Choosing an Educational Setting

Getting Started	What is a CI?	Candidacy	Performance
Decision Making	Process	Insurance	Surgery
Education	Communication	Sign Language	Deaf Community
Speech Processor	Listening	Resources	Versión en Español

By Debra Nussbaum, M.A., CCC-A

The task of choosing the most appropriate educational placement to facilitate language development, academic learning, and positive social-emotional development for deaf and hard of hearing children can be confusing. The choices are not always clearly defined as there are many factors that impact on a child's success with one setting over another, and there are varied professional recommendations related to one setting over another. The advent of the cochlear implant has made this decision-making process even more complex.

Each child arrives at the implant process with unique characteristics and potential outcomes. While the motivation and hopes of some families may be that their implanted child will participate in their neighborhood school with no additional educational support services, for some children this may not be an immediate outcome, and for some this may not be a realistic outcome.

As cochlear implant technology has become more common, so has the diversity in the types of children obtaining implants. During the early years when implantation first emerged as a choice for children, the children obtaining cochlear implants appeared to be a homogenous group. The group of implanted children was comprised primarily of Caucasian children with high levels of income that were enrolled in mainstream or oral environments. (Parents' Perceptions and Experiences with Their Children's Cochlear Implants: A Report of the Results of the Survey of Parents of Pediatric Cochlear Implantees, presented by Tom Allen, dean of the Graduate School and Research at Gallaudet University, in March 2000)

In addition, many of the children selected as candidates were post-lingually deaf or were children with prior auditory experience and demonstrated aptitude for developing spoken language. As growing numbers of children are obtaining cochlear implants, however, observation suggests that the population of implanted children is changing. Children obtaining cochlear implants now appear to come from increasingly diverse cultural backgrounds, socio-economic groups, and a broader range of ages (specifically, more infants and toddlers).

The bottom line is that there is no single "right" educational placement for a child with a cochlear implant. In addition, placement and communication choices may need to change based on a child's development or success in any given placement. It is necessary that placement choices be monitored and evaluated on an ongoing basis to assure the appropriateness of a placement.

Placement Options

The educational placement choices for a child with a cochlear implant include similar options available to other deaf and hard of hearing children. These placement options include:

• a neighborhood or private school with no additional supports,

• inclusion in a neighborhood or private school with supports integrated within the school (itinerant teachers, resource teachers, speech and language specialists, etc.),

• a self-contained classroom for children with hearing loss using:

• • an oral approach,
  • cued speech,
  • total communication, or
  • American Sign Language,

• a day school for deaf children that uses:

• • an oral only approach,
  • total communication, or
  • a bilingual approach (American Sign Language and English).

Considerations for Making Decisions

As individual outcomes vary for students with cochlear implants similar to all deaf students, a student should not be defined/placed/planned for based solely on his or her cochlear implant. As choices are made regarding educational placement for implanted children, it is important to consider the following individual characteristics of the child:

• Background:
  • medical and developmental history
  • hearing loss etiology, onset, and age of identification
  • quality and quantity of family support
  • cultural background

• Intervention:
  • age that intervention was initiated
  • quality, quantity, and consistency of intervention prior to cochlear implantation
  • quality, quantity, and consistency of amplification use prior to implantation
  • type of language use prior to implantation (spoken or signed)
  • quality, quantity, and consistency of language stimulation
  • language, cognitive, and academic functioning
  • learning profile, style, and characteristics
  • social/emotional development

• Implantation:
  • age at the time of implantation
  • pre-implant auditory experience
  • post-implant auditory experience
  • primary communication mode at age of implant
  • purpose of implant and expectancies of student and family
  • consistency in implant use

The following placement considerations should be kept in mind for children with cochlear implants as they would for any deaf child:

• Choose a program that takes into consideration the whole child. An appropriate educational program takes into consideration a child's overall functioning and goals in a variety of areas, not only development of listening and speech skills. A program that focuses solely on developing listening and speech skills at the exclusion of addressing other components of a child's education may not be in the child's best interest.

• For More Information

  Program components should be individualized and based on the Individualized Family Service Plan (IFSP)/Individualized Education Program (IEP). Don't assume that placement and services will be similar for any two students with a cochlear implant. Each child arrives at the implant process at a different stage in development. Placement and support service planning for each child should be driven by the IFSP/IEP process.

• Collaboration with hospital implant centers is beneficial. Ongoing collaboration between the implant centers and educational settings (i.e. observations between centers, workshops, teaming, attendance at IFSP/IEP meetings) is integral to promoting cohesive planning for students with cochlear implants. It is important that hospital implant centers understand the full range of issues involved in placement and communication planning, and the school understand the clinical and medical side of implantation so families are obtaining consistent guidance related to seeking services and placement after implantation.

• Keep in mind current functioning levels and goals for language development. Choose a program/classroom that is sensitive to the child's current language competency in spoken language, not only future hopes. While children may have similar abilities to be aware of sound with their cochlear implant, they have unique abilities to use this awareness for understanding spoken language. While it is beneficial to have the child in an environment that challenges him or her, it is not beneficial to have the child lost, overwhelmed, or frustrated.

• What about the use of interpreters in the mainstream? Interpreters should be considered for inclusion in a child's program only if the child is already a "user" of sign language. If a child is having difficulty following spoken language in a mainstream classroom, interpreters should not be viewed as an answer for clarifying information for a deaf student who is not already familiar with sign language. Sign language cannot be effectively learned through use of an interpreter and is not recommended as a remedy to a child's inability to learn through spoken language. If this situation arises, placement considerations should be carefully revisited.

• What about the use of an FM system? There are varying opinions related to the use of FM equipment for students with cochlear implants. Some hospital implant centers recommend initially having the child adjust to listening through his or her implant without adding the FM system. This allows the child the opportunity to learn to listen in an "implant only" situation. Increasing numbers of students are beginning to utilize and evaluate the use of FM systems as the technology continues to miniaturize and improve. Each student's needs should be taken into consideration as the decision whether or not to use an FM system is made.

• Varying ages of implantation means varying programming needs. It is easier to design a program for young implanted children to facilitate development of spoken language since the goals of most early childhood programs revolve around the facilitation of language development. For students first obtaining cochlear implants when they are older, designing a program to balance spoken language development and academic needs becomes trickier. The focus of the school day revolves around obtaining academic information. When a child obtains an implant, it becomes necessary to expand attention to developing spoken language skills without sacrificing attention to learning.

• Accessibility to information—Keep in mind that the process of moving a child through the hierarchy of listening skill development, to the point where he or she has access to information through hearing, takes time. Each implanted child brings a different level of accessibility to information through his or her hearing. This means that he or she will have different levels of accessibility to academic information, social interactions, and incidental learning. It is important to determine if a setting provides an opportunity for the child to have sufficient access through his or her listening to be involved and active participants in the environment.

  Even if the child can hear some sounds, it doesn't mean that the child can learn complex information auditorily. In addition, some children may be effective social communicators using spoken language, yet suffer communication breakdown when it comes to learning academic information through their listening. It is important that implanted children have sufficient access to all levels of information around them.

• Least Restrictive Environment (LRE)—It is important to determine if a placement is truly the "least restrictive environment" for a child with a cochlear implant. While the goal may be for an implanted child to ultimately reside in a neighborhood classroom, this may not be the best place for a newly implanted child. What may seem like the "least restrictive environment" without all of the necessary supports could result in insufficient attention to the comprehensive needs of the child.

• Social interactions—While placement choices for cochlear implanted children are often chosen for their opportunity to facilitate spoken language development, it is crucial that the placement be evaluated related to promoting positive social opportunities. It is important that implanted children be in an environment where they feel comfortable communicating with their peers to facilitate development of age-appropriate social skills, friendships, and behavior. These issues demand serious attention when evaluating a specific placement.

• Sufficient support services—It is crucial to assure that a child's educational placement provides comprehensive student assessments and necessary support services. As placement decisions are evaluated, make sure professionals qualified in evaluating children who are deaf are serving the child. In addition, make sure the child has access to technological devices that may be needed such as captioned materials, FM systems, or other assistive technologies (i.e., direct audio input from the computer to the cochlear implant).

• Teacher/staff training—Teachers and other involved faculty and staff members should have opportunities for ongoing professional development to facilitate effectively involving implanted children in their school. Many teachers and support staff, even those who have been involved for years in the education of deaf children, may be unfamiliar with the technology of cochlear implants, strategies for working with implanted students, and expected outcomes. It is necessary that professionals be trained related to all components of planning and implementing a comprehensive program for implanted students.

• For more information about educational placement considerations, see the following Web sites: Evaluating School Programs for Deaf and Hard of Hearing Children

  Other learning issues—While some children may have behavior and learning issues that resolve following cochlear implantation as a result of their improved communication skills, a cochlear implant is not going to remedy issues unrelated to hearing loss. Children with additional learning disabilities or emotional issues unrelated to deafness will continue to display these concerns. Placement decisions should be made taking all of the child's learning issues into consideration, not only a child's cochlear implant.

• Family support—Family involvement is integral to a child's success with his or her cochlear implant and educational program. Look for a program that supports families in understanding the communication and training process following implantation. For families where English is a second language, assure that a program provides access to information in the family's first language.