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Reforms: The Impact on Deaf and Hard of Hearing Students|
Before initiatives to identify children with hearing loss at an early age, diagnosis of students who are deaf or hard of hearing often came late into their language development years. As a result, many children had decreased exposure to language (either speech or sign language) during what is considered a sensitive period for language and cognitive development. The Universal Newborn Hearing Screening program, authorized by the Public Health Service Act, Title III, Section 301, 42 U.S.C. 241, provides federal funds for states to screen infants for hearing loss before they leave the hospital (for a discussion of similar initiatives in other countries, see Storbeck & Calvert- Evans, 2008). In states with screening programs, children with potential hearing loss receive follow-up information and connections with resources within the community at the very earliest stages of language development.
Early identification of hearing loss has led to a greater emphasis on amplification and oral communication options for students who are deaf or hard of hearing (Vohr, 2003; Yoshinaga-Itano & Gravel, 2001). In the past few years, a growing number of children with the most significant hearing losses have undergone cochlear implant surgery (Belzner & Seal, 2009; Niparko & Blankenhorn, 2003). In a person with functioning hearing, the inner ear acts to convert sounds into electric impulses that are then sent to the brain (U.S. Food and Drug Administration, 2004). Although the cochlear implant does not create normal hearing, it can give auditory input to the brain to help process speech and other sounds (Barker & Tomblin, 2004). According to the Gallaudet Research Institute 2007–08 Annual Survey, approximately 14% of children attending schools or programs for deaf or hard of hearing students had a cochlear implant (Gallaudet Research Institute, 2008). Cochlear implants have been on the rise steadily over the last decade: cochlear implant use among children has grown by approximately 1% per year between 1999 and 2007. Although implantation trends may shift in the future, use of cochlear implants among students who are deaf or hard of hearing is currently experiencing a steady increase.
Cochlear implants have potentially far-reaching implications for the Deaf community (Christiansen & Leigh, 2002; Marschark & Spencer, 2006; Moores, 2006; Simms & Thumann, 2007). Proponents of cochlear implants view the procedure as medically safe and an effective means of giving deaf children access to the sounds of speech (Geers, 2002). Research has provided some evidence for increased speech and language outcomes when implantation is followed by consistent, intensive speech therapy (Blamey, Sarant, Paatsch, Barry, Bow, Wales et al., 2001; Geers & Brenner, 2004; Moog, 2002; Tomblin, Spencer, Flock, Tyler, & Gantz, 1999). Yet those who object to cochlear implants note the severity of brain surgery on those very young children within the population who cannot give informed consent (Lane, 1999; Moores, 2006). Not all children who have an implant follow predicted trajectories of speech and language development (Duchesne, Sutton, & Bergeron, 2009) and often need to use sign language for effective communication (Moores, 2009; Nussbaum, La Porta, & Hinger, 2003). Furthermore, the level of speech therapy required is potentially intrusive and expensive given the possibly limited gain.
The above three demographic characteristics of students who are deaf or hard of hearing have implications for how we investigate the impact of accountability reforms on this population. First, low-incidence populations are often aggregated into summaries of student outcomes across multiple groups, so outcomes for those with characteristics or educational needs very different from those of students who are deaf or hard of hearing are often combined. Nevertheless, being a part of the larger “students with disabilities” umbrella may be beneficial when gaining access to resources such as those through the Americans With Disabilities Act of 1990. However, aggregation of low-incidence populations can also mask some of the unique characteristics of each subgroup, resulting in muddied waters for not only addressing educational needs but also implementing educational reform. As we will discuss further in Chapter 4, it is very difficult to determine the status of students who are deaf or hard of hearing under the current accountability system.
The second demographic characteristic is the presence of multiple disabilities. Additional disabilities add to the complexity of language, communication, and instruction for students with hearing loss. For example, a Deaf student who also has a learning disability may require additional support beyond a sign language interpreter to experience academic success. Most summaries of students who are deaf or hard of hearing rely on information from students who have a primary designation for hearing loss. Yet up to half of these students are likely to have a second disability. Summaries of academic performance based only on the primary disability reduce our understanding of how students who are deaf or hard of hearing fare under educational reform. Inversely, some students with hearing loss have other primary disabilities and, thus, may not be recognized as a member of the deaf or hard of hearing subgroup. Most performance summaries of students who are deaf or hard of hearing do not include students with hearing loss as a secondary disability. The goal of accountability reform is to make measures of student achievement more transparent. For students who are deaf or hard of hearing, it is necessary to include both groups—students with primary and secondary hearing loss designations—to meet that goal.
Third, the use of cochlear implants with children, discussed above, brings with it some evidence for improved speech and language in particular circumstances, but it also brings its own set of controversies and concerns. Evidence of improvements must be further verified, and concerns, not only for safety and health reasons but also for financial reasons, need to be addressed.
In summary, heterogeneity in the deaf and hard of hearing population has always been a challenge for the field. When making recommendations about changes for instructional strategies in deaf education or best practices in teacher preparation, the characteristics of students in the research base is critical to making predictions about the effectiveness of changes for this diverse group (Antia, Jones, Reed, & Kreimeyer, 2009; Johnson, Liddell, & Erting, 1989). Educational policy that supports a “one size fits all” approach to instruction and assessment risks misapplying strategies designed with “typical” students in mind. This risk of misapplication is particularly true for students who are deaf or hard of hearing. In Chapters 4 and 5, we will investigate ways that assessment and accountability approaches oversimplify the learning process for students who are deaf or hard of hearing with multiple disabilities.
Finally, accountability reform (as are all large-scale reforms) is applied on top of, and not instead of, the local educational context. In deaf education, cochlear implants and the controversy surrounding their use is part of the local context of how parents, teachers, and students approach education. The use of a medical procedure to change the impact of a disability may not apply only to children who are deaf. Its potential interpretation as an agenda for eradicating a culture and way of life is, however, unique to the Deaf community. One argument in favor of cochlear implants is that implants may help children who have profound hearing loss be more fully mainstreamed into regular education classrooms by improving speech and subsequent academic achievement. When accountability reforms measure the effectiveness of schools from a single perspective, with English as the primary mechanism for demonstrating language and academic proficiency, it is possible that the reforms become a way to gather evidence for or against cochlear implantation. In a sense, this strategy may be a case of using the end goal of English proficiency to promote the success of cochlear implants. This unintended consequence of accountability reform may have significant impact on how it is implemented in the Deaf community.