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Evaluating the Effectiveness of Early Identification and Intervention. Kathryn Kreimeyer, Ph.D. kkreimeyer@asdb.state.az.us Lylis Olsen, M.S. Lylisolsen@msn.com. The Impact of Newborn Hearing Screening.
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Evaluating the Effectiveness of Early Identification and Intervention Kathryn Kreimeyer, Ph.D. kkreimeyer@asdb.state.az.us Lylis Olsen, M.S. Lylisolsen@msn.com
The Impact of Newborn Hearing Screening • Increased number of children receiving early intervention • Length of time receiving early intervention services has increased • Large number of children with mild hearing loss • Growing percentage of cochlear implants for children who are deaf
Arizona Service Delivery Model • Home based state-wide services initiated early 1970s • Model based on service coordinators with certification in education of deaf/hard of hearing • State divided into geographic regions • Part-time early interventionists • Backgrounds in Education of Deaf/Hard of Hearing, Audiology or Speech and Hearing.
Arizona Service Delivery Model NORTHERN 1 Regional Director 1.5 Coordinators 7 PT Parent Advisors CENTRAL 1 Supervisor 3.4 Coordinators 33 PT Parent Advisors 1 FT Parent Advisor 1 PT Audiologist SOUTHERN 1 Supervisor 1.5 Coordinator 1 FT Parent Advisor 27 PT Parent Advisors 1 Audiologist WESTERN 1 Coordinator 8 PT Parent Advisors 25 families 148 families Western Region 10 families Yuma 55 families
Why explore ways to evaluate what we do? • With national focus on accountability, impetus to critically evaluate what we do • Resources available through CDC cooperative agreement • Generation of state-wide data base to assess children from screening to outcomes of early intervention • Desire to provide evidence that early intervention makes a difference
What variables impact outcomes of 2 year old DHH children? • Developmental performance data collected on 62 children • Age Identified • 1 month to 30 months (mean 8.8 months) • Age Referred to Early Intervention • 1 months to 30 months (mean 11.7 months) • Age Aided • 2 months to 32 months (mean 13.6 months) • Chronological Age at Data Collection • 20 months to 35 months (mean 27 months)
Child Development Inventory(Ireton, H. 1992) • Parent completed inventory of child’s performance • Expressive Language • Language Comprehension • Social Development • Self Help • Gross Motor • Fine Motor • Yes/No response • Yes: child currently performs or previously performed • No: child doesn’t perform • 270 items • Normative data on children from 15 months to 6 years of age
Child Development Inventory • Language Factor • Expressive Language • Language Comprehension • Social Skills • Self Help/Motor Factor • Self Help Skills • Gross Motor Skills • Fine Motor Skills
Correlations betweenDemographic Variables and CDI Language Factor Results
Summary • The earlier a hearing loss is identified, the better the language outcome • Not possible to determine optimal age of identification • The earlier services begin, the better the language outcome • The earlier a child is aided, the better the language outcome
Summary • The milder the hearing loss, the better the language outcome • The presence of a deaf adult positively impacts language comprehension and social outcomes • Neither home language nor mode of communication significantly impact language outcomes
Identifying Early Intervention Goals and Supporting Evidence • During 2003-2004, a team of service coordinators, interventionists and parents identified goals for children and families receiving services from the Arizona Schools for the Deaf and the Blind and assessment instruments • Collected outcome data from June 2003 – June 2004
What prompted us to look at how we work with families and children? • National focus on accountability • Resources available through CDC cooperative agreement • Generation of state-wide data base to assess children from screening to outcomes of early intervention • Desire to provide evidence that early intervention makes a difference
What is Important? • Critical Goals for Infants/Toddlers • What do you want children to know and be able to do by the time they are three years of age?
Initial Evidence for Critical Goals • Outcome data obtained for 121 children from June 2003-June 2004 • Assessment instruments addressed specific goals • Progress over time evaluated for a limited number of children
Goal: Communicates wants, needs, emotions, feelings and ideas with age-appropriate language • Infant Development Inventory - IDI (Ireton,1994) • Norms for birth - 21 months • Parent Completed Chart • Performance delineated by month with one-two behaviors to evaluate/month of age • Language Subscale • Child Development Inventory - CDI (Ireton,1992) • Norms for 15 months - 6 years • Expressive Language Subscale • Language Comprehension Subscale
Description of Children on Whom Infant Development Inventory Completed
Goal: Communicates wants, needs, emotions, feelings and ideas with age-appropriate language
Goal: Communicates wants, needs, emotions, feelings and ideas with age-appropriate language
Goal: Communicates wants, needs, emotions, feelings and ideas with age-appropriate language
Description of Children on Whom Child Development Inventory Completed
Goal: Demonstrates Social, Self Help and Fine Motor Skills at Age Level
Goal: Communicates wants, needs, emotions, feelings and ideas with age-appropriate language
Goal: Communicates wants, needs, emotions, feelings and ideas with age-appropriate language
What is Important? • Critical Goals for Parents • What do you want parents to know and be able to do by the time their child turns three years of age?
Parent Goals: Assessed Through Parent Survey • Goal: Know they are the most important and valued advocate in their child’s development • I am the most important and valued person in my child’s development • Goal: Have a basic understanding of their child’s hearing loss and a commitment to the use of amplification, if appropriate • I understand my child’s hearing loss • I feel it is important that my child use the hearing aid/cochlear implant regularly
Parent Goals and Assessment Through Parent Survey • Goal: Know strategies to promote or increase child's language development • I have ways of teaching language to my child in everyday situations. • Goal: Communicate meaningfully with their child using a common language • My child understands what I communicate to him/her. • I understand what my child communicates to me.
Parent Goals and Assessment Through Parent Survey • Goal: Have realistic expectations for their child in all developmental areas and are able to describe their child’s strengths and progress. • I know what skills are age appropriate for my child. • I can tell others about my child’s progress and what he/she does well. • Goal: Comfortably read stories with their child. • I am comfortable reading stories with my child.
Parent Survey • Designed by parents and service coordinators • Parent Advisor leaves survey with parent and collects at subsequent home visit • English and Spanish versions • 5 point rating scale • 1 = Never 5 = Always • Completed every 6 months
Goals: 1. Comfortably Read Stories with Child 2. Know Age Appropriate Skills for Child
Summary of Parent Survey • Spanish speaking parents rated multiple items lower than English speaking parents • Parents of older children generally rate survey items higher than parents of younger children • Important to increase size of sample
How can we best describe the impact of Early Intervention? • Pursue assessment of both parent and child goals • Evaluate alignment of assessment procedures and goals • State accountability requirements • Document progress in multiple ways • Group performance • Individual performance • Disaggregate data by demographic characteristics of children
How can we use obtained child and parent data? • Evaluate learning experiences and instruction • Curriculum • Materials • Sequence of instruction • Determine whether family demographics indicate differentiated service needs • Evaluate impact of qualifications and training of early interventionists • Determine whether current structure of service delivery appropriate • Use child and parent data to address individual needs