Roles of Speech-Language Pathologists and Teachers of Children Who Are Deaf and Hard of Hearing in the Development of Communicative and Linguistic Competence
Joint Committee of the American Speech-Language-Hearing Association and the Council on Education of the Deaf
About this Document
This technical report was developed by the Joint Committee of the American Speech-Language-Hearing Association (ASHA) and the Council on Education of the Deaf (CED). It was approved by ASHA's Executive Board in 2003 and the Executive Board of CED in 2003. Members of the Joint Committee of ASHA/CED include vice president for professional practices in audiology (2001–2003), Susan Brannen, Evelyn Cherow (past ex officio), Carol Erting, Larry Fleischer, Dawna Lewis (past member), Martha McGlothin (chair), Ann Pruitt Shough, Marilyn Sass-Lehrer, Patrick S. Stone (past member), and Evelyn J. Williams, (ex officio).
The Joint Committee of the American Speech-Language-Hearing Association (ASHA) and the Council on Education of the Deaf (CED) [JC ASHA/CED] was founded in 1970 to address the personnel needs of children in schools for the deaf with an initial emphasis on enhancing audiology service delivery in this specific setting. Since its inception, JC ASHA/CED has developed several documents that were adopted by both organizations including the 1998 position statement Hearing Loss: Terminology and Classification and the 1994 technical report Service Provision Under the Individuals with Disabilities Education Act—Part H as Amended (IDEA-Part H) to Children Who are Deaf and Hard of Hearing Ages Birth to 36 Months of Age. Both organizations are concerned with the unique needs of children who are deaf or hard of hearing and who are educated and/or receive related services in a variety of educational environments (JC ASHA/CED, 1994; JC ASHA/CED, 1998). Similarly, this technical report and the companion position statement and guidelines have been developed to address service delivery issues for children who are deaf or hard of hearing ages birth through 21 years and for those who may have concomitant disabilities.
As early as 1975, the JC ASHA/CED invited experts to address the committee about the unique language, communication development, and communication access needs of children who are deaf or hard of hearing as well as the complementary and supplementary roles of both SLPs and Teachers in working with children and their families. Inherent in those discussions and presentations was the apparent confusion between the two professional groups and among educational program administrators concerning the education and roles of each profession. Each profession, as a result of unique education and credentialing requirements, addresses certain aspects of the language development needs (spoken and signed) as well as cognitive, social-emotional and communication considerations of children who are deaf or hard of hearing.
During the past 25 years, landmark federal and state education and health care legislation and regulations designed to provide children with disabilities with appropriate education and health care have been enacted (Rehabilitation Act, 1973; Education of the Handicapped Act Amendments, 1974; Education for All Handicapped Children Act, 1975; Education of the Handicapped Act Amendments, 1986; Americans with Disabilities Act, 1990; Individuals with Disabilities Education Act (IDEA), 1990, IDEA Amendments, 1997; State Children's Health Insurance Program, August 1997). These statutes and their accompanying regulations have significantly contributed to the provision of services for children who are deaf or hard of hearing. The legislation and regulations, however, do not specify the various roles assumed by professionals serving these children. Misunderstandings related to professionals' roles continue to affect developmental, academic, and social/emotional outcomes for children who are deaf or hard of hearing (i.e., clarification of roles related to the development of communicative competence for these children) (Moeller, 2000; Karchmer & Allen, 1999; Seal, Rossi, & Henderson, 1998).
It is important to recognize that the current educational system does not meet the unique needs of all children who are deaf and hard of hearing (Siegel, 2000). One study (Bess, Dodd-Murphy, & Parker, 1998) estimated a prevalence of 5.4% of school-age children with minimal sensorineural hearing loss (MSNHL) and 11.4% prevalence of hearing loss of all types and severity in a sample of 1,218 children. School records indicated that 37% of the children with MSNHL failed at least one grade and exhibited below average scores on measures of behavior, energy, stress, social support, and self esteem. This study supports earlier findings (Tharpe & Bess, 1999; Oyler, Oyler, & Matkin, 1988; Bess & Tharpe, 1986; Bess & Tharpe, 1984) reflecting the linkage between language development and academic success.
A number of studies conducted during the past 30 years confirm the important relationship between language development and academic success for children who are deaf or hard of hearing. The Gallaudet Annual Survey of Deaf and Hard of Hearing Children and Youth (Karchmer & Allen, 1999), presents data collected on the classroom functioning of deaf and hard of hearing children as reported by school personnel. The findings indicate that in the judgment of these raters, one-third of the 30,198 children have a disability in thinking or reasoning skills. Half were judged to have communication limitations and almost half were judged to have at least one cognitive, behavioral, or social limitation  . The functional assessment findings are consistent with related findings obtained over the 30 years of the Gallaudet Annual Survey; (i.e., that children who are deaf and hard of hearing on the average achieve a fourth grade reading level upon leaving high school) (Allen, 1986; Commission on Education of the Deaf, 1988; Schildroth & Hotto, 1994; Gallaudet University Center for Assessment & Demographic Study, 1998; Traxler, 2000). Factors that may influence the development of communicative competence of children who are deaf or hard of hearing include:
Over the last decade, in addition to the JC ASHA/CED documents (JC ASHA/CED, 1994; 1998), several other documents and studies have addressed the language learning and communication needs of children who are deaf or hard of hearing (Commission on Education of the Deaf, 1988; Johnson, Liddell, & Erting, 1989; U.S. Department of Health and Human Services, Public Health Services, 1990, 2000; Baker-Hawkins & Easterbrooks, 1994; Council of Organizational Representatives, 1994; Joint Committee on Infant Hearing, 1994, 2000; Stredler-Brown & Yoshinaga-Itano, 1994; Stredler-Brown, 1998; ASHA, 1999; Yoshinaga-Itano, Sedley, Coulter, & Mehl, 1999; Calderon, 2000; Moeller, 2000). An underlying theme of these and related documents is the need to provide early, timely, culturally-sensitive, family-centered identification and intervention programs for children with congenital and acquired hearing loss to maximize communication access and development (Calderon, Bargones, & Sidman, 1998; Meadow-Orleans, Mertens, Sass-Lehrer, & Scott-Olson, 1997; Siegel, 2000). A critical component of these programs is the provision of services by personnel who are knowledgeable about language differences among spoken, signed, and written languages and the role models and communication skills needed to stimulate language development (Seal, Rossi, & Henderson, 1998).
To this end, the 2003 JC ASHA/CED technical report, position statement and guidelines offer a framework for synergistic collaborative approaches to resource allocation of SLPs and Teachers of children who are deaf and hard of hearing to optimize communicative and linguistic competence and related outcomes for these children.
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For purposes of the companion position statement (JC ASHA/CED, in press b) and guidelines (JC ASHA/CED, in press a) as well as this technical report, communicative competence is defined as the ability to understand and use one or more languages (signed and/or spoken) effectively in a variety of sociocultural contexts. It recognizes that language users depend on knowledge that includes not only phonological, grammatical and lexical features but also the cultural and context-specific rules that govern language use and interpretation (Cook-Gumperz & Gumperz, 1982). While this concept originally referred to communication during face-to-face social interaction, it is expanded here to include more recent definitions of literacy that “…recognize the complex relationships among reading, writing, ways of talking, [signing], ways of learning, and ways of knowing” (Snow, Barnes, Chandler, Goodman, & Hemphill, 1991). For children who are deaf or hard of hearing, communicative competence includes the ability to communicate with individuals who are deaf, hard of hearing, and hearing through languages that are spoken, signed, written, and/or generated through assistive technology (ASHA, 1991; 1998).
If SLPs and Teachers are to facilitate the development of communicative competence, several provisions must be in place and factors must be considered. As stated in the 2003 JC ASHA/CED position statement, the development of communicative competence must be a fundamental component of early intervention and educational programs for children who are deaf or hard of hearing, ages birth through 21 years. Furthermore, children who are deaf or hard of hearing must be allowed to communicate through a variety of communication modalities, languages, and strategies. In addition, the roles and responsibilities of SLPs and Teachers in the development of communicative competence may be overlapping, complementary, and/or supplementary when collaborating to achieve optimal outcomes for the child who is deaf or hard of hearing (JC ASHA/CED, in press a).
SLPs and Teachers should have an understanding of the interrelationship of linguistic, cognitive, and social development as well as an understanding of how hearing loss, community, educational, and familial factors affect the overall development of the child is critical. SLPs and Teachers must also establish communication and linguistic goals for purposes of the child's reaching developmental milestones and academic achievement that are comparable to hearing peers. Consistent with Individuals with Disabilities Education Act of 1997 (IDEA 1997), these goals must address the general education curriculum for school-age children.
The potential influence of a variety of factors must also be considered in the development of communicative competence. Factors include, but are not limited to:
Age of onset and of identification of hearing loss
Age at which the child begins using amplification and/or other auditory or visual assistive technologies
Consistent use of available and appropriate amplification and/or other auditory or visual assistive technologies
Access to communication and language(s)
Access to communication and language(s) at home and at school
Language models and communication partners
Individual ability to acquire language through auditory, visual, and/or tactile/kinesthetic senses
Education and services
Access to appropriate early intervention and educational programming for children who are deaf or hard of hearing and their families
Quality and quantity of communicative and linguistic environments and services
Qualifications and competencies of professionals
Family and community support
Family, culture, and community support of individuals who are deaf or hard of hearing
Quality of family/caregiver and child interaction
Individual characteristics of the child
Visual, auditory, motor, and cognitive abilities
Presence of disabilities co-occurring with hearing loss
Temperament, personality, and learning styles
Additionally, SLPs and Teachers require specialized knowledge and skills to communicate effectively with families whose linguistic and cultural backgrounds differ from the professionals providing services (ASHA, 1989, Nuru, 1993). Working with language interpreters and acquiring an understanding of protocols, terminology, and communication styles will facilitate the communication exchanges between the professionals and families of children with hearing loss (Cohen, Fishgrund, & Redding, 1990; Cohen, 1993; Cohen, 1997; Lynch & Hanson, 1998; Christensen, 2000; Ohtake, Santos, & Fowler, 2000). Finally, developing technologies, research, and societal influences will increase the communicative and linguistic opportunities and competence of children who are deaf or hard of hearing.
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SLPs earn a Certificate of Clinical Competence in Speech-Language Pathology (CCC-SLP) from ASHA by completing the following requirements: a master's or doctoral degree with requisite coursework and supervised observation and clinical practicum from an institution accredited by the Council on Academic Accreditation in Audiology and Speech-Language Pathology, completion of a supervised clinical fellowship, and a passing score on the National Examination in Speech-Language Pathology (ASHA, 1994). ASHA-certified SLPs are bound by ASHA's Code of Ethics (ASHA, 2001a), and their professional activities are defined by ASHA's scope of practice. Additionally, SLPs may be required to hold state licensure, registration, or certification. Teacher certification through state education agencies may also be a requirement.
SLPS have an educational background that consists of a well-integrated course of study including basic science coursework in the following: a) the biological/physical sciences and mathematics; b) the behavioral and/or social sciences including normal aspects of human behavior and communication; and c) the nature, prevention, evaluation, and treatment of speech, language, hearing, and related disorders. This coursework must specify basic human communication processes to include content in anatomic and physiologic bases, physical and psychophysical bases, and linguistic and psycholinguistic aspects of speech, language, and hearing.
SLPs receive specific preparation in the nature, prevention, evaluation, and treatment of speech, language, and hearing disorders affecting children and adults. National certification standards require that the core of professional preparation be in the area of speech-language pathology with the remainder of required studies in the area of audiology, specifically hearing loss, hearing evaluation, and habilitative/rehabilitative procedures for individuals with hearing loss. This profession works closely with audiologists.
The role of the audiologist cannot be overlooked in managing spoken language communicative competence and collaboration among audiologists, SLPs, and Teachers is essential. Understanding the child's acoustic abilities within the framework of the communication choice is critical to setting realistic expectations. Goals relative to classroom listening, decoding, phonemic development, and receptive language can often be better understood when the audiologist provides information and an understanding of the child's phonemic and acoustic access. Audiologists also facilitate communicative competence through collaboration with the SLP and Teacher in the provision of audiologic (re)habilitation services (ASHA, 2002a).
The acoustics of classrooms and other learning environments can significantly alter the child's ability to access spoken language. Even the best amplification cannot rid the learning space of poor acoustics or excessive ambient noise. This affects the child's ability to gain communication competence in an oral/aural modality. The audiologist is able to assist the school team in modifying these learning environments.
Amplification is critical for children where families have chosen auditory access as part of the communication modality. Fifty percent of children's personal amplification or educational amplification are reportedly malfunctioning on any given day (Langan & Blair, 2000) and with expanding technology, determining whether amplification is functioning properly is a greater challenge. This is compounded with the increasing growth of cochlear implants where simple troubleshooting strategies become more complicated for the school team. The audiologist can train personnel in appropriate daily assessment protocols.
The audiologist working in or for the schools—often termed educational audiologists—are uniquely educated and trained to provide services to children who are deaf or hard of hearing. ASHA-certified audiologists possess the Certificate of Clinical Competence in Audiology (CCC-A), have a master's or doctoral degree from an institution accredited by the Council on Academic Accreditation in Audiology and Speech-Language Pathology with requisite coursework, observation, and clinical practicum. They have also successfully completed a supervised clinical fellowship and received a passing score on the National Examination in Audiology (ASHA, 2001b). Audiologists working in the schools need expertise in pediatric audiology, classroom acoustics and their measurements, educational and personal amplification, and regulations governing public education. Their working environment becomes the classroom or the community as the challenge of meeting the listening needs of children in the general education environment increases.
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Teachers of Deaf and Hard of Hearing Children earn certification from the Council on Education of the Deaf (CED) after completing a CED-approved teacher education program. CED is a national organization whose Executive Board consists of two representatives from each of the following organizations: Alexander Graham Bell Association of the Deaf (AGB), American Society for Deaf Children (ASDC), Association of College Educators-Deaf and Hard of Hearing (ACE-DHH), Conference of Educational Administrators of Schools and Programs for the Deaf (CEASD), Council of American Instructors of the Deaf (CAID), National Association of the Deaf (NAD). Standards for CED-approved programs represent preservice preparation program requirements for teachers of deaf and hard of hearing children and were developed jointly by CED and the Council for Exceptional Children (CEC). CED-certified teachers graduate from institutions of higher education approved and administered by regionally-accredited institutions of higher education and meet criteria and standards identified by CED and CEC. Teachers who have earned CED certification are prepared to address the specialized communication and language needs of children in one of the following program areas: auditory/oral English, ASL-English Bilingual, or comprehensive  . Certified teachers also complete a specialization component in Parent/Infant, Early Childhood, Multiple Disabilities, Elementary, or Secondary Education with content area expertise.
In addition to professional certification, each state has established separate certification standards for teachers of children who are deaf and hard of hearing. Individuals who meet the standards specified by the CED and the state in which they are teaching are considered to possess the entry level competencies to teach children who are deaf or hard of hearing (Baker-Hawkins and Easterbrooks, 1994; Council on Education of the Deaf, 1995).
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The JC ASHA/CED, through this technical report, seeks to provide to SLPs, Teachers, and others, with a resource that examines issues related to service delivery to facilitate the development of communicative competence in children who are deaf or hard of hearing. In addition to highlights of related legislation and research studies, the report includes a definition of communicative competence and identification of factors that can impact the development of communicative competence in deaf and hard of hearing children. The discussion of preservice credentials for SLPs and Teachers describes the training and certification requirements for each profession as well as the roles of the audiologist in working with this population of children. While both SLPs and Teachers have an integral role in facilitating the development of communicative competence, each brings unique education and expertise to the process.
This technical reports supports the position statement that precedes this report and the guidelines that follow.
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 The term “limitations” used in the Karchmer & Allen (1999) report comes from the specific language used in the scales presented in the Gallaudet Annual Survey of Hearing Impaired Children and Youth (Schildroth and Hotto, 1992).
 As stated in the CED Program Manual Standards for the Certification of Professionals Involved in the Education of Deaf and Hard of Hearing Children and Youth.
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