EARLY CHILDHOOD
INTERVENTION
2014 OUTCOME RESULTS
Hearing loss is one of the most common disabilities in newborns, affecting approximately 2 in 1,000 babies each year.
National Framework for Neonatal Hearing Screening August 2013
ABOUT THE
CORA BARCLAY CENTRE
The Cora Barclay Centre The aim of the Cora Barclay Centre is listening and spoken language as their
to help children who are deaf or hearing primary mode of communication and to
is the oldest and most impaired achieve life-long social and facilitate their inclusion in mainstream
comprehensive dedicated emotional well-being and economic education from the earliest age
independence. possible. Parents and caregivers actively Listening & Spoken participate in therapy and are guided
Language (LSL) program The Centre provides evidence-based, and coached to facilitate their child’s
multi-disciplinary services for children spoken language development through
in Australia providing who are deaf or hearing impaired, listening.
intensive, evidence- the majority of whom are fitted with hearing aids, cochlear implants or other Thanks to early diagnosis and continuing
based intervention listening devices. Programs include early advances in hearing technologies, the
through Auditory-Verbal childhood intervention, student support vast majority of children attending the
services, social participation programs, Cora Barclay Centre (and other First
Therapy (AVT). and ongoing monitoring and assessment Voice centres*), who have no additional
to children from birth to 18 years and disabilities, achieve speech, language their families. and comprehension that is comparable to children of the same age with normal The objectives of our Early Childhood hearing by the time they go to school. Intervention program are to assist children with hearing loss to develop
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 deaf people to listen and speak.
CORA BARCLAY CENTRE
ASSESSMENT PROTOCOLS
In February 2010, the Cora Barclay 2. to enable objective comparisons The assessment tools are:
Centre introduced a new standardised between children who are deaf or
assessment protocol as part of the hearing impaired undertaking the 1. Pre-School Language Scale
First Voice early childhood intervention Cora Barclay Centre AVT Program and Edition 4 & 5 (PLS-4/PLS-5) outcome measures. This protocol children with normal hearing of the
assesses the speech, language and same age in order to determine if their 2. Peabody Picture Vocabulary
vocabulary development of children spoken language skills are equivalent to Test Edition 4 (PPVT-4) aged 9 months to 5 years enrolled in their hearing peers.
the Early Childhood Intervention AVT 3. Goldman Fristoe Test ofProgram. 3. to monitor and evaluate Articulation (GFTA-2)
the effectiveness of Cora Barclay
The purpose of Centre therapy programs. Cora Barclay Centre programs are
assessment is: constantly reviewed in the light of Children attending the Cora Barclay national and international research and
1. to obtain objective measurements Centre AVT Program receive a range its own program evaluations. As part of
of standardised assessments annually. of each child’s speech and language its evidence-based approach, the Cora The tests are designed to measure the development to form their individual Barclay Centre contributes its data to children’s understanding of language, therapy plan. the First Voice national clinical database, expressive use of language and their which consolidates data for over 700 clarity of speech. children across Australia and New Zealand in early childhood intervention programs provided by First Voice centres.
92% of children with permanent hearing loss are born to hearing parents.
Mitchell & Karchmer, 2004
CORA BARCLAY CENTRE
ASSESSMENT METHOD
Fifty-five (55) children All children (n55) were assessed using The stages and ages of assessment were:
the Pre-school Language Scale Edition
aged between 9 months (PLS-4/PLS-5). 6 months post hearing aid (HA)
and 5 years who were or Cochlear Implant (CI) fitting In addition, children aged between 3
enrolled in AVT early and 5 years (n27) were assessed with 12 months post HA or CI fitting
intervention at Cora Barclay the Peabody Picture Vocabulary Test 24 months post HA or CI fitting
Edition 4 (PPVT-4) and the Goldman
Centre were assessed from Fristoe Test of Articulation (GFTA-2). Within 3 months post 3rd birthday*
January 2014 to the end Within 3 months post 4th birthday of December 2014. Within 3 months post 5th birthday
The amount of time the children had been receiving AVT at the Cora Barclay Centre ranged between 5 and 61 months with the mean being 30 months.
- Where the 3rd birthday occurs within 6 months of the 24 month post-fitting criterion the 3rd birthday is taken as the priority assessment time.
Figure 1: Clients assessed
by assessment age 6 7 6 months 3 years
12 months 4 years Number of children assessed
by assessment age in 2014 (N=55). 9 24 months 5 years
12 55
13 8 13+22+14+23+16+12+D
Figure 2: Severity of 15 15
hearing impairment
Degree of hearing loss of children on service at the Cora Barclay Centre. 10
The children in the AVT Program had varying degrees of hearing impairment which ranged from unilateral hearing
impairment to profound deafness. 4 4
3
1 1 1 1
Unilateral Mild Mild/Moderate Mild/Profound Mild/Severe Moderate Moderate/Severe Severe Severe/Profound Profound
Figure 3: Hearing devices 28
Number of children using each type of Amplification Device.
This graph shows that 28 children participating in AVT at the Cora Barclay Centre were wearing two hearing aids and 13 had bilateral cochlear implants. 13 The five (5) children not currently fitted with an amplification device all had a 5 unilateral hearing loss. 2
5
CI - Cochlear Implant Bilateral
HA - Hearing Aid 1 1
BC - Bone Conduction Hearing Aid Unilateral
2CI 1CI/1HA 2HA 1BC 1HA None
THE THREE KEY ASSESSMENT
TOOLS USED BY THE
CORA BARCLAY CENTRE ARE:
1 2 3
PRE-SCHOOL PEABODY PICTURE GOLDMAN FRISTOE
LANGUAGE SCALE VOCABULARY TEST TEST OF ARTICULATION
EDITION (PLS-4/PLS-5) EDITION 4 (PPVT-4) (GFTA)
The PLS-4/PLS-5 is divided into 2 The PPVT-4 tests a child’s understanding The GFTA is a norm-referenced
parts: (1) Auditory Comprehension of words used to name objects and assessment of articulation which
which assesses the understanding of describe actions and attributes. It is provides standard scores and percentiles
spoken language; and (2) Expressive a norm-referenced assessment of from early childhood to adulthood.
Communication which assesses the vocabulary which provides standard The test provides information about
child’s verbal language. Both parts of scores, percentiles, and age-equivalent a child’s articulation ability by sampling
the assessments are used to calculate scores from early childhood to both spontaneous and imitative sound
the total language score. adulthood. Standard scores have a production of consonants. The standard
mean or average of 100 and one score system for the GFTA is similar
The PLS-4/PLS-5 is a norm-referenced standard deviation is a difference of 15. to the PPVT, in that it has a mean
assessment which provides standard Therefore children who score between or average of 100 and one standard
scores, percentiles, and age-equivalent 85 and 115 fall within one standard deviation is a difference of 15.
scores for children from birth to six deviation of the mean of 100 and Therefore, children who score
years. Standard scores have a mean are within the ‘normal range’. between 85 and 115 fall within one
or average of 100 and one standard standard deviation of the mean of deviation is a difference of 15. Therefore 100 and are within the ‘normal range’. children who score between 85 and 115 fall within one standard deviation of the mean of 100, which is regarded as ‘the normal range’. Sixty-eight percent (68%) of the overall population falls within this range (i.e., one standard deviation of the mean).
ASSESSMENT TOOL RESULTS
Pre-School Language Scale Edition
(PLS-4/PLS-5) 1
Figure 4A: Comparison
100 97.98 100 97 100 96.10of PLS standard scores
– all assessed clients
Comparison of the PLS Mean Standard
Scores gained by all children assessed
in the Cora Barclay Centre AVT Program
(n55) with the Mean Score gained by the general population. Hearing impaired This graph demonstrates that children enrolled children enrolled at the Cora Barclay in AVT Centre are obtaining scores that are comparable to the general population. General population
Auditory Expressive Total Language
Comprehension Communication Score
Figure 4B: Comparison
of PLS standard scores 100 100 100
92.40 91.40 89.60
– diagnosed post 12 months
A comparison of the Mean Standard Scores gained by children assessed
in the Cora Barclay Centre AVT
Program diagnosed post 12 months with the Mean Score gained by the Hearing general population. impaired children This graph demonstrates that children enrolled in AVT diagnosed after 12 months of age are achieving scores slightly below children General who are diagnosed before 12 months of population
age. It also shows that these children are Auditory Expressive Total Language
obtaining scores within one standard Comprehension Communication Score
deviation of the norm (85-115) that are comparable to the general population.
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 speak.
Figure 5A: PLS Range
of Total Language Scores
140 The range of Standard Scores gained by each child enrolled in the Cora
Barclay Centre AVT Program on
115 the PLS-4/PLS-5 sub-tests.
PLS Total
13 individual children are below one Language 100
standard deviation (85); 22 within Score the ‘normal range’ and 7 above one 85 standard deviation with 1 achieving the remarkable score of 140!
NB Two of the children below the standard deviation had additional disabilities which impacted on their 40
development and a further two had 1 Clients Assessed 43
only recently established consistent hearing aid wear.
Assessment Tool Results
Peabody Picture Vocabulary Test Edition 4
(PPVT-4) 2
Figure 6: PPVT
Standard Score
Comparison of the Mean Standard Scores gained in the PPVT-4 by children enrolled in the CBC AVT
Program with the Mean Score 103.48 100
gained by the general population.
This graph shows that children accessing the Early Intervention AVT Program have vocabulary knowledge that is higher than the Mean Score of
the general population. These results Children who are deaf General
suggest that individualised AVT from a or hearing impaired Population
enrolled in AVT. young age improves listening skills and ultimately vocabulary development.
Figure 7A: Range of PPVT 140
Scores by Assessment Age
115 The range of Standard Scores gained 100 by the children enrolled in the Cora Barclay Centre AVT Program within each 85 assessment group on the PPVT-4 (n27). 60
This graph shows the range of vocabulary 3 years 4 years 5 years
knowledge scores for children aged 3, 4 and 5 years (n27). It demonstrates that 20 children approaching school age have vocabulary knowledge equal to or better than their hearing peers. 0
Figure 7B: PPVT Scores
by Assessment Age 130
The range of Standard Scores gained 115 by each child enrolled in the Cora 110
Barclay Centre AVT Program within
PPVT
each assessment group on the PPVT-4. Standard Score 90 This graph demonstrates that all of the 85
children receiving AVT in 2014, except 3 years 4 years 5 years
for 2, had vocabulary knowledge equal 70 to or better than their hearing peers.
50
1 6 9 12
Individual client assessment results
Assessment Tool Results
Goldman Fristoe Test Of Articulation
(GFTA) 3
Figure 8: GFTA
Standard Score
Comparison of the Mean Standard Scores
of the GFTA gained by children aged 3-5 91.56 100years (N27) enrolled in the AVT Program with the Mean Score gained by the general population.
This graph demonstrates that children
enrolled in the Cora Barclay Centre AVT Children who are deaf General
program are obtaining speech results or hearing impaired Population
enrolled in AVT within one standard deviation of the mean.
Figure 9: Range of standard 160 scores gained from GFTA
The range of Standard Scores gained by children enrolled in the AVT Program within 120 each assessment group in the GFTA-2. 115
This graph demonstrates variability in the 85 80 speech skills of children with a hearing loss,ranging from below average to above.
A number of factors can contribute to this 3 years 4 years 5 years
variability e.g. age of diagnosis,consistent 40 use of hearing equipment etc.
0
WHAT DO THESE
ASSESSMENT
RESULTS TELL US?
These assessments show that children 2. Verbal language comparable who are deaf or hearing impaired in the with children with normal hearing Cora Barclay Centre Auditory-Verbal of the same age (Assessment: PLS Therapy Program in 2014 have: – Expressive Communication)
- An understanding of language 3. Vocabulary knowledge equal to or comparable with children with normal better than children with normal hearing hearing of the same age (Assessment: of the same age (Assessment: PPVT)
PLS – Auditory Comprehension)
- Speech skills comparable with children with normal hearing of the same age (Assessment: GFTA)
NATIONAL COMPARISON OUTCOMES FOR EACH
CHILD ATTENDING THE
At the national level, all five Australian The Cora Barclay Centre uses these
First Voice centres follow the same objective assessments: (1) to review CORA BARCLAY CENTRE
standardised assessment protocols and modify each child’s individual These outcomes demonstrate that yielding a consolidated national service plan in order to achieve the children who are deaf or hearing outcomes database of over 1,000 best possible outcomes for each child impaired who participate in listening children in our listening and spoken and (2) to evaluate our programs and spoken language early childhood language programs. Analysis of the and compare them with those of intervention programs have excellent First Voice clinical database shows comparable organisations. prospects of learning to listen and speak outcomes very similar to those reported fluently; attending mainstream schools; above, providing further validation completing secondary education of the effectiveness of listening and or other vocational pathways; and spoken language early childhood ultimately attaining high levels of intervention as practised in Australia. social and emotional well-being and economic independence.
185 Melbourne Street
North Adelaide 5006
08 8267 9200
corabarclay.com.au