Cochlear Implant Education Center
What is a CI?
Language and Communication
Versión en Español (muy pronto)
Choosing an Educational Setting
Developed by Debra Berlin Nussbaum, Coordinator, Cochlear Implant Education Center, Laurent Clerc National Deaf Education Center
Educational placement considerations for a child with a cochlear implant include similar options available to other children who are deaf or hard of hearing. Options include:
- a day school or residential school (varied language and communication approaches may be used).
- a self-contained classroom for children who are deaf or hard of hearing (varied language and communication approaches may be used ranging from an auditory/oral approach, to cued speech/language, to total communication, to an ASL/English bilingual approach), and
- a public or private school with no additional supports,
- inclusion in a public or private school with supports integrated within the school (e.g., itinerant teachers, resource teachers, interpreters, speech and language specialists),
Regardless of where a child is placed, it is critical that the program have a systematic plan to guide the supports and services for the child. It is recommended that any educational setting include:
- language and communication practices that match the communication characteristics of the child (see module: Language and Communication Planning), and
- systematic monitoring of a child’s progress in development and use of spoken language, social interactions, and academic progress.
The following considerations should be kept in mind for children with cochlear implants as educational placement choices are made:
- Determining an appropriate educational placement should take into consideration all of a child’s needs, not only spoken language development. An appropriate educational program should take into consideration a child's overall functioning and goals in a variety of areas, not only development of listening and speech skills. While a placement choice for a child with a cochlear implant is often made based on its potential to facilitate spoken language development, it is crucial that the placement also provide ready access to academic learning and social interactions. It is important to choose a program that incorporates and values spoken language as well as reflects a child’s language and communication strengths and preferences.
An individualized language and communication plan should be incorporated into the child’s Individualized Family Service Plan (IFSP)/Individualized Education Program (IEP). Use of a cochlear implant device alone should not be the sole determining factor in educational placement decisions. It is important to evaluate if a placement is truly the "least restrictive environment" for a child with a cochlear implant, meaning an environment that would provide opportunities for the child to develop and utilize his or her spoken language and at the same time participate fully in the environment academically and socially. Don't assume that placement, language use decisions, and support services will be similar for any two students with a cochlear implant. Each child with an implant may be at a different stage in development. Language and communication planning for each child should be driven by the IFSP/IEP process.
For more information on the IDEA and IEP planning for children with cochlear implants see:
- 2004 IDEA Final Regulations Finally Here!, by Cheryl Johnson & Leeanne Seaver (Printed in the Hands & Voices Communicator, V10-1, Fall 2006)
- Meeting the Educational Needs of Students with Cochlear Implants and IDEA 2004. Bureau of Exceptional Education and Student Services, Florida (Technical assistance paper; January 2007)
- Keep in mind that designing a program for a young child in the early language learning years will be different than designing a program for a later-implanted older child. It is easier to design educational programs to meet the spoken language needs of young children who are implanted when language is typically developing. Activities and strategies can be naturally incorporated throughout the child’s routines and in structured activities. It is trickier to design an appropriate placement for an older child who is new to listening. It is difficult to find a balance between providing opportunities to develop listening and speaking skills while at the same time facilitating access to academic information and social interactions. Regardless of a child’s age, it is important that the placement address spoken language skill development and use without sacrificing attention to academic learning and other areas of a child’s development.
- Plan appropriately for the percentage of children with cochlear implants who have additional learning challenges. Placement decisions should be made taking additional learning challenges into consideration, not only a child's cochlear implant. For younger children obtaining cochlear implants prior to the time when additional learning challenges may be evident, it is important to closely monitor them for the emergence of possible additional disabilities that may impact a child’s progress and placement choice.
For more information:
Plan appropriately for the percentage of children with cochlear implants who come from homes using a language other than spoken English. For children who are raised in families where a language other than English is used in the home, spoken language abilities may be impacted. The factors that appear to predict the best outcomes for bilingual spoken language development for a child with a cochlear implant are: 1) two spoken languages used in the home, 2) early age of implantation (before age 2), 3) strong speech perception skills, 4) absence of additional disabilities, 5) intact language learning ability for the language of the home, 6) parent involvement, 7) motivation for bilingual learning, and 8) opportunities to use both languages in meaningful contexts with native users. (McConkey Robbins, 2007). More information can be found at Clinical management of bilingual families of children with cochlear implants. Loud & Clear!
There are also children with cochlear implants from culturally Deaf families who use ASL in the home. Optimizing spoken language may warrant additional supports in the school. For all bilingual/multilingual children, it is necessary to identify and apply strategies and techniques in bilingual language learning based on which will be most effective for each child in relation to their language strengths coupled with language use in the home.
For more information:
- Use guidelines to transition a child from a signing environment to an oral environment. If the transition from a signing environment to an oral environment is under consideration, this process should involve purposeful planning and a systematic approach to evaluating the appropriateness of this transition for the child. All areas of a child’s development should be considered when deciding if an oral environment is an appropriate placement even if he or she is demonstrating increasing competence as an auditory learner. One tool to evaluate the appropriateness of a child’s transition from a sign-based environment to an oral mainstream environment is Children with Cochlear Implants Who Sign: Guidelines for Transitioning to Oral Education or a Mainstream Setting. These guidelines may also be helpful in monitoring children already in oral settings to determine if they are appropriately placed. A set of checklists to assist in making educational placement decisions for students who are deaf and hard of hearing are PARC: Placement and Readiness Checklists: Children Who are Deaf and Hard of Hearing. These checklists help evaluate the skills of a student and match them with an appropriate learning environment.
- Consider the possible benefits and roles of an interpreter. An educational interpreter can provide access to communication and learning in a mainstream environment for children with cochlear implants who do not demonstrate the auditory, speech, and spoken language competency to fully access the curriculum and communicate with their peers. Decisions regarding use of an interpreter may change over time as auditory skills develop. Therefore it is critical that the role of an interpreter continuously be evaluated. Decisions regarding whether or not to continue with an interpreter following implantation should not be made based on the implant alone. The interpreter’s role may be expanded to provide support in areas such as pre-teaching concepts, clarifying information upon request, clarifying multiple meaning of words (e.g., present, park, run), clarifying words that sound the same but are spelled differently (e.g., bear/bare), and cueing the student during fast-paced discussions. If the interpreter is to take on multiple responsibilities in conjunction with interpreting, it is critical that the interpreter, educational program professionals, and the child’s family agree on these services as a component of the planning/IEP process and that the interpreter be qualified to take on these added responsibilities. Interpreters can incorporate strategies that offer students the opportunity (as appropriate) to rely on their spoken language ability. These include allowing a child to listen to the teacher or other students before immediately providing interpretation, allowing the child to first listen to the message and then signing words and concepts for clarification as needed, and assisting the child in making links between sign and spoken language (e.g., say it–sign it or sign it–say it). Some children may also be using a Cued Speech transliterator in the classroom.
- An ASL/English bilingual program can be designed to effectively support children with cochlear implants. With purposeful individualized planning, an educational program that uses an ASL/English bilingual approach can be designed to effectively meet the needs of children with cochlear implants. This type of program can be designed to include learning through both auditory and visual modalities. Referred to as an ASL/English bimodal bilingual approach, both ASL and spoken English can be addressed as independent languages. Strategies to develop and use spoken English can be implemented to match the characteristics and goals of each child. ASL can serve an integral role in promoting linguistic and cognitive competence, academic growth, and psycho-social development. Language foundations in ASL can also be used to facilitate spoken English development.
For more information:
- Scott, S., & Schatz, S. (2009). Establishing an ASL/English bilingual program to meet the needs of children with cochlear implants. Proceedings of the Cochlear Implants and Sign Language: Building Foundations for Effective Educational Practices. Washington, DC. Retrieved from http://www.gallaudet.edu/Clerc_Center/Information_and_Resources/Cochlear_Implant_Education_Center/Cochlear_Implants_and_Sign_Language_Building_Foundations_for_Effective_Educational_Practices.html
- Swanwick, R., & Tsverik, I. (2007). The role of sign language for deaf children with cochlear implants: Good practice in sign bilingual settings. Deafness and Education International, 9(4), 214-231. doi: 10.1002/dei.226
- Nussbaum, D. B., Scott, S., & Simms, L.E. (2012). The "How" and "Why" of an ASL/English Bimodal Bilingual Program. Odyssey, 13, 14-19.
- Nussbaum, D., & Scott, S. (2011). The Cochlear Implant Education Center: Perspectives on Effective Educational Practices. In R. Paludneviciene & I. Leigh (Eds.), Cochlear implants: Evolving perspectives (pp. 175-205). Washington, DC: Gallaudet University Press.
- Clerc Center Webinar: Everything You Ever Wanted to Know About ASL/English Bimodal Bilingual Education (Family Education Workshop-Part 1 and Part 2)
For more information:
- Providing a Range of Support Services. Support services are integral to successfully meeting the needs of children with cochlear implants. Regardless of the educational setting, the following supports should be considered:
- Auditory and speech habilitation/rehabilitation. Educational programs for children with cochlear implants should include opportunities to address development of spoken language skills as well as opportunities for spoken language to be used and valued in the child’s daily learning environment. There is no set formula for the “appropriate” amount of habilitation/rehabilitation that should be provided in an educational placement. Some children may require individualized training sessions to develop skills while others may more readily develop listening, speech, and spoken language skills in natural environments without direct teaching. If a child is receiving therapy through his or her hospital implant center or a private auditory habilitation specialist/speech-language pathologist, this may reduce the amount of individualized skill development sessions needed at school. For more discussion about considerations for auditory and speech habilitation, see the module on Training the Ear to Listen.
- Collaboration with hospital CI centers. Ongoing collaboration between hospital implant centers and educational settings (e.g., observations between centers/schools, communication about mapping, attendance at IFSP/IEP meetings) is integral to promoting ongoing functioning of the cochlear implant equipment, effective language and communication planning, and educational program implementation for children with cochlear implants. It is important that hospital implant centers understand the full range of issues involved in educational placement and language/communication planning and that the school understand the clinical and medical side of implantation. This collaboration is vital to facilitating unified and cohesive recommendations to the family regarding educational placement and language use as well as habilitation practices.
- Equipment troubleshooting. A child’s success with an implant depends on the device’s consistent functioning. Although it is not common, the internal component of the implant device can fail. More common are issues related to the functioning of the implant’s external speech processor. To assure optimal functioning, it is critical that professionals working with the child are comfortable with the device, know the personal device settings for each child, and can check the device on a daily basis. For more information and resources on troubleshooting, see the module on Training the Ear to Listen.
- Use of assistive listening technologies. There are many assistive technologies available to enhance listening through a cochlear implant. There are specific cables and cords available from each cochlear implant manufacturer or from associated companies to attach from the cochlear implant to telephones, computers, tape recorders, music players, televisions, DVD players, etc. Children with cochlear implants may also use Frequency Modulation (FM) systems to enhance listening in background noise and at a distance. Some children may use an FM system that directly connects to their cochlear implants, while others may use a sound field device with speakers placed strategically in their classroom or natural environment. For more information on FM systems, see the module on Fitting the Speech Processor.
Classroom acoustics. Classroom acoustics should be evaluated and modified to support ease of listening for children with cochlear implants as well as children with hearing aids.
For more information related to classroom acoustics:
- Student support groups. If an educational program has several students with cochlear implants, it is beneficial to set up support groups. Support groups provide students with the opportunity to discuss issues specific to their personal experiences with a cochlear implant. Older students can be role models for younger implanted students.
- Peer Orientation. For students in an educational setting who are not familiar with cochlear implants (school for the deaf or mainstream environment), it is helpful to educate other students about this technology. Consider providing students with some type of orientation about cochlear implants so that they will understand what their classmate with a cochlear implant may be experiencing.
- 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.
- Professional Development. There are numerous professional training opportunities and resources available for educators to facilitate professional development.
- Hearing with a CI Poster/Who is a CI Candidate? resource card (PDF, 444kB)
- Becoming Familiar with CIs article (PDF, 1MB)
- Becoming Familiar with CIs PowerPoint presentation (PPT, 7MB)
- Cochlear Implants in the Classroom article (PDF, 3MB)
- Tips for Teaching a Child with a CI reference card (PDF, 630kB)
- Cochlear Implant Audiology Referral Form (PDF, 396kB)
- School Input form (PDF, 407kB)
- Behavioral Listening Check form (PDF, 403kB)
- Static Electricity and Cochlear Implants reference card (PDF, 413kB)
- Parent and School Communication Log (PDF, 636kB)
- Cochlear Implant Programming Record (PDF, 638kB)
- Audiogram of Familiar Sounds (PDF, 509kB)
- Preparing Students to be Successful in Their Learning Environments
- LSLS Strategies in the Classroom
- Triangle Time: Parents as Partners
- Planning More Effective Lessons
- Planning More Creative Lessons: School
- Audiologists and Teachers (or Therapists) Working Together
- High Expectations and Optimal Outcomes for Students with Cochlear Implants
- Captioning and Note Taking: How Does That Work?
- Mainstreaming Issues for Children with Cochlear Implants
- Back to School with Cochlear Implants: The Top 10 Things Parents Need to Know
- HOPE for Next Year: IEP Goals & Reports
- Push In or Pull Out: Intervention Ideas for 1-on-1 Services
- Working Together: Teaching Teams
- Working Together: Parents and Professionals
- Clear Speech: Applying Research Findings to the Classroom
- Education and Access Laws that Support Children with Hearing Loss
- On the Road Again: The Role of the Itinerant Teacher for Children with Cochlear Implants
- Making a Case for Classroom Acoustics
- CLIC IT! Creating Listeners in the Classroom: Ideas for Teaching
- Lessons from a First Grade Mainstream Classroom: A Teacher and Parent Share their Experiences
- Sign Language and the Cochlear Implant: The Real Story
- Gearing Up My Classroom: Strategies to Support a Student with a Cochlear Implant
The above videos are associated with the article: “Deaf Learners and Successful Cognitive Achievement.”
For students with cochlear implants who use an interpreter, there is often discussion surrounding whether the interpreter should use ASL or a sign system to support English. If a child has utilized ASL for academic content learning prior to implantation, shifting to use of a manually coded English system when a student has only basic listening skills and is unfamiliar with accessing information via an English based sign system may not provide the best avenue for conveying information or developing spoken language skills. A child's individual communication strengths and preferences should be considered in determining how sign should be incorporated via an interpreter for a child with a cochlear implant.
Also, a note of caution surrounding the recommendation of adding an interpreter into a classroom for a student with a cochlear implant who is not progressing in his or her spoken language development. An interpreter should only be considered if the child is already competent using either ASL or a sign system. Sign language cannot be effectively learned through the use of an interpreter.
For more information on interpreting:
- Learn UNC: Modes of Communication, Interpreters, Hearing Aids, and Cochlear Implants (video and links to information on working with children who are deaf and hard of hearing in inclusive classrooms
- Interpreting for Students with Cochlear Implants: Registry of Interpreters for the Deaf (2009)
- Educational Interpreter Performance Assessment; Boystown National Research Hospital
- Tips for Working with Cuers in the Classroom
For further information, see the info below on Advanced Bionics, the Cochlear Corporation, and MED EL with their respective links.
Classroom Management Downloads—
Cochlear Corporation: HOPE ON-Line Courses (archived)—Serving Children In Schools:
Chute, P., & Nevins, M. E. (2006). School professionals working with children with cochlear implants. San Diego, CA: Plural Publishing, Inc.
NC Learn, UNC School of Education—On-line videos and discussion on teaching children who are deaf and hard of hearing:
Revised May 2012/Updated June 2014