Measuring Costs and Outcomes of Tele-Intervention When Serving Families of Children who are Deaf/Hard-of-Hearing

Background: Optimal outcomes for children who are deaf/hard-of-hearing (DHH) depend on access to high quality, specialized early intervention services. Tele-intervention – the delivery of early intervention services via telehealth technology - has the potential to meet this need in a cost-effective manner.Method: Twenty-seven families of infants and toddlers with varying degrees of hearing loss participated in a randomized study, receiving their services primarily through TI or via traditional in-person home visits. Pre- and post-test measures of child outcomes, family and provider statisfaction, and costs were collected.Results: The TI group scored statistically significantly higher on the expressive language measure than the in-person group (p =.03). A measure of home visit quality revealed that the TI group scored statistically significantly better on the Parent Engagement subscale of the Home Visit Rating Scales-Adapted & Extended (HOVRS-A+; Roggman, et al., 2012). Cost savings associate with providing services via TI increased as the intensity of service delivery increased. Although most providers and families were positive about TI, there was great variability in their perceptions.Conclusions: Tele-intervention is a promising cost-effective method for delivering high quality early intervention services to families of children who are DHH

The Effects of Early Identification and Intervention on Language Outcomes of Children Born with Hearing Loss

This study adds to the existing body of research by (a) including a comprehensive analysis of published reviews and primary studies investigating the effects of early identification of hearing loss and intervention on language outcomes; and (b) using advanced statistical techniques to further examine existing data on nearly 5,200 children with hearing loss. Analysis of reviews of primary studies showed these reviews exhibited severe sampling bias, lacked systematic methods for analyzing studies, and did not include a common metric for comparing results across studies nor a mechanism for analyzing how findings from primary studies covaried with other important factors such as parental involvement, fidelity of intervention, or study quality. Without a more rigorous analysis of primary studies, the conclusions drawn from these reviews are questionable. The review of primary studies revealed many methodological problems including weak experimental designs, small sample sizes, attrition or questionable sample selection methods, differences in length of treatment and characteristics of the participants, and inadequate reporting. Many researchers unjustifiably concluded that earlier intervention produced better developmental outcomes. However, almost half of the studies in which children were assessed at older ages showed no relationship between age at identification or intervention and language outcomes. Use of structural equation modeling (SEM) with the SKI*HI National Data Set did not result in models that adequately fit the underlying data. As such, these methods did not result in findings from which we can draw strong conclusions regarding the relationship between age at identification of hearing loss or intervention and child outcomes. To conclude, we know too little about whether earlier identification and intervention is better for children born with hearing loss or who acquire it at young ages. In addition to stronger research designs with sufficient sample sizes, use of reliable measures to collect a broader array of data related to important covariates, better collection of data, and measurement of intervention characteristics, perhaps we should also be asking different questions. We need to know more about what interventions, in which order, provided by whom, and in what ways are most effective for improving developmental outcomes for children with hearing loss

The effectiveness of Early Head Start for 3-year-old children and their parents

Early Head Start, a federal program begun in 1995 for low-income pregnant women and families with infants and toddlers, was evaluated through a randomized trial of 3,001 families in 17 programs. Interviews with primary caregivers, child assessments, and observations of parent-child interactions were completed when children were 3 years old. Caregivers were diverse in race-ethnicity, language, and other characteristics. Regression-adjusted impact analyses showed that 3-year-old program children performed better than did control children in cognitive and language development, displayed higher emotional engagement of the parent and sustained attention with play objects, and were lower in aggressive behavior. Compared with controls, Early Head Start parents were more emotionally supportive, provided more language and learning stimulation, read to their children more, and spanked less. The strongest and most numerous impacts were for programs that offered a mix of home-visiting and center-based services and that fully implemented the performance standards early

The effectiveness of Early Head Start for 3-year-old children and their parents

Early Head Start, a federal program begun in 1995 for low-income pregnant women and families with infants and toddlers, was evaluated through a randomized trial of 3,001 families in 17 programs. Interviews with primary caregivers, child assessments, and observations of parent-child interactions were completed when children were 3 years old. Caregivers were diverse in race-ethnicity, language, and other characteristics. Regression-adjusted impact analyses showed that 3-year-old program children performed better than did control children in cognitive and language development, displayed higher emotional engagement of the parent and sustained attention with play objects, and were lower in aggressive behavior. Compared with controls, Early Head Start parents were more emotionally supportive, provided more language and learning stimulation, read to their children more, and spanked less. The strongest and most numerous impacts were for programs that offered a mix of home-visiting and center-based services and that fully implemented the performance standards early