Early Intervention Outcomes Project

1. Early Intervention Outcomes Project Allison Sedey, Ph. D. University of Colorado, Boulder Kathryn Kreimeyer, Ph. D. University of Arizona, Tucson Arlene Stredler Brown, CCC-SLP, CED University of Colorado, Boulder Shirin Antia, Ph.D. University of Arizona, Tucson

2. Faculty Disclosure Information In the past 12 months, we have not had significant financial interest or other relationship with the manufacturer of the products or providers 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.

3. Marion Downs National Center for Infant HearingNational Early Intervention Coalition for D/HH Mission Statement (March, 2001) The first step in universal newborn hearing screening programs has resulted in the identification of a high number of babies with hearing loss. There is a need for qualified early intervention providers who can institute effective family-centered programs for these young children. One of the goals of this initiative is topromote the measurement and tracking of outcomes for children in early intervention programs

4. Examining Outcomes of Early Identification and Intervention • A collaborative project between • Early Intervention programs in six western states • Arizona • Colorado • Idaho • New Mexico • Utah • Wyoming • Research faculty at two universities • University of Colorado – Boulder • University of Arizona

5. Project Goals • Build capacity for a multi-state data bank • Use outcome data to • evaluate impact of early intervention on the language outcomes of DHH children beyond the geographical confines of a single state or program • monitor progress of individual children • identify child, family and program factors that predict optimal developmental outcomes for children • establish a state-level accountability system in each state to guide • state’s early intervention programs, • augment professional preparation, • influence the structure of each state’s program, • identify funding priorities • generate norms for D/HH population

6. Project Goals • Support best practices for EI by examining relationship between • service characteristics • child and family characteristics • child outcomes

7. Pilot Goals • Identify a common core of instruments to evaluate child outcomes • General development • Language development • Obtain demographic information on each child for whom assessment data are obtained • Develop questionnaires to investigate • Quality indicators of EI services • Parent satisfaction with services

8. Participating Children • A minimum of 10% of children served within each state who meet the following criteria: • Nine to 24 months of age at first assessment • No additional severe disabilities • English the primary home language • Bilateral permanent hearing loss • Conductive or sensorineural

9. Participant Selection • EI coordinator identified providers seeing a number of children and with whom can easily communicate • From these caseloads, identified children who met criteria • As of September 1, 2005, began assessing children as IFSP update due

10. Demographic Information • Collected on each child and updated every six months • General information • Hearing Loss Information • Language Use • Additional Disabilities • Intervention Services

11. General Development Instruments • Parent-report inventories • Kent Inventory of Developmental Skills (Reuter & Gruber, 2000) • Children 9 months – 14 months • Child Development Inventory (Ireton, 1992) • 15 months – 36 months of age • Include situation-comprehension scale from original (1974) version of inventory • Normed on typically developing children • Scales adapted to reflect both speech and sign performance • Completed initially and updated every six months

12. Language Instruments • MacArthur-Bates Communicative Development Inventory (1992) • Words and Gestures • Receptive and expressive vocabulary • Normed on typically developing children 8-16 months of age • Words and Sentences • Expressive vocabulary • Normed on typically developing children 16-30 months of age • Part 1 – Words Children Use • Parent-report assessment • Adapted for sign and speech

13. Participants and Completed Assessments

14. Percent of Male and Female Participants (n=60) 53% (n=32) 47% (n=28)

15. Degree of Loss(n = 54)

16. Ethnicity (n = 60)

17. Screening, Identification and Intervention • All children screened by one month of age • Hearing loss identified in 71% of children at or before 3 months of age • Identified in 87% of children by 6 months of age • Intervention initiated for 71% of children at or before 6 months of age. • Not yet reached EHDI 1-3-6 goal for all children

18. Age of Identification, Intervention and Amplification

19. Type of Amplification

20. Mode of Communication Used by Primary Caregiver

21. Minutes per Week Receiving Intervention • Nine to 30 months (n = 44) • Median 60 minutes/week • Range 15 – 300 minutes (home based/toddler group) • 31 to 40 months (n = 16) • Median 400 minutes/week (includes preschool attendance) • Range 45 to 1,440 minutes

22. Language Results

23. Determining Language Quotient (LQ) • Language Age/Chronological Age x 100 • If LQ = 100, Language Age = CA • If LQ < 100, Language Age < CA • If LQ > 100, Language Age > CA • Performance Ranges • 80 or above = normal • 70 to 79 = borderline • Less than 70 = below average

24. Kent Inventory of Developmental Skills (n=6)

25. Child Development Inventory Expressive Language

26. Child Development Inventory Language Comprehension

27. MacArthur-Bates Expressive Vocabulary

28. Language Summary • Children identified by 3 months and receiving intervention by 6 months scored higher than full sample on CDI language measures • Difference on MacArthur-Bates likely not significant • Children younger than one year of age • Lowest language quotients on Kent • Speech/auditory items may depress score • Slight delay at younger age creates lower LQ • Evaluate/modify intervention

29. Language Summary • Children 14 months or older • CDI Expressive Language higher than Language Comprehension • Median language quotients within normal range in both areas • MacArthur-Bates Expressive Vocabulary addressed children from 9 months to 40 months • Median language quotient in borderline range • Hearing children learning 30 words/month as of 18 months of age • Need to increase rate at which DHH children learning vocabulary

30. Significant Accomplishments • Collaboration across multiple states • Common demographic information • Common assessments • Obtained outcome data on 60 children • Repeated measures on 33 children

31. Next Steps • Performance over time • Qualifications of providers and relationship to child performance • Develop instrument to describe intervention • Investigate relationship between intervention and outcomes • Increase number of children on whom assessments are completed • Provide training on how to interpret state level and individual results • Encourage more programs to implement outcome-based/evidence-based intervention

32. Contact Information • Kathryn Kreimeyer • kreimeye@email.arizona.edu • Arlene Stredler Brown • arlene.brown@colorado.edu • Allison Sedey • allison.sedey@colorado.edu • Shirin Antia • santia@email.arizona.edu