Introduction     

Family-based early intervention is crucial for children who have delays or disabilities, including those who have hearing loss (Division for Early Childhood, 2014; Moeller, Carr, Seaver, Stredler-Brown, & Holzinger, 2013). Many of these families receive support and early intervention services through Part C of the Individuals with Disabilities Education Act; in Michigan these services are provided by the Early On® program. Best practices suggest that early intervention service providers work directly with parents in order to support positive parent-child interactions (Moeller et al., 2013; Spencer & Marschark, 2010; Division for Early Childhood, 2014). For families who have children with hearing loss, this includes providing parents with unbiased support regarding communication options, and encouraging parents to provide language-rich environments for their children (Joint Committee on Infant Hearing, 2007; Yoshinaga-Itano, 2014). When families are more directly involved in early intervention, parents have more positive feelings about their ability to support their children and more satisfaction with the early intervention services they receive (Dunst, Trivette, & Hamby, 2007). However, little is known about parents’ experiences and feelings about the early intervention services they receive in the state of Michigan related to their children’s hearing loss. Learning more about parents’ views of the strengths and areas of improvement for these early intervention services provides an opportunity to better understand how to meet the needs of these children and their families.

Research Questions

In order to better understand the early intervention experiences of parents who have infants and toddlers with permanent hearing loss, we asked:

• What did parents most appreciate about the early intervention services they and their child received and their service provider(s)?
• What ways did parents feel that the early intervention services or their interactions with their service provider(s) should be improved?

Overview of Study Methods

We partnered with Early On® to recruit families in order to learn more about their experiences with early intervention for their children who had permanent hearing loss. Criteria for being in the study included the following: (a) children had to be between 12 and 30 months of age, be enrolled in an early intervention program, and have no cognitive delays or additional disabilities, and (b) both of their parents had to use English as their primary language and have typical hearing, since mismatches between parents’ and children’s hearing statuses puts these children at greater risk for delayed language development (Spencer, Erting, & Marschark, 2000; Meadow-Orlans, 1997; Meadow-Orlans & Spencer, 1996). Children could have any degree of hearing loss, and families could be using any form of communication with their children (e.g., signed, spoken or combination of both). To make participation easier for families, only one parent per family was asked to participate in the study. Twelve parent-child dyads who lived throughout the state of Michigan participated. Children’s degree of hearing loss ranged from mild to profound, and most families were using spoken language with their children and supplementing this with the use of signs.

In order to learn about families’ experiences, we conducted home visits which included semi-structured parent interviews. Parents were asked about what they like the most and find most useful about the early intervention services they receive and the service providers with whom they interact, as well as their ideas about ways in which these early intervention services could be improved. Based on these interviews, we searched for themes in parents’ responses related to the research questions stated above.

Results

Parents reported that their early intervention experiences had been primarily positive, mostly due to the supportive relationships they developed with their service providers. Some parents, however, noted areas where their services or experiences should be improved, such as an increase in the amount of services and receiving information that is more specific to their child’s disability. Figure 1 shows the patterns in parents’ interview responses regarding strengths of the early intervention services they and their children receive and aspects of these services they felt should be improved.                                                                              

                                        Figure 1

Strengths of early intervention. One of the most common responses from parents during interviews was that they are generally very satisfied with the services they receive, and with the interpersonal relationships they had developed with their service providers. Parents felt that overall, they were benefiting from the knowledge their service providers had to offer. They expressed appreciation for service providers’ words of advice, ideas for what to do at home with their children, and the different resources to which Early On® service providers referred them. Parents also expressed that they felt their service providers were capable and competent; parents especially appreciated service providers who knew sign language, and who had previous experience or training related to working with children with hearing loss.

Parents’ satisfaction with their early intervention services was also related to how they personally felt about their service providers. Parents spoke positively about service providers who made them feel reassured and comforted, and with whom they felt could relate well. Other major strengths of their early intervention service providers included patience, openness, and supportiveness. Parents especially appreciated feeling like their service providers genuinely cared about them and their children. For example, one parent said, “They care about what the parents go through, too, in the process. And they care about if it’s difficult or hard; they know that it’s hard and it’s a struggle sometimes. So, the fact that they just are genuinely caring about the whole situation and understanding is the most important thing to me because I don’t get involved with anything if I feel uncomfortable.”

Areas for improvement. While parents were thankful to be working with Early On®, most parents did report areas where they felt their services should be improved. A common theme throughout the interviews included parents’ desire for more of the services they already received; parents wanted more visits from service providers, additional advice and information on what they could be doing to help their child, and new ways to connect with other parents of children with hearing loss. In addition, some parents discussed their desire to work with service providers who are fluent in the use of American Sign Language and who have additional expertise relate to serving children who have hearing loss. For example, one parent who was not receiving support from his service providers to learn American Sign Language said, “I guess if I could change anything, if I could have got assistance from early intervention in terms of learning sign language myself. That was something we totally had to do on our own.” Lastly, while parents were appreciative of receiving advice and reassurance about general parenting issues and questions, some expressed that they would like to receive more information about their child’s hearing loss, as well as detailed information that is specifically relevant to their children’s unique needs because of his/her hearing loss. Some parents said they felt that the advice they received was very general, or applicable to many infants and toddlers instead of being specific to the needs of their child with hearing loss.

Conclusions

Overall, the parents interviewed for this study shared many strengths and positive experiences about their early intervention services and service providers; they reported feeling very satisfied with the services that they receive. Parents appreciate their interactions with their service providers, whom they often described as warm and caring individuals. The primary areas for improvement that parents identified included the need for more visits and services, a desire to work with service providers who are fluent in the use of American Sign Language, and the need for more nuanced, disability-specific information.

Key Implications for Practice

• Developing caring, personal relationships with parents is essential to parents’ reports of positive early intervention experiences.
• Each family who has a child with hearing loss should have access to an early intervention service provider who is fluent in the use of American Sign Language and has experience working with children who have hearing loss.
• Early intervention service providers should seek out opportunities to learn more about the specific, nuanced information that may be most helpful for parents who have children with permanent hearing loss and relay that information to parents. See Moeller et al. (2013) and Yoshinaga-Itano (2014) listed in the References section for an excellent overview and ideas for additional reading. In addition, Cruz et al. (2013) is a great resource that provides examples of language strategies parents use while interacting with their children. For instance, parents’ use of the strategy called parallel talk is shown to be beneficial for the language development of children with hearing loss; therefore, encouraging parents to discuss, via spoken and/or signed language, what their children are interested in or attending to is one way to support positive parent-child communication for these families.

Contact Information
For more information about this study contact: Kalli Decker, Kalli.Decker@montana.edu.

References

Cruz, I., Quittner, A.L., Marker, C., DesJardin, J. L., & CDaCI Investigative Team. (2013). Identification of effective strategies to promote language in deaf children with cochlear implants. Child Development, 84, 543-559. doi:10.1111/j.1467-8624.2012.01863.x

Division for Early Childhood. (2014). Recommended practices in early intervention and early childhood special education. Retrieved from http://www.dec-sped.org/recommendedpractices

Dunst, C. J., Trivette, C. M., & Hamby, D. W. (2007). Meta-analysis of family-centered helpgiving practices research. Mental Retardation and Developmental Disabilities Research Reviews, 13, 370-378. doi: 10.1002/mrdd.20176

Joint Committee on Infant Hearing. (2007). Year 2007 position statement: Principles and guidelines for early intervention after confirmation that a child is deaf or hard of hearing. Pediatrics, 120, 898-921. doi: 10.1542/peds.2007-2333

Moeller, M. P., Carr, G., Seaver, L. Stredler-Brown, A., & Holzinger, D. (2013). Best practices in family-centered Early Intervention for children who are deaf or hard of hearing: An international consensus statement. Journal of Deaf Studies and Deaf Education, 18, 429-445. doi: 10.1093/deafed/ent034

Spencer, P.E., & Marschark, M. (2010). Evidence-based practice in educating deaf and hard-of-hearing students. New York: Oxford University Press.

Yoshinaga-Itano, C. (2014). Principles and guidelines for early intervention after confirmation that a child is deaf or hard of hearing. Journal of Deaf Studies and Deaf Education, 19, 143-175. doi: 10.1093/deafed/ent043