Evaluating the Effectiveness

of Early Identification

and InterventionKathryn 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 interventionLength of time receiving early intervention services has increasedLarge 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 1970sModel based on service coordinators with certification in education of deaf/hard of hearingState divided into geographic regionsPart-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

Western Region10 families

Yuma

55 families

148 families

25 families

Why explore ways to evaluate what we do?

With national focus on accountability, impetus to critically evaluate what we doResources available through CDC cooperative agreement Generation of state-wide data base to assess children from screening to outcomes of early interventionDesire 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)

Description of 62 ChildrenVariable Number Percent

Gender Male 25Female 37

Male 40Female 60

Degree of Loss(PTA better ear)

26-46 dB 1641-55 dB 1456-70 dB 971-90 dB 1991+ dB 4

26-46 dB 2641-55 dB 2356-70 dB 1471-90 dB 3191+ dB 6

Type of LossSensorineural 55Conductive 7

Sensorineural 89Conductive 11

DHH Adult in Home 7 of 62 11

DHH Sibling 10 of 62 16

Description of 62 Children

Variable Number PercentDaily Hearing Aid Use (Hours Amplified)

0 hrs. daily 4Less than 3 hrs 84 to 5 hrs 76 to 10 hrs 43

0 hrs. daily 7 Less than 3 hrs 134 to 5 hrs 116 to 10 hrs 69

Primary Language Used with Child

English 48Other 14

English 77Other 22

Primary Mode Used with Child

Spoken 44Signed 18

Spoken 71Signed 29

Child Development Inventory(Ireton, H. 1992)

Parent completed inventory of child’s performance Expressive LanguageLanguage ComprehensionSocial DevelopmentSelf HelpGross MotorFine Motor

Yes/No responseYes: child currently performs or previously performed No: child doesn’t perform

270 itemsNormative data on children from 15 months to 6 years of age

Child Development Inventory

Language FactorExpressive LanguageLanguage ComprehensionSocial Skills

Self Help/Motor FactorSelf Help SkillsGross Motor SkillsFine Motor Skills

Correlations betweenDemographic Variables and

CDI Language Factor Results

Variable Expressive Comprehension SocialAge ID -.32* -.38 -.03

Age Aided -.37** -.41** -.18Age Referred -.29* -.32* -.14

Degree of Loss -.39** -.43** -.04Type of Loss .16 .20 .13DHH Adult .20 .29* .37**

DHH Sibling .18 .21 .22Daily HA Use -.14 -.19 -.25*

Lang with Child .01 -.04 -.07Mode with Child .18 .12 .04

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 outcomeThe earlier a child is aided, the better the language outcome

Summary

The milder the hearing loss, the better the language outcomeThe presence of a deaf adult positively impacts language comprehension and social outcomesNeither 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 accountabilityResources available through CDC cooperative agreementGeneration of state-wide data base to assess children from screening to outcomes of early interventionDesire 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?

Aligning Goals and Assessments

 

What do we want children to know and be able to do by the time they are three years of age?

Critical Goal Source of Evidence

1. Communicate wants and needs, emotions, feelings and ideas with age-appropriate language

a. Infant/Child Development Inventoryb. McArthur Communicative

Development Inventoryc. SKI*HI Language Scaled. Parent Report

2. Demonstrate social, self-help, cognitive and motor skills at age level

a. Infant/Child Development Inventoryb. Vineland Adaptive Behavior Scalec. Therapist reports and evaluations.

3. Accept and use amplification (as appropriate)

a. Parent Report

Initial Evidence for Critical Goals

Outcome data obtained for 121 children from June 2003-June 2004Assessment instruments addressed specific goalsProgress 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

Variable Number (105) PercentGender Male 58

Female 47Male 55Female 45

Ethnicity White 48Other 57

White 46Other 54

Additional Disability

Yes 23No 82

Yes 22 No 78

Age of Identification

Birth – 3 mths 614 mths – 6 mths 207 mths – 12 mths 19More than 12 mths 5

Birth – 3 mths 584 mths – 6 mths 19 7 mths – 12 mths 18More than 12 mths 5

Goal: Communicates wants, needs, emotions, feelings and ideas

with age-appropriate languageLanguage Performance Levels on the Infant Development Inventory

0102030405060708090

100

First Admin(n=83)

Second Admin(n=51)

Third Admin(n=17)

Perc

ent o

f Chi

ldre

n

TypicalDelayed

Goal: Communicates wants, needs, emotions, feelings and ideas

with age-appropriate language

IDI Language - Developmental Increase Compared to Age Increase

0102030405060708090

100

Admin1 to Admin2 (n=51) Admin2 to Admin3 (n=16)

Perc

ent o

f Chi

ldre

n

Developmental Increase Equal to or Greater Than Age IncreaseDevelopmental Increase Less Than Age Increase

Goal: Communicates wants, needs, emotions, feelings and ideas

with age-appropriate language

Individual Child Language Performance Over Time (1=Developmental Increase Equals Age Increase)

0

0.5

1

1.5

2

Admin 1 to Admin 2 Admin 2 to Admin 3

Dev

elop

men

tal/A

ge R

atio

Child 1 Child 2 Child 3

Description of Children on Whom Child Development Inventory Completed

Variable Number (57) PercentGender Male 29

Female 28Male 51Female 49

Ethnicity White 26Other 31

White 46Other 54

Additional Disability

Yes 9No 48

Yes 16 No 84

Age of Identification

Birth – 3 mths 194 mths – 6 mths 107 mths – 12 mths 9More than 12 mths 12Unknown 7

Birth – 3 mths 334 mths – 6 mths 18 7 mths – 12 mths 16More than 12 mths 21Unknown 12

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

Performance Levels On Child Development Inventory

(Time 1 n = 57, Time 2 n = 16)

0102030405060708090

100

Social1 Social2 SelfHelp1 SelfHelp2 FineMtr1 FineMtr2

Perc

ent o

f Chi

ldre

n

TypicalBorderlineDelayed

Goal: Communicates wants, needs, emotions, feelings and ideas

with age-appropriate language Language Performance Levels on

Child Development Inventory (Time 1 = 55; Time 2 = 15)

0102030405060708090

100

LangComp 1 LangComp 2 ExpLang 1 ExpLang 2

Perc

ent o

f Chi

ldre

n TypicalBorderlineDelayed

Goal: Communicates wants, needs, emotions, feelings and ideas

with age-appropriate language

CDI Language - Developmental Increase Compared to Age Increase (n=15)

0102030405060708090

100

ExpLang 1 to 2 LangComp 1 to 2

Perc

ent o

f Chi

ldre

n

Developmental Increase Equal to or Greater Than Age IncreaseDevelopmental Increase Less Than Age Increase

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 lossI 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 SurveyDesigned by parents and service coordinatorsParent Advisor leaves survey with parent and collects at subsequent home visitEnglish and Spanish versions5 point rating scale

1 = Never 5 = AlwaysCompleted every 6 months

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

Average Survey Rating (1-never; 2-not often; 3-sometimes; 4-usually; 5-always)

012345

Comfortably ReadStories

Know Age Appr.Skills Undstand Child'sCommun

Rat

ing

Home Lang. Spanish (n=5) Home Lang English (n=4)

Summary of Parent SurveySpanish speaking parents rated multiple items lower than English speaking parentsParents of older children generally rate survey items higher than parents of younger childrenImportant to increase size of sample

How can we best describe the impact of Early Intervention?

Pursue assessment of both parent and child goalsEvaluate alignment of assessment procedures and goals

State accountability requirementsDocument progress in multiple ways

Group performanceIndividual performance

Disaggregate data by demographic characteristics of children

How can we use obtained child and parent data?

Evaluate learning experiences and instructionCurriculumMaterialsSequence of instruction

Determine whether family demographics indicate differentiated service needsEvaluate impact of qualifications and training of early interventionistsDetermine whether current structure of service delivery appropriate

Use child and parent data to address individual needs