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Online education has been a struggle for many students. Those with hearing loss have additional issues when accessing virtual education. The CAVE Checklist or Communication Access in Virtual Education has been increasingly in use by DHH professionals since last fall. To learn about the CAVE and see some results in report form, Read More.

Timing is everything. The CAVE Checklist  was released just as many educators of students who are deaf or hard of hearing were searching for ways to ensure their students were receiving appropriate access to online learning AND ways to illustrate to school teams the need for appropriate access if the student’s access was less than required to meet class expectations. The CAVE  was received with much excitement and relief as a means to obtain information about student access levels during online learning.
Download:   English CAVE,   Spanish CAVE,   French CAVE,   Fillable English CAVE.

The CAVE Checklist poses 10 questions that students must read (or consider in interview format) and then select the answer that applies in the situation most of the time. Very similar to the LIFE-R Student Appraisal (online, fillable form, or with pictures), the student must select  one of 6 responses.  Not every situation will apply to every student. Situations indicating appropriate access will be marked by the student as always or mostly easy. Situations in which difficulty was indicated need to be addressed for appropriate access needs.

The CAVE further asks the student what they think would help them most during online learning:

1. 1.) To have/use at home during e-learning I would like to:
2. 2.) During only learning my teachers would:
3. 3.) My comments about online learning

Example Use in Assessment Reports

Excerpts from example reports were provided by Vicki Anderson, AuD, Educational Audiologist. Details have been altered for student confidentiality.  Excerpts relate specifically to online learning situations to illustrate how the CAVE Checklist and an online FLE can assist in identifying access needs and recommendations.

Kindergarten (bilateral loss moderate, hearing aids, DM system, classroom amplification system):

Communication Access in Virtual Learning (CAVE Checklist): Developed by Karen L. Anderson, Ph.D. (2020), this self-assessment tool was designed to identify possible communication access issues that may occur during virtual education situations. Students check off closed-choice emojis representing their responses ranging from “Always Easy” to “Always Difficult” or “Doesn’t Happen”.

The CAVE was completed on STUDENT’s behalf by her father and older brother, who help her with her online classes.  There were no online learning situations that were rated as Easy for STUDENT.  Even the best-case scenario (teacher’s face is visible on screen and a boom microphone is used) was rated as Sometimes Difficult for her to hear and understand the words the teacher is saying.  When (1) the teacher’s face is visible but she is not using a microphone, (2) when her face is not visible (e.g., showing a worksheet but she is using a microphone), (3) when her face is not visible nor is she using a microphone—any of these virtual situations are Mostly Difficult for STUDENT to access the content.  An interpreter and/or captioning is currently not used and captioning, nor is any other accommodation made to allow STUDENT to understand her classmates in discussions.  It was indicated that during e-learning, family thinks it helps her most to listen through the built-in speaker of her tablet, and to be able to see teacher’s face and the faces of her classmates when they are talking.

In virtual learning, the teacher should use a boom microphone and assure STUDENT can see her face, with the computer camera on to allow student speechreading.  Age-appropriate captioning (e.g., key words and vocabulary) is recommended for all live or recorded sessions, including, PowerPoint and video presentations. With continued exposure, captioning and speechreading will improve her communication access and support her listening.

Elementary (bilateral loss mild, hearing aids, DM system)

Online Functional Listening Evaluation: this functional assessment samples the communication access of hard of hearing students in various virtual learning conditions.  We know that students with typical hearing respond with 90+% accuracy when listening in noise, even when the noise level is equal to the speech presentation level.  It is reasonable to assume that the degradation in sound that occurs when a teacher’s voice is presented over an internet streaming service (like Zoom) will not significantly decrease the speech perception and auditory comprehension ability of students with typical hearing.  For equal access, students with hearing loss should be able to perform with at least 90% accuracy during online learning presentations.

STUDENT was administered the online FLE test by the educational audiologist during a Zoom meeting accompanied by his IEP Manager.  Nonsense Children’s Phrases (C.D. Johnson, 2011) were presented under conditions representing the various teaching scenarios experienced during on-line learning. Nonsense Phrases were used to simulate new curriculum or new vocabulary.  STUDENT was wearing headphones over his hearing aids. Three conditions were tested. (1) In the ideal or “best” virtual condition, the presenter wore a boom microphone, the camera was on and STUDENT was encouraged to watch the face of the person speaking. The camera was turned off, as in a PowerPoint presentation, but the boom microphone was still used.(3) the computer microphone only was used along with the camera (visual speechreading cues). After that the computer mic was used and the camera was turned off, which exemplifies a typical live PowerPoint presentation.  Finally, to sample two in-person learning scenarios, a clear face mask was worn with only the computer microphone (no boom microphone), and lastly a clear mask was worn while using the boom microphone (this would also represent use of the Roger microphone plugged into the STUDENT’s tablet).
Results show that for STUDENT to achieve equal access to school curriculum as his normally hearing peers, for virtual learning he needs the “ideal” teaching modality where teachers use a boom microphone AND allow speechreading with the cameral ON. For in-person education in a COVID environment, teachers should wear a clear mask AND use his remote microphone system.  In virtual learning, teachers should use boom microphones and assure he can see their face with the computer camera on, and use captioning for PowerPoint or video presentations.

High school (fluctuating conductive hearing loss, student choice to not use DM system, classroom amplification systems in use in each classroom)

Communication Access in Virtual Learning (CAVE Checklist): Developed by Karen L. Anderson, Ph.D. (2020), this self-assessment tool was designed to identify possible communication access issues that may occur during virtual education situations. Students check off closed-choice emojis representing their responses ranging from “Always Easy” to “Always Difficult” and “Doesn’t Happen”.  STUDENT reported appropriate (“Mostly Easy”) access in 5 of 10 online learning situations.  Two situations were rated as “Sometimes Difficult”: 1) When teachers show information on the screen and their face is not shown, and they are not using a microphone (only the computer microphone); 2) When classmates are talking into the microphone of their devices during a group discussion.  Three accommodations she indicated “Doesn’t Happen” included use of her remote microphone technology during online learning, teachers’ use of captioning, and captioning of students’ comments.  Teachers’ wearing a boom microphone, assuring teacher’s face is visible on the screen, repeating or rephrasing students’ comments, and consistently using closed captioning for all talkers will improve and assure appropriate and equal access to online learning for STUDENT, compared with her typically-hearing peers.

Peers’ comments in class discussions should be repeated in-person and in virtual settings. In virtual learning, teachers should use boom microphones and assure she can see their face, with the computer camera kept on.  Captioning should be used for all live or recorded sessions, including, PowerPoint and video presentations.

Summary

Access denied is opportunity denied. Children with IEPs due to being deaf or hard of hearing comprise only 1% of the total number of children receiving special education services. For almost all of the other 99% the educational issue is due to a learning disorder, and not secondary to sensory access issues. Virtual education adds greater challenge to students who are deaf or hard of hearing.

Having the tools to identify student access issues and the data to make the case for appropriate access accommodations to be provided is a necessary step for students with hearing loss.

Academic success is driven by communication access. I encourage you to use the CAVE Checklist and perform the online FLE to gather the access data needed so that our students CAN be full participants in learning at the rate expected of their peers.

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Students with hearing loss, whether hard of hearing or deaf, are at high risk for deficits in syntax due to their imperfect perception of the English language. Word endings, tense, and other grammatical features are often lost when these ‘bits and pieces’ are not perceived. Extra direct instruction in grammar and syntax is usually necessary for students with hearing loss, as their missing bits often result in poorer comprehension – whether of conversation or the written word. These deficits can be glaring when a student turns in a written assignment.

The challenge: Effectively teaching grammar and syntax is a daunting task. Hearing peers largely absorb correct syntax through listening alone and have a good handle on it as they begin to develop reading skills. As early as kindergarten, typical students following the general education curriculum should be able to (with adult assistance) speak/sign, read, and write a grammatically correct sentence as simple as “I like pizza.” to as complex as “My brother rides his red bike around the park after school.” By the fourth grade, typical students should be able to speak, read, and write sentences as simple as “I like pepperoni pizza from Pizza Hut.” to as complex as “Jason, Kim and I rode in my mother’s dark blue Suburban to the movies on Friday night where we saw three of the most popular students in our school.”  By middle school, typical students are responsible for the intricate content of novels. They are often given a prompt or topic as a writing assignment and a few ideas at which point they are on their own to generate the rest. Where typically hearing and developing students gradually absorb syntax with minimal extra instruction, students with hearing loss often have to work hard to keep up with this rate and complexity of typical development.

What we need to know about syntax skills whether students use spoken language or a sign system:

• Can the student speak/sign a sentence with a subject and a verb?
• Use tense markers?
• Use singular and plural forms? Many times, the /s/ on the end of plural words is not heard. The same can hold true for the possessive ‘s. If the student uses ASL, plural is shown by repeating the sign, such as CHAIR-CHAIR-CHAIR for “chairs”
• Use articles and determiners? (the, a, that, this, etc.).
• Are there any descriptive words being used? Prepositions?
• For ASL users, is the student using classifiers? Nonmanual markers?

Assessment: As with other areas of instruction, it always helps to start with the basics – identifying the student’s challenges. As part of a functional assessment for syntax, taking language samples is a great way to take inventory of what a student knows. Use a smart phone to record a student as you read a book together or discuss a topic. Try to obtain about 50 utterances, which may take more than one session with some students. After doing recorded language samples several times, you will begin to feel adept at listening and looking for patterns in the student’s language. Other assessment methods are provided as follows.

Does the language make sense? (Is it sequential?)

When language samples have been analyzed, gaps can be determined as can targets for instruction.  Whatever your method for obtaining data whether it is language sampling, formal tests, or functional assessments suggested below, syntax is an important piece of the reading and  comprehension puzzle and must be assessed!

Other tools for gathering functional data:

Test of Grammatical Structures (TAGS)   PRESCHOOL and ABOVE

Part of the Preschool Language Pack, the CID Teacher Assessment of Grammatical Structures (TAGS) is a series of three rating forms developed to evaluate a child’s understanding and use of the grammatical structures of English. The rating forms provide a representation of grammatical structures for children with hearing loss who develop grammatical structures in smaller increments and at slower rates compared to children who are typically developing. This starter kit is a guide to using the CID TAGS system for teaching and tracking receptive and expressive language development in oral children who are deaf and hard of hearing. It can also be used to evaluate sentence structure for children who use sign language. The TAGS rating forms enable teachers to:

• determine present levels of syntax skills
• determine syntax goals for IEPs and lessons
• track syntax development over time and
• report syntax progress to parents and other professionals

Grammar Chipper Chat     GRADE K-5

These materials allow you to explore 16 of the grammatical structures found on most language assessments (i.e., CELF, TOLD). Each grammar area has 20-30 color-coded question cards with a sentence prompt on one side and images on the reverse side. The student fills in the missing word on the question side using the pictures as cues. A functional assessment can be performed using these cards. A subset of cards in each of the 16 areas (i.e 3-4 cards) can be shuffled together and presented in random order to the student. Additional cards can be presented in the areas in which there are errors to verify that there is a lack of functional use (up to 10 cards per problematic area). Refer to Brown’s Stages to assess or intervene in sequence of development. A valuable means to pinpoint issues and monitor progress in syntax learning.

Cracking the Grammar Code  GRADE 5 – ADULT
Within the 149-page FREE downloadable  Syntax Skill Pretests and Simple Skill Activities
sample book, there are pretests teachers can use to identify students’ skill levels. Each pretest has a rubric to diagnose specific skills in the broader category. The pretests and answer keys are provided for the following syntax skill areas: Nouns, Articles, Conjunctions, Verbs, Pronouns, Adjectives-Adverbs-Prepositional Phrases, Finding the Subject, and Subject-Verb agreement. A passing score is 80% on any of these functional assessments. If your student does not pass various parts of the pretest the specific lesson to start on within the Cracking the Grammar Code workbooks is provided.

Download the Free Syntax Skill Pretest book and start assessing your students ASAP!

Formal, norm-referenced testing

There are a number of test instruments typically administered by speech language pathologists that will assess a student’s level of syntax development. If a student has received an evaluation by a speech language pathologist in the previous 6 months it is often useful to review those results for insights into specific areas of syntax deficit that have already been identified.

Teachers of the deaf/hard of hearing often perform assessments related to students’ listening comprehension ability, specifically the ability to recall and understand information presented by others. Two popular assessments for this purpose also provide some information about student syntactic understanding or use. While not an extensive investigation into syntax, if a TDHH is performing one of these tests anyway, it may provide a starting place to focus additional syntax assessment, for example with the Cracking the Grammar Code free syntax skill pretest book.

Oral Passage Understanding Scale (OPUS)

For ages 5.0 to 21 years, the Oral Passage Understanding Scale is a measure of listening (auditory) comprehension. It evaluates a person’s ability to listen to passages that are read aloud and recall information about them. This ability is key to success in the classroom and social situations. It also measures memory skills, which are integral to listening comprehension. OPUS identifies how well a person can integrate and apply knowledge in three structural categories of language:

1. 1. Lexical/Semantic: knowledge and use of words and word combinations
2. 2. Syntactic: knowledge and use of grammar
3. 3. Supralinguistic: knowledge and use of language in which meaning is not directly available from the surface lexical and syntactic information.

Measuring higher-level comprehension skills, including inference and prediction, yields more detailed information beyond simply whether or not the individual can comprehend. These skills require deeper processing abilities.

Test of Narrative Language-2 (TNL2)

For ages 4.0 – 15-11, the TNL2 provides a format that shortcuts the typical lengthy language sample analysis process. No transcription is necessary. Children’s answers to the comprehension questions and their stories can be reliably scored from audio recordings (use your Smart Phone!). The instructions are scripted and clear examples are used for scoring. The TNL should be of great benefit in identifying students who have adequate language, but issues using their language ability for ongoing interactions in an age-appropriate manner.

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The IDEA law is consistent about looking at educational performance needs when considering a student’s eligibility for specialized instruction and support.  Educational performance is not equivalent to academic performance. While academic performance needs to be considered, it is no more important to consider than the other areas specified by IDEA which are functional, behavioral, social needs and any other performance considerations relevant to the specific child. If a school team only considers grades for eligibility then they are using a sole criterion, which goes against the IDEA requirement that eligibility determinations be made with consideration of at-risk areas as determined by the suspected area of disability.

Our students with hearing loss may ‘look fine’ in the classroom, yet we realize that there are usually subtle differences/needs that, added together, cause academic performance to erode over time. Even ‘good’ students with hearing loss can qualify IF there is someone on the multidisciplinary team who truly understands the impact of hearing loss on development AND uses appropriate assessments to use to tailor the evaluation process to the risk areas of students with hearing loss. Teachers of the deaf/hard of hearing and educational audiologists should have/receive the training needed to feel comfortable in assessment.

The defined purpose of IDEA⁴: To ensure that all children with disabilities have available to them a free and appropriate education that emphasizes special education and related services designed to meet their unique needs and prepare them for further education, employment and independent living. Performance of the expanded core skills needed for full participation (self-advocacy, communication repair, knowledge about hearing loss, amplification independence, etc.) are necessary for a student to be fully prepared to function as an adult. These are NOT standard areas of evaluation for other students with special needs, but they must be considered as part of a tailored assessment for students who are deaf or hard of hearing.

LIST OF RECOMMENDED ASSESSMENTS: The list includes recommendations for both functional and formal assessments for ages 3-5 years and school-age students. In evaluations, it is appropriate to look closely at social/emotional, self-advocacy, and the possibly subtle phonological/morphological awareness and ‘swiss cheese’ language skills that impact comprehension and reading fluency.

Low average language results reflect the impact of hearing loss, not capability. So often for our students, qualification for specialized instructional services hinges on the results of language assessment. A study⁵ found that 40% of students with hearing loss have a capacity for higher language levels beyond what test scores indicate. Further⁶, language learning for students with hearing loss occurs on average at 70%, or just above 2/3, of the rate of children with normal hearing. It is appropriate to anticipate that most children with hearing loss upon school entry will have some delay in expressive and/or receptive language, with greater degrees of hearing loss predicting greater levels of language delay. Also, the nature of hearing loss causes incidental language to be missed whenever a child is further away from about 3-6 feet of the speaker. This typically results in ‘spotty’ or ‘Swiss cheese’ language rather than solid overarching language delays. A student may therefore score higher than his or her actual functional language ability, based on the actual questions asked during the assessment and the individual’s particular vocabulary or conceptual knowledge.

One strong finding from the robust 2015 Outcomes of Children with Hearing Loss Study⁷ was that normative test scores overestimate the abilities of children who are hard of hearing as they are unlikely to reflect the level of effort that students are expending to maintain competitiveness with peers. Although 80%⁸ of children born deaf in the developed world receive cochlear implants, the success rate with cochlear implants is highly variable and cannot be assumed to ever ‘fix’ all language development issues, even for children with the best outcomes. We must consistently communicate with our school teams that students with hearing loss are not language disordered. Language, social, and reading delays occur secondary to lifelong decreased access to communication.

EVERY student with hearing loss who is going through initial assessment needs to have IQ testing in order to accurately and appropriately estimate if/how much the hearing loss has impacted development based on the student’s ability compared to peers who do not have hearing loss.⁹ Students with hearing loss (DHH-only) experience delays secondary to access issues. It is important to know the cognitive ability of each student with hearing loss as their communication access needs must be accommodated so that they reach the same level of achievement as their cognitive peers.

Although testing is performed in a few weeks’ time, evaluation isn’t just about a snap shot, it is about performance over time. Case in point, we received a call from a parent of a 5^th grader who is hard of hearing. The child had an IEP in kindergarten and grade 1 and was then dismissed. By the end of grade 4 the reading scores had decreased. The school team wasn’t concerned because the student ‘wasn’t very bad yet.’  Time should be taken to consider the percentile scores on reading across time to see if there has been a decline.  When looking at eligibility, dig into prior testing and see if you can make the case with declining percentile ranking in test results over time. For example, in grade 2 did the child score at the 48^th percentile in reading as compared to the 26^th percentile in grade 4? A public agency must provide a child with a disability special education and related services to enable him or her to progress in the general curriculum. The fact that there is a decline indicates that there are special needs that have not been addressed for the student. Access needs and/or deficits in specific skills foundational to reading comprehension would then need to be identified.

Sometimes administrators make the point that schools must provide educational benefit for students but do not have to guarantee that the student reaches his or her potential. Per the March 2017 decision of the US Supreme Court, schools may not settle for minimal educational progress by disabled students. Educational programs must be reasonably calculated to enable a child to make progress appropriate in light of the child’s circumstances. In the case of students with hearing loss, the expectation would be to provide full access to school communication and specialized instruction to fill in learning gaps PLUS support typical/expected levels of progress in the classroom. Therefore, evaluation must be tailored to identify the access, learning, and functional performance needs of every student with hearing loss so that they can progress equal to their cognitive peers.

References

1. Ninth Circuit Court of Appeals, June 1, 2018, S.P. v. East Whittier City School District: https://successforkidswithhearingloss. com/wp-content/uploads/2019/01/Court-case-RE-need-for-thorough-assessment-highlighted.pdf
2. IDEA section 300.324(2)(iv): Consider the communication needs of the child, and in the case of a child who is deaf or hard of hearing, consider the child’s language and communication needs, opportunities for direct communications with peers and professional personnel in the child’s language and communication mode, academic level, and full range of needs, including opportunities for direct instruction in the child’s language and communication mode.
3. LEAD-K: Language Equality and Acquisition for Deaf Kids. https://successforkidswithhearingloss.com/wp-content/uploads/2019/01/Court-case-RE-need-for-thorough-assessment-highlighted.pdf
4. The 2004 IDEA Commentary provides an overall ‘setting the stage’ for the IDEA law; on this webpage.
5. Language underperformance in young children who are deaf or hard-of-hearing: are the expectations too low? Journal of Developmental & Behavioral Pediatrics. September 19, 2017. Results² focused on children with hearing loss who have language levels within the average range on standardized measures. Researchers identified a mismatch between the cognitive level children test at and the expectations for their language skills. In examining the abilities of their 152 young child subjects they found that at least 40 percent have a capacity for higher language levels – beyond what their language test scores indicate.
6. The Effect of IQ on spoken language and speech perception development in children with impaired hearing. Cochlear Implants International, (11)1, June, 370-74. A 2010 study³ found that children were learning language at approximately 2/3 of the rate (or 70% of the rate) of their normally hearing peers. Subjects were 62 children ages 5-12 years who used oral communication and attended oral early intervention or school settings. Children in preschool learned language at a faster rate than children attending primary school. On average, children attending preschool were learning at 0.78 of the rate for normal hearing children as compared to a rate of 0.67 for students in primary school. Speech perception scores did not plateau until children had, on average, the language ability of a typically hearing 7-year-old.
7. Epilogue: Conclusions and Implications for Research and Practice. Ear and Hearing, 36, 92S-98S. Sole reliance on norm-referenced scores may overestimate the outcomes ofCHH. When the children who are hard of hearing (CHH) were compared with the norm-referenced group on various measures, the differences were small. However, when compared the CHH to a sample of CNH who were matched on age and SES, the size of the effect of HL on language doubled to two thirds of a standard deviation. These results question the sole reliance on comparison to norm-referenced test scores for judging eligibility. Standardized test scores may overestimate CHH as they are unlikely to reflect the level of effort that students are expending (cognitive and perceptual resources) to maintain competitiveness with peers in secondary schooling, where the cognitive demands increase. We need to closely monitor the outcomes of CHH including comparing their performance relative to neighborhood grade-mates. Many CHH in the OCHL study represent the best-case scenario. We might expect that a sample with greater diversity on these dimensions would not perform as well as the OCHL cohort
8. Language acquisition for deaf children: Reducing the harms of zero tolerance to the use of alternative approaches. Harm Reduction Journal, 2012, 9-16. Today, 80% of children born deaf in the developed world are implanted with cochlear devices. Due to brain plasticity changes during early childhood, children who have not acquired a first language in the early years might never be completely fluent in any language. If they miss this critical period for exposure to a natural language, their subsequent development of the cognitive activities that rely on a solid first language might be underdeveloped, such as literacy, memory organization, and number manipulation.9. Addressing the Need for Appropriate Use of Norm-Referenced Test Instruments. Supporting Success, December 2017.

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This article focuses on the ‘unseen’ challenges that children with hearing loss often experience when trying to keep up in the regular education setting.v

On the way to deeper understanding: For students with hearing loss, keeping pace in moving to a deeper level of understanding can be very challenging. A favorite study was reported by Christie Yoshinaga-Itano in 2010² and considered language learning of students with hearing loss from age 4 to age 7. There were 4 categories of results: children who were delayed at age 4 and still language delayed at age 7 (45%), those who had language within the normal range and 4 and still did at 7 (35%), those who actually closed their language learning gap from age 4 to age 7 (15%), and 10% of the children had language within the normal range at age 4, but due to lack of access and/or appropriate instructional support, developed a learning gap by age 7. Clearly, it cannot be assumed that just because a student has ‘okay’ language at school entry that they will be able to keep up with class expectations across the academic years.

Background, or world knowledge is necessary to build surface level understanding of a specific topic. Prior knowledge is an excellent predictor of performance. Our students tend to have ‘Swiss cheese language’ with unpredictable knowledge gaps in vocabulary and concepts. They also are often limited in the number of attributes they use to describe objects or concepts, further contributing to their gaps and limited world knowledge. Imagine learning about the conquistadors if you lacked knowledge of geography, discoveries of early explorers, and that there are different countries and they may desire different things.

Examples of Student Misunderstanding of Teacher Instruction³ 

“The Indians were dying because of the drought and the famine.” Student asked: “Why were they dying if they had all that fish?”  Lack of discrimination between d/t and f/s. Student thought the words ‘trout’ and ‘salmon’ were said.

Book Chicka Chicka Boom Boom was being read aloud by the teacher: “A told B and B told C, I’ll meet you at the top of the coconut tree.” At the end of the lesson, when asked to retell what was said the student replied, “Today we learned about cocoon trees.”  Thereby demonstrating that the vocabulary ‘coconut tree’ needed to be pretaught and connected to knowledge of other trees before the teacher read the story.

Filling the gaps. We can expect that surface learning will take longer for students with hearing loss than their typically hearing peers. Students who have a less complete understanding of surface level information are not going to benefit to the same degree, or at the same rate, during interactive activities meant to move them to deeper understanding.  “Closing the language gaps” is not just something that is a nice extra touch to provide to our students if there is a teacher of the deaf available; it is necessary for deeper learning. Add to this the fact that reduced precision listening ability often delays literacy skill development and slows reading fluency. Just teaching vocabulary, without sufficient phonological awareness, will not develop the reading fluency the students need for comprehension at the pace of peers. Filling in the gaps in prior knowledge is necessary if a child is to be able to develop the surface learning that is prerequisite to developing deeper understanding. Without this surface learning, a deeper understanding is not possible.

Conversational inequalities. Research⁴ has indicated that during one-on-one conversations in a quiet setting, students who are hard of hearing have conversational skills equivalent to their hearing peers. This includes skills for initiating a conversation, maintaining a dialogue over several turns, shifting the topic, and terminating the conversation. In a typical mainstream classroom, there are many choices for communication partners along with background noise, reverberation, and listening at distances beyond 3 feet that interfere with speech perception of students who are hard of hearing. Students with hearing loss make fewer overall communication attempts than their hearing peers. They also often seem unaware when their peers tried to initiate conversation and did not attempt to maintain the conversation. When they attempt to maintain the conversation they generally use one-to two-word phrases to maintain the communication and do not add new information. The research found that in a 1:1 conversation, 75% of the maintenance attempts by children with hearing loss were appropriate compared to 100% for hearing peers. They frequently tried to maintain the conversation by bringing up a topic that was unrelated to the conversation. In other words, they were not aware enough of the content of the conversation to contribute information, so they brought up a new topic.

Thus, educational practices to move to deeper understanding by way of interaction with peers is often very challenging for students with hearing loss. As can be inferred by the research, in quiet settings listening by students who are hard of hearing often approaches or equals peers. Therefore, it is the acoustic access inequality in the classroom that results in conversational challenges for students with hearing loss. This provides a powerful argument for the use of hearing assistance technology (HAT) that will improve perception of peer voices in 1:1 or group settings.

Challenges repairing breakdowns. Another aspect of conversation relates to what a person does when they do not fully understand. One study⁵ found that persons with hearing loss were able to cue into changes in topic but had much more difficulty when a shift in topic was made during the conversation. The research findings can be summarized as, the more predictable the conversation, the fewer the likely breakdowns. If a student is sitting with a group who maintains their focus on the problem-solving task, the level of understanding is likely much higher than if the student was in a group who wandered off topic repeatedly.  The teacher needs to be aware of this issue when pairing the student with different partners or groups. Moving to a quieter area for discussion will not ensure full participation by the student with hearing loss, but will make participation easier and more likely. Including him or her in a group that sticks to the topic will heighten the value of the exercise for the learner with hearing loss.

Keeping up in the classroom is a challenge for children with hearing loss due to access issues that interfere with understanding conversational communication and the gaps in knowledge resulting from decreased auditory access since infancy (or sign communication with limited language models since infancy). Filling the gaps of vocabulary and phonological awareness is necessary for students to keep up with class expectations for developing surface learning. Access to classroom discussion and for all group activities is a prerequisite for deep learning to occur. Providing the appropriate access technology is a necessity to facilitate deeper learning to occur within the classroom. Selecting appropriate group partners and honing communication repair skills is also critical to students with hearing loss achieving at the same rate and to the same level as peers.

References:

1. Fisher, Frey, Hattie (2016) Visible Learning for Literacy Grades K-12: Implementing the Practices that Work Best to Accelerate Student Learning. Corwin/SAGE, Thousand Oaks, California

2. Yoshinaga-Itano (2010). The longitudinal language learning of infants and children with hearing loss. ASHA Virtual EHDI Conference, October.

3. Meyer, Kym (8/17/2017). Wait – There’s a Student with Hearing Loss Coming into My Class? Webinar viewable at https://www.youtube.com/watch?v=r3ytOawiYuI&feature=youtu.be

4. Duncan (2001). Conversational skills of children with hearing loss and children with normal hearing in an integrated setting. The Volta Review, 101(4), 193-211.

5. Caissie (2002). Conversational topic shifting and its effect on communication breakdowns for individuals with hearing loss. The Volta Review, 102(2), 45-56

2017 © Karen L. Anderson, PhD, Late November Update, Supporting Success for Children with Hearing Loss http://successforkidswithhearingloss.com This information is not intended as legal advice.

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Special education students are first and foremost general education students. Many, if not most, school districts in the US are actively embracing the inclusion model of education, in which all students are educated in the mainstream classroom, regardless of the diversity of their needs.

Students who are deaf and hard of hearing (DHH) have special needs but not they are not due to learning disorders like most other special education populations. The primary difference between students with hearing loss and their classmates is that they do not access speech as fully. Background noise and distance have exaggerated effects on the student with hearing loss as compared to typically hearing peers. Students who are DHH-only have learning gaps and unique needs secondary to access to communication issues, not learning disorders.

Basics of inclusion:

Inclusion in education is an approach to educating students with special educational needs. Inclusion rejects the use of special schools or classrooms to separate students with disabilities from students without disabilities (source). Some inclusive classes use a collaborative team teaching (or co-teaching) model with a special education teacher in the room all day. Other inclusive classes have special education teachers ‘push in’ at specific times during the day. Both teachers are available to help all students. Studies show that inclusion is beneficial for all students – not just those who receive special education services.

Summary of the legal framework supporting appropriate education of students with hearing loss:

• Hearing loss fills the ADA/504 criteria as a life limitation that places a student at high risk for functional and/or performance needs. All students with hearing loss are eligible for 504 Plans and appropriate accommodations.
• Students with hearing loss should be evaluated to determine their level of unique needs including the need for auxiliary aids, related services, and specialized instruction necessary to address academic and/or functional performance issues.
• A high level of academic success does not preclude the need for specialized services or supports. Hearing loss will cause the student to have to expend additional time and effort to comprehend and fully participate, typically with less information perceived due to fragmented hearing, which impacts the ability to function and learn as compared to others.
• Specialized services are tailored to meet the student’s unique needs and should provide the support(s) needed for the student to be able to make progress similar to their cognitive peers, as the access issues caused by hearing loss are not learning disorders impacting the level to which a student with hearing loss can learn.

Refer to the end of this article for more specifics and sources of this legal framework.

Changing face of deaf education:

Our students: While the majority of students with hearing loss (DHH-only) appear to have academic skills at the same level, or within 6 months, of age peers, we do continue to have a group that have significant delays. Although almost all students with congenital hearing loss are identified shortly after birth, we still have about 35% of parents who are unresponsive (source), choosing to not receive early childhood services, having no access to effective EI services, or not attaining consistent amplification use and/or effective use of visual communication. When performed, these actions together minimize the predictable delays observed at school entry. Students with hearing loss are not a heterogeneous population and, while their needs may appear similar to other special needs groups, they have unique needs that set them apart, such as the need to develop auditory skills, sign language expertise, awareness in how their hearing loss impacts them, skills in use/troubleshooting hearing devices, and eventually become competent in self-advocacy skills if they are to become full participants in the classroom. These skills are not extensions of the general education curriculum but are necessary for the student to access/perform in general education at the level of peers.

Changing district policies:
In the US, we are in a very challenging period for deaf education as many schools have moved toward the inclusion model, which (strongly) discourages any pull-out services by special educators. For students with hearing loss, this move to inclusion is being applied to all students, whether skills are commensurate with classmates or multiple years of delay are present. The inclusion model then means that these itinerant teachers ‘push-in’ to regular classes to try to address IEP goals rather than pulling students out for specific teaching, or only provide consultative services to school staff.

Detriments/specific issues for children with hearing loss in inclusive settings:

• Intrinsic challenges of performing with a hearing loss in a classroom: A 2014 extensive literature review (source) examined how children who are deaf or hard of hearing interact with hearing peers in inclusive settings. Children who are DHH have many barriers to communicating, initiating and/or entering into social groups, and maintaining interactions with hearing peers, even though today they are more likely to be identified in early life and fitted with advanced sensory aids from a very young age. Fewer communication interactions occur between children who are DHH and their hearing peers, even when a child has a cochlear implant. Children who are DHH can often understand their peers when in a quiet environment but have difficulty expressing complicated linguistic content. The success rate of children with DHH when initiating communication and maintaining social interactions are much lower as compared to hearing peers, complicated by vocabulary, social interaction, and acoustic challenges. They have been found to be more often rejected or ignored by their hearing peers, who are also impatient when asked to repeat themselves. In summary, children who are DHH face great difficulties in communicating, initiating/entering, and maintaining interactions with hearing peers in inclusive settings.

• Lack of meeting DHH unique needs: The inclusion model prevents all the necessary skills from being taught as these skills are designed to improve functional performance and are not an extension of academic skills. Said another way, skills necessary for the student with hearing loss to be able to appropriately access and benefit from the general education environment can only be taught outside of the mainstream classroom. Specifically, it is not possible to teach many auditory development skills because of the noise present in the typical classroom. Developing an awareness of the impact of hearing loss on listening, learning and socialization and hearing device management are specific to our students and teaching does not fit into a small group instructional model as the students are typically the only ones with hearing loss in their schools. These are just two examples of unique needs that are highly unlikely to be met in an inclusive special education model. As an analogy, how could a low vision student be taught orientation and mobility skills within an inclusion classroom? It should not be surprising that the environmental and direct teaching requirements to meet the unique needs of students with limited or no hearing would also be incompatible within the inclusion classroom. In addition, it can be presumed that the typical fragmented auditory perception plus gaps in vocabulary cause students with hearing loss results in a more limited comprehension of surface learning information when the class moves to activities to promote deeper understanding, such as problem-based or small group learning. If a student lacks sufficient surface knowledge, moving to these activities prematurely is ineffective to, and may delay, the overall learning process¹.

• Itinerant DHH model applied to the inclusion model to meet student needs: The move to provide specialized instruction at a student’s neighborhood school has necessitated the growth of the itinerant DHH teacher service model, in which itinerant teachers of the deaf/hard of hearing go to an average of 10 schools per week, and serve an average of 15-25 students². The number of DHH teachers available in many districts is often insufficient to allow them to provide the intensity of pull-out services required for students with hearing loss to (a) make up language delays missed by lack of access, (b) maintain progress at the expected rate due to decreased access to classroom communication on a daily basis, and (c) teach specifically to develop auditory or sign language skills, build self-advocacy skills, and address other skills unique to the student with hearing loss. The inclusion model presumes that supports will be provided within the classroom. In the inclusion model, the itinerant DHH teacher will be unable to spend all day or very unlikely to spend a portion of every school day in one student’s classroom.

• Lack of sufficient intensity to meet unique needs: While language delays, auditory or sign language development, building self-advocacy skills, and other skills unique to the student with hearing loss could be efficiently taught in a pull-out model of sufficient intensity, having to provide this teaching as push-in services severely decreases the time available to specifically teach the needed skills. If a student with hearing loss is 6 months behind age peers, an itinerant DHH teacher cannot maintain a year’s growth and make up the existing delay with only twice a week 30 minute 1:1 teaching sessions. If this same itinerant DHH teacher is now expected to both close the student’s 6-month delay and support keeping pace with classroom learning, it is not possible to do so in a push-in model that allows only small group or team-teaching, which rarely can be directly focused on meeting the needs of the single student with hearing loss. Some students are 1-2+ years delayed due to late identification or lack of communication access (auditory or sign) prior to school entry who are also being placed in inclusive classrooms with the unrealistic assumption that their unique needs will be able to be met through this model. The benefits of inclusion do not replace nor supercede the need for appropriate intensity to appropriately meet the unique needs of the student with hearing loss.

• Lack of peers with hearing loss: Many of our students are the only one in their school with hearing devices, have no role models, and rarely or never see another DHH student. Across all educational models (center-based, specialize resource, local groupings, one-and-only), approximately 25% of students reject their hearing devices³. Those who are ‘one-and-onlies’ are 5 times more likely to reject hearing devices as compared to students who spend time daily or weekly with a cohort of DHH peers. In many school districts it is a rarity for more than 10% of secondary students who are ‘one-and-onlies’ to consistently use FM/DM systems or even their personal hearing aids. Not using amplification severely decreases access to instruction and results in either the student working immensely harder to keep up, the student performing much more poorly, or both. This high rejection rate can be interpreted as a strong sign that the unique social-emotional needs of these students are not being met. These students require connections with other students who sign or use amplification devices to be able to develop a healthy identity as a person with a hearing loss and as a strategy for exchanging self-advocacy strategies. Teaching to achieve understanding of the impacts of hearing loss, self-advocacy skills to support full participation, and addressing significant social-emotional needs are not unimportant nor perfunctory if the expectation is meet the unique needs of students who are deaf/hard of hearing and prepare them for further education or employment. Due to the move away from center-based programs, addressing the social-emotional needs of students has often been a significant challenge for the itinerant DHH teacher providing 1:1 services. The ability to do so within the inclusion model is remotely possible, or more likely, impossible to achieve.

Benefits of the inclusion model for students with hearing loss

The 5 benefits specified in italics below were taken from this source. Comments have been added to each to relate these benefits to the unique needs of students with hearing loss.

Benefit #1: Differentiated Instruction

All students learn differently. This is a principal of inclusive education. One key teaching strategy is to break students into small groups. By using small groups, teaching can be tailored to the way each student learns best. This is known as differentiated instruction. Teachers meet everyone’s needs by presenting lessons in different ways and using Universal Design for Learning (UDL). For example, they may use multisensory instruction. In math, that may mean using visual aids and manipulatives like cubes or colored chips to help kids learn new concepts. (See more examples of multisensory math techniques.)

Differentiated instruction and UDL are very positive aspects of inclusive education. Many students with hearing loss benefit with attention to learning syntax, morphology, vocabulary, reading comprehension, etcetera, which would be amenable to differentiated instruction and small group learning. Since students with hearing loss are so low incidence, they would likely be grouped with students who are learning disabled or who have language disorders. Teaching to disorders is not necessarily the same as closing gaps due to delays, especially when the gaps can be very spotty (“Swiss cheese language”). A DHH student’s reason for not understanding is likely to be related to fragmented hearing, which would benefit from acoustic highlighting, stating information in different ways, or support via sign language, which would likely not occur in teaching a group of students. The quality of a sign language interpreter directly impacts the level of comprehension of the student who is DHH and a visual or visual plus auditory communicator. Many school districts do not hire fully qualified sign language interpreters which inadvertently undermines the outcomes of many students who are deaf (source). Teaching to the vocabulary development needs of students who are hard of hearing or deaf is not likely to be sufficient in a small group learning situation within the inclusive environment.

Benefit #2: Supportive Teaching Strategies

In an inclusive classroom, teachers weave in specially designed instruction and support that can help students make progress. Kids may be given opportunities to move around or use fidgets. And teachers often put positive behavioral interventions and supports (PBIS) in place. These strategies are helpful for all students—not only for students with learning and attention issues.

Teaching strategies that support quieter classrooms during communication would be excellent for the student with hearing loss. The fact that inclusive classrooms tends to group students to work together more often than traditional classrooms will result in an overall noisier environment. While some supportive teaching strategies may indeed be good for the student with hearing loss, it can be assumed that some will be detrimental as well. Per Title II of the American’s with Disabilities Act, the consistent use of necessary accommodations must always be kept in mind (source). Teacher accommodations during lecture are often consistently implemented. As about 1/3 of the school day is devoted to group learning activities (source), use of accommodations to reduce noise can be very problematic to consistently implement. Although there have been some technological advances, it continues to be difficult to achieve consistent and effective use of the FM/DM system in small group discussions due to the communication dynamics of active discussion.

Benefit #3: Reduced Stigma

Inclusive classrooms are filled with diverse learners. That lets kids talk about how everyone learns in their own way. They may find that they have more in common with other kids than they thought. This can go a long way in reducing stigma for kids with learning and attention issues. It can also help kids build and maintain friendships.

Diversity in the classroom is a plus for any student with ‘differences.’ Students will naturally come to see themselves as belonging to one or more groups within the classroom setting. Most classrooms will have students who have LD, ESOL, attention issues, etc. Since it is unlikely that there is another student with hearing loss in class, the result is that these students will emotionally and/or intellectually strive to join a group where they find acceptance. Therefore, the urge to reject hearing aids and ‘become LD’ or ‘become one of the kids who don’t comply’ may be even stronger in an inclusive setting than in more traditional educational models. Due to the hearing loss, the social communication issues (especially in noise) will continue to set them apart, even among their ‘chosen’ groups, which will continue to be a basis for teasing or bullying. Without the opportunity to leave the class to meet with someone knowledgeable in DHH who can help them work through identity and emotional issues related to hearing loss, the student who is deaf or hard of hearing may feel even more isolated and unsuccessful socially in an inclusive class than they would in a pull-out model of support.

Benefit #4: Effective Use of Resources

In more traditional special education settings, many kids are “pulled out” for related services, like speech therapy or for other specialized instruction. An inclusion class often brings speech therapists, reading specialists and other service providers into the classroom. These professionals can provide information and suggestions to help all students.

Increased focus on basic communication skills, vocabulary, syntax, morphology, improving comprehension – all are issues where inclusive settings would be of benefit. The itinerant DHH teacher going in to the mainstream may be able to work with a small group that includes the student with hearing loss on these issues. It is unlikely that the itinerant DHH teacher will be able to address the needs that are truly unique to students with hearing loss. DHH teachers are increasingly challenged by school administration with “What do you that is different than the SLP or LD teacher?” In the inclusive model in general, strategies specific to teach reading to DHH are not appropriate to use in a group, or self-advocacy skills that feature focusing on what was heard so the student can appropriately request clarification of information missed, or other needs unique to students with hearing loss are NOT appropriate to teach to a group of students who all do not have hearing loss. If the only skills that are applicable to teach in inclusive settings are the communication and academic supports that can also be provided by SLPs and LD teachers, then the value of having a highly trained teacher specifically for students with hearing loss is likely to be dismissed as unnecessary. With this in mind, it is projected that the greater the implementation of fully inclusive settings, the less valued and effective will be the teacher of the deaf/hard of hearing AND the students’ unique needs specific to hearing loss will go unmet, with increasing numbers of students performing more poorly academically, socially, emotionally, and/or behaviorally over time. Inclusion is beneficial to students with hearing loss, but only to the degree that the student is able to learn effectively and the appropriate level of support is provided.

 Benefit #5: High Expectations for All

Individualized Education Program (IEP) goals should be based on the academic standards for your state. Those standards lay out what all students are expected to learn in math, reading, science and other subjects by the end of the school year. Differentiated instruction and co-teaching in a general education classroom make it easier for students with standards-based IEPs to be taught the same material as their classmates. In some schools, only certain classrooms are inclusion classes. In that case, schools may assign general education students randomly to inclusive or non-inclusive classes. Other schools may choose students who benefit from the emphasis on meeting the needs of all learners at all ability levels.

Common core standards based IEPs strongly support development of skills that result in full participation in the classroom, and therefore have a positive influence on the education of students with hearing loss. Unlike students with hearing however, the unique needs that must be met for students with hearing loss to become full participants in the classroom are beyond that of their classmates, and distinctly different than other special education populations. Achieving goals to address the unique performance needs secondary to hearing loss largely requires pull-out services into environments supportive for learning these listening, social, and self-advocacy goal areas.

Summary
The inclusion model of special education has been adopted by many school districts throughout the US. The positives of having a diverse learning community, implementing differentiated learning, varied teaching strategies, and universal design for learning principles are all beneficial aspects of the inclusion model. Many students – both regular education and special education students – thrive in inclusion classrooms. The participation of all children is a purpose of inclusive practice and classroom activities. However, it cannot be assumed that social communication and interaction between children who are D/HH and hearing peers will occur naturally. It is essential that opportunities for all children to interact with each other must be appropriately designed, supported, and developed in inclusive educational practice.

Specialized services, by law, are tailored to meet the student’s individual needs. In the case of DHH-only students, an appropriate inclusion/support network is needed to provide the support(s) for them to be able to make progress commensurate with their cognitive peers. Meeting all the unique needs of students with hearing loss within the inclusive classroom environment is at best unrealistic, if not highly unlikely. The student with hearing loss does not know what he does not hear because he did not hear it. Specific teaching needs to occur if the student is to be able to successfully identify and request appropriate support when faced with road blocks. If the statement “He hears just fine” continues to be made by school staff, we can assume that the unique access and learning needs of students with hearing loss are not being adequately or appropriately met within the inclusion environment.

As a continuum of services and supports are required by IDEA to allow individual needs to be met, the fully inclusive model cannot be put forth as the only model of special education support provided by a school district. Gone are the days when most student with hearing loss were educated primarily in a center-based DHH-specific program. Despite the move away from this intensive model, students with hearing loss do continue to require some pull-out services by persons specialized in the unique educational needs of students who are deaf and hard of hearing so that they can learn necessary skills to allow them equal access to, and the ability to fully participate in, the general education setting. Hearing loss is not a learning disorder. Hearing loss is a communication access issue that is predictive of listening, interaction, and learning challenges. The inclusion environment is GOOD for students with hearing loss, as long as they are receiving the specialized support they require to keep pace in the classroom AND their access and learning needs are fully supported during ALL classroom activities.

Karen L. Anderson, PhD, Director, Supporting Success for Children with Hearing Loss, Early October Bimonthly Update, 2017. http://successforkidswithhearingloss.com This information is not intended as legal advice.

References:

1. D., Frey. N., & Hattie, J. (2010). Visible Learning for Literacy: Implementing the Practices that Work Best to Accelerate Student Learning. PP 36-44.

2. Survey results: Role/Duties of an Itinerant Teacher of the Deaf/Hard of Hearing. Conducted by Supporting Success for Children with Hearing Loss, April – May 2017 (267 respondents).

3. Survey results: Children Rejecting Hearing Devices: Who, Why, When? Conducted by Supporting Success for Children with Hearing Loss, August 2016 – April 2017 (88 respondents representing a total caseload of 1863 students with hearing loss).

The post Is the Inclusion Model Good for Students with Hearing Loss? first appeared on Supporting Success For Children With Hearing Loss.

The information below has been derived from sections of the law, Office of Special Education Program comments and discussion provided at  http://idea.ed.gov/explore/home. The guidance provided in that website helps clarify the intent of IDEA and may be useful to professionals and parents alike who are trying to advocate appropriate services and supports for children with hearing loss. Another valuable and brief summary is athttp://www2.ed.gov/about/offices/list/ocr/docs/hq9806.html

NOTE: the information below this does NOT constitute legal advice.

FAQ Information on 504 from US Department of Education

Accommodations via 504 Plans and the ADA      Student Transition to Adulthood

Section 504 of the Rehabilitation Act of 1973

• Civil rights legislation that includes education services: academic, nonacademic, extracurricular activities
• Applies to any person with a disability that substantially affects life activity such as hearing – considers the abilities of the person without mitigating measures (amplification devices, tutoring, excessive studying)
• Acoustic accessibility for children with hearing loss is a barrier to listening/understanding auditory information
• 504 applies regardless of grades/’giftedness’
• Results in identification of accommodations on a 504 Plan, typically for students not eligible for Special Education. Unfunded; limited recourse if not followed.

Court Case RE: issues providing supports via a 504 Plan

Differences between IDEA Services and 504 Accommodations

• IDEA requires adverse educational affect, 504 does not
• IDEA considers function with amplification devices, 504 does not (mitigating measures)
• IDEA is obligated to provide an appropriate education;  504 may extend beyond the common special ed programs
• IDEA has funding attached (federal + state obligations), 504 accommodations are funded via general ed funds
• IDEA has procedural safeguards; 504 –Office of Civil Rights complaint of discrimination; ‘neutral fact finder’, school districts must conduct impartial hearings for resolution
• IDEA services are specially designed; 504 accommodations are based on access needs to the education program

Can a child receive DHH services under 504?

“Auxiliary aids and services” as defined by the ADA are services or devices, such as an interpreter for a person who is deaf or large print or Brailled materials for a person who is blind, that assists someone with vision or hearing disabilities to communicate effectively.” This is a definition of auxiliary aids and services that also applies to 504. Generally, auxiliary aids in our context refers to hearing devices. A strong case can be made auxiliary services to include school staff inservice / consultation, as in quarterly classroom observation and discussion with teacher to support effective communication. 504 accommodations do not include services to build student skills, just accommodations for equal access, specifically effective communication. There is no ‘obligation’ to provide DHH teacher support (inservice/consultation), unless the school team deems it necessary to ensure effective communication so that the student can benefit from the general education setting as well as peers.

The post 504 Plans first appeared on Supporting Success For Children With Hearing Loss.

The following does not constitute legal advice. Please refer to the original sources listed at the bottom of this page for more information. 

No, then Yes!

In 1977, OSEP said “no” in response to a question whether schools were required to provide eyeglasses and hearing aids. The 1977 OSEP Policy Letter states: “Individual prescribed devices (e.g., glasses and hearing aids, etc.) are generally considered to be personal items, which are not required to be provided under Part B [of P.L. 94-142].

In 1993, the issue of schools’ duties to provide needed hearing aids and eyeglasses was raised again, this time in the context of the 1990 addition to the IDEA of the definition of assistive technology devices. The 1993 OSEP Policy Letter reverses its earlier judgment about “personal devices.” It makes two points: first, schools must evaluate students who have or are suspected of having hearing and/or vision impairments. This is both a general obligation under the IDEA, 34 C.F.R. ” 300.530 et seq., and it is a specific obligation under the definition of assistive technology services. 34 C.F.R. ‘ 300.6(a). Second, if those evaluations identify needs for devices that fall within the definition of assistive technology devices, then the school districts must provide them. The Policy Letter explains this duty in the context of the IDEA regulations related to assistive technology. No further mention is made of the “personal device” exception. The proper conclusion to be drawn from the Policy Letter is that the 1977 clarification did not survive the addition by the IDEA of the provisions related to assistive technology.

Hearing aids and eyeglasses are without question within the scope of “assistive technology devices.” Assistive technology devices are defined to include: “any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve the functional abilities of children with disabilities.” 34 C.F.R. ‘ 300.5. The question then, is this: if hearing aids are assistive technology devices, and can be shown to be necessary, does it automatically follow that school districts are required to provide them?  The answer is “yes,” according to the 1993 OSEP Policy Letter.

From the 11/19/1993 OSEP Letter “Thus, participants at the meeting held to develop a child’s IEP must determine whether, in light of a particular child’s educational needs, the public agency must make an assistive technology device and/or service available in order for the child to receive FAPE. In the situation you describe, the IEP team has determined that the child requires a hearing aid in order to receive FAPE, and the child’s IEP reflects the need for the hearing aid. Accordingly, the public agency would be responsible for providing the hearing aid at no cost to the child and his or her parents.”

There also have been some decisions and policy letters since the 1990 Amendments. For example: 18 IDELR 627 (OSEP 1991) taking technology home); 18 IDELR 1039 (OSEP 1992) (FM training system can be an assistive technology device); Letter dated Nov. 19, 1993 from Thomas Hehir to Peter Seiler schools may be required to purchase hearing aids as assistive technology devices). See the Summary of legal supports and writings regarding assistive technology.

Free and Appropriate Education (FAPE) & Assistive Technology

As with any other special education service, the need for AT must be determined on a case by-case basis, considering the unique needs of each child. OSEP Policy Letter to Anonymous, 29 IDELR 1089 (11/6/97). The regulations require that AT devices and services are made available to any student with a disability, “if required.” 34 C.F.R. § 300.308. The basic standard to be met is whether the student needs the AT to receive a FAPE. OSEP Policy Letter to S. Goodman, 16 Education for the Handicapped Law Reports (EHLR) 1317 (8/10/90); 34 C.F.R. § 300.308. The question to be considered is the relationship between the educational needs of the student and the AT device or service. OSEP Policy Letter to D. Naon, 22 IDELR 888 (1/26/95). As noted above, “supplementary aids and services” can be used to assist a student in nonacademic, educationally-related settings.

Therefore, when looking at the AT needs for a student, the “educational” needs must also include these nonacademic settings. See 20 U.S.C. § 1401(29) and 34 C.F.R. § 300.306. AT may be considered as special education, related services, or “supplementary aids and services” to maintain a student in the LRE. Note that because IDEA ’97 now defines “supplementary aids and services” and requires that those services also appear on the IEP, the above quote should be modified to indicate that if the AT is considered a supplemental aid or service it still must be included on the IEP. See 20 U.S.C. § 1414(d)(1)(A)(iii).

In determining whether a student is benefitting from an education, the analysis cannot be limited solely to academic achievement. Even if a student is making significant academic progress, that can no longer be the end of the inquiry. By adding that the purpose of IDEA is to prepare students for employment and independent living, Congress simply took what already applied to students during the transition years and applied it to students of all ages. IDEA ’97 expands the question of what the purpose of an education is. Therefore, if a student will need AT to prepare for adult living, even if he or she is making academic progress, the AT should be provided.

Use of Private Insurance or Medicaid to Pay for Hearing Aids Necessary for FAPE

IDEA ’97 specifically authorizes the use of Medicaid. The regulations also authorize the use of a parent’s private insurance. 34 C.F.R. § 300.301(b). May a school compel a parent to use Medicaid or private insurance when it is available to the family? The U.S. Department of Education has stated that this use must be voluntary. A school cannot deny services if parents refuse to authorize the use of Medicaid or private insurance. Moreover, such use must not result in any cost to the parents, such as: copayment, deductible, or reduction of an annual or lifetime cap on coverage. OSERS Policy Letter to Rose, 18 IDELR 531 (4/19/91). The school can eliminate the possibility of cost to the parents by paying for the deductible or copayment.  If the parent refuses to consent to their use, special education services cannot be denied. Financial cost includes: (1) out-of-pocket expenses such as deductibles or copayments; (2) a decease in available lifetime coverage or any other benefit, including the family paying for services that would otherwise have been covered; (3) risk of loss of eligibility for home and community-based waiver programs; and (4) an increase in premiums or the discontinuation of the insurance. 34 C.F.R. § 300.142(e). A school may pay the costs of accessing the private or public insurance for parents who would otherwise have consented to the use of the insurance. Id. § 300.142(g)(2). However, as with private insurance, a child’s right to a FAPE is not dependent upon whether parents consent to the use of public insurance, such as Medicaid. Federal Register, p. 12569, 3/12/99. If the parents refuse to give consent to using Medicaid, the school is still responsible for providing the recommended services.

Paying for Repairs

The definition of AT services includes repairing, maintaining and replacing AT devices. 20 U.S.C. § 1401(2); 34 C.F.R. § 300.6(c). Therefore, if an AT device is damaged during the course of its use, the school should be responsible for any repairs. Accordingly, the U.S. Department of Education has stated that if parents agree to use family-owned AT to fulfill the IEP, the school is responsible for maintenance and repair if it was damaged on the school bus or at school. The Department of Education reasoned that if the school did not use the family-owned device, it would be responsible for providing and maintaining a needed device itself. OSEP Policy Letter to Anonymous, 21 IDELR 1057 (8/9/94).

Nevertheless, the Department of Education made the following observations in a policy letter on repairs and maintenance of AT devices: If the IEP Team determines that a student needs an AT device at home to receive a FAPE, the device must be provided at no cost to the parents. This means a school cannot charge parents for normal use and wear and tear. However, state laws govern “whether parents are liable for loss, theft, or damage due to negligence or misuse of publicly-owned equipment used at home in accordance with a student’s IEP.” OSEP Policy Letter to S. Culbreath, 25 IDELR 1212 (2/7/97). This policy letter does not discuss how the definition of AT service, which includes maintenance and repair, applies. It did, however, note that any state laws must still be implemented consistently with IDEA and the right to a FAPE. Id. The comments to the new regulations restate this proposition: that parents cannot be charged for normal use, and wear and tear, but that state law, not IDEA, will generally govern parent liability for theft, loss, or damage due to negligence or misuse of AT at home or in other settings. Federal Register, p. 12540, 3/12/99.

Purchasing Hearing Aids Under 504 or ADA 

Students whose disabilities do not meet the criteria under IDEA, but who still may need some specialized assistance, including AT, are covered by section 504. U.S. Dept. of Ed, Joint Policy Memorandum, 18 IDELR 116 (9/16/91); OSEP Policy Letter to Teague, 20 IDELR 1462 (2/15/94).

A school could be required to take affirmative steps to avoid discriminatory treatment per 504 and ADA. Affirmative steps would be required if those steps did not impose undue financial and administrative burdens. Id. at 412. See New Mexico ARC v. New Mexico, 678 F.2d 847 (10th Cir. 1982). In keeping with the basic tenor of section 504, to prevent discrimination, schools must take all reasonable steps to ensure that students with disabilities have access to the full range of programs and activities offered by the school. 34 C.F.R. §§ 104.4, 104.21, 104.22, 104.34, 104.37. See Eldon (MO) R-I School District, EHLR 352:145 (OCR, 1/16/86); Beaver Dam (WI) Unified Sch. Dist., 26 IDELR 761 (OCR, 2/27/97)(Access to chorus room and auditorium); Saddleback Valley (CA) Unified Sch. Dist., 27 IDELR 376 (OCR, 5/5/97). A school district is not required to make every part of every building it owns fully accessible. However, it is responsible for ensuring that all of its programs are accessible to students with disabilities. 34 C.F.R. § 104.21. In meeting this program accessibility mandate, a school does not need to make structural changes to existing facilities if other effective methods are available [such as amplification devices]. However, the school must give priority to those methods which enable students with disabilities to participate “in the most integrated setting appropriate.” Id § 104.22(b).

Obligations to Students who are Not Using Amplification

School districts have an obligation to inform parents of their rights and of the district’s rights to provide FAPE and to meet their ADA/504 obligations. Families have the right to choose to limit their child’s educational success by not supporting amplification use. If a parent has made it clear that they do not wish their child to use amplification in school then the school then it may be interpreted that the district’s legal obligations may have been fulfilled. The alternative would be to proceed to court or to file child neglect complaints, which would be very rare for a school district to undertake in this situation.

If instead, the family is supportive of their child using hearing aids but cannot afford to pay for this technology, as long as educational needs are related to the child’s hearing loss and it is evident that educational needs can be addressed as a part of a child’s FAPE, then the district is obligated to assist the family in obtaining hearing aids for the student.

This webpage was compiled by Karen Anderson, PhD, March 2015, updated July 2018, for Supporting Success for Children with Hearing Loss. Sources used to compile this information include:

http://files.eric.ed.gov/fulltext/ED432846.pdf

http://www.csun.edu/~hfdss003/atacp/supplements/gph5.html

http://www.gpat.org/Georgia-Project-for-Assistive-Technology/Pages/Legal-Mandates-for-Assistive-Technology.aspx

http://nls.org/Disability/NYSAssistiveTechnologyProject/Archives/SpecialEdBooklet

https://www.advocacyinstitute.org/academy/Jan12AIM/AT.Caselaw.pdf

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