The Need for Early Identification and Intervention for Children who are Deaf/Hard of Hearing

1. The Need for Early Identification and Intervention for Children who are Deaf/Hard of Hearing A Cross Border Analysis Sara Moffatt, PhD Candidate Niagara University, Lewiston NY.

2. Agenda Facts to consider 3. Early Identification 4.Early Intervention 5. Canada and the USA : A Comparison 6. Organization and Policy Across Borders

3. Facts to Consider • Normal hearing develops in utero and a baby can begin to hear sounds before birth. • Hearing loss is the most common birth defect in America. • Approximately 5 in 1,000 babies are born Deaf/Hard of Hearing in North America. • Children with hearing loss who receive early intervention have significantly better developmental outcomes than similar children who begin intervention later. (Holt & Svirsky, 2008; Moeller, 2000; Nicholas & Geers, 2006)

4. Facts to Consider • Research proves the earlier hearing loss is detected the better. • Any degree of hearing loss can have detrimental effects on language learning for the rest of a child’s life. • If a child enters kindergarten with a language delay, the chances of that child being delayed for the rest of their lives is over 90%. • If a child enters kindergarten with age appropriate language levels they will likely remain age appropriate for the rest of their school career.

5. Facts to Consider • Most children with hearing loss who receive appropriate services from trained staff are able to progress at age-appropriate rates (Geers et al., 2009). • 92% of children with permanent hearing loss are born to two hearing parents(Mitchell & Karchmer, 2004). • The overall goal of early detection is to identify and initiate intervention for auditory and communicative development. • Hearing loss has been described by some as a “neurologic emergency” (Madell & Flexer, 2008; Berlin & Weyand, 2003).

6. Facts to Consider • Extended periods of auditory deprivation have a significant impact on the overall brain development and sensory integration of the child. • Deficits in speech, language, cognition, literacy, academic and social/emotional development have all been cited universally as an expected result of unmanaged hearing loss.

7. In order to develop a language a learner must have… • Exposure in Quality and Quantity to that language whether it is a spoken language or a signed language • The language must be accessible • The language must be delivered while engaged in meaningful activity • The language must be delivered by individuals who are already capable users of the language Dr. Connie Mayer

8. Early Identification • In states and provinces without early identification children are often not being diagnosed until they enter kindergarten. • Left undetected, mild or unilateral hearing loss can result in delayed speech and language acquisition, social-emotional or behavioral problems, and lags in academic achievement (Yoshinaga-Itano et al., 1998; Bess, 1985; Bess et al., 1988). • Despite extraordinary advances in early identification, early access to sound through technology and early intervention, there is widespread agreement among researchers, clinicians, program administrators and policy makers that many children ages 0–5 with permanent hearing loss are not receiving the benefits (White, 2007; White, 2004).

9. Early Intervention • With appropriate early intervention, children with hearing loss can be mainstreamed in regular elementary and secondary education classrooms. • Recent research has concluded that children born with a hearing loss who are identified and given appropriate intervention before 6 months of age demonstrated significantly better speech and reading comprehension than children identified after 6 months of age (Yoshinaga-Itano & Apuzzo, 1998; Yoshinaga-Itano et al., 1998). • Early detection is half the battleas early identification without appropriate intervention services is providing diagnosis without treatment. • For infants who are diagnosed with hearing loss, research shows the child’s family needs to play an essential role in the intervention programming in order for the child to be met with success.

10. Early Identification and Intervention Canada United States All 50 states have passed Early Hearing Detection and Intervention laws Newborn hearing screening has become the standard of care in the United States While 92% of all newborns are screened for hearing loss shortly after birth, only 54% of these babies actually receive the recommended hearing evaluation; the remaining 46% are "lost to the system". (Joint Committee on Infant Hearing, 2007) • Only Ontario and British Columbia have universal infant hearing screening programs, and Quebec has announced plans to create one • Other provinces like Alberta, Nova Scotia, New Brunswick and Prince Edward Island tend only to test babies at high risk of hearing loss, such as preemies and those suffering serious infections like meningitis • Just over 50% of babies found to have hearing loss in Ontario (which screens all babies) are not in high risk categories

11. Canada • In most of Canada, the average child with significant hearing loss is usually not identified until they are nearly 3 years of age. • There is no coordinated national approach to the issue of newborn hearing loss detection • Canadian practice for newborn hearing screening is inconsistent. • Even in Ontario where screening is consistent across the province the educational and communicative services available to families varies significantly from region to region which often leaves families intermittently without service or on waiting lists if they move within the province resulting in interrupted intervention.

12. United States • Of the 12,000 babies in the United States born annually with some form of hearing loss, only half exhibit a risk factor—meaning that if only high-risk infants are screened, half of the infants with some form of hearing loss will not be tested and identified (Harrison & Roush, 1996). • Nearly 40% of children identified with hearing loss and their families are not referred to the Part C early intervention system and may not be aware of the broad array of services and funding available to them. Part C is the primary source for families to link to other medical, audiologic and intervention services (Center for Disease Control and Prevention, 2008). • The National Agenda (NA) is a historic coalition of parent, consumer, professional, and advocacy organizations involved in the education of children who are deaf and hard of hearing , they are working to develop an effective, communication and language -driven educational delivery system for our children. • A NA was formed in 2005 to develop an effective, communication and language-driven, educational delivery for the US because the educational system in place serving deaf and hard of hearing children was incomplete and ineffective. • Deaf children to this day despite their innate abilities, passions, and dreams do not leave school with the skills necessary to be productive adults. http://www.asha.org/uploadedFiles/State-Hearing-Screening-Requirements.pdf

13. Cost • In provinces and states without mandated hearing detection and intervention services, special education for a child with hearing loss costs schools an additional $420,000, and has a lifetime cost of approximately $1 million per individual(Johnson et al., 1993). • Most of the severe to profound hearing loss population are poorer than other Americans (Blanchfield et al., 2001).

14. Cost • In total societal losses will amount to an estimated $4.6 billion over the lifetime of an individual who is D/HH. • If early identification and intervention shifted only 10% of the children into mainstreamed settings, the return on investments would be more than double. • A Quebec study estimated that a universal hearing program would result in an annual savings of $1.7-million in that province alone because special education classes are much more costly than treating hearing loss.

15. Organization and Policy Across Borders • It is evident that the organization of national identification and intervention programs in Canada and the USA is disorganized and seemingly unachievable. • There has been many policies passed and organizations created in both Canada and the USA, in an attempt to deliver quality intervention to D/HH children but none have proven to establish consistent delivery of services. • Consistent and National access to infant hearing processes and early intervention services is necessary for the success of Deaf and hard of hearing individuals in North America.

16. "There is always one moment in childhood when the door opens and lets the future in." ~ Deepak Chopra