Evaluating the Effectiveness of Early Identification and Intervention

1. Evaluating the Effectiveness of Early Identification and Intervention Kathryn Kreimeyer, Ph.D. kkreimeyer@asdb.state.az.us Lylis Olsen, M.S. Lylisolsen@msn.com

2. 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

3. 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.

4. 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

5. 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

6. 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)

7. Description of 62 Children

8. Description of 62 Children

9. 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

10. Child Development Inventory • Language Factor • Expressive Language • Language Comprehension • Social Skills • Self Help/Motor Factor • Self Help Skills • Gross Motor Skills • Fine Motor Skills

11. Correlations betweenDemographic Variables and CDI Language Factor Results

12. 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

13. 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

14. 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

15. 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

16. 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?

17. Aligning Goals and Assessments

18. 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

19. 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

20. Description of Children on Whom Infant Development Inventory Completed

21. Goal: Communicates wants, needs, emotions, feelings and ideas with age-appropriate language

22. Goal: Communicates wants, needs, emotions, feelings and ideas with age-appropriate language

23. Goal: Communicates wants, needs, emotions, feelings and ideas with age-appropriate language

24. Description of Children on Whom Child Development Inventory Completed

25. Goal: Demonstrates Social, Self Help and Fine Motor Skills at Age Level

26. Goal: Communicates wants, needs, emotions, feelings and ideas with age-appropriate language

27. Goal: Communicates wants, needs, emotions, feelings and ideas with age-appropriate language

28. 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?

29. 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

30. 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.

31. 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.

32. 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

33. Goals: 1. Comfortably Read Stories with Child 2. Know Age Appropriate Skills for Child

34. 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

35. 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

36. 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