OUTCOME RESULTS
2015
No limits For Children Who Are Deaf
Hearing loss is one of the most common disabilities in newborns, affecting approximately 2 in 1,000 babies each year.
Australian Hearing, 2013 #
ABOUT THE
CORA BARCLAY CENTRE
The Cora Barclay Centre The aim of the Cora Barclay Centre Thanks to early diagnosis and
is to help children who are deaf or continuing advances in hearing
is the oldest and most hearing impaired, achieve life-long technologies, the vast majority of
comprehensive dedicated social and emotional well-being and children attending the Cora Barclay
Listening and Spoken economic independence. Centre (and other First Voice centres*), who have no additional disabilities,
Language (LSL) program The Centre provides evidence-based, achieve speech, language and
multi-disciplinary services for children comprehension that is comparable to
in Australia providing who are deaf or hearing impaired, children of the same age with normal
intensive, evidence- the majority of whom are fitted with hearing by the time they go to school.
based intervention hearing aids, cochlear implants or other listening devices. Programs
through Auditory-Verbal include early childhood intervention, Therapy (AVT). student services, social participation programs, and ongoing monitoring and assessment to children from birth to 18 years and their families.
1 per 1,000 live births is the estimated rate of permanent childhood hearing loss that is identified at, or very close to, birth. By the time each ‘birth cohort’ has reached 5 years of age, this rate has risen to approximately 3 per 1,000 children. National Framework for Neonatal Hearing Screening August 2013, Page 4 http://health.gov.au/internet/main/publishing.nsf/Content/neonatal-hearing-screening
- First Voice is the national voice for six centres providing listening and spoken language early intervention for children with hearing loss in Australia and New Zealand. Members are the Cora Barclay Centre (SA), Hear and Say (QLD), The Shepherd Centre (NSW/ACT), Taralye (VIC), Telethon Speech and Hearing (WA) and the Hearing House (NZ). First Voice champions the right of all people who are deaf or hearing impaired to listen and to speak.
CORA BARCLAY CENTRE
ASSESSMENT PROTOCOLS
In February 2010, the Cora Barclay The Cora Barclay Centre is committed
Centre introduced a new standardised to evidence-based practice. Cora assessment protocol as part of the Barclay Centre Programs are continually First Voice early childhood intervention reviewed in light of national and outcome measures. This protocol international research and its own assesses the speech, language and program evaluations. The Centre uses vocabulary development of children its own assessment data to: aged 9 months to 5 years enrolled in the Early Childhood Intervention 1. AVT Program. Obtain objective measurements of each child’s speech and language The protocol of the Cora Barclay Centre development to inform their individual has been to extend the standardised therapy plan. assessment protocol to students of school age from 5 years to 18 years 2. measuring progress at different ages Enable objective comparisons between as part of the First Voice research. children who are deaf or hearing From 2015 all students on service were impaired undertaking the assessed using summative assessments Cora Barclay Centre AVT Program at ages 5 years, 9 years and 12 years. and children with normal hearing of the same age in order to determine whether their spoken language skills are equivalent to their hearing peers.
- Monitor and evaluate the effectiveness of Cora Barclay Centre Therapy Programs.
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92% of children with permanent hearing loss are born to hearing parents.
Mitchell & Karchmer, 2004
CORA BARCLAY CENTRE
ASSESSMENT METHOD
95 children aged between 6 months Cora Barclay Centre programs are and 12 years who were enrolled in the continually reviewed in the light of AVT Early Intervention (EI) or Student national and international research Services (SS) program at the Cora Barclay and its own program evaluations. Centre were assessed from January As part of its evidence-based approach, 2015 to the end of December 2015. the Cora Barclay Centre contributes its data to the First Voice national 5 year old data will be reported in both clinical database. Data collected in the EI and SS outcomes reports as some 2014 from 628 children from across students are assessed before they start Australia and New Zealand in the school at age 5 and others once they Early Intervention programs offered have started school. in First Voice Centres was reported in the ‘Sounds Outcomes’ project. Our results will be compared with the data from the First Voice report. This is available at firstvoice.org.au
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HEARING
LOSS
Permanent childhood hearing loss can English as an additional language be congenital, late-onset, progressive, and or dialect backgrounds or acquired in nature. Length of time optimally aided with Congenital Hearing loss refers to hearing hearing aids or cochlear implants loss that is present at birth and is often identified through a newborn hearing Presence of an additional disability screening conducted shortly after birth. Presence of an additional speech The Cora Barclay Centre defines Late and language disorder not related Diagnosis as congenital hearing loss to hearing loss. diagnosed after 12 months of age.
asha.org/Practice-Portal/Clinical-topics/ The Cora Barclay Centre supports
Permanent-childhood-Hearing-Loss/ children who experience one or more of the above factors and their assessment The Cora Barclay Centre 2015 Outcomes results have been included with the document highlights the outcomes for exception of those children who were children late diagnosed with hearing unable to participate in standardized loss. In addition to late diagnosis other testing. It is consistently reported that factors can contribute to outcomes below close to 40% of children with hearing the average range. These can include: loss have an additional disability.
Consistency of wear of agbell.org/Document.aspx?id=454 amplification device
Family engagement to early intervention and capacity to implement strategies in all communication settings
For children affected by hearing loss, the future prospects are positive.
Thanks to early diagnosis, continuing advances in hearing technologies and access to listening and spoken language early childhood intervention at a very young age, children who are deaf or hearing impaired have the potential to learn to listen and to speak.
THE KEY ASSESSMENT
TOOLS USED BY THE
CORA BARCLAY CENTRE
Early Intervention
Pre-School Peabody Picture Goldman Fristoe
Language Scale Vocabulary Test Test Of Articulation
Edition (PLS-5) Edition 4 (PPVT-4) (GFTA)
The PLS-5 is divided into 2 parts: The PPVT-4 tests a child’s understanding The GFTA is a norm-referenced
(1) Auditory Comprehension which of words used to name objects and assessment of articulation which
assesses the understanding of describe actions and attributes. It provides standard scores and percentiles
spoken language and (2) Expressive is
a norm-referenced assessment of from early childhood to adulthood.
Communication which assesses the vocabulary which provides standard The test provides information about a
child’s verbal language. Both parts scores, percentiles, and age-equivalent child’s articulation ability by sampling
of the assessments are used to scores from early childhood to adulthood. both spontaneous and imitative sound
calculate the total language score. Standard scores have a mean or average production of consonants and vowels.
of 100 and one standard deviation is a The distribution of errors is greatly
The PLS-5 is a norm-referenced difference of 15. Therefore children who skewed across ages and does not
assessment which provides standard score between 85 and 115 fall within one approach a normal distribution at most
scores, percentiles, and age-equivalent standard deviation of the mean of 100 ages. Therefore it may be better to
scores for children from birth to six and
are within the ‘average range’. refer to the percentile rather than the
years. Standard scores have a mean standard score when interpreting results or average of 100 and one standard for this particular assessment. deviation is a difference of 15. Therefore children who score between 85 and 115 A percentile is a way of comparing fall within one standard deviation of a child’s score to scores obtained the mean of 100. Sixty-eight percent by other children of the same age. (68%) of the population fall within one For example, a percentile rank of 5 standard deviation of the mean. indicates that out of 100 of the same age children, that child is performing at the same level or better than 5 out of 100 children. A percentile between 16 and 84 indicates abilities that are within the average range. Percentiles below 16 represent some developmental delay or impairment. Percentiles below 3 indicate a significant degree of delay or impairment.
Student
Services
The Clinical Evaluation of
Language Fundamentals
Edition 4 (CELF-4)
The CELF-4 Australian identifies children with delayed or disordered language from ages 5 to 21 and assists in determining the student’s language strengths and weaknesses in:
Receptive Language
Expressive Language
Language Structure
Language Content
Language Memory
Working Memory
The test provides information about a child’s understanding and use of spoken language by assessing the components of spoken language such as syntax, semantics, vocabulary, memory and comprehension. The standard score system for the CELF-4 is similar to the PPVT-4, in that is has a mean or average of 100 and one standard deviation is a difference of 15. Therefore, children who score between 85 and 115 fall within one standard deviation of the mean of 100 and are within the ‘average range’.
EARLY
INTERVENTION
Better Ear Hearing Loss
Figure 1: Degree of hearing loss of children assessed 7 receiving services from the 11 Mild (21-40dBHL)
Cora Barclay Centre Early
Intervention Team. Moderate (41-70dBHL)
The severity of hearing in the better 44 15 Severe (71-90dBHL)
ear was predominately moderate 11 (27%), with equal numbers of children with severe and profound Profound (>90dBHL) (20%), mild (13%) and children with
normal hearing in one ear (20%). 11 Normal (-10-20dBHL) 13+27+20+20+20+L
Assessment Age
Figure 2: Number of children
assessed grouped by 6 mth 2
assessment age in 2015.
12 mth 12 A total of 55 children were assessed using standardized assessments 24 mth 6 in 2015. Not all children were assessed using the entire battery
of Early Intervention Assessments. 3 yrs 12
4 yrs 18
5 yrs 5
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Hearing Devices
Figures 3 and 4: Hearing devices
The children in Early Intervention were reported to have the following types of aiding:
Two hearing aids 51%
Two cochlear implants 20%
One cochlear implant and one hearing aid 2%
One hearing aid 15%
One bone conduction hearing aid 2%
No device 10%
Bilateral Unilateral
1 1 3
1
11 2CI 1BC
2HA 5 1HA
44 1BC/1HA 11 None
5 1HA
28 None25+64+2+7+2+L 45+46+9+L
CI - Cochlear Implant
HA - Hearing Aid
BC - Bone Conduction Hearing Aid
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EARLY INTERVENTION - ASSESSMENT TOOL RESULTS
Pre-School Language Scale Edition
(PLS-5) 1
Figure 5: Total Language
Standard Scores for children aged between 6 months and 4 years.
An overview of the total language 145 scores for the Early Intervention data set (including students with additional disabilities and English as an additional
language and/or dialect). The average
range is a standard score falling between Score 115
85 and 115. Results found:
85 Standard71% of children scored within the average range or above (85 and above). Of that number 30% were late diagnosis. 45
38% of children aged between 12 1 Children Assessed 42
months and 4 years are considered to have a late diagnosis.
6 mths 12 mths - late diagnosis Average range (85-115)29% of children were below average
12 mths 24 mths - late diagnosis
range (below 85). Of that number 24 mths 3 yrs - late diagnosis
50% were late diagnosis. 3 yrs 4 yrs - late diagnosis
4 yrs
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EARLY INTERVENTION - Assessment Tool Results
Peabody Picture Vocabulary Test Edition 4
(PPVT-4) 2
Figure 6: Standard Scores
for children aged 3, 4 and 5 years.
An overview of the scores for the Early Intervention data set (including students with additional disabilities 125 and English as an additional language 115 and/or dialect). The average range is a standard score falling between 85
and 115. Results found: Score 95
79% of children scored within the 85average range or above (85 and Standard
above). Of that number 23% were 65 late diagnosis.
27% of children aged between 3 50
years and 5 years are considered 1 Children Assessed 33
to have late diagnosis.
21% of children were below average
range (below 85). Of that number 3 yrs 3 yrs - late diagnosis Average range (85-115)
4 yrs 4 yrs - late diagnosis 42% were late diagnosis. 5 yrs 4 yrs - late diagnosis
Results on the PPVT-4 are consistent with those on the PLS-5, again identifying children diagnosed after 12 months of age representing just below half of the children assessed with a vocabulary standard score below average range. This result reinforces the critical importance of
early diagnosis and early intervention
on listening and language outcomes. 12
EARLY INTERVENTION - Assessment Tool Results
Goldman Fristoe Test of Articulation
(GFTA) 3
Figure 7: Percentile ranks for children aged between 3, 4 and 5 years.
An overview of the scores for the Early Intervention data set (including students with additional disabilities 100 and English as an additional language 84 and/or dialect). The average range is a percentile between 16 and 84. Rank Results found: 60 79% of children scored within Percentile 40 the average range or above (between 16 and 84).
16 Of the children that fell below the average range 71% were children 0
that were late diagnosis. 1 Children Assessed 34
The results demonstrate that 79% of children with a hearing loss reported in
this data have age appropriate speech 3 yrs 3 yrs - late diagnosis Average range (85-115)
while highlighting the significant impact 4 yrs 4 yrs - late diagnosis
of late diagnosis on the development of 5 yrs 4 yrs - late diagnosis
children’s speech.
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70 % of children in Early
Intervention and Student
Services achieved spoken language outcomes commensurate to their hearing peers.
STUDENT
SERVICES
Figure 8: Degree of hearing loss in children assessed receiving services from the
Cora Barclay Centre Student
Services Team. 4 4
Mild (21-40dBHL)
The severity of hearing in the better Moderate (41-70dBHL) ear was predominately moderate (30%),
with equal numbers of children with 20 3 Severe (71-90dBHL)mild and profound (13%), severe (10%)
and children with normal hearing in one ear (34%). Profound (>90dBHL)
9 20+45+15+20+L
Figure 9: Number of children assessed grouped by assessment age in 2015.
5 yrs 3 A total of 30 children were assessed in 2015. 9 yrs 17
12 yrs 10
15
Figures 10 and 11: Hearing devices
The children in Student Services were reported to have the following types of aiding:
Bilateral hearing aids 37%
Bilateral cochlear implants 17%
Unilateral hearing aid 27%
Bilateral bone anchored hearing aids 3%
No device 16%
Bilateral Unilateral
3
2HA 1HA
1
2CI None
5 5 20 2BC 10
11 5
1HA55+25+5+15+L 50+50+L
CI - Cochlear Implant
HA - Hearing Aid
BC - Bone Conduction Hearing Aid
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Children diagnosed after 12 months of age when provided with ongoing support from
the Cora Barclay Centre
can achieve outcomes within or above the average range.
STUDENT SERVICES - ASSESSMENT TOOL RESULTS
Clinical Evaluation of Language Fundamentals – 4
(CELF-4) 4
Figure 12: Total Language
Standard Scores for
children aged 5, 9 and 12 years.
An overview of the total language 130 scores for the Student Services data set (including students with additional 115 disabilities and English as an additional 110 language and/or dialect). The average Score range is a standard score falling between 85 and 115. Results found: 70 85 Standard 86% of children scored within the average range or above (85 or 70 above). Of that number 42% were late diagnosis. 50
1 Children Assessed 30
43% of children assessed are considered to have a late diagnosis.
14% of children were below average
5 yrs 5 yrs - late diagnosis Average range (85-115)
range (below 85). Of that number 9 yrs 9 yrs - late diagnosis
50% were a late diagnosis. 12 yrs 12 yrs - late diagnosis
Results on CELF-4 are consistent with data collected from children in the Early Intervention program identifying children diagnosed after 12 months of age representing half of the students assessed with a language standard score below average range.
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WHAT DO THESE
ASSESSMENT
RESULTS TELL US?
These assessment results National Comparison demonstrate that in 2015: At the national level, all five Australian First Voice centres follow the same
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Over 70% of children in Early standardised assessment protocols Intervention and Student Services yielding a consolidated national achieved spoken language outcomes outcomes database of over 700 children in our listening and spoken commensurate to their hearing peers. language programs. Analysis of the First Voice clinical database shows
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Close to 80% of children in the outcomes very similar to those reported Early Intervention Program achieved above, providing further validation of the effectiveness of listening and speech outcomes commensurate to spoken language early childhood their hearing peers. intervention as practised in Australia.
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The majority of children diagnosed The Cora Barclay Centre uses these objective assessments: (1) to review after the age of 12 months had poorer and modify each child’s individual speech and language outcomes service plan in order to achieve the compared to children diagnosed best possible outcomes for each child and (2) to evaluate our programs before 12 months of age. and compare them with those of comparable organisations.
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Children diagnosed after 12 months of age when provided with ongoing support can continue to improve their spoken language and achieve outcomes within or above the average range.
SUMMARY
The results reinforce the critical importance of early diagnosis and early intervention on listening and spoken language outcomes and the continuing need for ongoing intervention at school age to ensure any gaps in language are addressed. The data demonstrates that a higher percentage of students diagnosed after 12 months of age are now performing with a standard score within or above the average range and the critical importance of ongoing intervention.
Design Art Direction kindly donated by Brighter Design brighter.comau
The Cora Barclay Centre is a
not-for-profit organisation and has
Deductible Gift Recipient(DGR)
status with the Australian Tax Office
NDIS Registered Number 88043740
ABN 44 598 581 496
185 Melbourne Street
North Adelaide 5006
08 8267 9200
corabarclay.com.au