Part C Eligibility Considerations for Childen With Hearing Loss

8/6/2019 Part C Eligibility Considerations for Childen With Hearing Loss

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FOR INFANTS & TODDLERS WHO ARE DEAF OR HARD OF HEARING

ITCA and NCHAM 1

Part C has theresponsibility of

ensuring that children

who are deaf or hard ofhearing are identified,determining which

children will be eligiblefor Part C services, andproviding appropriate

early interventionservices to children who

are eligible.

Part CEligibility

ConsiderationsFor Infants & Toddlers Who Are Deaf or Hard of Hearingis document was produced by a committee convened by the IDEA Infant & ToddlerCoordinators Association and the National Center for Hearing Assessment andManagement. January 2011.

Early Hearing Detection andIntervention (EHDI) programsexist in states and territories for

the purpose of creating effective newbornhearing screening, assessment, follow up,

and early intervention services for infantsand young children with hearing loss.Early intervention services for childrenidentified through state EHDI programsare frequently provided through statePart C systems that offer earlyintervention services under theIndividuals with Disabilities EducationAct (IDEA) 2004. e regulations ofIDEA (34 CFR 303.300) outline generalguidelines for eligibility in Part Cprograms. Under these regulations,children may qualify based on (1)developmental delay or (2) the existenceof a condition with a high probabilityof delay. Implicit in the statute andregulations is the understanding that statesmay not be able to serve all children whomight benefit from early interventionservices. States are given discretion inestablishing their individual criteriaboth for developmental delay and for

established conditions for child eligibility.As a result, definitions of eligibility forPart C differ significantly from state tostate. An individual states approach toestablishing overall eligibility criteria

influences how infants and toddlers withhearing loss are determined eligible forserviceseither by virtue of an establishedcondition or because of a developmentaldelay.


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PART C ELIGIBILITY CONSIDERATIONS

ITCA and NCHAM 2

It is essential thatdecisions concerning

eligibility for Part Cservices for childrenwith hearing loss be

made by a team thatincludes professionalsknowledgeable about

the identification,consequences, and

intervention for childrenwith permanent

hearing loss.

Approximately 12,000 babies are bornwith permanent hearing loss each year,which indicates up to 36,000 childrenwith hearing loss (birth to age 3 years) arepotentially eligible for services under statePart C systems at any point in time. Part

C has the responsibility of ensuring thatchildren who are deaf or hard of hearingare identified, determining which childrenwill be eligible for Part C services, andproviding appropriate early interventionservices to children who are eligible.

e purpose of this document is toprovide information that will assist peopleresponsible for state Part C systems in:

Making informed, evidence-baseddecisions as they develop or review

eligibility criteria related to infantsand toddlers who are deaf or hard ofhearing.

Determining the appropriatepersonnel to participate in eligibilitydetermination and the developmentof an Individualized Family ServicePlan (IFSP) to address service needsof the child and family.

Providing resource information tofamilies of children who do not meetthe eligibility criteria established bythe states Part C program.

Defining Hearing Loss

Because measures of receptive andexpressive language are notprecise for children birth through12 months, infants born with apermanent hearing loss and noadditional disability or conditionalmost never demonstrate earlydelays that qualify the infantfor early intervention servicesunder most states definitionsof developmental delay. IDEA,however, defines eligibility notonly by the establishment of adevelopmental delay but alsoby the existence of a conditionwith a high probability of delay,which includes hearing loss.ere is abundant evidence that

permanent hearing loss of any degree andconfiguration results in developmentaldelays if appropriate early interventionis not provided. e Joint Committee onInfant Hearing (JCIH, 2007) recommendsthat all children with congenital

permanent bilateral or unilateral hearingloss, including those with permanentconductive or neural hearing loss (i.e.,auditory neuropathy/ dyssynchrony),receive early intervention. Evidence-basedresearch confirms that all types of hearingloss outlined by JCIH result in delays inmultiple areas, including, but not limitedto, speech and language, communication,social-emotional development, cognition,and reading.

Membership of Eligibility

Team

It is essential that decisions concerningeligibility for Part C services for childrenwith hearing loss be made by a team thatincludes professionals knowledgeableabout the identification, consequences,and intervention for children withpermanent hearing loss. Professionalswith this expertise include audiologists,deaf educators, early interventionists, andspeech-language pathologists who have

skills and expertise in serving infants andyoung children who are deaf or hard ofhearing and their families. Te selectionof the appropriate personnel for theteam will be dependent on each states


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FOR INFANTS & TODDLERS WHO ARE DEAF OR HARD OF HEARING

ITCA and NCHAM 3

Ideally, Part C eligibilityguidelines would

encompass all infantswith permanent hearing

loss of any degree foreither ear. It is recognized

that state Part C systemsmay not have the

resources to serveall children with

hearing loss.

guidelines for eligibility determination.Eligibility determinations based on thehearing loss as a physical condition witha high probability of developmental delaywill require, at minimum, knowledgeand skill in infant hearing assessment

and interpretation of test results, as wellas knowledge of the impact of hearingloss on development. If the eligibilityteam is the same team that conductsthe multidisciplinary assessment anddevelops the IFSP, then additionalknowledge and skills are required,including information on the continuumof technology options (e.g., hearingaids, cochlear implants, FM systems),communication opportunities (e.g.,cued speech, sign languages, listening,and spoken language), and intervention

strategies available for children withhearing loss. All decisions concerningeligibility must be reflective of evidence-based practices, made individually foreach child within the context of supportservices within the state, and free frombias or ideology regarding appropriate orbest services for children with hearingloss.

Eligibility Criteria

JCIH (2007) states that all families ofinfants with any degree of bilateralor unilateral permanent hearing lossshould be considered eligible for earlyintervention services. Infants andyoung children with mild-to-profound

hearing loss who are identified in thefirst 6 months of life and provided withtimely, appropriate early interventionhave significantly better vocabularydevelopment, receptive and expressivelanguage, syntax, speech production,

and social-emotional development whencompared to infants whose hearing loss isidentified later in life (JCIH 2007). Federalguidelines state that practitioners shouldinitiate referrals to early interventionprograms within 2 days of confirmingthe presence of a hearing loss (CFR303.321d).

Ideally, Part C eligibility guidelines wouldencompass all infants with permanenthearing loss of any degree for either ear.It is recognized that state Part C systems

may not have the resources to ser ve allchildren with hearing loss that wouldbenefit from early intervention services.When prioritization is necessary, it isrecommended that state guidelinesreflect current research-based knowledgerelated to the impact of hearing loss ondevelopment (see insert). States shouldconsider the additional impact of co-existing developmental delays, establishedconditions, or diagnoses when developingeligibility criteria for early interventionservices for infants and young children

with hearing loss. When it is determinedthat a child with a hearing loss is noteligible for Part C services, it is imperativethat referral to other resources beprovided.


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PART C ELIGIBILITY CONSIDERATIONS

ITCA and NCHAM 4

Referral to Other Resources

Whether or not a child is determinedto be eligible for services in a statesPart C systemwith parental/caregiverpermissionnotification of the childs

eligibility status should be shared withthe state EHDI program and the childsmedical home. When a determination ismade that an infant or young child withpermanent hearing loss is not eligiblefor early intervention services under thestates Part C eligibility criteria, additionalsafeguards and systems must be in placeto ensure that families have access to otherresources. At minimum, it is recommendedthat information and/or referral sourcesfor the following be provided:

Non-Part C early interventionservices for children with hearingloss, including names and contactinformation of providers.

Periodic monitoring of hearing status(every 3 months for children through18 months and every 3 to 6 months forchildren through 36 months), including

monitoring of middle ear status. Periodic assessment of speech/

language development every 6 monthsthrough the infant toddler period andevery 12 months thereaer.

Periodic developmental monitoringevery 6 months through the infant/toddler period and every 12 months

thereaer to include discussionof parental concerns related tocommunication and languagedevelopment.

Family education and support related to

impact of hearing loss, risk of hearing

loss progression, communicationoptions, and related issues. Consideration for amplification, as

appropriate.

Suggested resources include, but are notlimited to, the states EHDI system, EarlyHead Start, Medicaid-funded programs,Title V services, other state or privatelyfunded services for children who are deaf orhard of hearing, the childs medical home,and any additional state tracking and/orfollow-along program that is available.

Although resources will vary based on eachstates system design, it is recommendedthat a network encompassing all the above-listed services be available to meet theindividual needs of children and families.Any change in a childs hearing status or theimpact of hearing on development shouldresult in a referral back to Part C.

Reference

Joint Committee on Infant Hearing.

(2007). Year 2007 Position Statement:Principles and guidelines for earlyhearing detection and interventionprograms.Pediatrics, 120(4), 898-921.

Whether or not a child isdetermined to be eligible

for services in a statesPart C systemwith

parental/caregiver

permissionnotificationof the childs eligibility

status should be sharedwith the state EHDI

program and the childsmedical home.


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PART C ELIGIBILITY CONSIDERATIONS FOR INFANTS & TODDLERS WHO ARE DEAF OR HARD OF HEARING

Impact

on Hearing

Potential Impact on Speech

& Language Development

Relationship of Degree of Hearing Loss to Child Development

Difficulty hearing or understanding speech innoisy or reverberant environments, especiallywhen the better ear is toward the noise.

Difficulty in hearing or understandingspeech if so or distant.

Difficulty determining where sounds arecoming from (localization) and who is the

speaker in family or group situations.

Language development may be delayed. Child may not understand questions or requests. Child may appear to not be paying attention. Child may have related delays in social-

emotional growth, cognition, adaptive andphysical development, and early literacy.

Impacton Hearing

Potential Impact on Speech& Language Development

Consider for Part C eligibility as well as: Audiological monitoring. Periodic assessment of speech and

language. Developmental monitoring. Consideration for amplification.

Part C EligibilityConsiderations

Difficulty hearing faint or so speech. Child likely to exhibit signs of hearing

difficulty in noisy environments or withincreased distance from speaker.

Comparable to listening with fingers inears.

Child may miss unstressed words, wordendings, and certain consonants.

Unaided, child may miss about 10% ofspeech.

Speech and language development may beslightly delayed.

Child likely to miss subtle conversation cuesthat could cause the child to appear inattentiveor inappropriate in his response to others.

Child will likely respond to speakers with huh?or confused look, especially in the presence ofbackground noise or with increased distance.

Child will have related developmental impact insocial/emotional growth, cognition, early literacy.

Part C Eligibility

Considerations

Consider for Part C eligibility as well as: Audiological monitoring. Periodic assessment of speech and

language. Developmental monitoring. Consideration for amplification. Access to information on communication

systems.

Impacton Hearing


Difficulty hearing so or distant speech. Cannot hear a whispered conversation in

a quiet environment a few inches from theear.

Unaided, child may miss up to 30%of speech, particularly in noisyenvironments.

Speech and language development likely tobe delayed.

Child will develop some speech communicationwith low to medium intelligibility as heardby unfamiliar and familiar listeners.

Speech and language development likely to bemarked by the absence of unstressed speech

sound (i.e., articles and other unstressedwords, tense markers, unvoiced consonants).


Part C Eligibility

Considerations

Highly recommended for Part C eligibility. Referral to other early intervention

resources, as appropriate.

NOTE: Numerical values, measured in decibels (dB HL), are based on the average of the hearing loss at three frequencies (500 Hz, 1000 Hz, and2000 Hz) in the better ear without amplification. Access to hearing technologies and/or visual language may lessen potential impact, but withoutearly intervention, the probability of delay remains.


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PART C ELIGIBILITY CONSIDERATIONS FOR INFANTS & TODDLERS WHO ARE DEAF OR HARD OF HEARING

Impact

on Hearing

Potential Impact on Speech

& Language DevelopmentPart C EligibilityConsiderations

Impacton Hearing



Impacton Hearing


Difficulty hearing or understandingspeech spoken at the loudness level of

normal conversation unless very close tothe speaker (0-3 feet).

Unaided, child may miss 50-75% to 80-100% of speech information (if hearingthresholds are at 55 dB)

Speech and language development will be delayed.

Child will develop some speech

communication but with poor intelligibilityas heard by unfamiliar and familiar listeners.

Language development will be compromisedin all major areas (content, form, use).

Likely to have delayed syntax, limitedvocabulary, errors in speech production, andatonal voice quality.



Highly recommended for Part C earlyintervention services.

Referral to other early interventionresources, as appropriate.

Cannot hear normal conversations in aquiet atmosphere at very close range (1 to

2 feet). Unaided, conversation must be very loud

in order for the child to recognize thatsomeone is speaking. Child may miss upto 100% of speech.


Child may develop some speechcommunication but with poor intelligibilityas heard by unfamiliar and familiar listeners.

Language development will be compromisedin all major areas (content, form, use)


Highly recommended for Part C early

intervention services. Referral to other early intervention

resources, as appropriate.

Cannot hear speech. Can only hear loudnoises at close range (i.e., lawn mower).

Child may hear someone yelling neartheir ear.

Unaided, child will miss up to 100% ofspeech.


Child may or may not develop speechcommunication but with no intelligibility asheard by unfamiliar to familiar listeners.





Impacton Hearing


Part C Eligibility

Considerations

Cannot hear speech. May only hear orfeel very loud noises (i.e., airplane at closedistance, chain saw).

Aware of vibrations.


Child will develop minimal to no speechcommunication.





Part C Eligibility Considerations for Childen With Hearing Loss

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