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Early Intervention Services:

Interview with Dr. Sandy Bowen, Associate Professor in the Special Education Department at the University of Northern Colorado.

Interview:

Early intervention services have received increased attention in recent years. What factors contributed to this change?

<Dr. Bowen> We have been concerned with early intervention really since the 1970's but you are right, in recent years an increased attention has been given to early intervention. I think one of the biggest reasons is Universal newborn hearing screening. Now that hospitals are screening for hearing loss before an infant is discharged from the hospital, we are identifying babies with hearing loss much earlier than we did in the past. Also there is a body of research that now suggests that early identification and subsequent intervention allows babies a chance to develop in a way that is more consistent with children without hearing loss, allowing them to enter school with age appropriate skills

Are there other contributing factors?

<Dr. Bowen> Yes, laws such as IDEA Part C, provide for early intervention services for all children (birth - three) who qualify. These funds have allowed more children to receive services.

What are you looking forward to with the upcoming re-authorization in relation to early intervention services?

<Dr. Bowen> One major area that is being looked at is the idea of natural environments. Natural environments provide for services to happen in the child's home, or other places that are more natural settings than a traditional therapy room or a hospital. There is strong agreement that we want natural environments, but there isn't always consensus on what a natural environment is, especially for children who are deaf. Let me give you an example. Many families of children who are deaf choose to use sign language as the primary mode of communication for their child. However, few hearing parents have had any exposure to sign language prior to the identification of their child. So they don't have friends or family members who sign. Having access to a play group in sign language may not be considered a natural environment by many Part C providers or advocates because it isn't something that typically developing child would participate in. However, in a natural setting, like the park or a play place, then it would be considered natural for how typical children would play.

It seems to me that a playgroup is much more natural than sitting one-on-one with a teacher as you learn individual signs.

<Dr. Bowen> Yes, that is true, but the critics would argue that if it is in sign language and you had to set up for the occasion, then it isn't "natural" for typically developing children. I think we have a large number of individuals who understand the benefits, but sometimes trying to make it fit within the parameters of the law is difficult.

That's interesting. How would these critics deal with helping a deaf child with hearing parents learn to sign?

<Dr. Bowen> That's a good question. Again, I think they are trying to see how it fits. Language is an important part of all early intervention programs, but usually it is not learning a new or second language, just facilitating the development of the first language. So, most professionals involved in early intervention don't understand how you might have to set up a "natural environment" for the purpose of exposing parents and children to sign language. I guess they do have a point, that if you have to "set up the environment", it doesn't seem very natural but in reality you are only providing opportunities in sign that typically developing children have in spoken language.

The key seems to be emphasizing the involvement of the family. If the family feels natural about what's happening and is likely to continue providing those opportunities without the early interventionist, we're moving in the right direction.

<Dr. Bowen> Yes, that is true. The family has to see how the "intervention" can become part of their everyday lives, and then it really is focused on the needs of the family and the child, rather than traditional therapy goals.

What are some ways that professionals can maximize the input from the family?

<Dr. Bowen> First and foremost by allowing the family to take charge. That doesn't happen overnight. Families have to be supported in their decisions and in their journey. For so long we have given the professionals the mantle of authority. Now we need to give that to the family. If they feel that they are truly in charge of their family and in control of the decisions made, they will feel more comfortable giving their input. Professionals have to give up that authority and trust the parents to make decisions that are best for their family.
Second by listening to the family. Professionals need to be good listeners, and empathetic listeners. And finally by respecting the family's decisions. When parents take control, they will make decisions that a professional may not think are the best choices. But we have to allow families to decide what is best for them, in their immediate circumstances.

You've mentioned the need for families to feel supported as they make decisions. What types of things can professionals do to be more supportive in the decision making process?

<Dr. Bowen> Again by listening to the family and by helping the family see what is occurring in the family. Often just bringing to their attention the positive things they are doing is helpful. Many times families feel that are not doing anything right, because they are learning so many new things and are trying to do everything that every professional has recommended as important. It can become overwhelming and parents reach a point that they feel that they aren't doing anything to help their child.

That's such a good point. With the overwhelming amount of information families are given at this time, I'm sure they sometimes feel a bit lost.

<Dr. Bowen> Yes, and some times it seems that the information is conflicting! One professional tells the family one thing and the next professional something different. Then add all the information available on the internet and it can become very overwhelming!

What about families with diverse backgrounds? Do you have some suggestions or strategies that will be helpful for professionals as they try to listen to the needs of a variety of families?

<Dr. Bowen> Working with families from diverse cultures and language backgrounds adds an additional challenge for early interventionists. One of the most important aspects of being an interventionist is being able to communicate with the family. Not only can language difference become a barrier but also communication styles. We have learned the unspoken rules and subtle nuances of conversation in our own language but these rules are not universal. How we say something is as important (if not more) than what we say. Additionally, family hierarchy is very important for professionals to understand. In some cultures, the father is the head of the household and the primary decision maker, in other cultures the matriarch (often the grandmother) is the primary decision maker, and in other cultures the entire extended family and friends make decisions for the family. So when the interventionist is asking the family to make a decision (for example about communication options or amplification options) it may not be as simple as it sounds. The interventionist needs to know who is making that decision and not overstep the boundaries of the culture by asking someone else to make the decision.

What are some strategies for early interventionists who don't use the same language as the family, and use an interpreter to facilitate communication?

<Dr. Bowen> It's interesting that you ask that, because just recently my opinion of that has changed. I use to advocate for families to work with an interventionist who was fluent in their language (regardless if they had the expertise in hearing loss) over someone who had the expertise in hearing loss, but didn't have the language. However, after observing the quality of services and interviewing parents about the services, I have changed my mind. I now believe that it is more important to have someone with the expertise in hearing loss working with a family, through an interpreter, than just simply finding a person who is fluent in the language but doesn't have the background information about hearing loss. Families need accurate information. They don't mind getting it through an interpreter. Of course the best-case scenario is when the interventionist has both the expertise and the language.

For that interventionist who has the expertise in hearing loss but is facing a language barrier, are there some things they can do to overcome that barrier?

<Dr. Bowen> First, make sure you (as the interventionist) have a good relationship with the interpreter. Make sure the interpreter understands what your role is and what their role is. Let them know that you want them to serve as a cultural broker too. Meaning that if you say or do something that is not culturally acceptable, that they help you and the family find a way to understand how to change it and do it better or differently. For example you don't want to sing "Pat-a-cake" with the family when there are more applicable songs in their own language. An interpreter, who is also willing to serve as a cultural broker can help you with those kinds of problems too.

Obviously, careful selection of the interpreter is an important factor.

<Dr. Bowen> Yes, but we don't always have that luxury. Rural areas often struggle with finding qualified people.

So far, we've discussed that a good early interventionist needs to be a good listener, an advocate for family rights, a positive support for the family, and a good communicator. What other skills does an early interventionist need in order to provide the best services for children who are deaf or hard of hearing? What elements do you think should be included in the training or preparation of an excellent early interventionist?

<Dr. Bowen> Let me answer the first part of your question. I guess I have just assumed that we are talking about qualified interventionists. But let me say that, for the record, the interventionist should have current knowledge of issues related to deafness; communication options, amplification options, typical language and child development, strategies for developing language, speech and auditory skills (when appropriate).

I think we have been talking about qualified interventionists, I just want to make sure for our audience that we say exactly what we feel those qualifications should be.

<Dr. Bowen> Now, the second part of your question what should be included in the training of an early interventionist..... Right now there are no uniform guidelines for interventionists. Each state has determined their own guidelines. I think the first step is for us (as a field) to develop more uniform requirements; that is currently happening. I think that these individuals should possess a master degree in a field related to deafness or hearing loss (i.e. deaf education, speech language pathology, audiology) or a closely related field (i.e. child development, psychology, special education, etc.) Some of the skills and expertise needed to work with families can be learned, others (especially the intra and interpersonal aspects) are part of who we are.

Do you expect the reauthorization to include information on guidelines for early interventionists, or is that coming from another source?

<Dr. Bowen> I hope the reauthorization addresses this issue, but I don't think it will be as detailed as some would like. There are groups who are working on these kinds of guidelines right now, but I guess we'll have to wait and see when they are ready.

Dr. Bowen, thank you so much for taking the time to share your thoughts and ideas with me. I'd like to wrap up today by looking at the future. In ten years, what do you see happening in deaf education as a result of improved/increased early intervention services?

<Dr. Bowen> I think we will see more deaf and hard of hearing children entering school with age appropriate skills in language. I think we will see parents taking the lead in the making laws and policies that affect children with hearing loss. I think we will see a degree or endorsement in early intervention and see states hiring qualified individuals to work as full-time interventionists in their states. Early intervention will impact school age programs because kids will come to school in a different place then they are currently. I think the way we look at educating deaf and hard of hearing students will soon change as a direct result of early identification and early intervention.