TY - JOUR
AU1 - Veyvoda, Michelle, A
AU2 - Kretschmer,, Robert
AU3 - Wang,, Ye
AB - Abstract Students who are deaf or hard of hearing (DHH) increasingly attend local public schools, in which speech and language clinicians (SLCs) may lack experience with the individualized needs of a heterogeneous student population. This study explored the experiences of SLCs with students who are DHH in three different types of educational settings. Fourteen SLCs were interviewed and discussed a case study. Responses were transcribed, data coded, and emergent themes identified. Analysis was verified through triangulation of data and trustworthiness strategies. Results indicated that the skill sets of SLCs working with children who were DHH were dependent on contextual factors, such as educational placement and communication mode used, and that development of these skills requires direct experience, collaboration, and structural supports. Institutions across the deaf education spectrum should consider forming alliances to improve information-sharing and collaborative learning in order to improve service delivery in all settings. Speech and language clinicians are typically an integral part of the educational team serving students who are deaf or hard of hearing (DHH). While many of these clinicians gain experience and expertise with this population through work at schools for the deaf, clinicians in local school districts are increasingly called upon to provide speech and language therapy to students who are DHH in the general education setting. Although children who are DHH have historically been included in regular education in various ways (Gordon, 1885), the number of children with severe-to-profound hearing loss attending local school districts and small regional programs has increased in recent years. The most recently published Annual Survey of Deaf and Hard of Hearing Children and Youth (Office of Research Support and International Affairs, 2014) indicates that 47.5% of students who are DHH are educated in the regular education setting, in which children who receive special education services or educational accommodations are placed in general education classrooms for certain periods of the day, depending on their strengths and needs. According to the most recent available data from the U.S. Government Accountability Office (2011), more than 85% of children who are DHH and receive support services (including speech and language therapy) through the Individuals with Disabilities Education Act (IDEA) are educated in local school district settings (public schools, including primary and secondary schools, attended by children from a specific, local geographic area). These settings include general education (integrated) classrooms and self-contained classrooms (alternative classrooms for children who need academic supports not offered in the general education setting). This statistic does not include children who are DHH who do not receive special education services, or whose only support services are legally mandated accessibility accommodations (such as a sign language interpreter). This represents a dramatic increase in public school attendance in recent decades and has resulted in an expanded role for public school-based speech and language clinicians1 (SLCs), who are responsible for providing aural (re)habilitation, serving on a cochlear implant team and inter-professional team (Blaiser & Nevins, 2017), and troubleshooting assistive listening devices (Moore & Teagle, 2002). The American Speech-Language-Hearing Association (ASHA) provides an extensive list of recommended knowledge and skills areas for SLCs working with children who are DHH (ASHA, 2001); however, for decades, scholars have documented a discrepancy between the speech and language therapy needs of children with hearing loss and SLCs’ preparedness to meet these needs in the local school district setting (Chabon, Brown, & Gildersleeve-Neumann, 2010; Compton, Tucker, & Flynn, 2009; Iverson, 2005; Moseley, Mahshie, Brandt, & Fleming, 1994; Yoshinaga-Itano, 1997). Changes in the Deaf Education Landscape There have been two primary factors driving the increased mainstreaming of children who are DHH in the United States. One is federal legislation, such as IDEA (2004) and Section 504 of the Rehabilitation Act (1973) IDEA requires that all children with disabilities be educated in the “least restrictive environment” (§1412 (a) (5)), meaning that children who are DHH should attend classes alongside their typically hearing peers to the greatest extent possible. Section 504 of the Rehabilitation Act prohibits the exclusion of any person with a disability from participation in a local school district by institutions that receive federal funding and guarantees the provision of FM systems, classroom modifications and sign language interpreters to DHH children (Welling & Ukstins, 2019). The Early Hearing Detection and Intervention (EHDI) Act of 2000 (re-authorized by Congress in 2017) created opportunities for earlier detection of hearing loss, earlier access to amplification, accessible communication, and early intervention, thus increasing the likelihood of developmental synchrony (Cole & Flexer, 2016) and increased likelihood of mainstreaming. The second factor involves advancement in hearing technologies, providing many children who are DHH with improved auditory access through digital hearing aids, cochlear implants, and FM systems. Combined, these factors have enabled many children who are DHH to develop spoken language skills that allow for increased participation in mainstream education and changing the landscape of deaf education in the United States (Purn, 2001). While many children who are DHH continue to attend Schools for the Deaf (SFDs), recent trends indicate that parents increasingly choose to place their children who are DHH in public schools (Marschark, Shaver, Nagle, & Newman, 2015; U.S. Government Accountability Office, 2011; Andrews, Leigh, & Weiner, 2004). Children who are DHH in mainstream educational programs have been documented as taking more academically challenging coursework than their peers in SFDs (Marschark, Lang, & Albertini, 2002). Desire for mainstream education combined with legislative and technological advances has led to a greater likelihood that school-based clinicians will encounter a child with cochlear implants than in previous years (Chute & Nevins, 2009) At the same time, educational research has drawn attention to the expense of SFDs (Zirkel, 2011; Snell, 2011). Thus, in an era of increased fiscal austerity, students may need to receive supports, communication access, and specialized services, including speech and language therapy, that SFDs have traditionally provided in their local school districts. The question is: will the SLCs in those districts be prepared? Challenges for Some DHH Children in the Mainstream While legislative and technological advances have paved the way for more students who are DHH to enter mainstream education settings, other factors, such as a child’s primary communication mode, intelligence/cognitive functioning, residual hearing, benefit from amplification/listening technology, additional physical, intellectual, behavioral, or emotional disabilities, and the family’s home language can influence a student’s success in a mainstream environment and can contribute to decisions made regarding delivery of speech, language and listening therapy (Marschark et al., 2015; Chute & Nevins, 2009; Andrews et al., 2004) SLCs working with students who are DHH who use spoken language and achieve developmental synchrony may primarily focus on maintenance of speech, language and auditory skills, vocabulary development, and support for academic achievement (Chute & Nevins, 2009). If, however, the economic climate in education leads to a reduction of SFDs, some students who have traditionally attended these schools will instead attend their local schools. SLCs in these schools may encounter more diverse groups of students who are DHH on their caseloads, including those who use sign language or a visual communication system, receive limited benefit from amplification, who live in poverty, and who may struggle academically, linguistically and/or socially in a regular education setting. Public school-based clinicians working alongside teachers of the deaf, classroom teachers and teacher aids would need the knowledge, experience and training to communicate effectively, identify academic difficulties that are related to hearing loss, employ multi-sensory techniques and strategies that are effective with severely-to-profoundly deaf students, and to advocate for the needs of their students who are DHH (ASHA, 2004) Mahshie, Moseley, Scott, and Lee (2006) outline five “intervention groupings” of students who are severely-to-profoundly deaf in school settings (p. 121–122.) While acknowledging that not all students who are DHH fit into one of these groupings (there is no grouping for students who are DHH with additional disabilities), the authors describe the categories of students SLCs might encounter as follows: (1) students with cochlear implants whose intervention focuses on auditory skills and spoken English; (2) students with hearing aids who present, at least superficially, with typical spoken language skills; (3) students with profound hearing loss who use hearing aids and develop access to spoken English through speechreading, cued speech, tactile information, or other means of communication that must be explicitly taught; (4) students who learn sign language as a first language, and may acquire some spoken English skills through their intervention program; and (5) students with late access to any language, due to delayed exposure to sign language and no exposure to spoken English during early development. These categories draw attention to the heterogeneity of students who are DHH; however, it is important to note that even within these categories, there is diversity among students. For example, there are many students with cochlear implants who become primarily auditory learners, but others do not. A small minority of students who use hearing aids or cochlear implants learn and develop language bilingually and “bimodally” by using their auditory access for spoken language while simultaneously learning sign language (Priestly, Enns, & Arbuckle, 2018). SLCs with a generalist background working in public schools may find it challenging to meet the needs of students with these various profiles. Students from some categories might easily fit into an integrated educational setting offering generalized speech and language services, while others might need more tailored instruction and intervention. Speech-language Clinicians and the DHH Population While the literature documents that SLCs generally report having limited educational and experiential training with the pediatric DHH population (Compton et al., 2009; Iverson, 2005), the American Speech-Language-Hearing Association (ASHA) notes that developments in research and technology have “expanded the range and increased the complexities of clinical activities that are now considered routine aspects” of providing speech and language therapy to severely-to-profoundly deaf students (2001, Introduction). By developing an outline of “minimal competencies” that speech-language pathologists working with students who are DHH should possess, ASHA suggests that only those clinicians who possess the clinical skills and training to work with the DHH population are competent to do so. Empirical research suggests that SLCs in public school systems lack the specific knowledge and expertise required for both aural rehabilitation and communication therapy (Ben-Itzhak, Most, & Weisel, 2005; Iverson, 2005; Moores, 2009; Moseley et al., 1994; Nunez & Chute, 2003; Wilson, 2006). Cosby (2009) found that 80% of SLCs working with students with cochlear implants had no graduate-level training in working with these devices. The same study found that of the sample, 60–80% reported having very limited knowledge of cochlear implant candidacy, surgery, and technology. Ben-Itzhak et al. (2005) found that more than two thirds of teacher and SLC participants studied perceived themselves to have insufficient knowledge about cochlear implant types, functioning and maintenance. Compton et al. (2009) found that of 190 survey participants, 47% reported having had either no instruction or only one lecture on cochlear implants, and 79% reported little to no confidence working with cochlear implants or providing services to students who use them. Brackett (1997) writes that SLCs in mainstream schools are typically competent in the demands of their profession as they relate to students with typical hearing, but lack experience in areas such as assessment of auditory skills and implementing an auditory training program, acting as a resource to classroom teachers regarding classroom acoustics and listening technology, and often appear “overwhelmed” by the extent of the delays students with severe-to-profound hearing loss demonstrate. Houston (2010) cites two surveys of SLCs in which few clinicians reported having any academic exposure or clinical experience with students with hearing loss during their graduate training. Prendergast, Lartz, and Fiedler (2002) suggest that in order for students with hearing loss to reap the full benefits of an intervention program, they must work with SLCs who are highly qualified and knowledgeable about deafness and its interaction with speech, language and listening development. However, since hearing loss is a low incidence disability (1.2% of the special education population according to the 2015–2016 data from the National Center for Education Statistics [NCES] (NCES, 2017)) few professionals have the opportunity to develop the skills needed for appropriate intervention, including the ability to communicate in visually accessible modes of communication and recognize the signs of auditory deprivation or incomplete language access, often consequences of late identification of hearing loss, and delayed access to language (Luft, 2016). For SLCs to provide high-quality services to students who are DHH (whether spoken language or sign language users), they would need knowledge and skills in the technology, communication modes, assessment procedures and intervention protocols that are specific to this population of students—that is, they would need to be specialists. There are SLCs who, through educational and clinical experience, have developed the ability to respond to the DHH population’s unique needs. A study conducted by Seal, Rossi, and Henderson (1998) explored the scope of practice and method of service delivery of SLCs working in SFDs. Respondents to this survey reported that their sign language abilities and their experience working with students who are DHH served as strong qualifications for their work with this low-incidence population. Quinto-Pozos, Forber-Pratt, and Singleton (2011) interviewed SLCs and other school professionals who work with native signers of American Sign Language (ASL) to determine if developmental communication disorders exist in sign language. Participants, all of whom worked at bilingual-bicultural (ASL-English) schools, reported identifying incorrect facial cues, signed stuttering, phonological misproductions and incorrect use of signing space in their students’ signing. These professionals were able to analyze students’ language for differences and delays specific to their first language because of their fluency in ASL. Contrast this with the findings of Moseley et al. (1994) and Ben-Itzhak et al. (2005) that most public school-based SLCs feel they lack the sign language skills and depth of experience needed to work with students with hearing loss. While the aforementioned studies explored the knowledge and preparation, related to students who are DHH, of SLCs in general education settings, little attention has been paid to the experiences and acquired skill sets of those SLCs that have worked with students who are DHH in schools for the deaf and other educational environments. These professionals represent an untapped resource—one that can help inform not only clinical practice of therapists in less restrictive educational settings, but policy decisions regarding the most appropriate educational placement options for students who are DHH. Research Questions This study aimed to illuminate the skills and preparedness for working with students who are DHH of SLCs from a variety of educational placements. However, the researchers were primarily focused on the preparedness of SLCs to work with children typical of the SFDs. Therefore, this study was driven by the following research questions: (1) What are the perceived skill sets of SLCs who have worked with students who are DHH? (2) What are the skills and techniques needed to provide appropriate services to students who are DHH, specifically those students typical of the SFDs? (3) How do SLCs acquire the skills and techniques for working with students who are DHH? Methods Research Design A comparative qualitative study using the phenomenological method of inquiry was employed to investigate the lived experiences of clinicians who work with students who are DHH in three types of educational settings. Phenomenological research has been used in educational research to explore and describe the common experiences of a group of individuals (Creswell, 2007) and allows researchers to search for “the central underlying meaning…” of the experience being explored (Creswell, 1998, p. 52). Through phenomenology, the researcher identifies descriptions of a phenomenon, typically gathered through interviews. While these descriptions may not offer new information, they are important and illuminate the reality of a phenomenon embodied by the participants’ experiences (Starks & Trinidad, 2007) The researchers believe that examination of the lived experiences of SLCs working with students who are DHH is an effective method to understanding their perceived strengths and weaknesses as they relate to this population, the supports they have utilized to develop their skill sets, and their beliefs about how to best support their communication and academic success. By illuminating these experiences, the researchers aim to provide evidence of the experiences of SLCs who work with students who are DHH, including those from diverse backgrounds, and the systemic structures and opportunities in their workplaces that have supported or hindered their ability to provide high-quality services to these students. The primary investigator conducted face-to-face interviews with clinicians working in three settings in New York State: (a) State-funded Schools for the Deaf (SFD), (b) Boards of Cooperative Educational Services (BOCES), which partner with local school districts to provide shared educational programs and services, and (c) Local School District (LSD) settings. In addition, the researcher presented each participant with a case study (Appendix A). The case study described a child who, based on the primary investigator’s experience working at an SFD and the demographics discussed above, possessed many characteristics typical of students educated in that setting. Participants were invited to discuss their impressions of the hypothetical child’s needs, how they would evaluate and provide therapy to this child, and what skills they possess or would need to develop in order to appropriately meet his needs. Participants Fourteen SLCs working with students who are DHH throughout New York State were interviewed: nine at SFDs, two in BOCES programs, and three in LSDs. The investigators were primarily concerned with SLCs serving students who have traditionally attended SFDs, specifically those who use sign language as their primary mode of communication; therefore participants were not recruited from auditory-oral and auditory-verbal settings. Purposeful sampling was used to recruit participants who worked as SLCs in either an SFD, BOCES program serving D/HH students, or a local school district. Considering the small population of students who are DHH and the small potential recruitment sample from local school districts, SLCs who have worked with at least one DHH student during their tenure in that district were eligible to participate. All SLC participants held either the New York State certification of Teacher of Speech and Hearing Handicapped (TSHH) or Teacher of Students with Speech and Language Disabilities (TSSLD) through the New York State Education Department. Nine participants held the credential of Certificate of Clinical Competence (CCC) through the American Speech-Language Hearing Association. One participant held certification from the American Academy of Audiology as an audiologist. Two participants were Certified Interpreters for the Deaf. In addition, two therapists reported being certified Teachers of the Deaf. Participants reported working with students in a variety of settings, including pull-out (providing therapy outside of the classroom) and push-in (therapy integrated into general education classes, special education classes, or special subject areas classes, such as art and physical education). Many also reported that performing consultations with teachers and other professionals constitutes part of their practice. Table 1 provides an overview of participants’ educational settings, communication modes, and number of years of experience. Table 1 Demographic information of participants Participant # years as a clinician # years with deaf children Type of work environment Communication modalities used P1 30 30 BOCES Spoken Language, AAC P2 23 8 SFD TC, Spoken Language P3 35 2 LSD Spoken Language P4 16 8 SFD TC, Spoken Language P5 26 25 SFD TC, Spoken Language P6 3 3 SFD TC, Spoken Language P7 29 30a BOCES TC, ASL, Spoken Language P8 4 2 LSD TC P9 31 3 SFD TC P10 15 30a SFD TC P11 15 13 SFD TC P12 31 31 SFD TC, AAC P13 18 32a LSD Spoken Language P14 7 9a SFD ASL, Spoken Language Participant # years as a clinician # years with deaf children Type of work environment Communication modalities used P1 30 30 BOCES Spoken Language, AAC P2 23 8 SFD TC, Spoken Language P3 35 2 LSD Spoken Language P4 16 8 SFD TC, Spoken Language P5 26 25 SFD TC, Spoken Language P6 3 3 SFD TC, Spoken Language P7 29 30a BOCES TC, ASL, Spoken Language P8 4 2 LSD TC P9 31 3 SFD TC P10 15 30a SFD TC P11 15 13 SFD TC P12 31 31 SFD TC, AAC P13 18 32a LSD Spoken Language P14 7 9a SFD ASL, Spoken Language aSome participants reported more years of working with the deaf population than years working as a clinician because they had worked with deaf children in another capacity. Note: SFD = State-funded Schools for the Deaf, BOCES = Board of Cooperative Educational Services, LSD = Local School District, ASL = American Sign Language, TC = Total Communication, AAC = Alternative and Augmentative Communication. Table 1 Demographic information of participants Participant # years as a clinician # years with deaf children Type of work environment Communication modalities used P1 30 30 BOCES Spoken Language, AAC P2 23 8 SFD TC, Spoken Language P3 35 2 LSD Spoken Language P4 16 8 SFD TC, Spoken Language P5 26 25 SFD TC, Spoken Language P6 3 3 SFD TC, Spoken Language P7 29 30a BOCES TC, ASL, Spoken Language P8 4 2 LSD TC P9 31 3 SFD TC P10 15 30a SFD TC P11 15 13 SFD TC P12 31 31 SFD TC, AAC P13 18 32a LSD Spoken Language P14 7 9a SFD ASL, Spoken Language Participant # years as a clinician # years with deaf children Type of work environment Communication modalities used P1 30 30 BOCES Spoken Language, AAC P2 23 8 SFD TC, Spoken Language P3 35 2 LSD Spoken Language P4 16 8 SFD TC, Spoken Language P5 26 25 SFD TC, Spoken Language P6 3 3 SFD TC, Spoken Language P7 29 30a BOCES TC, ASL, Spoken Language P8 4 2 LSD TC P9 31 3 SFD TC P10 15 30a SFD TC P11 15 13 SFD TC P12 31 31 SFD TC, AAC P13 18 32a LSD Spoken Language P14 7 9a SFD ASL, Spoken Language aSome participants reported more years of working with the deaf population than years working as a clinician because they had worked with deaf children in another capacity. Note: SFD = State-funded Schools for the Deaf, BOCES = Board of Cooperative Educational Services, LSD = Local School District, ASL = American Sign Language, TC = Total Communication, AAC = Alternative and Augmentative Communication. Settings In New York State, SFDs are located in the New York City metropolitan area (serving NYC’s five boroughs and numerous suburban school districts) and in two metropolitan areas in Western New York, which serve two cities and numerous suburban and rural school districts. Each school for the deaf served students from multiple school districts. The two SFDs in Western New York served more districts, including urban, suburban and rural districts (that are more sparsely populated) than the schools in the New York City metropolitan area. All SFD settings provided education and intervention services to students through sign language, with varying offerings in sign supported English and spoken language; BOCES and LSD settings varied in communication mode used for academics and therapy services. Data were collected in private rooms in which participants could speak openly and honestly. Procedure All participants signed an informed consent form, which was also verbally explained to them. The interview protocol was approved by the Institutional Review Board of Teachers College, Columbia University. Each participant completed a demographic survey (see Appendix B). Then the investigator conducted semi-structured interviews of five questions (see Appendix C), which lasted between 30 and 60 min. The researcher asked the same questions, in the same order, to each participant. Participants were encouraged to speak candidly, and when clarification or additional information was needed, the interviewer asked follow-up questions. The set of interview questions was purposely kept to five open-ended questions in order to allow participants the opportunity to speak freely and without structure imposed upon them. Questions were developed by the primary researcher based on her experience as an SLC, and in consultation with the secondary researcher, who had several decades of experience with deaf education. In addition, interview questions were informed by the research questions in order to in order to glean descriptions of the experiences of participants regarding how they learned to work with this specialized population, what they believe constitutes excellent service-delivery, and their awareness of how their skills developed. A consultant with experience in education policy was also involved in the creation and wording of interview questions. After participants had responded to each of the five interview questions, the investigator presented participants with a hypothetical case study (Appendix A) of a child typical of the SFDs. This case study was developed by the primary researcher based on her experiences with students in SFDs, as well as demographic data discussed in the literature review. Colleagues of the primary researcher’s from SFDs verified that it described characteristics of many students who attend those schools. For example, the child described first received access to sound through amplification outside of the critical period of language development (age 5), the child uses sign language to communicate, his speech intelligibility is described as “poor,” the family speaks a language other than English at home, and the parents do not invest time in supporting their child’s spoken language development. Participants were asked to read the case study and then talk through, with the investigator, how they would proceed to evaluate and provide therapy to the child. They were invited to discuss what their assessment protocol would be, goals and objectives they would establish, and techniques and strategies they could employ, and their perception of how effectively they could work with this child. Interview and case study responses were transcribed by the primary researcher, who listened to each interview at least two times to correct any transcription errors. Interview responses, case study responses, and field notes were cross-verified to achieve data triangulation. Data Analysis Interview and case study responses were analyzed separately, and then compared, along with field notes, for data triangulation purposes. During the first reading of transcripts, the primary researcher became familiar with the text. In the second reading, all text that was relevant to the research questions or that represented ideas that recurred throughout multiple transcripts was highlighted. These statements included: those that helped tell the story of the participants’ experiences, learning processes, and self-perception of clinical skills; were said multiple times by participants; were repeated by multiple participants; were declared to be important by the participant; were relevant to what has been documented in the literature; or that otherwise resonated with the researcher based on her extensive academic and clinical experience with students who are DHH as an SLC. Since similar statements and ideas were present across all transcripts, the PI began to identify ideas and concepts that these statements reflected. The PI generated names, or codes, for the concepts and noted them in the page margin next to highlighted text. During subsequent readings, similar or related codes were merged into categories, or themes (Luckner & Stewart, 2003). Line-by-line coding of each meaningful statement that had been highlighted was conducted. This process involved constant comparison, as detailed by Creswell (2007). Through constant comparison, the researcher continuously compared all meaningful statements to one another according to the categories already identified. On occasion, this necessitated some revision and modification of emergent categories to ensure that as much text as possible was included. Figure 1 provides a flow chart of this process, showing samples of meaningful text, themes they related to, and the categories that emerged from similar themes. This chart depicts how pieces of text that were related to common themes were grouped into larger categories. Figure 1 View largeDownload slide View largeDownload slide Flow chart depicting data analysis. Figure 1 View largeDownload slide View largeDownload slide Flow chart depicting data analysis. Interviews and case study transcripts shared some, but not all, categories; several new categories emerged during analysis of case study transcripts that had not been present in interview transcripts. Emergent categories are reported in the Results section and discussed in the Discussion section. In addition, the frequency with which each theme was addressed by each group of participants (SFD, BOCES, LSD) was tabulated. Tabulations were cross-checked by a graduate student in Speech-language Pathology; any discrepancies were revisited by the primary researcher, who after re-tabulating, made a final decision. Trustworthiness Lincoln and Guba (1985) outline four criteria for establishing the trustworthiness of data interpretation: credibility, transferability, dependability, and confirmability. Interview and case study data was triangulated to achieve credibility and confirmability. Data were reported in thick, descriptive detail to increase transferability (external validity). Finally, two graduate students in Deaf Education, trained as external auditors by the PI, were used to limit researcher bias and increase dependability. Due to logistical factors, auditors were not given blank transcripts to code. They were instead given already-coded copies of the interview and case study response transcripts and a list of codes with criteria for categorizing meaningful statements into those codes. These auditors independently determined their agreement with the following: the researcher’s grouping of meaningful statements into themes; agreement that the researcher’s criteria were followed when coding text; and agreement that text was appropriately coded. Initially, Auditor 1 agreed with approximately 85% of the PI’s codes, and Auditor 2 agreed with over 90%. Negotiation between the primary researcher and auditors ensued until both parties felt comfortable with the coding of text, and a 90% level of inter-rater agreement was achieved with both auditors. Results Many similarities were found among interview and case study responses; however, there were also differences both between and within-groups. Participants in the SFD group displayed the most homogeneity. In the BOCES and LSD groups, SLCs demonstrated greater variance in reported skill sets. In both groups, the SLCs who worked in urban areas and/or in programs that served a demographically diverse student population shared many of the same experiences and skill sets as the SLCs in SFDs. Those in more suburban or primarily listening and spoken language settings reported a more limited skill set. Interview Responses Six categories emerged through analysis of interview transcripts. In order of strength (determined by the frequency with which each category was addressed by participants), they were: perception of self as a professional; characteristics of students and families in school/program; description of school or program; scope of intervention; changes in the field that have occurred over time; references to outside entities. Figure 2 shows the average frequency, per participant group, with which each category was addressed by comments from participants. Figure 2 View largeDownload slide Average frequency, per group, with which category was addressed (interviews). Figure 2 View largeDownload slide Average frequency, per group, with which category was addressed (interviews). Each category, along with corresponding sub-themes and sample supporting quotations, is detailed in the following section. Theme I: Perception of self as a professional All participants discussed their self-perception of preparation and skills related to working with students who are DHH, especially the substantial amount they had to learn about the DHH population. Sub-themes in this category included: background and training, strengths and weaknesses, and perceived skill set. Background and training All participants reported drawing upon experiences in their undergraduate and graduate training, clinical experiences, and populations with which they had previously worked when discussing how they had become prepared to work with students who are DHH. Several felt that prior internship placements with students who are DHH, a depth of experience with deafness and a long-term interest in serving this population had helped prepare them to provide high-quality services to these students. For example, one SFD clinician said: “I went to a graduate program that specialized with working with DHH [children]…I interned at the NYU Cochlear Implant Center, that was one of my graduate placements, also Rochester School for the Deaf, and National Technical Institute for the Deaf. It was a regular speech graduate program but with additional coursework, with a focus toward working with this population…we did ASL, we learned cued speech.” Some clinicians also described ways in which their graduate training did not prepare them for issues they could only learn about “on the ground”. The clinician from a large urban LSD described the development of counseling skills through her experiences with her students who are DHH: “They’re completely different than any other population that you work with…they just want someone to talk with. And they don’t teach you that in graduate school – that you have to be a counselor, too, with a lot of these [children]. Sometimes that’s all they really want, is someone to just tell their problems to because they don’t have anybody else to talk to.” The same clinician also shared how she needed to prepare for this population: “I had to learn how to sign, how to use an FM system…if the students were receiving any input from their hearing aids, how to tell if their [devices] weren’t working…To feel really comfortable [with these new skills] where I wasn’t really nervous about it probably [took] a year. You know, to feel like I could just come in and I just knew what I was doing.” Seven therapists spoke of their ongoing work with assistive listening devices. Those with less experience with students who are DHH, such as the clinician from a suburban school district quoted below, shared their learning curve for acquiring skills to use and troubleshoot these devices. “Well, those first few months…when the consultant came, I would draw little pictures as she was talking me through [the FM system], because I was like “What’s i-connect? What’s the FM unit?” You know, these were all new, MAPping was new to me…the first two months I was thinking “Oh my goodness, I knew this would be a challenge but maybe I bit off more than I could chew.” But now I feel a bit more comfortable with it.” Those with more experience discussed how their knowledge of technology helped their clinical practice. One clinician who chose a graduate program in speech-language pathology due to its focus on the DHH population described how that specialized education supports her work with students’ technology. “We do daily listening checks and we can figure out what to do if the device isn’t working. [In graduate school] we had a whole course on cochlear implants so I know all about the parts, how to take it apart, how to troubleshoot, etc” Another clinician described how working with assistive technology is part of her daily clinical routine. “I told you, when every kid comes in, I do the Ling [sound test]. I need to make sure that their CI or hearing aids are functioning. I’ve caught so many issues – dead batteries, clog in the tubing…so like we just had a [child] this week whose CI isn’t working, we figured that out.” Strengths and weaknesses Therapists in the SFD group felt they were equipped with a variety of tools that specifically addressed the needs of their students who are DHH, and that they had developed this toolkit through years of experience with the population. One clinician from an SFD discussed how her knowledge of sign language, listening and spoken language, and audiology supports her work with students: “I know their ASL levels, I know their spoken language levels, I know their listening levels, I get to go over to audiology with kids, I prepare them for their audiology evaluations.” Clinicians from SFDs who had not worked with students who are DHH in previous employment settings discussed their learning curves and how they became stronger clinicians as they acquired new specialized skills. One clinician shared how her acquisition of ASL improved her ability to provide services to her students: “Definitely, my receptive [sign language] skills have improved a lot. And so I’m better able to understand [the students], I’m better able to meet their needs. And now that I can get to know them better and faster, I can kind of hone in on weak areas better now. And I think that’s just something that takes time and experience.” Another clinician at a SFD discussed a similar learning process, as well as some challenges she still faces as she learns ASL: “When I first came here, I had a huge learning curve so they gave me the babies. So we were learning together. We were learning “WATER,” basic verbs and nouns, that was helpful to me. So my first year’s experience was working with the babies which was wonderful because I could expand their vocabulary while I was expanding my own. Now I’m with the bigger children and we are signing away. It gets better every year. I’m definitely by no means an expert, but I can definitely communicate with the population. They understand me, they know my ability in signing. And sometimes the students themselves will correct my signing.” Perceived skill set One of the emergent themes was the reference to specific clinical skills, techniques and strategies that clinicians reported using with their DHH clients. Table 2 shows a non-hierarchical listing of self-reported skills. Table 2 Reported skills of therapists working with students who are DHH in schools for the deaf, BOCES programs, and local school districts Modify intervention methods depending on an individual child, school philosophy, parent preferences or type and status of a child’s amplification Knowledge of therapy materials for auditory goals Able to modify conventional therapy materials for students with hearing loss Able to modify assessment tools and procedures for the DHH population Have knowledge of auditory and speech hierarchies Able to educate parents about how to work on speech and language at home Able to establish auditory, speech-reading and “communication therapy” objectives Able to educate other staff and faculty in the school in methods to help stimulate speech, language and listening development Able to educate staff and faculty in school on assistive listening technology Able to scaffold therapy activities appropriately (moving back and forth seamlessly between auditory presentation, speech reading, sign language, gesture, writing) Able to sign and use visual communication Able to use cued speech Able to use communication boards Able to modify Communication mode depending on needs of child Able understand and interpret audiological information Able to troubleshoot listening devices, such as hearing aids, cochlear implants and FM systems Able to recognize the presence of additional disabilities secondary to deafness, and to perform differential diagnosis Able to counsel parents and to incorporate a family’s culture (including Deaf Culture) into therapy planning Modify intervention methods depending on an individual child, school philosophy, parent preferences or type and status of a child’s amplification Knowledge of therapy materials for auditory goals Able to modify conventional therapy materials for students with hearing loss Able to modify assessment tools and procedures for the DHH population Have knowledge of auditory and speech hierarchies Able to educate parents about how to work on speech and language at home Able to establish auditory, speech-reading and “communication therapy” objectives Able to educate other staff and faculty in the school in methods to help stimulate speech, language and listening development Able to educate staff and faculty in school on assistive listening technology Able to scaffold therapy activities appropriately (moving back and forth seamlessly between auditory presentation, speech reading, sign language, gesture, writing) Able to sign and use visual communication Able to use cued speech Able to use communication boards Able to modify Communication mode depending on needs of child Able understand and interpret audiological information Able to troubleshoot listening devices, such as hearing aids, cochlear implants and FM systems Able to recognize the presence of additional disabilities secondary to deafness, and to perform differential diagnosis Able to counsel parents and to incorporate a family’s culture (including Deaf Culture) into therapy planning Table 2 Reported skills of therapists working with students who are DHH in schools for the deaf, BOCES programs, and local school districts Modify intervention methods depending on an individual child, school philosophy, parent preferences or type and status of a child’s amplification Knowledge of therapy materials for auditory goals Able to modify conventional therapy materials for students with hearing loss Able to modify assessment tools and procedures for the DHH population Have knowledge of auditory and speech hierarchies Able to educate parents about how to work on speech and language at home Able to establish auditory, speech-reading and “communication therapy” objectives Able to educate other staff and faculty in the school in methods to help stimulate speech, language and listening development Able to educate staff and faculty in school on assistive listening technology Able to scaffold therapy activities appropriately (moving back and forth seamlessly between auditory presentation, speech reading, sign language, gesture, writing) Able to sign and use visual communication Able to use cued speech Able to use communication boards Able to modify Communication mode depending on needs of child Able understand and interpret audiological information Able to troubleshoot listening devices, such as hearing aids, cochlear implants and FM systems Able to recognize the presence of additional disabilities secondary to deafness, and to perform differential diagnosis Able to counsel parents and to incorporate a family’s culture (including Deaf Culture) into therapy planning Modify intervention methods depending on an individual child, school philosophy, parent preferences or type and status of a child’s amplification Knowledge of therapy materials for auditory goals Able to modify conventional therapy materials for students with hearing loss Able to modify assessment tools and procedures for the DHH population Have knowledge of auditory and speech hierarchies Able to educate parents about how to work on speech and language at home Able to establish auditory, speech-reading and “communication therapy” objectives Able to educate other staff and faculty in the school in methods to help stimulate speech, language and listening development Able to educate staff and faculty in school on assistive listening technology Able to scaffold therapy activities appropriately (moving back and forth seamlessly between auditory presentation, speech reading, sign language, gesture, writing) Able to sign and use visual communication Able to use cued speech Able to use communication boards Able to modify Communication mode depending on needs of child Able understand and interpret audiological information Able to troubleshoot listening devices, such as hearing aids, cochlear implants and FM systems Able to recognize the presence of additional disabilities secondary to deafness, and to perform differential diagnosis Able to counsel parents and to incorporate a family’s culture (including Deaf Culture) into therapy planning Those who worked with the most heterogeneous populations reported the largest representation of skills, such as those mentioned in this quote by an SFD clinician: “I think I have a good background in amplification devices, so I have the knowledge to do basic troubleshooting and what to look for, and the speech therapists in the preschool…I know about aural rehabilitation, knowledge of the auditory hierarchy, how to do the listening hierarchy, all of the tools and programs out there – the SPICE (Speech Perception Instruction Curriculum and Evaluation), CASSLS (Cottage Acquisition Scales for Listening, Language and Speech).” Alternatively, clinicians in settings serving a more homogenous population described a more limited skill set, such as in the quote by a LSD clinician in a suburban setting: “I need to know how to fix his FM. I test it every morning. I change his batteries if there are any issues. And I think a big part of it is just talking and helping the other professionals and staff in the building, explaining how to adjust issues [related to the FM] and how to handle them.” Theme II: Various characteristics of students and their families All therapists in the SFD group spoke about the variability in their caseload, which reportedly consists of students who use a variety of communication modes, students whose home languages are not English, students who recently immigrated, and students who have a range of auditory, speech and language skills. All clinicians in this group also described their caseloads as having students with multiple disabilities, including, as one SLC from an SFD described, “[children] on the autism spectrum…some syndromes, [children] with more medical issues, [children] in the preschool that have cerebral palsy or physical feeding issues, feeding tubes and walkers.” “We have one child whose parents don’t want any spoken English. It’s a very “ASL/Deaf” family, and he does not wear any amplification. Then we’ve got [children] whose parents tell me “We want to mainstream our child.” Some parents want CIs, some parents don’t…the children are so varied. I’ve had so many autistic [children] lately who are deaf.” “My caseload is very diverse. I put many hats on. I’m working with a nursery school child, and then all of a sudden with an eighth grader…I’m working with children who may have a really great ability to lipread and hear, so I’m doing a lot of auditory training, and then I can be working with a child who was born missing cochleas. Anatomically, they have a lot of issues. So you’re looking at a very diverse population.” This theme was also present in the interviews with therapists in one large urban school district and one BOCES program—both of which worked with heterogeneous populations. This is depicted by a quote from a BOCES clinician: “I’m working with one particular student pretty much “Deaf/ASL,” the others hard of hearing, others also with hearing loss and some other problems. The majority of my students have always been deaf with mostly other disabilities as well.” This theme was not present in interviews with therapists in the other two school districts and the second BOCES program (which generally accommodate only students who use listening and spoken language.) Theme III: Description of school or program All participants discussed characteristics of their school or program, relating to the environment in which they worked and how that environment supported their work and the needs of their students who are DHH. Sub-themes included: communication philosophy and accessibility, classroom placement options, and the supports available to professionals who work there. Communication philosophy and accessibility Therapists working in SFDs discussed the benefit to students of having accessible communication and a communication philosophy that values the communication modes and abilities of all students, as well as giving the students exposure to Deaf role models. For example, one clinician said “[The children] can sign and communicate freely knowing that we will be able to sign and communicate back to them.” In comparison to the SFD group, therapists in the BOCES and LSD groups mentioned communication less frequently. BOCES professionals reported having the ability to communicate with DHH students through multiple modalities, as evidenced by this quote: “We as therapists just have to find other avenues [of communication] and hopefully be in a program where other avenues are welcome…just being open to using a variety of communication approaches because that is going to benefit the student.” Reports from LSD clinicians indicated that some students who are DHH in that setting, specifically the students who use sign language to communicate, have limited interactions with the typically-hearing students in their setting due to limitations related to communication modality. This is exemplified by a quote from an SLC working in a large, urban school district: “They don’t really interact with the [hearing students] because they can’t communicate with them.” The one exception was a clinician working in a small LSD whose one profoundly deaf student was fully mainstreamed and reportedly had age-appropriate spoken language. Classroom placement options SFD clinicians reported that their schools have multiple placement options including auditory-oral preschool classrooms, sign-support classrooms, total communication classrooms, parent–infant programs, and classrooms for students with additional disabilities. This quote from an SFD clinician offers an example of placement options: “We have an oral preschool program. I have one student who is in an auditory and sign-support class. Then I have another student who is profoundly deaf and in an ASL-only class.” Another example of SFD options is discussed in this quote: “We provide interpreters for all their classes and also resource room if they need that as a support for their mainstream classes. If they have poor English skills, they might come to our [self-contained] class; we have an English teacher here who is fluent in sign language.” A third SFD clinician described classroom placements that address students’ individual language needs: “…this year I have [students from] mostly the auditory-oral classes, but I do have some in the Dual Language classes here, where we use sign support to varying degrees.” Placement options for BOCES programs varied depending on the geographic location of the BOCES and the variety of students with hearing loss it served—the more students who are DHH there were in a specific BOCES region, the more options it could offer. Of the two BOCES participants in this study, one was from a program that offered the kind of modifications and the specialized services that were available in the SFDs (sign language interpreting, self-contained classes for the DHH, opportunities for full or partial mainstreaming, and an array of support services). This quote illustrates those options: “Our [children] have the opportunity to get the resource room, the one-on-one, and they get to be included in a mainstream situation as well…it’s the least restrictive environment with support.” The options at the other BOCES program were more limited; the therapist reported that it was more of a “transitional program” for students going “back to a regular education program or a [more restrictive] special education program”. Clinicians in the LSD group who worked in large urban settings also reported a wide array of placement options for students who are DHH, including self-contained classrooms, auditory-oral and total communication classrooms, and mainstreaming with support from a teacher of the deaf. Only one of these districts offered self-contained classes with sign language as the primary language of instruction. A quote from an SLC in an urban LSD describes her program: “We have the self-contained classes for the children that need that level of support. But the majority of the DHH students [in the district] go to regular education.” The other two districts had support services in place to assist students with hearing loss in the classroom, but did not present with the resources to teach students whose primary mode of communication is sign language. The therapist from a small suburban district reported one option for a child with hearing loss in her district—mainstreaming with support services. “In this geographic area, [a child who is DHH would be] mainstreamed with a teacher of the deaf as a support person.” She shared that this arrangement was sufficient for her profoundly deaf student, an “auditory” learner for whom the support services offered in the general education environment were sufficient. Supports for professionals Therapists across the three types of programs reported receiving professional development opportunities to supplement their knowledge of hearing loss and aural rehabilitation. Clinicians in the SFD group reported receiving supports within their schools, specifically for developing their skills to work with students who are DHH. Examples included sign language classes offered to faculty and staff, site-based professional development opportunities that focus on aural habilitation skills, the ability to collaborate with Teachers of the Deaf, and mentorships with more experienced professionals, as noted in this quote: “Here, you’re given a mentor for a year…I had someone with a lot of experience by my side if I had questions about aural rehab.” One clinician at an SFD described pursuing community-based resources, such as ASL classes, as well as consultants hired by her school. “I tried doing the classes they have here, at night, because they offer free ASL classes, but it didn’t work with my schedule. [At the community college] I took ASL II, III, and I also took fingerspelling. One thing when I came on board here that was a really big help was, we have an actual certified auditory verbal therapist, she’s our consultant. So when I first came here, my supervisor wanted me right away to jump in and get educated in the whole auditory-verbal therapy mix. Techniques, strategies. So I had to go to conferences. And I found that enormously helpful.” Another SLC from this setting described the collaborative spirit of her institution: “I love to partner with the classroom teacher. I’ll go upstairs and say “What are you guys working on? This is what we’re doing downstairs, how can we incorporate this into your work up here?” I think that is so important. I’m not an island. I’m part of this community where it’s just to make sure this child can succeed.” Clinicians in SFDs also reported the ability to work together in cohorts with other clinicians, such as in this quote: “Our speech group, our department, happens to be wonderful and supportive, and we all help each other. We have eight speech teachers here and everybody has their door open, so if anyone has a question we can discuss it. On Thursday afternoons we have a department meeting from 3:00–4:00 and we come together and, like now, we’re presenting case studies – children that we feel we’ve been successful with or that we are having difficulty with. So we are supported that way and we can discuss what’s happening and everybody is really helpful.” The clinician in a suburban local school district described the supports she received to learn how to work with a deaf student: “The district paid for a private SLC who was also a teacher of the deaf to come in, to explain how to use the FM system and the cochlear implants and to troubleshoot because at the beginning this was foreign to me.” This same clinician shared her on-the-job learning experience of working with a consultant hired by her school district and other strategies she uses: “I have Phonak on speed dial. At the beginning, I really didn’t know how to do this…the district would pay for this private [Teacher of the Deaf] to come in, to explain how to use the FM [unit], not only the FM but also the cochlear implants and how to troubleshoot because at the beginning this was sort of foreign to me. And now I’m really able to troubleshoot so that is great.” A clinician from a BOCES setting shared that “the audiologist comes in a couple of times a week, and if I have a question for her I write it down and she can help me.” The clinician working in a large, urban school district described a sense of isolation in her setting due to the small number of students who are DHH; however, she emphasized that her supervisor wants to provide her with the support she needs: “I don’t want to say this in a bad way, but they’re [considered] “the hearing impaired class.” And only the people that work with them work with them. But my supervisor, she really wants them to do better. She wants to help me so she sends me to every conference that she can find. Overall, for a speech pathologist, [the district] provides a lot of training, just not for [DHH] children. There’s not a lot of us.” Theme IV: Scope of intervention All participants discussed the scope of their work with students who are DHH. They shared goals, objectives, and therapy techniques that they had learned or found useful, and many shared how they typically have to modify their method of therapy delivery depending on factors outside of their control. Therapy targets The scope of intervention with students who are DHH varied by participant group. For example, clinicians in SFDs reported providing comprehensive “communication therapy” in multiple modalities and targeting auditory, speechreading, articulation, language, communication strategies, assistive technology, and self-advocacy, as supported by this quote from an SFD clinician working on functional communication skills: “With the middle and high schoolers, just getting them to understand what they’re gonna need to communicate outside of [school]. So I try to help them if they need help with their writing, or the technology has really helped – texting, and there are programs that they can use to speak with. In fact, that’s what our lesson was just about – using all these devices, the Dynavox and the iPad has a couple of speaking programs on it.” The clinician in a suburban local district reported providing mainly support for mainstream education by “working on auditory memory, processing of information, how to get him to express what he wants to if he’s having trouble, kind of figuring out what the problem is.” Therapists in SFDs described therapy targets including auditory goals, functional communication such as reading, writing, speech reading and augmentative communication, articulation and pronunciation, and expressive and receptive language in both spoken and signed language. The following quote is from an SFD clinician who tailors her therapy targets to each student on her diverse caseload: “If you have a cochlear implant child [sic], well that’s gonna be all articulation skills and auditory skills. Or do you have a profoundly deaf mentally-challenged child with whom you’re gonna have to be working on social skills and pragmatic skills and language and vocabulary and basic communication skills. Like, “what do you write if your bus is late and you come back in and need to find someone to get you on a late bus?” Basic life skills kind of communication needs.” SFD clinicians also reported conducting listening checks, auditory and speech-reading training, as this example illustrates: “I do a listening check every session to check their frequency access. For auditory training, I use the SPICE and the WASP. I have one child who does not wear any amplification and with him its speechreading, using his voice for alerting.” Two of the three therapists working in local school districts, on the other hand, described a scope of intervention with their students who are DHH that was more limited than those at the SFDs, and mostly targeted support for success in the mainstream environment. “We work on auditory memory, processing of information, expressive spoken language…making sure he can generalize information to other environments.” (LSD clinician, small suburban district) “I work with them on reading, and then breaking down the vocabulary…Most of my [students] are pretty good readers. They can pronounce the words…and I stop them and say “What does that mean?” (LSD clinician) The third therapist, from a large urban school district, reported targeting mostly functional communication skills with students whose descriptions resembled those in the SFDs. “We’re working on them being able to advocate for themselves, so even if they have no verbal language, that they can say “Help” or something, so they’re able to communicate in the outside world, so they’re not so lost.” (LSD clinician, large urban district) Analysis of job description as a function of skill set revealed that there was a relationship between therapists’ skills and how they perceive their job description. For example, therapists who felt they had a strong command of ASL discussed their application of that knowledge to working to improve their students’ linguistic competence in ASL and English. One SFD clinician offered this example: “I think knowledge of how to evaluate these [children] is really important…knowing how to adapt tests for them. Like when using the Preschool Language Scale, I might sign a test item…and I know when something is an appropriate sign to use or if they’re just getting the meaning because it’s iconic.” This clinician is referring to ways of adapting spoken-language assessments for a signing population. While most speech and language assessments are not intended to be administered through sign language, clinicians may use these methods to extract valuable diagnostic information from an assessment, and describe their non-standard administration methods in the evaluation report. When using standardized assessments on students who speak a language other than English, clinicians typically inform readers of evaluation reports that results should be interpreted with caution (ASHA, n.d.) The suburban LSD clinician discussed that one of her job responsibilities is serving as a resource to her deaf student’s parents and the faculty at her school. “I’m a really good resource for the parents, because I am their liaison…his parents utilize me not just for the academics but for the social piece.” This clinician, like others, also discussed her need to regularly troubleshoot assistive listening devices: “His teacher will email me – “Please come down, the {FM receiver’s] light’s turning red, something’s happening, or he’s not hearing me.”” Therapy modification One responsibility described by several SFD clinicians was their ability to scaffold and modify therapy activities depending on factors such as child’s language modality and availability of amplification. One clinician discussed having to change her entire therapy delivery method when a child showed up for speech therapy without his cochlear implants. “A student has a goal that’s following two-or-three step directions. But then one day the student might show up without his cochlear implant. So I give him an activity like that, but I sign it, we do it that way.” This was echoed by another SFD clinician: “Yesterday I had a child come in I had a whole auditory lesson planned, and she left her [speech processor] at home. So immediately I was like ‘we’re not gonna work on speech and we’re not gonna work on audition. We’ll work on speech reading.’” Neither BOCES nor LSD therapists addressed the same necessity to spontaneously modify activities. Theme V: Changes in the field of hearing loss Ten of the therapists interviewed spoke of at least one dimension of change that had occurred in the field: technological advances, change in student population, legislative developments, and changes in the types of educational placements available for students who are DHH within their schools. The therapists who mentioned the most amount of change were those with the most years of experience. Technological advances As mentioned in the literature review, technological advances have driven many of the changes in the deaf education and intervention landscape. This was echoed by the participants. An SFD clinician shared this thought: “I think [children who are DHH] is probably one of the populations that has changed the most, in philosophical issues and methodologies because of technology. When I first started twenty-five years ago, I was working with deaf children who needed ASL and that was it. Now I’ve got profoundly deaf children who hear better than I do.” Change in student population Clinicians in the SFD group reported decreased enrollment in their schools. They also reported an increased concentration of students who are recent immigrants or who have additional intellectual, behavioral and physical disabilities in their schools. One therapist described: “I’ve seen our population has decreased and we’ve gotten a much more diverse population…and we have a lot more [children] with [cochlear] implants at all cognitive levels.” Another SFD clinician noted: “There’s a lot of frustration and the children of course have come in more handicapped than before, with more [additional disabilities.]” Legislative developments Clinicians also spoke of changes related to the legislations described earlier in this paper. Regarding legislative changes, a BOCES therapist said the following: “When I first started teaching was when the original IDEA had come in…prior to that, you only have [SFDs] and specialized programs. If you had any type of severe hearing impairment, you’d have never seen a public school up to that point.” Changes in available educational options Clinicians in the SFD group spoke of modifications their schools had made in order to accommodate students with cochlear implants, including offering auditory-oral preschool classes and classes with varying degrees of spoken language instruction to meet the needs of students with increased auditory access. One SFD therapist described the following changes implemented in her school: “They put up a cochlear implant program within the lower school, because that was where the [children] were who were being implanted. And then we had more and more [children] being implanted, so the school administration invested in training for the rest of the speech therapists.” Theme VI: References to outside entities Nine therapists from all three groups referenced entities outside of their school or program. Participants referred to educational alternatives (such as more- or less-restrictive environments), Committees on (Preschool) Special Education, transitional opportunities, and homeroom classes in general education environments. Overall, SFD participants discussed frustrations and concerns with the students’ home districts, and most participants were dubious that local school districts could meet the needs of all students who are DHH. Some conveyed distrust and skepticism that the school district knew how to evaluate and recommend appropriate educational placement for the students, such as in the following quote by an SFD therapist: “I have a girl that’s ten years old, but she’s only had auditory access for five years, and the district’s like “Why isn’t she functioning more like a ten year old…?” There’s a sense that [district administrators] don’t really understand the [listening] age and chronological age differentiation.” A BOCES SLC described the difficulties he believes local districts have serving students who are DHH: “working with DHH students tends to be very individualized and a district may only have one student in their entire district that may go to the school for the deaf, so if it closed, all of the support services they would have to bring in would be something that usually the districts don’t even have the resources to do.” A clinician from an SFD described the social and academic limitations her students might have in a public school: “If they were in a public school, for example, the teacher may not know sign. So they’d really just be alone, unable to communicate because they cannot hear.” Another SFD clinician echoed concerns regarding public school settings, saying: “When the kids go off to kindergarten, we worry about them – the kids that are going to get mainstreamed. Because our impression of mainstream kindergarten or elementary schools is that a lot of the classroom teachers don’t know about the equipment. So the kids could be sitting there in a kindergarten or first grade class and have both their hearing aids with the battery died…is he gonna ask for help? If he does ask for help, is the teacher gonna know how to do that?” Case Study Responses Three themes emerged through analysis: appropriateness of school or program; self-perception of preparedness; and references to alternative placements. Themes are presented in order of strength (determined by the frequency with which participants addressed each theme). Figure 3 shows the average frequency, per participant group, with which participants discussed each theme. Figure 3 View largeDownload slide Average frequency, per group, with which category was addressed (case study). Figure 3 View largeDownload slide Average frequency, per group, with which category was addressed (case study). Theme I: Self-perception of preparedness to work with Brendan All therapists discussed their perception of readiness to work with Brendan, and the following sub-themes emerged: experience with deafness, ability to articulate a clear therapy plan, and necessary clinical skills. SFD clinicians discussed their preparedness with the most frequency, followed by BOCES clinicians. Experience with deafness All SDS clinicians agreed that they had worked with students similar to Brendan. As one SFD clinician shared, “I’ve seen this before. It doesn’t have to be Chinese, we have a lot of children that are coming from Africa, they’re coming from Yemen, they’re coming from different places.” Some SFD clinicians discussed experiences they’ve had with students with language deprivation, and how that would inform their analysis of this case study. For example, one said “I would still use sign language as a back-up…he’s at an age where he’s going to be missing out on too much language and learning to be taking away the language at this point.” A BOCES therapist who works with a diverse group of students who are DHH shared “[Brendan] is like a mixture of all the [children] that I have here”. SFD clinicians’ discussion of their preparedness related to the settings in which they currently work. The LSD clinician from a suburban setting shared that most of her knowledge and experience with deafness stems from conferences she has attended, rather than clinical experience: “I know when I’ve gone to meetings in the city through the [Children’s] Hearing Institute, they talk about situations like this…I didn’t realize the percentage, you know, in New York City of families who English is not their primary or some of the families don’t even speak English.” Ability to articulate a clear therapy plan SFD clinicians expressed confidence with their ability to create a therapy plan for Brendan. Those who had reported feeling experienced with the DHH population felt they would be able to provide high-quality services for Brendan, as evidenced by the following quote: “The first thing we find out is how the family communicates with the child…I would see if he does play audiometry and see what Ling 6 sounds he responds to…I need to make sure he’s MAPped correctly…I would also begin the SPICE to see if he can tell me the difference between an intermittent and a continuous sound, can he respond to his name? …and then look at his ASL skills. What does his conversational competence look like? Does he answer questions, does he make good eye contact?” Within the LSD group, there was variance in responses. One SLC from an urban setting made no reference to a therapy plan, while another from an urban setting that works with students similar to Brendan described a multi-faceted approach to therapy including the use of sign language, speechreading, and reviewing his audiological information. The SLC from a suburban setting, on the other hand, made reference to only spoken language-related therapy approaches: “The prosody of language, having him learn to wait a turn, listen, and even babbling, and building up from there.” Necessary skills SFD clinicians expressed confidence in their skills for working with Brendan, and many expressed that their only perceived shortcoming would be lack of knowledge of Brendan’s home language. One SFD clinician, when asked if there were any additional skills she’d need to work with Brendan, responded straight-forwardly: “I’m all good.” BOCES and LSD therapists varied in their responses. The skills they reportedly would bring to working with Brendan were a function of the setting in which they worked—those in larger settings that served a more diverse DHH population reported having more skills that would help them treat Brendan, such as the ability to work on speechreading. The suburban LSD clinician shared the following: “I don’t know sign language…I’ve never worked [with a child] like this…so this is out of my comfort zone. And my [children] are not severe, or anything like this…this is totally out of my purview.” Theme II: Appropriateness of program SFD therapists overwhelmingly agreed that their schools, which provide visual communication, individualized speech therapy, and therapists experienced with the DHH population, would be appropriate placements for Brendan. The following quote illustrates the variety of options available in one SFD, and the clinicians belief that one of those could accommodate Brendan. “The classrooms downstairs are like 50/50 [spoken/sign] where there is more signing and their auditory skills are less…and then you have 100% auditory classes, so you really have that spectrum here so that depending on what it is determined this child needs, there is a placement for him at this school.” BOCES and LSD clinicians varied on this point, but four out of five reported that their programs would not be a good “fit” for Brendan. The suburban LSD clinician said the following about her setting: “He would never be in this school…not because he has a CI or anything, but because he wouldn’t pass our kindergarten screening…given all the options of most restrictive to least restrictive environment [in our district] there would be no place for this child in my school district. We would be sending a referral out.” While a clinician from an urban LSD said her program would be an option for Brendan, she did not feel it was ideal for him, saying “I think we’re kind of like the last resort, where [the students] have behavior issues.” Theme III: References to alternative programs for Brendan Seven of the therapists referred to alternative programming available in their communities for Brendan. SFD therapists generally believed those alternatives would be insufficient for Brendan’s needs, and expressed sentiments such as skepticism and distrust when speaking about local school districts. For example, one SFD clinician implied that she felt clinicians in public schools are not accustomed to differentiating their treatment in the way SFD clinicians are: “[In the public schools] therapists can go into an articulation group, it’s not rocket science. Working with profoundly deaf children takes a lot more differentiation. It’s not like you can take a group of our [children] and do a group [session]. Our [children] are tough, you can’t just do articulation work.” BOCES and LSD therapists referred to SFDs as viable placements for Brendan. A therapist from a large urban LSD said the following about placement for Brendan: “Is there an option for a school for the deaf? Because that’s where he should be…in this geographic area, without a school for the deaf right now, he would be mainstreamed with a teacher of the deaf as a support person. No. I would hate to see this kid without a school for the deaf. There is still that need.” Discussion This study explored perceived skill sets of SLCs working with students who are DHH in schools for the deaf, BOCES programs, and local school districts, with a particular focus on the acquisition of skills for working with children typical of schools for the deaf. In light of educational trends indicating that students who are DHH increasingly enter the regular education setting and concerns that some schools for the deaf have closed or are at risk of closure, the investigation of the experiences of SLCs working with this population in three different settings was useful both to confirm previous findings and to illuminate some newer areas of focus. Perceived skill set Similar to the findings of Seal et al. (1998), SLCs in the SFDs expressed confidence and a self-perceived skill set for working with this population. Conversely, the SLC in a general education setting, while experienced and well-credentialed, felt poorly prepared to work with students typical of the SFDs and the child in the case study. This aligned with past research (Ben-Itzhak et al., 2005; Compton et al., 2009) Also, as noted by Chute & Nevins (2009) clinicians working with students who are DHH in general education settings typically focus on speech, language and auditory skills and the provision of academic support. This was the case with both of the clinicians interviewed from general education settings. Necessary skills and techniques While the researchers embarked on this study to illuminate a specific set of skills for working with this population, they discovered the reported skill sets were indeed contextual. The skills with which any given clinician reported approaching his or her clinical practice was determined not only by academic and clinical preparation, but by the context within which he or she had developed those skills and gained clinical experience. Skill sets did not, as the researchers had anticipated, differ along the lines of educational setting (SFD, BOCES, and LSD.) Rather, they differed along the lines of the population that was served in each individual setting. For example, one LSD clinician worked with a high-SES population and with students who use only spoken language. Her counterpart in an urban setting worked with students who live in poverty, who have additional disabilities, and who use Total Communication. These two clinicians, despite working in the same type of educational setting, had different on-the-job experiences and thus had developed different skill sets. Indeed, there were large differences in skill sets and reported preparedness to work with Brendan between SLCs working in less restrictive settings (fully integrated LSD and BOCES environments) and those in the more restrictive settings (SFDs, self-contained classes in LSDs and BOCES programs). This is an important factor for SLCs and school administrators to be aware of and examine critically if trends in deaf education continue toward increased regular education settings. From the experience of the authors, clinicians tend to be “siloed” into working environments supportive of specific philosophies or approaches to deaf education and language development. For example, SLCs in a listening and spoken language environment may have few opportunities to engage with clinicians from educational environments in which sign language or cued speech is used. Collaborative efforts such as The Common Ground Project between the Conference of Educators and Administrators of Schools and Programs for the Deaf [CEASD] and OPTION Schools, representing listening and spoken language-based schools and centers (CEASD, 2015), have developed to address this issue, and the results of this study indicate that such an effort is warranted. One of the SFD clinicians noted her concern over preschool students of hers who go on to enter kindergarten in the regular education setting. She expressed fear that public school teachers would not know how to attend to their assistive technology needs, such as troubleshooting an FM device. Concerns such as hers could be assuaged by increased opportunities for clinicians from different educational settings to interact and learn from one another. Merging the various silos of deaf education and increasing opportunities for collaborative learning among practitioners should be strongly considered in order to maximize the potential of all clinicians to serve all students who are DHH to the highest possible standard. Acquiring the Skills to Work with Children who are DHH While the majority of therapists interviewed for this study reported possessing a wide range of skills for working with students who are DHH, there was at least one therapist in each group (SFD, BOCES, and LSD) that felt either inexperienced or under-qualified to provide high-quality services to students who are DHH. Analysis of interview transcripts revealed that this self-perception had no connection to the quality of academic training therapists had received or their number of years of clinical experience. All therapists were credentialed with state licensure and a Master’s degree in either deaf education or speech-language pathology, and those who reported feeling poorly prepared to work with the population at hand included clinicians with only a few years of experience and those with decades of experience. Rather, this self-perception was related to their amount of exposure to and experience with students who are DHH, both in their academic preparation and in their careers, suggesting that, as with many specializations, the best form of clinical training and professional development is through direct experience. In addition, it related to the supports each clinician received, whether directly through their institutions or through external learning opportunities. Direct experience The benefit of direct experience on learning has been documented in other related fields. van de Weil, Van den Bossche, Janssen, and Jossberger (2010) reported that when physicians were asked what activities most contributed to their professional development, the most common response was “contact with patients” and “patient review meetings.” The authors discuss that workplace learning is “embedded in clinical work.” This supports the notion that all SLCs learn from their clinical experiences, but also that SLCs not working with students who are DHH do not have the same opportunities to learn about this population as their colleagues who work almost exclusively in this specialty area. In all three groups, clinicians noted that they adapted and learned on-the-job. They accomplished this through a combination of practical experience, institutional support, personal resilience, and grit. Therefore, the researchers concluded that the skill set of SLCs working with students who are DHH in SFDs as well as alternative placements is contextually-bound and takes time and resources (outside of academic preparation) to develop. While there may be an “ideal” skill set for working with a heterogenous population of students who are DHH, it does not exist as a specific, discrete and finite skill set. Its development is influenced by numerous factors, including the length of time working with students who are DHH, type of educational setting in which the clinician has gained experience, and various characteristics of the students with whom clinicians have worked. While this may seem an obvious conclusion, it is problematic because deafness is a low-incidence disability, and few clinicians in local school districts will encounter more than a handful of students who are DHH throughout their careers. Graduate training programs typically offer no more than one course in aural rehabilitation, often geared toward work with the geriatric, not pediatric, population. Historically, this has not been a concern because students who are DHH were typically in center-based SFDs, where therapists had years of experience and had pursued much of their professional development in the field of deafness. With increases in mainstreaming, therapists in local school districts now may encounter more students who are DHH than in the past. Some of those students, due to technological advances and successful outcomes from early intervention, may be high-functioning spoken language (Cole & Flexer, 2016). If, however, schools and center-based educational programs for students who are DHH continue to reduce in size and availability, some of the students who are DHH entering local school districts would require visual communication modes and a remedial intervention model. It is with this population of students that this study was primarily concerned, and that school administrators, clinicians and policy makers must consider when addressing the changing landscape of speech, language and communication therapy for students who are DHH in school settings. A supportive network Therapists without a strong clinical background or extensive experience with students who are DHH in BOCES and LSD settings reported that they had limited opportunities to attain this experience and had to seek professional development opportunities outside of their workplace to gain new clinical skills to supplement their previous training; therapists in SFDs spoke of the myriad ways in which their learning and continued professional development is supported in their schools. These opportunities, which were detailed by therapists and administrators alike in SFDs, included: (a) mentoring relationships between new and more experienced colleagues; (b) continuing education opportunities brought into the schools, such as training through a deafblind collaborative and literacy programs targeting students who are DHH; (c) free ASL classes that are open to all faculty, parents, and members of the community; and (d) the team work afforded by such an extensive network of faculty with shared skill sets and experiences. These support mechanisms allow the SFDs, when necessary, to hire therapists less-experienced with students who are DHH while ensuring that they gain experience and knowledge expeditiously, thereby hastening their “learning curve.” Horn (2005) and van de Wiel et al. (2010) both write of workplace learning that occurs in “communities of practice” (Horn, 2005, p. 229.) Horn (2005) writes of mathematics teachers learning on-the-job and using resources available among communities of teachers, such as opportunities to discuss students with colleagues. van de Weil et al. (2010) write that physicians interviewed regarding their on-the-job learning reported having the opportunity to “ask for advice” and discuss cases with their colleagues. These examples echo what many SLCs in the SFDs said about their educational settings and the types of supports available to them, such as departmental meetings, colleagues with an “open-door policy,” and mentoring programs. On the other hand, clinicians in non-SFD settings reported having fewer resources upon which to draw and fewer colleagues from whom to seek advice and support to gain the knowledge and skills necessary for working with students who are DHH. While these clinicians reported having access to external professional development opportunities, such as conferences, they did not have regular access to the types of internal supports the SFD clinicians referred to. This indicates that even as clinicians in less restrictive environments work to improve their skills for working with students who are DHH, the institutions in which they work may not be equipped to support the expeditious acquisition of knowledge and clinical skills. Limitations One limitation of this study is the possibility for research bias, due to the primary researcher’s professional and personal background with SFDs and the students in those environments. This may have influenced her interpretation of interview responses and led to the inadvertent and unintentional judgment of clinicians serving students who are DHH in non-SFD settings. These effects were minimized to the greatest extent possible through the auditing process and other techniques previously described to achieve trustworthiness. The method of achieving trustworthiness was limited by logistical factors. Typically, trustworthiness would be established by two researchers separately analyzing data and then comparing codes. In this case, due to logistical reasons, a coded copy of the transcript was given to auditors, who then indicated their agreement or disagreement with how data was coded. An unfortunate, but unavoidable, limitation of this study was the small size of the LSD and BOCES groups as compared to the SFD group. Few professionals from LSD and BOCES settings responded to the recruitment email. Perhaps a larger representation of participants from LSD and BOCES settings would have resulted in a different interpretation of interview data. Another important limitation of this study is that the participants themselves had their own biases. While the researcher can only take the participants’ statements at their face value, it is likely that interview responses contained reflections on individual beliefs and preferences, rather than sweeping “truths.” This may account for certain assumptions clinicians made about the importance of sign language or spoken language, and these assumptions may be reflective of participant beliefs or perspectives on language development in students who are DHH. Although data were triangulated, the researcher did not have the opportunity to observe participants in clinical settings, or to collect other forms of data that might have more objectively demonstrated the clinicians’ skill set. The researcher could only record and interpret what the therapists reported, and while participants shared a great deal of information, their responses to questions were likely filtered by their own biases, opinions, and interpretations of the questions. Directions for Future Studies This study was concerned primarily with collecting and analyzing information from clinicians regarding service provision to students who are DHH typical of the SFDs. This study leaves open the opportunity for future research into the skill set of SLCs working with students who are DHH in auditory-oral environments, those working with hard of hearing students, and those who target only listening and spoken language development. Considering the extent to which on-the-job learning and institutional support was reported by participants, additional research should focus on ways in which educational settings support the learning of clinicians lacking previous experience with the DHH population. In addition, future research should expand the scope of the current study beyond its limited geographic area of focus. Conclusions and Implications Studies conducted over the past several decades have documented an increase in public school attendance for students who are DHH, resulting in reduced enrollment at SFDs, closure or threat of closure for many SFDs, and increased demand on service providers in local schools to provide high-quality speech and language therapy to students who are DHH. This study adds to a body of literature demonstrating that SLCs in public schools typically perceive themselves to be under-prepared to work with this specialized population, but it illuminates the reality that the skill sets possessed by SLCs working with this population, regardless of setting, is contextual. This study exposed a need to increase opportunities for collaboration and information-sharing among professionals who work with students who are DHH in a variety of educational settings. Conflicts of Interest No conflicts of interest were reported. Footnote 1 Since the clinicians who participated in this study had a variety of certifications, the general reference “speech and language clinician” will be used, rather than “speech teacher” or “speech-language pathologist.” References American Speech-Language-Hearing Association ( 2001 ). Knowledge and Skills Required for the Practice of Audiologic/Aural Rehabilitation [Knowledge and Skills]. Available from www.asha.org/policy. American Speech-Language-Hearing Association (ASHA) Effects of hearing loss on development. Available at: www.asha.org/public/hearing/effects-of-hearing-loss-on-development. Accessed July 5, 2018. American Speech-Language-Hearing Association (n.d. Bilingual Service Delivery (Practice Portal). Retrieved September 28, 2018, from www.asha.org/Practice-Portal/Professional-Issues/Bilingual-Service-Delivery American Speech-Language-Hearing Association (ASHA) ( 2004 ) Roles of speech-language pathologists and teachers of children who are deaf and hard of hearing in the development of communicative and linguistic competence [Guidelines]. Available from www.asha.org/policy. Andrews , J. , Leigh , I. , & Weiner , M. ( 2004 ). Psychology and deaf people: Evolving perspectives in psychology, education and sociology . Boston, MA : Allyn and Bacon . Ben-Itzhak , D. , Most , T. , & Weisel , A. ( 2005 ). Relationships among professionals’ knowledge, experience, and expectations regarding cochlear implants . American Annals of the Deaf , 150 , 329 – 342 . doi:10.1353/aad.2005.0040 Google Scholar Crossref Search ADS PubMed Blaiser , K. M. , & Nevins , M. E. ( 2017 ). Practitioner reflection that enhances interprofessional collaborative practices for serving children who are deaf/hard-of-hearing . Perspect ASHA SIGs , 2 , 3 – 9 . doi:10.1044/persp2.SIG9.3 Google Scholar Crossref Search ADS Brackett , D. ( 1997 ). Intervention for children with hearing impairment in general education settings . Language, Speech and Hearing Services in the Schools , 28 , 355 – 361 . doi:10.1044/0161-1461.2804.355 Google Scholar Crossref Search ADS Chabon , S. , Brown , J. E. , & Gildersleeve-Neumann , C. ( 2010 ). Ethics, equity and English-language learners: A decision-making framework . The ASHA Leader , 15 , 10 – 13 . doi:10.1044/leader.FTR1.15092010.10 Google Scholar Crossref Search ADS Chute , P. M. , & Nevins , M. E. ( 2009 ). Serving students with hearing loss in the schools: Speech and language services for students in the mainstream . The ASHA Leader , 14 , 12 – 15 . doi:10.1044/leader.FTRI1.14122009.12 Google Scholar Crossref Search ADS Cole , E. B. , & Flexer , C. ( 2016 ). Children with hearing loss: Developing listening and talking, birth to six . San Diego, CA : Plural Publishing . Compton , M. V. , Tucker , D. A. , & Flynn , P. F. ( 2009 ). Preparation and perceptions of speech-language clinicians working with children with cochlear implants . Communication Disorders Quarterly , 30 , 142 – 154 . doi:10.1177/1525740108325554 Google Scholar Crossref Search ADS Conference of Educational Administrators of Schools and Programs for the Deaf ( 2015 , April 15) The common ground project: Joint meetings between CEASD and OPTION schools. Retrieved from http://www.ceasd.org/child-first/common-ground-project/progress-april-2015 Cosby , J. ( 2009 ). Pediatric cochlear implants: Knowledge and skills of speech-language clinicians . The ASHA Leader , 14 , 6 – 18 . doi:10.1044/leader.FTR1.14022009.6 Google Scholar Crossref Search ADS Creswell , J. W. ( 1998 ). Qualitative inquiry and research design: Choosing among five traditions . Thousand Oaks, CA, US : Sage Publications . Creswell , J. ( 2007 ). Qualitative inquiry and research design: Choosing among five approaches, second edition . London, England : Sage Publications . Gordon , J. C. ( 1885 ) Deaf-mutes and the schools from 1815-present day. American Annals of the Deaf and Dumb. Washington, DC: 30(1), 121–143. Retrieved from http://www.jstor.org/stable/44468518 Horn , I. ( 2005 ). Learning on the job: A situated account of teacher learning in high school mathematics departments . Cognition and Instruction , 23 , 207 – 236 . doi:10.1207/s1532690xci2302_2 Google Scholar Crossref Search ADS Houston , K. T. ( 2010 ). For children with hearing loss: The times they are a-changin’ . Perspectives on Hearing and Hearing Disorders in Childhood , 20 , 48 . doi:10.1044/hhdc20.2.48 Google Scholar Crossref Search ADS Individuals With Disabilities Education Act , 20 U.S.C. § 1400 ( 2004 ). Iverson , S. ( 2005 ). A survey to identify therapists’ preparedness for providing (re)habilitative therapy for cochlear implant users . Washington, DC : Gallaudet University . Unpublished manuscript. Lincoln , Y. S. , & Guba , E. G. ( 1985 ). Naturalistic inquiry . Newbury Park, CA : Sage Publications . Luckner , J. L. , & Stewart , J. ( 2003 ). Self-assessments and other perceptions of successful adults who are deaf: An Initial investigation . American Annals of the Deaf , 148 , 243 – 250 . doi:10.1353/aad.2003.0020 Google Scholar Crossref Search ADS PubMed Luft , P. ( 2016 ). What is different about deaf education? Journal of Special Education , 51 , 27 – 37 . doi:10.1177/0022466916660546 Google Scholar Crossref Search ADS Mahshie , J. , Moseley , M. J. , Scott , S. , & Lee , J. ( 2006 ). Enhancing the communication skills of children who are deaf or hard of hearing children in the mainstream . Clifton Park, NY : Thomas-Delmar Learning . Marschark , M. , Lang , H. , & Albertini , J. ( 2002 ). Educating deaf students: From research to practice . New York, NY : Oxford University Press . Marschark , M. , Shaver , D. M. , Nagle , K. , & Newman , L. ( 2015 ). Predicting the academic achievement of deaf and hard-of-hearing students from individual, household, communication, and educational factors . Exceptional Children , 81 , 350 – 369 . doi:10.1177/0014402914563700 Google Scholar PubMed Moore , J. A. , & Teagle , H. F. B. ( 2002 ). An introduction to cochlear implant technology, activation, and programming . Language, Speech, and Hearing Services in Schools , 33 , 153 – 161 . doi:10.1044/0161-1461 Google Scholar Crossref Search ADS PubMed Moores , D. F. ( 2009 ). Residential schools for the deaf and academic placement past, present and future . American Annals of the Deaf , 154 , 3 – 4 . doi:10.1353/aad.0.0077 Google Scholar Crossref Search ADS PubMed Moseley , M. J. , Mahshie , J. J. , Brandt , F. D. , & Fleming , L. F. ( 1994 ). A survey of professionals delivering speech-language services to children with hearing loss . Language, Speech, and Hearing Services in Schools , 25 , 100 – 104 . doi:10.1044/0161-1461.2502.100 Google Scholar Crossref Search ADS National Center for Education Statistics , U.S. Department of Education ( 2017 ) Children 3 to 21 years old served under Individuals with Disabilities Education Act (IDEA), Part B, by type of disability: Selected years, 1976-77 through 2015-16. In Digest of Education Statistics, 2016. Retrieved on January 28, 2019, from https://nces.ed.gov/programs/digest/d17/tables/dt17_204.30.asp Nunez , L. M. , & Chute , P. ( 2003 ). Graduate student survey: Training and attitudes related to the field of cochlear implantation. Paper presented at the 9th International Symposium on Cochlear Implants in Children, Washington, DC. Office of Research Support and International Affairs ( 2014 ). Regional and National Summary Report of Data from the 2013-14 Annual Survey of Deaf and Hard of Hearing Children and Youth . Washington, DC : RSIA, Gallaudet University . October. Prendergast , S. , Lartz , M. N. , & Fiedler , B. C. ( 2002 ). Ages of diagnosis, amplification, and early intervention of infants and young children with hearing loss: Findings from parent interviews . American Annals of the Deaf , 147 , 24 – 30 . doi:10.1353/aad.2012.0198 Google Scholar Crossref Search ADS PubMed Priestly , K. , Enns , C. , & Arbuckle , S. ( 2018 ). Altering practices to include bimodal-bilingual (ASL-spoken English) programming at a small school for the deaf in Canada . The Journal of Deaf Studies and Deaf Education , 23 , 82 – 94 . doi:10.1093/deafed/enx040 Google Scholar Crossref Search ADS PubMed Purn , J. ( 2001 ). Hearing-impaired children in the mainstream: What schools need to know . The Hearing Journal , 54 , 74 . doi:10.1097/01.HJ.0000294506.42067.8a Google Scholar Crossref Search ADS Quinto-Pozos , D. , Forber-Pratt , A. J. , & Singleton , J. L. ( 2011 ). Do developmental communication disorders exist in the signed modality? Perspectives from professionals . Language, Speech, and Hearing Services in Schools , 42 , 423 – 443 . doi:10.1044/0161-1461 Google Scholar Crossref Search ADS PubMed Rehabilitation Act of 1973 , Pub. L. No. 93-112, 87 Stat. 355 ( 1973 ) Seal , B. , Rossi , P. , & Henderson , C. ( 1998 ). Speech-language clinicians in schools for the deaf: A survey of scope of practice, service delivery, caseload, and program features . American Annals of the Deaf , 143 , 277 – 283 . doi:10.1353/aad2012.0197 Google Scholar Crossref Search ADS PubMed Snell , L. ( 2011 , December 15). The price tag for schools for the deaf. The New York Times. Retrieved from https://www.nytimes.com/roomfordebate/2011/07/31/do-states-need-schools-for-the-deaf/the-price-tag-for-schools-for-the-deaf Starks , H. , & Trinidad , S. B. ( 2007 ). Choose your method: A comparison of phenomenology, discourse analysis, and grounded theory . Qualitative Health Research , 17 , 1372 – 1380 . doi:10.1177/1049732307307031 Google Scholar Crossref Search ADS PubMed U.S. Government Accountability Office ( 2011 ). Deaf and hard of hearing children: Federal support for development language and literacy. Retrieved from https://www.gao.gov/products/GAO-11-357 van de Weil , M. W. , Van den Bossche , P. , Janssen , S. , & Jossberger , H. ( 2010 ). Exploring deliberate practice in medicine: How do physicians learn in the workplace? Advances in Health Sciences: Theory and Practice , 16 , 81 – 95 . doi:10.1007/s10459-010-9246-3 Google Scholar Crossref Search ADS Welling , D. R. , & Ukstins , C. A. ( 2019 ). Fundamentals of audiology for the speech-language pathologist . Burlington, MA : Jones & Bartlett Learning . Wilson , K. ( 2006 ). Beyond early intervention: Providing support to public school personnel . The Volta Review , 106 , 419 – 431 . doi:10.1097/MAO.0000000000000906 Yoshinaga-Itano , C. ( 1997 ). The challenge of assessing language in children with hearing loss . Journal of Language Speech and Hearing Services in the Schools , 28 , 362 – 373 . doi:10.1044/0161-1461.2804.362 Google Scholar Crossref Search ADS Zirkel , P. ( 2011 , August 1). What the law says about educating the disabled. The New York Times. Retrieved from https://www.nytimes.com/roomfordebate/2011/07/31/do-states-need-schools-for-the-deaf/what-the-law-says-about-educating-the-disabled Appendix Appendix A: Case Study Description Brendan is a six year-old boy with a severe-to-profound hearing loss who communicates mostly through sign language. He received a cochlear implant at five years of age. With his CI, he detects sound consistently but has difficulty with speech sound discrimination. He cannot rely on the use of his CI for oral communication. Brendan’s receptive spoken language improves when he uses speechreading, although he still depends on sign language for communication. Brendan has been using sign language since beginning a parent–infant program at a school for the deaf at age 2. His family speaks only a Chinese dialect at home, so his only exposure to spoken English is during the school day. His speech intelligibility is judged to be poor. He produces mostly vowels with a few bilabial consonants in imitation. His only intelligible words are “mama,” “more,” and “up.” Brendan’s parents want him to improve his spoken language, but they don’t devote time to practicing his speech and listening skills at home. They both work long hours and haven’t had the time to attend speech sessions or meet Brendan’s teachers and therapists. They don’t feel it is a priority for Brendan to exclusively use spoken language. Appendix B: Demographic Survey What is your highest level of education? __ Bachelor’s degree __ Master’s Degree __ Clinical Doctorate __PhD __ Ed.D. How many years of experience do you have working as a speech therapist? How many years of experience do you have working with children with severe-to-profound hearing loss? What is your current caseload? __ <10 students __ 10–15 students __ 16–20 students __ 21–25 students __ >25 students What is the severity of the communication disorders of the majority of your caseload? __ mild __ moderate __ severe __ profound In what types of situations do you work with the students on your caseload? (Check all that apply) __ pull-out in separate “speech room” __ push-in to general education classroom __ push-in to special education classroom __ consulting with teachers and other professional __ push-in to “specials” and other non-classroom activities What is your job title? __ Speech-language pathologist __ Speech Teacher __ Other (please specify) _______________ What relevant professional certifications do you currently have? __ ASHA Certificate of Clinical Competence (CCC) __ New York State Teacher of Speech and Hearing Handicap (TSHH) __ New York State Teacher of Students with Speech and Language Disabilities (TSSLD) __ other (Please specify) ________________ In which of the following clinical services areas of speech language pathology do you consider yourself to be strongly experienced? (Check all that apply) __ Apraxia of speech  __ Auditory Processing __ Augmentative and Alternative Communication (AAC) __ Aural Rehabilitation  __ Autism Spectrum Disorders __ Cognition  __ Deaf and Hard of Hearing __ Dementia  __ Early Intervention __ Fluency  __ Hearing Screenings __Language and Literacy  __Mental Retardation/Developmental Disabilities __Orofacial Myofunctional Disorders  __Prevention of Communication Disorders __ Severe Disabilities  __ Social aspects of Communication __ Swallowing  __ Voice and Resonance In which of the following clinical services areas do you consider yourself to be inexperienced? __ Apraxia of speech  __ Auditory Processing __ Augmentative and Alternative Communication (AAC) __ Aural Rehabilitation  __ Autism Spectrum Disorders __ Cognition  __ Deaf and Hard of Hearing __ Dementia  __ Early Intervention __ Fluency  __ Hearing Screenings __Language and Literacy  __Mental Retardation/Developmental Disabilities __Orofacial Myofunctional Disorders  __Prevention of Communication Disorders __ Severe Disabilities  __ Social aspects of Communication __ Swallowing  __ Voice and Resonance In which of the following clinical services areas have you pursued continuing education units (CEUs?) __ Apraxia of speech  __ Auditory Processing __ Augmentative and Alternative Communication (AAC) __ Aural Rehabilitation  __ Autism Spectrum Disorders __ Cognition  __ Deaf and Hard of Hearing __ Dementia  __ Early Intervention __ Fluency  __ Hearing Screenings __Language and Literacy  __Mental Retardation/Developmental Disabilities __Orofacial Myofunctional Disorders  __Prevention of Communication Disorders __ Severe Disabilities  __ Social aspects of Communication __ Swallowing  __ Voice and Resonance What percentage of your treatment time do you typically spend in a week treating communication disorders in the following areas: Articulation __ 10% __20% __30% __40% __50% or more Language __ 10% __20% __30% __40% __50% or more Fluency __ 10% __20% __30% __40% __50% or more Voice __ 10% __20% __30% __40% __50% or more Phonemic Awareness __ 10% __20% __30% __40% __50% or more Feeding/ Swallowing __ 10% __20% __30% __40% __50% or more Auditory Training __ 10% __20% __30% __40% __50% or more Other __ 10% __20% __30% __40% __50% or more Articulation __ 10% __20% __30% __40% __50% or more Language __ 10% __20% __30% __40% __50% or more Fluency __ 10% __20% __30% __40% __50% or more Voice __ 10% __20% __30% __40% __50% or more Phonemic Awareness __ 10% __20% __30% __40% __50% or more Feeding/ Swallowing __ 10% __20% __30% __40% __50% or more Auditory Training __ 10% __20% __30% __40% __50% or more Other __ 10% __20% __30% __40% __50% or more Articulation __ 10% __20% __30% __40% __50% or more Language __ 10% __20% __30% __40% __50% or more Fluency __ 10% __20% __30% __40% __50% or more Voice __ 10% __20% __30% __40% __50% or more Phonemic Awareness __ 10% __20% __30% __40% __50% or more Feeding/ Swallowing __ 10% __20% __30% __40% __50% or more Auditory Training __ 10% __20% __30% __40% __50% or more Other __ 10% __20% __30% __40% __50% or more Articulation __ 10% __20% __30% __40% __50% or more Language __ 10% __20% __30% __40% __50% or more Fluency __ 10% __20% __30% __40% __50% or more Voice __ 10% __20% __30% __40% __50% or more Phonemic Awareness __ 10% __20% __30% __40% __50% or more Feeding/ Swallowing __ 10% __20% __30% __40% __50% or more Auditory Training __ 10% __20% __30% __40% __50% or more Other __ 10% __20% __30% __40% __50% or more (Please specify Below) ________________________________________________ Appendix C: Interview Questions Tell me about your experience working with severely-to-profoundly deaf students. What have you learned about this student population by working with them? What do you believe to be the minimum standard of excellence for working with this student population as an SLC? Tell me about when and how you realized you were skilled at working with this population. What can you tell me about working with this population that no one else can? © The Author(s) 2019. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)
TI - Speech-Language Clinicians Working with Deaf Children: A Qualitative Study in Context
JF - The Journal of Deaf Studies and Deaf Education
DO - 10.1093/deafed/enz008
DA - 2019-07-01
UR - https://www.deepdyve.com/lp/oxford-university-press/speech-language-clinicians-working-with-deaf-children-a-qualitative-VQ2CU8mcZ6
SP - 289
VL - 24
IS - 3
DP - DeepDyve
ER -