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

Faculty Disclosure Information In the past 12 months, we have not had significant financial interest or other relationship with the manufacturer of the products or providers of the services that will be discussed in our presentation. This presentation will not include discussion of pharmaceuticals or devices that have not been approved by the FDA.

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

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

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

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

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

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

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

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

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

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

Participants and Completed Assessments State Total Participants One Assessment Two Assessments Three Assessments TotalAssessments Arizona Colorado Idaho New Mexico Wyoming Totals

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

Degree of Loss (n = 54) Degree of Loss dB range Percentage (number) High Frequency 30dB 30dB 4% (2) Mild 26 – 40 dB 24% (13) Moderate dB 20% (11) Mod/Severe dB 11% (6) Severe dB 9% (5) Profound >90 dB 19% (10) Severe or Profound NR to clicks on ABR 13% (7)

Ethnicity (n = 60)

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

Age of Identification, Intervention and Amplification MedianRange Age of ID 2.0 months 0 to 30 Months from ID to Intervention 1.75 months 0 to 14 Months from ID to Amplification 2.0 months 0 to 17

Type of Amplification

Mode of Communication Used by Primary Caregiver

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

Language Results

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

Kent Inventory of Developmental Skills (n=6)

Child Development Inventory Expressive Language

Child Development Inventory Language Comprehension

MacArthur-Bates Expressive Vocabulary

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

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

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

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

Contact Information Kathryn Kreimeyer Kathryn Kreimeyer Arlene Stredler Brown Arlene Stredler Brown Allison Sedey Allison Sedey Shirin Antia Shirin Antia