who is usually not a certified teacher, but an assistant who can help the child in the classroom. The person may be needed to help the student refocus or assist with behavioral issues. Helping with actual academics may also be part of this job. Care and training are needed to insure that the assistant/aide doesn’t interfere with the natural relationship between the teacher and the student. We don’t want a child returning to the mainstream to be dependent on a teacher assistant/aide, but want the child dependent on the classroom teacher with the aide as a helper.
• Shadow – This individual is similar to an individual teacher aide/assistant. He/she can be used to help refocus a youngster or cue him to what he is missing. Again, the shadow should not be the main focus for the child in the mainstream classroom.
• Language facilitator – An individual trained in language and communication can help facilitate language in small group instruction and during free play activities throughout the school day. This individual may be an assistant within the class who helps cue the child with hearing loss to other students’ communicative interactions.
• Intervention assistant – This person is similar to the other assistants, but may concentrate on refocusing and making sure behavior is appropriate. There may be some language facilitation as well.
• Interpreter (sign or oral)- The child’s main focus should be listening to the teacher. Group discussion and classroom interaction is most difficult for deaf and hard of hearing youngsters. The ability to understand what is said via an interpreter may be helpful. The interpreter might point to different speakers in the classroom, and be used to sign/say questions asked
  
  • A sign language interpreter may be needed when signing children return to the mainstream and are learning to use their auditory skills. Some children require the use of an interpreter throughout the day. Other children, whose auditory skills are developing nicely, would use an interpreter more for clarification (sign support), while the teacher uses the FM microphone. A sign language interpreter may also be utilized to interpret what a child with poor speech production is saying.
  • An oral interpreter may be used when a child has good lip reading skills. The child would watch the interpreter for information the teacher is trying to impart, as well as being directed to a peer who is talking. The oral interpreter may also repeat comments or questions of peers.
  • Note taking – Some type of note taking system may be appropriate in the mainstream. This is usually recommended for youngsters who are older, such as middle and high school students, where language is complex and academics difficult. There are different types of note taking systems
  • Student/adult note taker -Some children have another student or a specific adult who writes summaries of class discussions and teacher presentations. This can be tedious, difficult to read, and not all information clearly written.
  • CART (Computer Assisted Real Time Translation)- This is real time note taking and is typed by a trained stenographer or court reporter. The student receives the information from a computer on his/her desk. The benefit of this is that it is word for word presentation, giving the student the benefit of understanding all classroom interactions. The down side is the expense. This system will be found more in colleges.
  • Remote CART- This is similar to CART, but the reporter is off site. The teacher uses a microphone that transmits directly to the reporter. The information is typed in real time. It costs less than CART but may miss student comments. This could be used as a potential back up plan if the CART reporter is absent.
  • C-Print- This system is utilized similarly to CART. There are various abbreviations utilized, and information may be summarized. The typist is trained in this system, but a good typist at any school can do this.
  • CAN (Computer Assisted Note Taking)- With this system, a professional or good typist is used to input all the information discussed in class. One computer is attached to another using a long cable. This hook up is quite feasible in school and the cost is minimal. The best part about any computer assisted note taking is the fact that information can be saved on a disc for later use.
• Counseling – Some children may benefit from counseling services provided by a school psychologist or social worker. This may take the form of individual sessions or small groups. Transitioning to a mainstream environment may require support from a trained individual.
• Specialists – Outside consultants may be an important part of a child’s educational experience. These may include an Applied Behavior Analysis (ABA) specialist, a learning disabilities expert, speech pathologist, or specialist from the cochlear implant center. Personnel in the mainstream are not expected to be expert in the field of deafness and the related technology and teaching modifications. Having experts come into the schools to train staff is a valuable and cost-effective way of having the school gain knowledge to maximize the child’s education.

Individualized Education Plan (IEP)

Services for a child are driven by an Individualized Education Plan (IEP), which is created by a multidisciplinary team as required under IDEA (Individuals with Disabilities Education Act). Parents are a powerful part of this team. Children with disabilities have the right to a free and appropriate public education (FAPE) that must be provided in the least restrictive environment (LRE). The law supports the child with a disability. The main contents of the IEP include:

• Type of disability – Students are characterized as deaf, hard of hearing, or auditorally impaired. A child who hears with a cochlear implant would still be considered deaf.
• Present levels of performance – This includes testing and other evaluations that the school has performed. Usually speech/language evaluations, achievement tests, and cognitive testing are included.
• Program placement recommendations – Where the child will be placed for the following school year is presented. Present placement is included as well.
• Extended school year – The extended school year is usually included if there is concern that the child may regress without summer services. It is imperative that service providers working with a deaf and hard of hearing child document regression over extended absences or vacations. They can also document if it is more than the typical hearing student. Many youngsters receive the benefit of some summer services, depending on individual needs. These could include TOD services, speech, or a full time program.
• Assistive Technology – All youngsters should receive the benefit of an FM system, for hearing aids and/or cochlear implants. An FM system consists of a microphone worn by the teacher, and FM receivers attached to the child’s hearing aids/cochlear implants. Fortunately, as technology advances, FM systems are becoming smaller, and/or integrated, so even older students are more accepting of these devices. Personal FM systems are more effective than sound fields in counteracting poor classroom acoustics. Almost all classrooms have poor acoustics.
• Modifications – All students need some level of modifications to be successful in the classroom. Some of these modifications are intended for school use, while others are provided within the home to enhance school performance. For a deaf and hard of hearing youngster, understanding everything is difficult. Students with multiple challenges may need districts to create individualized modifications. The following are some examples of typical modifications listed on the IEP.
  
  • Preferential seating – Although this used to mean front and center seating, that is not the case anymore. Preferential seating means a preferred seat in the classroom, where a student can understand best. A TOD or consultant from a cochlear implant center should evaluate this. It could also mean movement from one area of the room to another as activities change.
  • Acoustic modifications – This could include carpeting or area rugs; tennis balls on the legs of chairs, desks, and tables; dropped ceilings with acoustic tiles; mounted bulletin boards or some sound-absorbing materials on walls; window covering, such as curtains or drapes. These modifications will make a difference in controlling the reverberation and background noise in the room.
  • Modified homework – Some students require a great deal of time in completing homework assignments due to language or motor deficits. Modifying homework assignments such as eliminating repetitive problems (math) can help this special group of youngsters. Extended time for long-term assignments may also be helpful.
  • Exempt from foreign language – Although in the past most students with hearing loss were automatically exempt from a foreign language, with improved technology that is not the case today. Many students are taking foreign languages and enjoying success in those classes. There is the option for exemption.
  • Extra set of books at home – Many deaf and hard of hearing youngsters may have homework each night in various subjects, or need to review school work each day after school. Some students have tutors or individuals who work with children at home in order to preview and review concepts and vocabulary
• Test Accommodations – All states give standardized tests to students in various grades, and schools require many tests throughout the year. Therefore, it is important that students receive accommodations to help give them an equal opportunity to demonstrate acquired knowledge and skills. Some of these accommodations include.
  
  • Extended time (up to double time) – Many students need longer time to process information. They may also need additional time because a proctor may be explaining language of directions or providing additional examples of questions. This is the amount of allowable time, although students may require less time for some tests. If students receive the accommodation of questions read or signed, use of an interpreter or repetition of auditory comprehension items, extended time is needed
  • Frequent breaks – Some students require breaks during tests on a more frequent basis, due to various difficulties in sitting and attending for long periods.
  • Auditory comprehension items (up to double the standard amount) – These items may be repeated more than the standard amount with breaks between sections to allow for note taking.
  • Separate location-Many of the other accommodations require that the tests be administered in a separate, quiet location.