Collaborating with Additional Service Providers

“Let’s go! Time to see Adam!” my first grader calls out, referring to his Occupational Therapist (OT), fist pumping the air as he hurries down the hall. Our individual session is finished but my time with him continues. My student runs into the OT room, sits at his workspace, and begins to grab for items on the table, responding to Adam’s verbal prompts to wait as I observe from a few feet away.

            Many students that I work with have service providers in addition to my support as their teacher of the deaf/HOH, and the support of a speech and language pathologist. Occupational therapists, physical therapists, behavioral or ABA therapists and vision specialists are just some of the professionals my students see regularly. In order to maximize growth and skills throughout the school day, everyone on the team must understand the impact of hearing loss on learning and language. Especially for young students or new listeners (e.g. a recently implanted student) collaboration between the teacher of the deaf and other professionals is essential. Below are a few areas I highlight when working with other service providers.

For Occupational and Physical Therapists:

•       As the teacher of the deaf/HOH, work with your therapists to identify the best place to sit when communicating and working with the student. This is usually across from the student to maximize visual access but your student may have a “better” ear making it more ideal for the therapist to be on the side of the “better” ear.

•       Encourage therapists to make eye contact with the student before giving instructions or beginning a task.

•       Work with therapists to incorporate language and vocabulary by asking the student to verbally describe the steps in a task using sequential language, and by asking the student to name the materials and their purpose (e.g. “Scissors are a tool we use for cutting.”)

•       Provide sequence for multi-step tasks.

•       Support verbal instruction with visuals (e.g. pictures, text).

•       Work with the student’s speech and language pathologist and teacher of the deaf to learn what language structures your student does and does not understand. Multi-step directions, complex clauses, and new vocabulary can impede a student’s ability to complete a task and negatively impact a therapy session.

•       Explicitly teach the names of the materials you will be using in order to ensure comprehension when instructions are given.

•       When working in small groups, set clear expectations for turn-taking and social interactions.

•       Ask the student to verbally repeat directions before beginning.

•       Incorporate language by describing actions (e.g. “Sam jumped high, Jack jumped higher, and I jumped the highest!”)

For Vision Specialists:

While I have a general understanding of my students’ vision loss, I benefit from ongoing collaboration with vision specialists to refine my materials in order to meet those needs. Similarly, vision specialists benefit from an understanding of a student’s auditory abilities and limitations. For example, when using iPads or similar technology, a direct auditory input connection is generally best in terms of access but specialists must understand that the student is probably still not receiving 100% access to the information; clarity is compromised due to the hearing loss.

·      Verbal explanations may need to be simplified or modified to meet a student’s receptive language abilities. This can prevent frustration due to misunderstandings.

·      Many vision specialists that I work with incorporate reading and phonics into their sessions. An understanding of how hearing loss impacts phonemic skills is beneficial, as is how the audiogram reflects what the student is able to perceive in terms of sounds. This type of ongoing consult again allows for productive sessions as vision specialists can tailor phonics and literacy work to meet the needs of the students .

How do you work with additional service providers?

Taking and Analyzing Language Samples

We’ve made it halfway through the school year! At this point, students and teachers have settled into routines, we’re working hard to meet those IEP objectives and some teams are even starting to think about upcoming spring evaluations and transitions.

With progress reports on the horizon, language samples can provide valuable data to include in a student’s evaluation. Language sampling is a great way to analyze the structures that students are using spontaneously, as well as to determine which structures they omit outside of structured activities. I like to compare language samples three times each year: Starting in the fall, midway through winter and a final formal evaluation at the end of the school year.

While there are many ways to obtain language samples, I prefer to use my iPad to record the sample that I will analyze—rather than depending on my ear alone. This way I have what my student actually said, in terms of both the actual language used, and the speech sounds they used, omitted, or substituted. In order to get an accurate representation of the language structures my student uses, I generally record a casual conversation, during which I ask my student open-ended questions. For instance, I’ll ask them to retell a familiar story or to narrate a personal experience. Additionally, I provide materials of interest (such as dolls, Legos or a magnet board with a variety of magnets) and ask my student to create and narrate a story, which I also record.

After recording and transcribing the language sample, analysis begins. A tool like the Cottage Acquisition Scales for Listening Language and Speech (CASLLS) helps break down language in a way that makes it easy to see where our students lack skills, and assess language from Pre-Verbal through Complex Sentences. 

Determining the Mean Length Utterance (MLU)—the average number of words used in a sentence—is important for understanding how our students with hearing loss compare with their peers with typical hearing. The goal over time is for our students to speak in the long, complex sentences that their peers with typical hearing tend to use, rather than in shorter, simpler sentences. 

Additionally, a Type Token Analysis allows for an objective look at the type of words our students are using, not just the number of words per sentence. Students with hearing loss often tune into nouns and verbs, subsequently using just these types of words in their connected language. It is important to be sure we are helping them use various types of words—not just nouns and verbs. Charts such as the one below allow to analyze the words they’re using. From a transcribed language sample, it is easy to count the nouns, verbs, prepositions, adjectives, etc. and write the number of each word type in each column. Over time, we can chart growth by recording how our students use a wider variety of words and higher number of more complex, rich words. 

         Language sampling takes some time to complete and analyze, but it is the most comprehensive and objective way to really know the type of language our students use.

How do you use language samples to inform your own work?

Assessment Considerations for Students with Hearing Loss: Part Two

This post is a continuation from last week’s, in which I explained variables to consider when assessing skills in speech, language, and self-advocacy. 

For the areas of assessment covered in this post—audition, academic/ reading/ writing, and psychological/ cognitive assessments—I have again listed some tests that your team may want to consider when assessing deaf or hard of hearing students. Because each student faces unique challenges and possesses different strengths, you will have to work with your team to determine the best options.  My suggestions are meant to serve as examples.

Audition: As part of a comprehensive assessment, we need to know what our students are accessing. A FunctionalListening Evaluation is sometimes a good option to get a sense of the student’s access in the classroom. Other less formal measures such as those on Karen Anderson’s site take less time to administer and provide similar information.

Examples of audition tests:

·      Functional Auditory Performance Indicators (FAPI)

·      Contrasts for Auditory and Speech Training (CAST)

·      COMPASS Test of Auditory Discrimination

Academic/Reading/Writing: Many schools use a version of the Woodcock-Johnson to assess academic skills. While this is generally considered to be the standard test, savvy students can appear more skilled than they actually are by guessing correctly on the multiple-choice items. More challenging tests—such as the Weschler Individual Achievement Test (WIAT)—which require students to read passages and respond to open-ended questions may provide a better picture of the student’s skills. Formal reading (including phonemic awareness, phonics, fluency, decoding, vocabulary, accuracy and self-correction, and comprehension) and a writing assessment should also be included with test results compared with student work samples.

Examples of academic/reading/writing tests:

·      Dynamic Indicators of Basic Early Literacy Skills (DIBELS)

·      Phonological Awareness Literacy Screening (PALS)

·      Gray Oral Reading Test 5 (GORT 5) 

Psychological/Cognitive: Testing in this area is most often done by the school psychologist and analyzes verbal and non-verbal abilities as well as auditory memory. A critical component of this testing is to look at the difference between verbal and non-verbal scores. Often our students with hearing loss will score lower in the verbal portions of the test as a direct result of their hearing loss, which indicates the need for intervention. 

Examples of psychological/cognitive tests:

·      Weschler Intelligence Scale for Children  (WISC)

·      WPPSI for younger children, WAIS for students age 17 and older

How are you involved with student assessment?

Assessment Considerations for Students with Hearing Loss: Part One

December! How is it possible that we are almost half way through this school year? Many of my students have evaluations coming up in the spring and I’ve already begun working with my teams to ensure comprehensive testing in the next few months by meeting with teachers, discussing concerns and progress with parents, and analyzing my own session notes. I am not always the one to administer the tests, but I am always involved in the analysis and offering expertise on hearing loss. Sometimes I am even able sit in during the testing, since the school professionals who administer formal tests likely have experience with the administration and analysis, but may not understand how hearing loss impacts the results. Additionally, school staff may not have an understanding of the best tests to administer in order to get an accurate picture of our students’ skill levels.

The following areas must be addressed in comprehensive testing for students with hearing loss. In addition, I have listed some tests that your team may want to  consider when assessing students with hearing loss. Every student has different needs and therefore different tests are appropriate in each situation and many more assessments are available, not just the ones I’ve listed here!

This week I’ll cover speech, language, and self-advocacy assessments. Next week, I’ll go over assessments in the areas of audition, academic/reading/writing skills, and psychological/cognitive abilities.

Speech: Speech assessments are most often administered by the student’s SLP. It is still necessary for the TOD/HOH to be part of the analysis of test results. As TODs, we understand how auditory access impacts speech production. Comparing articulation errors to the student’s audiogram and using our knowledge of hearing technology, we can work with SLPs to set high (but reasonable) expectations for articulation goals. For example, we know that students with cochlear implants may not have great access to short vowel sounds and may need practice in discriminating and producing these sounds at the word or sentence level.  In contrast, a student with a high frequency loss may have limited or no access to high frequency speech sounds even with hearing aids. Such information shared with the SLP can enhance the productivity of speech sessions, rather than creating frustration for the SLP and the student.

Examples of speech tests:

·      Clinical Assessment of Articulation and Phonology (CAAP)

·      Goldman Fristoe Test of Articulation II

Language: Comprehensive language assessments will include vocabulary; relationships between words; and receptive and expressive language tests at word level, as well as in connected speech/passages.

TODs understand how hearing loss impacts language development and rather than simply looking at the percentile rank or standard score, we can analyze the test items that our students miss and look for patterns in the errors. The majority of my students are “average” according to their scores but with a closer analysis of the test items, patterns emerge and these are the areas I want to be sure to address during my time with the student in order to bridge the “gaps” we so frequently hear about. Again, even if I am not the one administering these tests, I always ask to meet with the test administrator and look at the breakdown of test items.

Additionally, language samples provide real life examples of what our students produce. Comparing formal testing with language samples allows for a more complete picture of our student’s language skills.

Examples of language tests:

Peabody Picture Vocabulary Tests – expressive and receptive vocab

·      Critical Evaluation of Language Fundamentals  (CELF )

·      Cottage Acquisition Scales for Listening Language and Speech (CASLLS)

·      Oral and Written Language Scales (OWLS-II)

·      Comprehensive Assessment of Spoken Language (CASL)

·      Test of Narrative Language (TNL)

·      Test of Written Language 4 (TOWL IV)

Self-Advocacy / Pragmatics: Karen Anderson has many tools that can be used with students of a variety of ages and abilities and I've described how I use some of them in an earlier post. Some are observational tools that I use in the classroom and others I fill out with teachers. A student-completed report is always included as well. Such assessments can be supplemented with anecdotal data from observations within the classroom. Areas to look at include pragmatics, social skills, the student’s understanding of and ability to explain his hearing loss and amplification, and the student’s ability and willingness to self-advocate.

Examples of self-advocacy tests:

·      Test of Pragmatic Language (TOPL)

·      Minnesota Social Skills Checklist

·      Placement and Readiness Checklist (PARC)

Stay tuned for my next post, in which I’ll discuss considerations for assessments in audition, academic skills, and cognitive abilities.

How are you involved with student assessment?