Transcript Slide 1

Early Intervention Applications:
Connecticut Guidelines
Antonia Brancia Maxon, Ph.D., CCC-A1, 2
Linda Goodman, M.A., M.P.A. 2
Lynn Skene Johnson, M.S. 2
1
New England Center for Hearing Rehabilitation
Hampton, CT
2
Connecticut Birth to Three Program
Hartford, CT
Faculty Disclosure Information
In the past 12 months, we have not had a significant
financial interest or other relationship with the manufacturer
of the product or provider of the services that will be
discussed in our presentation.
This presentation will not include discussion of
pharmaceuticals or devices that have not been approved
by the FDA.
Connecticut Birth to Three Mission
• Strengthen the capacity of Connecticut’s
families to meet the developmental and
health-related needs of their infants and
toddlers who have delays or disabilities.
• The system ensures that all families have
equal access to a coordinated program of
comprehensive services and supports.
CT Guidelines 2005
Connecticut Birth to Three Mission
• Ensure that all families have equal access
to services and supports that:
– foster collaborative partnerships;
– are family centered;
– occur in natural settings;
– recognize current best practices in early
intervention; and
– are built on mutual respect and choice
CT Guidelines 2005
Part C Implementation: Connecticut
• The Connecticut Birth to Three System provides
comprehensive services to children with a wide
range of disabilities and delays and their families
through a network of approved programs.
• Implementation of Part C for infants and toddlers
with hearing loss in Connecticut is conducted in
a unique way.
• Three state-wide specialty programs have
specific expertise in working with children who
are hard of hearing or deaf and their families.
CT Guidelines 2005
Connecticut Part C Program for I/T
With Hearing Loss
• Three statewide programs that specialize
in working with children who are hard of
hearing or deaf
– Serve children living in any town in
Connecticut
– Families may choose the program most
compatible with their desired outcomes
regardless of geographic location
– Families may also choose one of the
comprehensive programs
CT Guidelines 2005
Connecticut Part C Program for I/T
With Hearing Loss
• Guidelines for Infants and Toddlers Who are
Deaf or Hard of Hearing
– developed by an interdisciplinary group of
professionals and parents in 1999
– revised in 2005
– assists families in understanding their child’s hearing
loss
– ensures that families are aware of the services that
are appropriate and necessary for their children
– organized according to 8 principles
Intervention: Principle 1
•
Early identification and diagnosis is
essential
– Behavioral characteristics of children who
are hard of hearing or deaf
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presented to help with hearing loss identification
for young children who have late-onset,
progressive or acquire a hearing loss
CT Guidelines 2005
Intervention: Principle 2
• Ongoing audiological assessment and
management must be conducted by
professionals trained to work with infants
and young children.
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Professionals involved in hearing management
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Pediatricians
ENTs
Audiologists
Hearing aid dispensers
CT Guidelines 2005
Intervention: Principle 2 (cont’d)
Trained professionals (cont’d)
– What to expect from a pediatric audiologist
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14 criteria described to help parents make choices
– Descriptions of tests used by pediatric audiologist
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Auditory Brainstem Response
Otoacoustic Emissions
Immittance Measures
Behavioral Observation Audiometry
Visual Reinforcement Audiometry
Conditioned Play Audiometry
CT Guidelines 2005
Intervention: Principle 3
• The intervention team should assist the
family in learning about the nature of their
child’s hearing loss.
– Descriptions of the parts of the ear
– Descriptions of different types of hearing loss
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Conductive
Sensorineural
Mixed
Auditory Neuropathy
Unilateral
CT Guidelines 2005
Intervention: Principle 4
• Intervention requires a team approach.
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The family is the most important member of this
team.
The Birth to Three System offers support,
assistance, and advice to families on how to best
meet their child’s unique needs.
This should include access to a wide variety of
information that is shared in an unbiased manner.
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Communication modality
Use of amplification
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CI candidacy
CT Guidelines 2005
Intervention: Principle 4 (cont’d)
Intervention requires a team approach (cont’d).
– components of family training
– components of parent support services
– listing of potential members of the intervention team
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Audiologist
Auditory-Verbal Therapist
Speech-Language Pathologist
Special Education Teacher
Teacher of the Hearing Impaired
Others
Medical professionals
CT Guidelines 2005
Intervention: Principle 5
• Parents and children are partners in
communication and must develop a
communication system in order for a
language system to develop.
– communication approaches and options
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Auditory-Oral/Auditory Verbal
Cued Speech
Total Communication
CT Guidelines 2005
Intervention: Principle 6
• Language development begins as soon as
a child is born and develops through
interactions with the family during daily
routines.
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Families understand aspects of language
development
Children and families need a way to communicate
with one another
Children need daily opportunities to learn and use
language in natural settings
CT Guidelines 2005
Intervention: Principle 7
• Parents need to understand and manage
the hearing aids and/or auditory equipment
for their child. A program must help the
family learn how to maintain any hearing
aids or equipment.
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Understanding initial and ongoing needs
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“Work in Progress”
Understanding what assistive technology is
needed and how it works
CT Guidelines 2005
Intervention: Principle 8
• Parents are advocates for their children
who are hard of hearing or deaf. Early
intervention should help parents
understand their rights as identified in state
and federal legislation.
• IDEA (Parts B and C)
• Section 504
• Americans with Disabilities Act
CT Guidelines 2005
Transitioning From Part C Services
• Transition from B23 to Preschool/Part B
– transition plan included in all IFSPs
– referral to school district by 24 months
– transition conference at least 90 days and up
to 9 months before 3rd birthday
• Parents need to be knowledgeable about
Part B eligibility and programming
• Things parents should consider as part of
transition from Birth to Three services
Transitioning From Part C Services
• Things parents should consider as part of
transition from Birth to Three services to
LEA
– the child’s continued need for audiological
services;
– assistance with acquiring and maintaining any
assistive technology the child currently uses;
– communication modality (access to language
in the modality the family has chosen);
Transition Considerations
(cont’d)
– who the family will contact for ongoing
information and guidance with the child’s
hearing impairment;
– interaction with peers including children who
are and are not hard of hearing or deaf;
– transportation;
– any additional need for equipment;
– the classroom environment including the
acoustics of the setting;
Things to consider
– the philosophy of the school program;
– staffing;
– training needs for staff; and
– levels of support needed.
The PPT (including parents) reviews
developmental information to determine
eligibility.
Questions and Answers
A series of frequently asked questions posed by parents with
answers. Some examples:
Q: My child’s audiologist has not been able to complete an audiogram
on my child, yet she wants him to wear hearing aids. Is that OK?
A: Yes, the identification of a child with a hearing loss is the first step in
the process of audiological services. When a child is very young, it
may take a series of evaluations to complete a hearing profile. At
the same time, the audiologist should put hearing aids on the child
as soon as possible and refine them over time. A pediatric
audiologist will use the information acquired in testing as well as in
trial periods with hearing aids to complete the audiological
recommendations for your child.
Questions and Answers
Q: How do I know if my son is a candidate for a
cochlear implant?
A: This is a discussion you will need to have with
a variety of people, including your son’s primary
health care provider, audiologist, and
intervention team. This decision will be made
based on the extent of your son’s hearing loss,
the benefit he gets from wearing hearing aids,
and an evaluation performed at a cochlear
implant center. Your son’s service coordinator
can provide you with information and resources
about this process.
Appendices and Index
1. Mission of the Connecticut Birth to Three
System
2. Types of Hearing Tests
3. Description of and Audiogram
4. Resources Available on the Internet,
Connecticut Resources and National
Resources
5. What is Relay Service?
Specialty Programs
• In Connecticut infants and toddlers who
are hard of hearing or deaf can receive
services through one of the three specialty
programs.
– American School for the Deaf
– New England Center for Hearing
Rehabilitation
– Soundbridge
Specialty Programs
– Benefits
• Service coordinators have expertise in hearing loss
and its associated developmental effects
• Audiologists part of the program
• Staff knowledgeable about needs of I/Ts with
hearing loss and their families
• Staff knowledgeable about assistive technology
• Staff knowledgeable about the child’s needs in
preschool – the transition process
• Staff knowledgeable about IFSP components for
I/Ts with hearing loss
Specialty Programs
– Difficulties
• Statewide travel
• Incorporating other services
• Intensity of services
Assistive Technology
– B23 payer of last resort for assistive
technology
– Request for funding pending insurance
payments
– All assistive technology and supplies are
ultimately funded (after approval)
• significantly reduces delay in providing
amplification, earmolds, supplies
• audiologists are willing to move forward with
amplification
Unique Needs of Infants and Toddlers
with Hearing Loss
• Connecticut’s Part C implementation recognizes
the unique needs of infants and toddlers with
hearing loss and their families
• Audiological management and assistive
technology are included as a service in the
child’s Individualized Family Service Plan
(IFSP).
– recognizes that auditory development is basic to
communication regardless of modality
Connecticut’s Service Provision Model
• This model of service provision recognizes that all
infants and toddlers with hearing loss need intensive
services.
– Children who need other services (e.g., PT) will have them
included in the IFSP.
• As the professionals have expertise in hearing loss all
early intervention services can be provided in a familycentered, supportive approach that addresses the
specific associated needs.
• Families are not required to select one of the three
specialty programs. They may opt for one of the
comprehensive programs.