The task of choosing the most appropriate educational placement
to facilitate language development, academic learning, and positive
social-emotional development for deaf and hard of hearing children
can be confusing. The choices are not always clearly defined as
there are many factors that impact on a child's success with one
setting over another, and there are varied professional recommendations
related to one setting over another. The advent of the cochlear
implant has made this decision-making process even more complex.
Each child arrives at the implant process with unique characteristics
and potential outcomes. While the motivation and hopes of some families
may be that their implanted child will participate in their neighborhood
school with no additional educational support services, for some
children this may not be an immediate outcome, and for some this
may not be a realistic outcome.
As cochlear implant technology has become more common, so has the
diversity in the types of children obtaining implants. During the
early years when implantation first emerged as a choice for children,
the children obtaining cochlear implants appeared to be a homogenous
group. The group of implanted children was comprised primarily of
Caucasian children with high levels of income that were enrolled
in mainstream or oral environments. (Parents' Perceptions and
Experiences with Their Children's Cochlear Implants: A Report of
the Results of the Survey of Parents of Pediatric Cochlear Implantees,
presented by Tom Allen, dean of the Graduate School and Research
at Gallaudet University, in March 2000)
In addition, many of the children selected as candidates were post-lingually
deaf or were children with prior auditory experience and demonstrated
aptitude for developing spoken language. As growing numbers of children
are obtaining cochlear implants, however, observation suggests that
the population of implanted children is changing. Children obtaining
cochlear implants now appear to come from increasingly diverse cultural
backgrounds, socio-economic groups, and a broader range of ages
(specifically, more infants and toddlers).
The bottom line is that there is no single "right" educational
placement for a child with a cochlear implant. In addition, placement
and communication choices may need to change based on a child's
development or success in any given placement. It is necessary that
placement choices be monitored and evaluated on an ongoing basis
to assure the appropriateness of a placement.
Placement Options
The educational placement choices for a child with a cochlear implant
include similar options available to other deaf and hard of hearing
children. These placement options include:
- a neighborhood or private school with no additional supports,
- inclusion in a neighborhood or private school with supports
integrated within the school (itinerant teachers, resource teachers,
speech and language specialists, etc.),
- a self-contained classroom for children with hearing loss using:
- an oral approach,
- cued speech,
- total communication, or
- American Sign Language,
- a day school for deaf children that uses:
- an oral only approach,
- total communication, or
- a bilingual approach (American Sign Language and English).
Considerations for Making
Decisions
As individual outcomes vary for students with cochlear implants
similar to all deaf students, a student should not be defined/placed/planned
for based solely on his or her cochlear implant. As choices are
made regarding educational placement for implanted children, it
is important to consider the following individual characteristics
of the child:
- Background:
- medical and developmental history
- hearing loss etiology, onset, and age of identification
- quality and quantity of family support
- cultural background
- Intervention:
- age that intervention was initiated
- quality, quantity, and consistency of intervention prior
to cochlear implantation
- quality, quantity, and consistency of amplification use
prior to implantation
- type of language use prior to implantation (spoken or signed)
- quality, quantity, and consistency of language stimulation
- language, cognitive, and academic functioning
- learning profile, style, and characteristics
- social/emotional development
- Implantation:
- age at the time of implantation
- pre-implant auditory experience
- post-implant auditory experience
- primary communication mode at age of implant
- purpose of implant and expectancies of student and family
- consistency in implant use
The following placement considerations should be kept in mind for
children with cochlear implants as they would for any deaf child:
- Choose a program that takes into consideration the whole
child. An appropriate educational program takes into consideration
a child's overall functioning and goals in a variety of areas,
not only development of listening and speech skills. A program
that focuses solely on developing listening and speech skills
at the exclusion of addressing other components of a child's education
may not be in the child's best interest.
-
Program components should be individualized and based on the
Individualized Family Service Plan (IFSP)/Individualized
Education Program (IEP). Don't assume that placement and services
will be similar for any two students with a cochlear implant.
Each child arrives at the implant process at a different stage
in development. Placement and support service planning for each
child should be driven by the IFSP/IEP process.
- Collaboration with hospital implant centers is beneficial.
Ongoing collaboration between the implant centers and educational
settings (i.e. observations between centers, workshops, teaming,
attendance at IFSP/IEP meetings) is integral to promoting cohesive
planning for students with cochlear implants. It is important
that hospital implant centers understand the full range of issues
involved in placement and communication planning, and the school
understand the clinical and medical side of implantation so families
are obtaining consistent guidance related to seeking services
and placement after implantation.
- Keep in mind current functioning levels and goals for language
development. Choose a program/classroom that is sensitive
to the child's current language competency in spoken language,
not only future hopes. While children may have similar abilities
to be aware of sound with their cochlear implant, they have unique
abilities to use this awareness for understanding spoken language.
While it is beneficial to have the child in an environment that
challenges him or her, it is not beneficial to have the child
lost, overwhelmed, or frustrated.
- What about the use of interpreters in the mainstream? Interpreters
should be considered for inclusion in a child's program only if
the child is already a "user" of sign language. If a
child is having difficulty following spoken language in a mainstream
classroom, interpreters should not be viewed as an answer for
clarifying information for a deaf student who is not already familiar
with sign language. Sign language cannot be effectively learned
through use of an interpreter and is not recommended as a remedy
to a child's inability to learn through spoken language. If this
situation arises, placement considerations should be carefully
revisited.
- What about the use of an FM system? There are varying
opinions related to the use of FM equipment for students with
cochlear implants. Some hospital implant centers recommend initially
having the child adjust to listening through his or her implant
without adding the FM system. This allows the child the opportunity
to learn to listen in an "implant only" situation. Increasing
numbers of students are beginning to utilize and evaluate the
use of FM systems as the technology continues to miniaturize and
improve. Each student's needs should be taken into consideration
as the decision whether or not to use an FM system is made.
- Varying ages of implantation means varying programming needs.
It is easier to design a program for young implanted children
to facilitate development of spoken language since the goals of
most early childhood programs revolve around the facilitation
of language development. For students first obtaining cochlear
implants when they are older, designing a program to balance spoken
language development and academic needs becomes trickier. The
focus of the school day revolves around obtaining academic information.
When a child obtains an implant, it becomes necessary to expand
attention to developing spoken language skills without sacrificing
attention to learning.
- Accessibility to information—Keep in mind that the
process of moving a child through the hierarchy of listening skill
development, to the point where he or she has access to information
through hearing, takes time. Each implanted child brings a different
level of accessibility to information through his or her hearing.
This means that he or she will have different levels of accessibility
to academic information, social interactions, and incidental learning.
It is important to determine if a setting provides an opportunity
for the child to have sufficient access through his or her listening
to be involved and active participants in the environment.
Even if the child can hear some sounds, it doesn't mean that
the child can learn complex information auditorily. In addition,
some children may be effective social communicators using spoken
language, yet suffer communication breakdown when it comes to
learning academic information through their listening. It is
important that implanted children have sufficient access to
all levels of information around them.
- Least Restrictive Environment (LRE)—It is important
to determine if a placement is truly the "least restrictive
environment" for a child with a cochlear implant. While the
goal may be for an implanted child to ultimately reside in a neighborhood
classroom, this may not be the best place for a newly implanted
child. What may seem like the "least restrictive environment"
without all of the necessary supports could result in insufficient
attention to the comprehensive needs of the child.
- Social interactions—While placement choices for
cochlear implanted children are often chosen for their opportunity
to facilitate spoken language development, it is crucial that
the placement be evaluated related to promoting positive social
opportunities. It is important that implanted children be in an
environment where they feel comfortable communicating with their
peers to facilitate development of age-appropriate social skills,
friendships, and behavior. These issues demand serious attention
when evaluating a specific placement.
- Sufficient support services—It is crucial to assure
that a child's educational placement provides comprehensive student
assessments and necessary support services. As placement decisions
are evaluated, make sure professionals qualified in evaluating
children who are deaf are serving the child. In addition, make
sure the child has access to technological devices that may be
needed such as captioned materials, FM systems, or other assistive
technologies (i.e., direct audio input from the computer to the
cochlear implant).
- Teacher/staff training—Teachers and other involved
faculty and staff members should have opportunities for ongoing
professional development to facilitate effectively involving implanted
children in their school. Many teachers and support staff, even
those who have been involved for years in the education of deaf
children, may be unfamiliar with the technology of cochlear implants,
strategies for working with implanted students, and expected outcomes.
It is necessary that professionals be trained related to all components
of planning and implementing a comprehensive program for implanted
students.
-
Other learning issues—While some children may have
behavior and learning issues that resolve following cochlear implantation
as a result of their improved communication skills, a cochlear
implant is not going to remedy issues unrelated to hearing loss.
Children with additional learning disabilities or emotional issues
unrelated to deafness will continue to display these concerns.
Placement decisions should be made taking all of the child's learning
issues into consideration, not only a child's cochlear implant.
- Family support—Family involvement is integral to
a child's success with his or her cochlear implant and educational
program. Look for a program that supports families in understanding
the communication and training process following implantation.
For families where English is a second language, assure that a
program provides access to information in the family's first language.
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