preferred practice guidelines for the assessment of...

Preferred Practice Guidelinesfor the

Assessment of Children Birth to Three Who are Deafor Hard of Hearing

Developed by Oakland Schoolsand the Oakland County Birth to Three Deaf and Hard of Hearing Stakeholders’ Committee January 2008

Preferred Practice Guidelines for the Assessment of Children Birth to Three Who are Deaf or Hard of Hearing�

ForewordPreferred Practice Guidelines

For the Assessment of Children Birth to Three Who are Deaf or Hard of Hearing

While standard assessment procedures may be appropriate for many children birth to three years, children who are deaf or hard of hearing may have cultural and/or linguistic differences that make the assessment process challenging. In order for educational teams to more meaningfully assess children, Oakland County educators are faced with the task of expanding their knowledge about this unique population. With this in mind, the Preferred Practice Guide-lines for the Assessment of Children Birth to Three Who are Deaf or Hard of Hearing was developed. It is our hope that these guidelines will assist in achieving systematic and knowledge-based assessment procedures for this low incidence population.

The contents of the Preferred Practice Guidelines for the Assessment of Children Birth to Three Who are Deaf or Hard of Hearing are deliberately concise so they may be as useful as possible to the assessment team. They include the features we believe are essential to remember when assessing a child, birth to three years of age, who is deaf or hard of hearing. Each guideline lists resources that will allow the team to gain more information, as needed. While the resources are not all inclusive, we feel they will give the team a place to begin should they desire more informa-tion on a topic. We encourage you to share these guidelines and resources with families since they are an integral part of the assessment team.

In providing these guidelines, we would like to acknowledge members of the Oakland County birth to three deaf and hard of hearing stakeholders committee, who provided ideas, reviewed documents, and helped write sections of these guidelines. Additionally, the book, Meeting the Needs of Students Who Are Deaf or Hard of Hearing, Edu-cational Service Guidelines, written by the National Association of State Directors of Special Education, Inc. was invaluable as a resource for our guidelines.

Many thanks to...Susan Dilgard

Kid Black FedioDiane Fekete

Michelle GarciaNancy GaronJanet Gilbert

Shon HalackaKristi Kirschman

Dawn KogerMary Ann Lyon

Kylie SharpSusan SwartzNancy TaylorRichard Totin

Howard Yerman

For additional information about this document contact Student Services at 248.209.2308.

Preferred Practice Guidelines for the Assessment of Children Birth to Three Who are Deaf or Hard of Hearing �

Table of Contents

Foreword ............................................................................................................................................................................ 2

Section 1: Foundations for Assessment of Children who are Deaf/Hard of Hearing • Communication Etiquette ..................................................................................................................................... 4 • Full Access to an Interpreter .................................................................................................................................. 5 • Resources and Information about Deaf and Hard of Hearing Individuals ....................................................... 6

Section 2: Providing Quality Assessment • Using the Comprehensive Multi-Domain Assessment ....................................................................................... 7 • Interpreting the Audiogram and Medical Information ....................................................................................... 9 • Language and Communication .......................................................................................................................... 10


In a preferred practice assessment, before theIEP/IFSP, the team needs to consider:

Guideline # 1: Communication etiquette

• Raising your voice or shouting does not help and can be detrimental because it distorts typical facial and mouth movements. Only speak louder if requested. Brief, concise written notes may be helpful.

• If you need to attract the attention of a person who is deaf or hard of hearing, touch him or her lightly on the shoulder.

• Look directly at the person. Speak clearly, naturally and at a normal pace. Do not exaggerate your lip movements or shout. Speak expressively because the person will rely on your facial expressions, gestures and eye contact. Not all persons with hearing loss can read lips. (Note: It is estimated that only four out of ten spoken words are visible on the lips.)

• Place yourself facing the light source and keep your hands and other objects away from your mouth when speaking.

• In the United States many deaf people use American Sign Language (ASL). It is a language with its own syntax and grammatical structure.

• When scheduling an ASL or oral deaf interpreter for a person, be certain to retain a qualified interpreter that speaks and interprets in the language of the person.

• If an interpreter is present, it is commonplace for the interpreter to be seated across from the person requiring the interpreter. Speak directly to, and maintain eye contact with, the person requiring interpreting and not the

interpreter.

• Interpreters facilitate communication but should not take over the role of a team member unless asked to function as such.

Resource:www.ada.gov


In a preferred practice assessment, before the IEP/IFSP, the team needs to know about:

Guideline # �: Full access to an interpreter for any language

The State of Michigan provides services to students who are eligible for Special Education from birth to 26 years of age. State and federal law mandate the use of a qualified interpreter of the deaf when necessary to ensure effective communication during all stages of the assessment and placement process.

• Recent Michigan legislative action (PA 23 and PA 24) defines a “qualified” interpreter of the deaf as a person who is certified through the National Registry of Interpreters for the Deaf or by the Division of Deaf and Hard of Hearing (DODHH) in the Department of Labor and Economic Growth (DLEG). Some deaf adults may need a qualified ASL interpreter, and some oral deaf adults may require a qualified oral interpreter or use of

Communication Access Realtime Translation (CART).

• If spoken English is not the parents’ or legal guardians’ native language, or if access to spoken language is compromised, a qualified interpreter must be used for the consent to evaluate, assessment process and IEP/IFSP.

• Further, there are additional procedural safeguards to ensure that testing and evaluation materials and procedures utilized for the purposes of evaluation and placement of children with disabilities for service... will be selected and administered so as not to be racially or culturally discriminatory.

• Materials or procedures shall be provided and administered in the child’s native language or mode of communication, unless it clearly is not feasible to do so, and no single procedure shall be the sole criterion for

determining an appropriate educational program for a child.

In summary, if parents’, legal guardians’ or child’s native language is other than spoken English, or if access to spoken language is compromised, a qualified interpreter must be used during all stages of the assessment. When considering giving procedural safeguards to families whose native language is ASL, the assessment team needs to know that ASL currently has no written form.

Resources:• Division of Deaf/Hard of Hearing www.michigan.gov (Search for 2007 Interpreter Directory)• Communication Access Realtime Translation, (CART) www.michigan.gov/disabilityresources


In a preferred practice assessment, before the IEP/IFSP, the team needs to know about:

Guideline # �: Resources and Information about Deaf and Hard of Hearing (d/hh) Individuals

Your assessment team may have never evaluated a young child who is deaf or hard of hearing. Some general facts may be helpful:

• In the United States, approximately 1 in 1,000 newborns are born profoundly deaf. Another 2 to 3 out of 1,000 babies are born with partial hearing loss.

o There are approximately 14, 623 live births per year in Oakland County. This means that approximately 15 babies will be born with deafness and another 29 with partial hearing loss.

• 90% of deaf and hard of hearing (d/hh) children are born to parents with normal hearing so approximately 39 of the families of Oakland County babies will have parents with normal hearing and 5 families will have parents who are deaf or hard of hearing.

• Approximately 90% of d/hh people listen to and use spoken language, so approximately 4 families will have deaf or hard of hearing parents who use spoken language while one may not. In families where the parents are deaf or hard of hearing, you may find different attitudes about being deaf or hard of hearing.

• Infants identified with hearing loss can be fitted with amplification as young as 4 weeks of age.

• Even mild hearing loss or hearing loss in one ear can significantly interfere with the reception of spoken language and educational performance (American Speech-Language-Hearing Association, 2007).

It is also helpful for your team to know that:• Many people who are deaf identify themselves as members of a specific culture, rather than as having a loss or

impairment. This culture is defined by a shared heritage, similar experiences and a common language which is American Sign Language (ASL). Therefore, many deaf families and individuals consider themselves to be

multicultural because they value their personal ethnic heritage, as well as the unique aspects and traditions related to their identity with the Deaf Culture.

• Other people who are deaf or hard of hearing believe their sensory inheritance must be respected and utilized to the fullest extent possible. The presence of a hearing loss may have an adverse affect on the awareness of

environmental sounds and speech, but it does not preclude the development of spoken language. Early and proper use of technology and other interventions to maximize residual hearing are crucial in providing the foundation for spoken language and effective oral communication.

Everyone agrees that early identification and intervention are crucial for the development of language in all children who are deaf/hard of hearing.

Resources:• www.agbell.org/MI/ Alexander G. Bell Association for the Deaf and Hard of Hearing - Michigan chapter • http://www.mihandsandvoices.org/ Hands and Voices Association – Michigan chapter• www.deafcan.org - Deaf Community Advocacy Network – Deaf C.A.N.!


In a preferred practice assessment, before the IEP/IFSP,the team needs to:

Guideline # �: Appropriately Use the Comprehensive Multi-Domain Assessment

Initial eligibility for Early On® is determined by a multidisciplinary assessment team, including parent(s), and must consider the following sources of information:1) a developmental history reported by the parent(s) and/or primary caregiver about the prenatal, peri-natal, and

family life experiences that may have influenced the child’s development;2) a health status appraisal from a nurse, nurse practitioner, or a physician that follows standards set by the American Academy of Pediatrics; 3) an observation of the child with the parent(s) and/or the primary caregiver; and4) an appropriate formal, developmental assessment measure that systematically observes abilities and skills (standardized developmental test, inventory, or a behavioral checklist). This formal measure shall not be used as

the sole criterion to determine the absence of a delay.

The following information must be included as part of the evaluation process:

1) Developmental History

• Complications during pregnancy or delivery• Family history of hearing loss, language problems, or

speech problems• High risk indicators present at birth• Hospitalizations• Previous therapies or early intervention services• Parent observations regarding child’s hearing status• Information about daily care-giving• Parent observations regarding developmental milestones, including communication• Information about family communication patterns/

style (primary language, gestures, words, signs, etc.)• Feelings about the overall parenting experience

3) Parent-Child Observation

• Observations of child development within the context of the care-giving environment

• Focus on interactions during caretaking, play and other daily routines

• Examination of development across domains• Parent-child communication within the natural environment

2) Health Appraisal

• A recent and comprehensive health examination (within the last 3 months for a child under the age of 18 months, or the last 6 months for a child over the age of 18 months) which is reviewed and placed in the child’s file

• Previous hospitalizations• Current medications• Past illnesses• Ear infections, disorders, or surgery(-ies)• Previous or current therapies• A comprehensive examination from a licensed audiologist who has expertise working with infants

and toddlers 4) Formal and Developmental Assessment

• Multi-disciplinary team• Administered by a qualified professional(s)• Standardized, formal assessment measure that looks

at all of the following developmental domains (regardless of the reason for referral) • Gross Motor • Fine Motor • Cognitive • Social-Emotional • Communication • Self Help • Hearing • Vision


Other necessary evaluation components:

I. Comprehensive Visual ExaminationIt is important to consider a comprehensive visual evaluation. The evaluation should be conducted by an ophthal-mologist who has expertise working with infants and toddlers, and include at a minimum assessments for:• Astigmatism• Left-right tracking• Fluidity in scanning for and focusing on a stimulus• Eye teaming• Color blindness• Depth perception

II. Family PrioritiesWith parental consent, an evaluation must also consider the family’s concerns, priorities, and resources. This process helps identify what the family needs to help their child grow and learn.

Note:The specific abilities and issues that children who are deaf or hard of hearing bring to the evaluation process may challenge the validity of some items in any assessment instrument. It is important that the assessment instruments your team uses measures what they are designed to measure and not the effects of the child’s inability to hear.

Resources:• SKI-HI Curriculum – Assessment Section www.skihi.org• Colorado Home Intervention Program The F.A.M.I.L.Y Assessment www.csdb.org• Laurent Clerc National Deaf Education Center/Gallaudet University www.clerccenter.gallaudet.edu

A Teacher or Teacher Consultant for Deaf/Hard of Hearing, who has experience with young children, can behelpful with assessment in the areas of communication, spoken or sign language, speech, and auditory skilldevelopment using the appropriate instruments for Deaf /Hard of hearing children birth to three years of age.

Oakland County Resources:• http://www.oakland.k12.mi.us/Departments/SpecialEducation/StudentServices/HearingImpairment/tabid/768/

Default.aspx Hearing Services Team – teacher consultants• Supervisor, County-wide Deaf /Hard of Hearing Early Intervention Program and Teacher Consultant Services Bloomfield Hills School District (http://dhh.bloomfield.org) Phone 248.341.7175 and Videophone 248.341.7179• http://www.oakland.k12.mi.us/Departments/SpecialEducation/StudentEvaluation/SpeechandLanguage/tab-

id/1656/Default.aspx Speech and Language consultants


In a preferred practice assessment, before the IEP/IFSP,the team needs:

Guideline # �: Resources to interpret the audiogram and medical informationA comprehensive audiological evaluation is more than an audiogram, the plotted hearing test results. It serves two functions for infants and toddlers. It is the first step toward determining eligibility for Special Education and it also assists with identification of needs and services. According to the Individuals with Disabilities Act (IDEA), a child with a bilateral or unilateral hearing loss of any degree meets the disability component for eligibility for Special Edu-cation services. Neither IDEA nor state regulations define a minimum hearing level requirement. Within Michigan, the Revised Administrative Rules for Special Education (2002) identify how eligibility for Special Education services is determined:

R 340.1707 Hearing Impairment explained; determination:Rule 7

1) The term “hearing impairment” is a generic term which includes both students who are deaf and those who are hard of hearing and refers to students with any type or degree of hearing loss that interferes with development or adversely affects educational performance. “Deafness” means a hearing impairment that is so severe that the student is impaired in processing linguistic information through hearing, with or without amplification. The term “hard of hearing” refers to students with hearing impairment who have permanent or fluctuating hearing loss which is less severe than the hearing loss of students who are deaf and which generally permits the use of the auditory channel as the primary means of developing speech and language skills.

2) A determination of impairment shall be based upon a comprehensive evaluation by a multidisciplinary evaluation team, which shall include an audiologist and an otolaryngologist or otologist.

the audiological evaluation consists of information gathered:• By a licensed audiologist who has expertise working with the pediatric population• Using objective physiological or electrophysiological measures as well as behavioral measures specific to the

child’s developmental level• To guide amplification, language and communication choices• To determine the need for medical follow-up

A comprehensive otologic (medical) evaluation by an ear, nose and throat physician includes, but is not limited to,a) physical examination of the earsb) indication of type and level of hearing lossc) determination of any contraindications for amplification use.

Resources: • http://www.oakland.k12.mi.us/Departments/SpecialEducation/StudentEvaluation/Audiology/tabid/1589/Default.

aspx - Oakland Schools Audiology• http://www.oakland.k12.mi.us/Departments/SpecialEducation/StudentServices/HearingImpair-ment/tabid/768/

Default.aspx - Hearing Services Team - Teacher consultants• Supervisor, County-wide Deaf /Hard of Hearing Early Intervention Program and Teacher Consultant Services Bloomfield Hills School District (http://dhh.bloomfield.org) Phone 248.341.7175 and Videophone 248.341.7179

For information about otologists contact Oakland Schools Audiology services at 248.209.2259.

Preferred Practice Guidelines for the Assessment of Children Birth to Three Who are Deaf or Hard of Hearing10

In a preferred practice assessment, before the IEP/IFSP, the team needs:

Guideline # �: Resources about language and communicationChildren with hearing loss may build their communication skills using the following languages:

a. American Sign Language (ASL) is a complex visual-spatial language that employs signs made with the hands and other movements, including facial expressions and postures of the body. ASL is a linguistically complete,

language. It is the native language of many Deaf adults and children and the recognized language of the Deaf community. ASL has its own rules for the creation of words, rules for hand shapes, and grammar that is very

unlike that found in spoken languages. Currently, there is no written form for ASL. Resource: http://www.deaflibrary.org/asl.html

b. Spoken Language is a complex auditory language in which words are said through the mouth. Spoken Language also involves listening. Most hearing persons and many hard of hearing adults and children acquire their first language by listening to spoken language. Some deaf adults and children also acquire language by listening to spoken language with the assistance of amplification. Spoken language has its own set of sounds, vocabulary, grammar and word order. Spoken language has a written form.

Resource: Crystal, David (1997). English as a Global Language. Cambridge: Cambridge University Press.

The following are communication /educational methodologies:

• ASL/English (Bilingual/Bicultural) means learning two languages and two cultures. It incorporates the use of American Sign Language (ASL) as the primary language of instruction in the classroom. ASL/English supports instruction in Deaf culture, and English is taught as a second language through reading and written print.

Resource: Schwartz, Sue (1996). Choices in Deafness: A Parents’ Guide to Communication Options. Bethesda, Maryland:

Woodbine House Inc.

• Auditory-Oral combines amplified residual hearing through hearing aids or electronically stimulated hearing through cochlear implants with contextual cues, such as speech-reading, to assist in understanding. It involves training to develop spontaneous speech and process language through auditory pathways by listening.

Resource: http://www.bradingrao.com/auditory1.htm and www.agbell.org

• Auditory-Verbal uses amplified residual hearing or electronically stimulated hearing through cochlear im-plants to listen and process spoken language. It involves early intervention training to develop spontaneous speech and process language through auditory pathways by listening.

Resource: http://www.agbellacademy.org/AuditoryVerbalTherapy.htm

Preferred Practice Guidelines for the Assessment of Children Birth to Three Who are Deaf or Hard of Hearing 11

• Cued Speech is a visual communication system that uses eight hand-shapes for consonants in different placements near the face to indicate vowels. It combines with the mouth movements of speech to make spoken

language visible. Cueing provides for the eyes the same linguistic building blocks that spoken language creates for the ears. Hand cues clarify sounds that look alike (“p” and “b”) or those that may be invisible on the lips

(“k” and “g”). Resource: www.cuedspeech.org

• Pidgin Signed English (PSE) is the process of signing American Sign Language in English word order. This signing incorporates some features of ASL and some features of English. Resource: http://infotogo.gallaudet.edu/545.html

• Signed Exact English (SEE) follows the grammatical structure of English. It makes visible everything that is spoken. SEE supplements what a child cannot get from hearing amplification and/or speech-reading.

SEE modifies and supplements the vocabulary of American Sign Language. Resource: http://www.seecenter.org/faq.htm

• Total Communication utilizes all means of communication including, sign language, voice, finger-spelling, lip-reading, amplification, writing, gesture, and pictures. The method uses all available sensory and

communication abilities to assist the child in communicating in whatever way is most effective. Resource: http://deafness.about.com/cs/communication/a/totalcomm.htm

Preferred Practice Guidelines for the Assessment of Children Birth to Three Who are Deaf or Hard of Hearing1�

Special Education2111 Pontiac Lake RoadWaterford, MI 48328-27362484.209.2308www.oakland.k12.mi.us

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