Early Intervention Outcomes Project

Early Intervention Early Intervention Outcomes ProjectOutcomes Project

Allison Sedey, Ph. D.Allison Sedey, Ph. D.University of Colorado, Boulder University of Colorado, Boulder

Kathryn Kreimeyer, Ph. D.Kathryn Kreimeyer, Ph. D.University of Arizona, TucsonUniversity of Arizona, Tucson

Arlene Stredler Brown, CCC-SLP, CEDArlene Stredler Brown, CCC-SLP, CEDUniversity of Colorado, BoulderUniversity of Colorado, Boulder

Shirin Antia, Ph.D.Shirin Antia, Ph.D.University of Arizona, TucsonUniversity of Arizona, Tucson

Faculty Disclosure Faculty Disclosure InformationInformation

In the past 12 months, we have not had In the past 12 months, we have not had significant financial interest or other significant financial interest or other relationship with the manufacturer of relationship with the manufacturer of

the products or providers of the the products or providers of the services that will be discussed in our services that will be discussed in our

presentation. presentation.

This presentation will not include This presentation will not include discussion of pharmaceuticals or discussion of pharmaceuticals or

devices that have not been approved by devices that have not been approved by the FDA.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 Marion Downs National Center for Infant Hearingfor Infant Hearing

National Early Intervention Coalition National Early Intervention Coalition

for D/HH Mission Statement for D/HH Mission Statement (March, (March, 2001)2001)

Examining Outcomes Examining Outcomes of Early Identification of Early Identification

and Interventionand Intervention A collaborative A collaborative

project between project between – Early Intervention Early Intervention

programs in six programs in six western stateswestern states

ArizonaArizona ColoradoColorado IdahoIdaho New MexicoNew Mexico UtahUtah WyomingWyoming

– Research faculty at Research faculty at two universitiestwo universities

University of University of Colorado – BoulderColorado – Boulder

University of University of ArizonaArizona

Project GoalsProject Goals

Build capacity for a multi-state data bankBuild capacity for a multi-state data bank Use outcome data to Use outcome data to

– evaluate impact of early intervention on the language evaluate impact of early intervention on the language outcomes of DHH children beyond the geographical outcomes of DHH children beyond the geographical confines of a single state or program confines of a single state or program

– monitor progress of individual childrenmonitor progress of individual children– identify child, family and program factors that predict identify child, family and program factors that predict

optimal developmental outcomes for childrenoptimal developmental outcomes for children– establish a state-level accountability system in each establish a state-level accountability system in each

state to guide state to guide state’s early intervention programs, state’s early intervention programs, augment professional preparation, augment professional preparation, influence the structure of each state’s program, influence the structure of each state’s program, identify funding prioritiesidentify funding priorities

– generate norms for D/HH populationgenerate norms for D/HH population

Project GoalsProject Goals

Support best practices for EI by Support best practices for EI by examining relationship betweenexamining relationship between– service characteristicsservice characteristics– child and family characteristicschild and family characteristics– child outcomeschild outcomes

Pilot GoalsPilot Goals

Identify a common core of instruments Identify a common core of instruments to evaluate child outcomesto evaluate child outcomes– General developmentGeneral development– Language developmentLanguage development

Obtain demographic information on Obtain demographic information on each child for whom assessment data each child for whom assessment data are obtainedare obtained

Develop questionnaires to investigate Develop questionnaires to investigate – Quality indicators of EI servicesQuality indicators of EI services– Parent satisfaction with servicesParent satisfaction with services

Participating ChildrenParticipating Children

A minimum of 10% of children A minimum of 10% of children served within each state who served within each state who meet the following criteria:meet the following criteria:– Nine to 24 months of age at first Nine to 24 months of age at first

assessmentassessment– No additional severe disabilitiesNo additional severe disabilities– English the primary home languageEnglish the primary home language– Bilateral permanent hearing lossBilateral permanent hearing loss

Conductive or sensorineuralConductive or sensorineural

Participant SelectionParticipant Selection

EI coordinator identified providers EI coordinator identified providers seeing a number of children and seeing a number of children and with whom can easily with whom can easily communicatecommunicate

From these caseloads, identified From these caseloads, identified children who met criteriachildren who met criteria

As of September 1, 2005, began As of September 1, 2005, began assessing children as IFSP update assessing children as IFSP update duedue

Demographic Demographic InformationInformation

Collected on each child and Collected on each child and updated every six months updated every six months – General informationGeneral information– Hearing Loss InformationHearing Loss Information– Language UseLanguage Use– Additional DisabilitiesAdditional Disabilities– Intervention ServicesIntervention Services

General Development General Development InstrumentsInstruments

Parent-report inventoriesParent-report inventories– Kent Inventory of Developmental Skills (Reuter & Kent Inventory of Developmental Skills (Reuter &

Gruber, 2000)Gruber, 2000) Children 9 months – 14 monthsChildren 9 months – 14 months

– Child Development Inventory (Ireton, 1992) Child Development Inventory (Ireton, 1992) 15 months – 36 months of age15 months – 36 months of age Include situation-comprehension scale from original Include situation-comprehension scale from original

(1974) version of inventory(1974) version of inventory Normed on typically developing childrenNormed on typically developing children Scales adapted to reflect both speech and sign Scales adapted to reflect both speech and sign

performanceperformance Completed initially and updated every six Completed initially and updated every six

monthsmonths

Language InstrumentsLanguage Instruments

MacArthur-Bates Communicative MacArthur-Bates Communicative Development Inventory (1992)Development Inventory (1992)– Words and Gestures Words and Gestures

Receptive and expressive vocabularyReceptive and expressive vocabulary Normed on typically developing children 8-16 Normed on typically developing children 8-16

months of agemonths of age– Words and SentencesWords and Sentences

Expressive vocabularyExpressive vocabulary Normed on typically developing children 16-30 Normed on typically developing children 16-30

months of agemonths of age Part 1 – Words Children UsePart 1 – Words Children Use

Parent-report assessmentParent-report assessment Adapted for sign and speechAdapted for sign and speech

Participants and Participants and Completed AssessmentsCompleted Assessments

StateState Total Total ParticipantParticipant

ss

One One AssessmeAssessme

ntnt

Two Two AssessmenAssessmen

tsts

Three Three AssessmenAssessmen

tsts

TotalTotal

AssessmenAssessmentsts

ArizonaArizona 2121 44 1212 55 4343

ColoradoColorado 1717 1313 44 00 2121

IdahoIdaho 1010 66 44 00 1414

New New MexicoMexico

66 22 44 00 1010

WyominWyomingg

66 22 22 22 1212

TotalsTotals 6060 2727 2626 77 100100

Percent of Male and Percent of Male and Female Participants Female Participants

(n=60)(n=60)

0

20

40

60

80

100

Per

cent

of Childre

n

Male Female

53% (n=32)

47%(n=28)

Degree of LossDegree of Loss(n = 54)(n = 54)

Degree of LossDegree of Loss dB rangedB range Percentage Percentage (number)(number)

High FrequencyHigh Frequency < < 25dB w/ some 25dB w/ some freq freq >> 30dB 30dB

4% (2)4% (2)

MildMild 26 – 40 dB26 – 40 dB 24% (13)24% (13)

ModerateModerate 41-55 dB41-55 dB 20% (11)20% (11)

Mod/SevereMod/Severe 56-70 dB56-70 dB 11% (6)11% (6)

SevereSevere 71-90 dB71-90 dB 9% (5)9% (5)

ProfoundProfound >90 dB>90 dB 19% (10)19% (10)

Severe or Severe or ProfoundProfound

NR to clicks on NR to clicks on ABRABR

13% (7)13% (7)

Ethnicity Ethnicity (n = 60)(n = 60)

12%

2%

8%10%

68%

CaucasianHispanicCaucasion/ HispanicOther Mixed EthnicityNative American

Screening, Screening, Identification and Identification and

InterventionIntervention All children screened by one month All children screened by one month

of ageof age Hearing loss identified in 71% of Hearing loss identified in 71% of

children at or before 3 months of agechildren at or before 3 months of age– Identified in 87% of children by 6 Identified in 87% of children by 6

months of agemonths of age Intervention initiated for 71% of Intervention initiated for 71% of

children at or before 6 months of children at or before 6 months of age.age.

Not yet reached EHDI 1-3-6 goal for Not yet reached EHDI 1-3-6 goal for all childrenall children

Age of Identification, Age of Identification, Intervention and Intervention and

AmplificationAmplificationMedianMedian RangeRange

Age of IDAge of ID 2.0 months2.0 months 0 to 300 to 30

Months from Months from ID to ID to InterventionIntervention

1.75 months1.75 months 0 to 140 to 14

Months from Months from ID to ID to AmplificationAmplification

2.0 months2.0 months 0 to 170 to 17

Type of AmplificationType of Amplification

2%

22%7%

67%

2%

None

Hearing Aids

Hearing Aid + FM

Cochlear Implant

Cochlear Implant +Hearing Aid

Mode of Communication Mode of Communication Used by Primary Used by Primary

CaregiverCaregiver

23%

47%

28%2%

0

10

20

30

40

50

60

70

80

90

100

Perc

ent of Childre

n

Spoken Only

Spoken +Occassional SignSpoken + Sign

Sign Only

Minutes per Week Minutes per Week Receiving InterventionReceiving Intervention

Nine to 30 months (n = 44)Nine to 30 months (n = 44)– Median 60 minutes/week Median 60 minutes/week

Range 15 – 300 minutes (home Range 15 – 300 minutes (home based/toddler group)based/toddler group)

31 to 40 months (n = 16)31 to 40 months (n = 16)– Median 400 minutes/week (includes Median 400 minutes/week (includes

preschool attendance)preschool attendance) Range 45 to 1,440 minutesRange 45 to 1,440 minutes

Language ResultsLanguage Results

Determining Language Determining Language Quotient (LQ)Quotient (LQ)

Language Age/Chronological Age x 100Language Age/Chronological Age x 100If LQ = 100, Language Age = CA If LQ = 100, Language Age = CA If LQ < 100, Language Age < CAIf LQ < 100, Language Age < CAIf LQ > 100, Language Age > CA If LQ > 100, Language Age > CA

Performance RangesPerformance Ranges80 or above = normal80 or above = normal70 to 79 = borderline70 to 79 = borderlineLess than 70 = below averageLess than 70 = below average

Kent Inventory of Kent Inventory of Developmental Skills Developmental Skills

(n=6)(n=6)

17%

33%

50%

0

10

20

30

40

50

60

70

80

90

100

Perc

ent

of

Childre

n

Normal Borderline Below Average

Language Quotient Performance Levels

Child Development Child Development Inventory Expressive Inventory Expressive

LanguageLanguage

74%80%

12% 12% 14% 9%0

10

20

30

40

50

60

70

8090

100

Perc

ent

of Child

ren

Normal Borderline Below Average

Language Quotient Performance Levels

Full Sample (n = 50)

ID by 3 mths (n = 35)

Child Development Child Development Inventory Language Inventory Language

ComprehensionComprehension

62%74%

14%9%

24%17%

010

2030

40

5060

70

8090

100

Perc

ent

of Child

ren

Normal Borderline Below Average

Language Quotient Performance Levels

Total Sample (n = 50)

ID 3 mths (n = 35)

MacArthur-Bates MacArthur-Bates Expressive VocabularyExpressive Vocabulary

42%

44%

28%

31% 30%26%

01020

30405060

708090

100

Perc

ent

of Child

ren

Normal Borderline Below Average

Language Quotient Performance Levels

Full Sample (n=53)

ID by 3 mths (n=39)

Language SummaryLanguage Summary

Children identified by 3 months and Children identified by 3 months and receiving intervention by 6 months receiving intervention by 6 months scored higher than full sample on CDI scored higher than full sample on CDI language measureslanguage measures– Difference on MacArthur-Bates likely not Difference on MacArthur-Bates likely not

significantsignificant Children younger than one year of age Children younger than one year of age

– Lowest language quotients on KentLowest language quotients on Kent Speech/auditory items may depress scoreSpeech/auditory items may depress score Slight delay at younger age creates lower LQSlight delay at younger age creates lower LQ Evaluate/modify interventionEvaluate/modify intervention

Language SummaryLanguage Summary

Children 14 months or older Children 14 months or older – CDI Expressive Language higher than CDI Expressive Language higher than

Language ComprehensionLanguage Comprehension Median language quotients within normal range Median language quotients within normal range

in both areasin both areas MacArthur-Bates Expressive MacArthur-Bates Expressive

Vocabulary addressed children from 9 Vocabulary addressed children from 9 months to 40 monthsmonths to 40 months– Median language quotient in borderline Median language quotient in borderline

range range – Hearing children learning 30 words/month Hearing children learning 30 words/month

as of 18 months of ageas of 18 months of age– Need to increase rate at which DHH Need to increase rate at which DHH

children learning vocabularychildren learning vocabulary

Significant Significant AccomplishmentsAccomplishments

Collaboration across multiple Collaboration across multiple statesstates– Common demographic informationCommon demographic information– Common assessmentsCommon assessments

Obtained outcome data on 60 Obtained outcome data on 60 childrenchildren– Repeated measures on 33 childrenRepeated measures on 33 children

Next StepsNext Steps

Performance over timePerformance over time Qualifications of providers and relationship to Qualifications of providers and relationship to

child performancechild performance Develop instrument to describe intervention Develop instrument to describe intervention

– Investigate relationship between intervention and Investigate relationship between intervention and outcomesoutcomes

Increase number of children on whom Increase number of children on whom assessments are completedassessments are completed

Provide training on how to interpret state level Provide training on how to interpret state level and individual resultsand individual results

Encourage more programs to implement Encourage more programs to implement outcome-based/evidence-based interventionoutcome-based/evidence-based intervention

Contact InformationContact Information

Kathryn Kreimeyer Kathryn Kreimeyer – [email protected]@email.arizona.edu

Arlene Stredler BrownArlene Stredler Brown– [email protected]@colorado.edu

Allison SedeyAllison Sedey– [email protected]@colorado.edu

Shirin AntiaShirin Antia– [email protected]@email.arizona.edu