Outcome in Children with Hearing Loss in Specialized Educational Programs

Transcription

1 Outcome in Children with Hearing Loss in Specialized Educational Programs Tamala Bradham, Ph.D., CCC-A Vanderbilt University, Department of Hearing and Speech Sciences K. Todd Houston, Ph.D., CCC-SLP, LSLS Cert. AVT University of Akron, School of Speech-Language Pathology and Audiology Maura Berndsen, M.ED., CED, LSLS Cert. AVT Listen & Talk November 15, 2012

2 Abstract As providers of quality services for children and families impacted by hearing loss, professionals working in OPTION schools find themselves blending art and science daily. A key element in this process is documentation, including the collection and analysis of anecdotal, criterion-referenced and standardized data. OPTION Schools, Inc., like other professional organizations in the field of serving children with special needs, has reflected in recent years on the challenges faced in this area. To address this challenge, the member schools developed the listening and spoken language data repository (LSL-DR) a web-based, secure data repository that allows OPTION Schools to collect and ultimately describe aggregate outcomes of the children they service. Results from outcome measures completed by speech-language pathologists, audiologists, and teachers from 48 OPTION Schools with 2,619 children with hearing loss will be presented. Preliminary, prospective data will be shared including but not limited to are demographics, functional outcomes, and standardized measures.

3 Disclosures OPTION Schools, Inc. has contracted with Vanderbilt University to provide oversight of this project Vanderbilt Institute for Clinical and Translational Research grant support (UL1TR from NCATS/NIH) Cochlear Foundation

4 Thank you OPTION Member Schools Atlanta Speech School, Auditory Oral School of San Francisco, Auditory/Oral School of New York, Buffalo Hearing and Speech Center, Carle Auditory Oral School, CASTLE, CCHAT - Sacramento, Center for Hearing and Speech, Central Institute for the Deaf, Child s Voice, Children's Hearing & Speech Centre of BC, Clarke Jacksonville, Clarke New York, Clarke Pennsylvania, Clarke School East, Clarke School for the Deaf, DePaul School for Hearing and Speech, Echo Horizon School/Echo Center, Hear in New Hampshire, Hear ME Now!, Hearing School of the Southwest, Hearts for Hearing, Instituto Oral Modelo, Jean Weingarten Peninsula Oral School, John Tracy Clinic, Lexington Hearing and Speech Center, Listen and Talk, Magnolia Speech School, Mama Lere Hearing School at Vanderbilt, Memphis Oral School for the Deaf, Montreal Oral School for the Deaf, Moog Center for Deaf Education, Moog School at Columbia, New Orleans Oral School, Northern Voices, Ohio Valley Voices, Oralingua School for the Hearing Impaired, Presbyterian Ear Institute, Quebec Oral School for Deaf Children, Sound Beginnings of Cache Valley, St Joseph Institute for the Deaf - Indianapolis, St Joseph Institute for the Deaf -Kansas City, St Joseph Institute for the Deaf -St. Louis, Summit Speech School, Sunshine Cottage School for Deaf Children, The Elizabeth Foundation, The HOPE School, The Omaha Hearing School for Children, Tucker- Maxon Oral School, University of Miami Debbie Institute OPTION Data Committee and Subcommittees Tamala Bradham, Teresa Caraway, Jean Moog, Todd Houston, Ellen Estes, Robin Feder, Maura Berndsen, Janet Ledet, Karen Kupper, Andrea Osman, Teri Ouellette OPTION Executive Board (Past and Present) Maura Berndsen, Kristina Blaiser, Tamala Bradham, Danielle Darcy, Barbara Hecht, Lillian Lippincott, Teri Ouellette, Martha Perusse, Anne Sullivan, Michelle Wilkins, Comer Yates Biostatisticians/Statistician Christopher Fonnesbeck Zengqi (Kelly) Lu Megan Roberts

5 Project Overview and Background

6 Challenges and Needs Across Schools and Programs Limited outcome data That s the research but what about your school and outcomes. Emphasis on evidence-based practice Accountability, Pay for Performance Varying levels of infrastructure and resources across programs Not all schools are created equally Effective way to manage data Project must be doable with time and resource constraints

7 Responding to the Need A Data Committee was formed in 2008 Individual schools and programs explored ways to gather and manage data The Moog Center Magnolia Speech School Challenges remained in implementing identified tools across schools and programs HIPPA rules presented challenges

8 Modified OPTION Schools, Inc. Strategic Plan to address the need for data and A strategic goal addressed data and outcomes: Document Services and Outcomes to Demonstrate Benefits of High Quality LSL Programs

9 Getting Started Three key initiatives to help the schools get ready for the data project Facts and Figures Document (2009/2013) Assessment Reference Guide (2010/2013) Listening and Spoken Language Data Repository (LSL-DR; November 15, 2010)

10 Facts and Figures During the last 20 years there has been a revolution in how we identify and educate children with permanent hearing loss in the United States 2009 Edition Tamala S. Bradham, Editor, Teresa Caraway, Jean Moog, K. Todd Houston, and Julie Rosenthal 2012 Edition Tamala S. Bradham, Jean Moog, K. Todd Houston, Robin Feder, Day Mullins, Kristina Blaiser, and Ruth Auld

11 Table of Contents Facts on Hearing Loss in Children Facts on Early Hearing Detection and Intervention Facts on Technologies Facts on Costs Facts on Listening and Spoken Language Facts on Educational Environments

12 Samples Children with hearing loss who begin early intervention earlier have significantly better developmental outcomes than similar children who begin intervention later. Moeller, M.P. (2000). Early intervention and language development in children who are deaf and hard of hearing. Pediatrics, 106(3), e43. (n=112) Nicholas, J.G. & Geers, A.E. (2006). Effects of early experience on the spoken language of deaf children at 3 years of age. Ear & Hearing, 27(3), (n=76) Holt, R.E & Svirsky, M.A. (2008). An exploratory look at pediatric cochlear implantation: is earliest always best? Ear & Hearing, 29(4), (n=96)

13 92% of children with permanent hearing loss are born to two hearing parents.. Mitchell, R.E. & Karchmer, M.A. (2004). Chasing the mythical ten percent: Parental hearing status of deaf and hard of hearing students in the United States. Sign Language Studies, 4(2),

14 Providing a cochlear implant and parent-infant intervention by age one and supplementing early parent-infant intervention with an intensive toddler class designed specifically for developing spoken language in children with hearing loss by two years of age significantly increased the probability that a child would reach normal language levels by kindergarten. Geers, A.E., Moog, J.S., Biedenstein, J., Brenner, C., & Hayes, H. (2009) Spoken language scores of children using cochlear implants, compared to hearing age-mates at school entry, Journal of Deaf Studies and Deaf Education, 14(3): (n=153) Moog, J.S. & Geers, A.E. (2010) Early Educational Placement and Later Language Outcomes for children with cochlear implants, Otology & Neurology, 31(8): (n=39)

15 Assessment Reference Guide Membership school survey revealed 66 different instruments used by OPTION Schools members to assess speech, language, cognition, literacy, and audition (not including all the audiology measures) Authors and Editors Tamala Bradham, Editor Andrea Osman and Karen Kupper, Reviewers Julie Rosethal, Adrian Taylor, Luke Watts, Graduate Students at Vanderbilt University

16 Table of Contents Adaptive Behavior Articulation and Phonology Auditory Language Literacy School Readiness/Academic Vocabulary

17 Goldman-Fristoe Test of Articulation 2 (GFTA-2) Author Publisher Contact Information Ronald Goldman, Macalyne Fristoe Pearson Attn: Inbound Sales & Customer Support Bulverde Road San Antonio, TX Phone: ; Fax: ; ClinicalCustomerSupport@Pearson.com Cost $ (Price current as of May 23, 2011) Purpose Age Range Time Scores or Subtests Description Provides SLP's (or another examiner trained in phonetic transcription) with a measure to assess articulation proficiency in children; assesses consonant sounds; can be used for diagnostic potential to determine the level of articulation difficulty; growth of articulation skills over time can also be monitored 2-21;11 years 5-15 minutes (Sounds-in-Words subtest) Subtests: Sounds-in-Words, Sounds-in-Sentences, Stimulability (imitation of speech sounds) Looks at articulation in multiple contexts to effectively evaluate ability and stimulability of different sounds. There are 77 target words. Reliability Internal reliability for females: 0.96; Median reliability for males: 0.94; median test-retest reliability 0.98 for initial, medial, and final sounds; inter-rater reliability median percentages of agreement for initial, medial, and final sounds are 93, 90, 90 respectively.

18 Validity Norms Who Can Give the Test Strengths Concerns Content: 23 of 25 sounds recognized as Standard American English consonants were included on the test. Construct: Means and Standard Deviations for Standard Sample by Age: Age N Mean SD Data from a representative sample of 2,350 subjects was used to develop the normative scores. There are age-based standard scores, percentiles, and test-age equivalents available. The sample controlled for age/gender, race, geographic region, SES/parent education, and included special populations (did not say what specific special populations). Speech-language pathologist or another professional who is trained in phonetic transcription Easy to administer; most widely used test of articulation; user-friendly color-coding for recording initial, medial, and final sounds as well as initial consonant blends; colorful, entertaining pictures to elicit responses Limited sample size and cultural bias of standardization sample; developmental data given may be outdated; does not assess vowel production

19 LSL-DR: Data Collection Project

20 Data Project Reviewed multiple systems Selected REDCap (Harris et al, 2009) REDCap Consortium 497 active institutional partners in 48 countries More than 50,900 projects with 67,800 users

21 Data Privacy and Security Project is approved by Vanderbilt University Institutional Review Board (IRB) since 2009 and each year thereafter Data Use Agreement between OTPION Schools and Vanderbilt University for the purposes of compliance with Health Insurance Portability and Accountability Act (HIPPA) and Family Educational Rights and Privacy Acts (FERPA) Data Use Agreements between each school and OPTION School regarding privacy and ownership of data Data must be entered by June 30 of each year All data is de-identifiable and contains no Protected Health Information (PHI)

22 Pilot Project Pilot Schools Atlanta Speech School, CCHAT Center- Sacramento, CID-Central Institute for the Deaf, Listen and Talk, Mama Lere Hearing School at Vanderbilt, and the Moog Center for Deaf Education Ask & Know Sessions Develop FAQ for schools Prior to the launch, each school completed a two hour training on data entry

23 Live Date Project went live November 15, 2010 LSL-DR 47 active schools in 4 countries 2 projects with 134 users LSL-DR LSL-DR Help Desk 1,027 variables (version 1) 1,467+ variables and counting (version 2) 2,619+ students with over 5,800 records

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25 Four Forms Demographics Audiology Mandatory Tests Optional Tests Longitudinal study

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28 Demographics

29 Data Collection From OPTION Member Schools No OPTION Schools 1-2 OPTION Schools 3 or more OPTION Schools Argentina, United Kingdom, England

30 Sample Graphs: Gender (n=2,510)

31 Primary Language Spoken at Home (n=1,993)

32 Total Number of Children in the Home (n=1,954)

33 Age When First Amplified (i.e., hearing aids, cochlear implant, etc.; n= 2,173)

34 Technology Used in the Right Ear (n=2,269) Technology Used in the Left Ear (n=2,265)

35 Degree of Hearing Loss Right Ear (n=2,101) Degree of Hearing Loss Left Ear (n=2,099)

36 Type of Hearing Loss Right Ear (n=2,103) Type of Hearing Loss Left Ear (n=2,100)

37 Outcomes in Standardized Measures

38 Preliminary Analysis Articulation Arizona Articulation Proficiency Scale Goldman-Fristoe Test of Articulation Expressive Vocabulary EOWPVT EVT Receptive Vocabulary ROWPVT PPVT Sample size 4,635 Hierarchical Bayesian mixed-effects model (Gelman & Hill, 2006) Linear regression analysis controlling for variability among schools while simultaneously estimating the influence of various parameters

39 Articulation Frequency 392 Frequency Age in Years

40 Articulation Age Sample Size Mean Standard Deviation Range 2 years years years years years years years years years years

41 Baha Male Age at time of testing <36 weeks (Premature) # of children in house Hearing Aid Degree of HL Age of Amplification Cochlear Implant Non-English

42 Receptive Vocabulary Frequency Age in Years

43 Receptive Vocabulary Age Sample Size Mean Standard Deviation Range 2 years years years years years years years years years years

44 Male Age at time of testing Baha # of children in house Age of Amplification Degree of HL Hearing Aid <36 weeks (Premature) Cochlear Implant Non-English

45 Expressive Vocabulary Frequency Age in Years

46 Expressive Vocabulary Age Sample Size Mean Standard Deviation Range 2 years years years years years years years years years years

47 Baha Male <36 weeks (Premature) Age at time of testing # of children in house Hearing Aid Age of Amplification Degree of HL Cochlear Implant Non-English

48 Outcomes in Functional Measures 1. Family Involvement 2. Spoken Language Comprehension 3. Spoken Language Expression 4. Audition

49 Family Involvement Rating (n=2,177) 7% 1% Ideal Participation Good Participation 21% Average Participation 52% Below Average 19% Limited Participation

50 Percentage of Functional Progress Over Time 100% 90% 20% 17% 15% 80% 70% 60% 50% 40% 30% 42% 44% 45% 20% 38% 39% 40% 10% 0% Comprehension (n=914) Expression (n=908) Auditory (n=864) No Changes 1 Level Change from Previous Year 2 or More Level Changes from Previous Year

51 Spoken Language Comprehension (Receptiveness; n=1,011)

52 Spoken Language Expression (Expressiveness; n= 1,009)

53 Audition (n=963)

54 Closing the Gap with Hearing Peers What percentage of children maintain progress from year to year? Expressive Vocabulary 75% to 90%; median=83% Receptive Vocabulary 71% to 87%; median=78% Articulation 71% to 88%; median=79%

55 Closing the Gap with Hearing Peers What percentage of children are averaging more than one year s progress (+1SD) in one year s time? Expressive Vocabulary 11% to 30%; median=21% Receptive Vocabulary 8% to 18%; median=13% Articulation 11% to 30%; median=22%

56 Thank you!