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This document is a supplement to the recommendations in the year 2007 position statement of the Joint Committee on Infant Hearing (JCIH)1 and provides comprehensive guidelines for early hearing detection and intervention (EHDI) programs on establishing strong early intervention (EI) systems with appropriate expertise to meet the needs of children who are deaf or hard of hearing (D/HH).EI services represent the purpose and goal of the entire EHDI process. Screening and confirmation that a child is D/HH are largely meaningless without appropriate, individualized, targeted and high-quality intervention. For the infant or young child who is D/HH to reach his or her full potential, carefully designed individualized intervention must be implemented promptly, utilizing service providers with optimal knowledge and skill levels and providing services on the basis of research, best practices, and proven models.The delivery of EI services is complex and requires individualization to meet the identified needs of the child and family. Because of the diverse needs of the population of children who are D/HH and their families, well-controlled intervention studies are challenging. At this time, few comparative effectiveness studies have been conducted. Randomized controlled trials are particularly difficult for ethical reasons, making it challenging to establish causal links between interventions and outcomes. EI systems must partner with colleagues in research to document what works for children and families and to strengthen the evidence base supporting practices.Despite limitations and gaps in the evidence, the literature does contain research studies in which all children who were D/HH had access to the same well-defined EI service. These studies indicate that positive outcomes are possible, and they provide guidance about key program components that appear to promote these outcomes. This EI services document, drafted by teams of professionals with extensive expertise in EI programs for children who are D/HH and their families, relied on literature searches, existing systematic reviews, and recent professional consensus statements in developing this set of guidelines (eg, refs 2 and 3; H.M. Schachter, T.J. Clifford, E. Fitzpatrick, S. Eatmon, M. Morag, A. Showler, J.C. Johnston, M. Sampson, and D. Moher, unpublished data, 2002).Terminology presented a challenge throughout document development. The committee noted that many of the frequently occurring terms necessary within the supplement may not reflect the most contemporary understanding and/or could convey inaccurate meaning. Rather than add to the lack of clarity or consensus and to avoid introducing new terminology to stakeholders, the committee opted to use currently recognized terms consistently herein and will monitor the emergence and/or development of new descriptors before the next JCIH consensus statement.For purposes of this supplement:This supplement to JCIH 2007 focuses on the practices of EI providers outside of the primary medical care and specialty medical care realms, rather than including the full spectrum of necessary medical, audiologic, and educational interventions. For more information about the recommendations for medical follow-up, primary care surveillance for related medical conditions, and specialty medical care and monitoring, the reader is encouraged to reference the year 2007 position statement of the JCIH1 as well as any subsequent revision. When an infant is confirmed to be D/HH, the importance of ongoing medical and audiologic management and surveillance both in the medical home and with the hearing health professionals, the otolaryngologist and the audiologist, cannot be overstated. A comprehensive discussion of those services is beyond the scope of this document.Since the first universal newborn hearing screening programs were established in the early 1990s, significant progress has occurred in the development and implementation of protocols for screening, audiologic evaluation, fitting of amplification, medical management of children who are D/HH, and support services for families. Despite this progress, provision of the highest quality EI for infants/children who are D/HH and their families remains an urgent priority. The Centers for Disease Control and Prevention (CDC) reported that over 96.9% of all newborns were screened in 2008.7 In the United States, there is evidence that earlier identification of children who are D/HH, accompanied by timely and appropriate interventions, can result in language, communication, cognitive, and social-emotional skills that are consistent with children’s cognitive abilities and chronological age.8–10 The ultimate goal of EHDI is to optimize language, social, and literacy development for children who are D/HH.Although the first EHDI programs in the United States were established more than 20 years ago, most states/territories are not yet able to provide documentation of outcomes resulting from EI services. Lacking such documentation, it is unclear whether state/territory systems are accomplishing the goal of preventing or minimizing communicative delays typically observed in late-identified children who are D/HH. EHDI programs are complex systems requiring a high degree of collaboration at local, state/territory, and national levels among families, birthing hospitals, audiologists, physicians, educational personnel, speech-language pathologists, state health and educational agencies, private service providers, leaders who are D/HH, and support networks. Personnel constraints, financial limitations, and the lack of existing systems have hindered attainment of some of the EHDI goals.11 This supplement is designed to provide support for the development of accountable and appropriate EI follow-through systems. All goals stated within this document should begin with a baseline measure specific to each state/territory. The goal should be for the program to show annual improvements that lead to 90% attainment of the goal at the end of a 5-year period.An optimal EI service team centers around the family and includes professionals with pediatric experience. The specific professionals on each team should be individualized on the basis of family needs. This list of professionals may include, but is not limited to, an audiologist, teacher of the D/HH, speech-language pathologist, service coordinator, individuals who are D/HH, and representatives of family-to-family support networks. Depending on the needs of the child, it also could include physical therapists, occupational therapists, psychologists, and educators with expertise in deaf/blind, developmental delay, and/or emotional/behavioral issues.This best practice document for the implementation of EI services (habilitative, rehabilitative, or educational) is intended to assist the state/territory EHDI systems in optimizing the development and well-being of infants/children and their families. Another goal of this document is to facilitate the development of systems that are capable of continuously evaluating and improving the quality of care for infants/children who are D/HH and their families. Finally, this document outlines best practices to promote quality assurance of EI programs for children from birth to age 3 years and their families.Screening hearing in newborns creates an opportunity but it does not guarantee optimal outcomes. Timely access to quality EI providers is a critical component of a successful system. The Colorado EDHI program is an example of a program that has been able to collect comprehensive outcome data due to the implementation of EI and a consistent EI program (eg, criteria for selection of EI providers, professional development through in-service training and mentoring, a standard protocol of developmental assessments at regular intervals). The Colorado EHDI system was established in 1992 and focused on timely and coordinated access to EI with statewide data management to ensure follow-through. Beginning in 1995 and continuing to the present, a series of articles on the Colorado system was published. These studies had over 500 different infant participants who were D/HH, who had no additional disabilities, and who had hearing parents. The studies included longitudinal data on 146 children from infancy through 7 years of age. Almost all were early-identified and had timely access to an appropriate and consistent EI system.12 On average, these children achieved age-appropriate developmental outcomes not in the first 3 years of but through age studies support for these but the before establishing universal newborn hearing screening, children from a consistent EI services of the requires that and with EI services from birth to age 3 services are to an individualized family service A to the development of comprehensive systems for children who are D/HH is the lack of between and state state EHDI and existing systems for children who are D/HH. goals for and children who are D/HH, a strong with will be necessary at the state/territory, and At the time, systems from universal screening to confirmation that a child is D/HH, to in and to developmental outcomes are in many but there are currently a few coordinated to documentation and to are to the effectiveness of EHDI systems. in these is a high to strengthen the development of EHDI systems. data reported to the indicate that a significant of lack documentation of audiologic and/or in is that currently in children who are D/HH are to an EI to documentation and for services (eg, with hearing in some also may to to service is the for the implementation of the and with and service This is the first of for families. The service families in access to the child and family in information about their and services within their and in the development of the and and the delivery of the first with the family should within of the audiologic and the goal should be no than a The with first needs knowledge and that include educational for who are D/HH and their families, specific to families with children who are development of and language, and cognitive, and social-emotional who first must be able to about and hearing and provide support in understanding including the screening audiologic development from infancy through early including language, and social-emotional to with who are medical such as of of or in hearing and (eg, systems or or support from professionals who are about infants/children who are D/HH and their families, between and may be to that in hearing is and is more in the Colorado EI program were in EI services for families who have children who are D/HH. outcomes of the Colorado EI program were studies and could not whether a causal between expertise and these social-emotional the studies that a program with service and EI service providers is related to positive family and child social-emotional outcomes. In there is evidence in the literature that some service is by individuals without the knowledge and skills for with children who are to ensure that EI providers meet at criteria for and skills necessary to who are D/HH and their families. Because of the of professionals, it is that a system for at the and A primary goal of the EI program is to promote children’s development of strong of the or by the family (eg, language, This goal is critical it is recognized that skills as a for and literacy 3 on providers, and for that families access and are not intended to be they key quality providers are or that or are not included in goals or they are not these are implemented by families, the same The purpose of goal 3 is to ensure that families and children have providers, of the to purpose of these recommendations is to assist and in the provision of high-quality EI research that outcomes for young children and their families are providers have training specific to with and who are D/HH and their families, more evidence is consensus statements the for service providers with specific training in children who are A of from with in the of EI for children the to a set of for EI with children who are D/HH A. unpublished data, providers have a of and may not have and/or that the needs of children who are D/HH from birth to age 3 years and their families. a they may lack knowledge and skills to with this population E. unpublished data, M. A. unpublished data, of all in the United States have a professional or that includes children who are D/HH from birth to age 3 A. unpublished data, the and may not include and that the needs of and who are D/HH and their most specific to children who are D/HH, the of and limited training a for systematic For the with children who are D/HH, appropriate professional development guidelines that support and practice must be of training and training outcomes is the quality of the professional training is in the on child and family outcomes. in the skills of the providers and the developmental outcomes of children who are D/HH throughout the United States and development guidelines to be in with the existing of of the and with the in each state or (eg, or for EI system of EI service providers must be for all families the spectrum of that has been particularly for families who is access to an EI who is a with children who are D/HH in the of access to and In EI and are not among EI establish the of for a newborn infant who is D/HH, access to and is of the is it is not to a professional to provide EI services. with children who are identified also information and from EI professionals on to provide an that their early an the program is a that can provide and training for who are D/HH to support a of The families can be and support in through collaboration with professionals who are D/HH and who in In who are D/HH are for the young child and family The child and the family and are to deaf The a for and and that children of hearing who are to a and through services have positive outcomes. the children have a knowledge and use of but they were also developing skills at a than children who not services and services from a development of and skills is for the of infants/children who are D/HH additional they are identified early and are with early and appropriate EI services with fitting of that the spectrum of the The consensus of professionals who in intervention for and for children who are D/HH is that these skills are frequently not in training programs of educators of the pathologists, or service delivery systems have a series of and as well as to ensure of intervention. For an EI should be able to information the and to the with the This information can assist the in and the hearing This system should ensure that has been to the child, the child optimal access to In the EI should be for in the hearing which can due to or These are most to be a of the hearing and in hearing can also EI to be able to services to the with their In the EI needs expertise and developmental and the to use to ensure that the are the most that there are for the development of skills and the first years of a are critical for development in these optimize this in a families and infants/children who are D/HH the highest of skills at the of the most EI systems currently provide limited access to professionals with expertise in and and not collect outcome data on children’s development of and data are to ensure that families and children have high-quality intervention with targeted outcomes. EI systems not professional development to ensure for the EI providers, they and/or to guarantee of the intervention These are critical of best practices in and are to be is from studies that to of all children who are D/HH have in to These additional the to access and use information is about development in the first years of for children who are D/HH with additional appropriate EI services should result in for children who are D/HH with additional as for children who are D/HH who are D/HH, were identified before of and had cognitive skills from of 20 to than children with in the first 3 to years of they were early-identified and timely EI some children who are D/HH and have additional disabilities, it may be that hearing is not the primary of the primary it is critical to the of for and the of communicative delays on developmental the team of professionals the child must include expertise in the access needs of the children who are D/HH with additional should be able of and diverse children who are D/HH in the United States and is In some and in some the of diverse is the is a and population of children who are D/HH in in which the primary is not who use as the of within the home are also a and diverse additional of is the significant of families who have limited levels of and/or family These families are at high of to access and from educational services. research within the United States has that it is to EI services that result in appropriate development of children of families from diverse is that the information to families is of the same quality and to and that it is in a that is to the families. diverse families are able to in or they may have and that their understanding and of information in These and may also their or to through on it is that the in which information is is of the and of the families and their of throughout the have in and For a child to skills in any language, or must have access to high-quality in that EI providers to to skill development for the of to the of the the family a systems are and around the language, many families are not about their and of or systems in the United States is appropriate by the developmental of children with is designed to that EI services developmental for and children with In EHDI systems have been established for the or of the developmental delays with children who are D/HH. developmental for this population is designed to ensure that the children are the developmental skills appropriate for their age and cognitive identification of children who are D/HH has been established with the goal of of delay, not of of providing appropriate EI services is by evidence of and limited of EI that are the for and The goal of EI services for infants/children who are D/HH is to provide support to ensure that the child appropriate progress developmental The best opportunity to this goal is the of developmental progress should be with that are should be appropriate for the and system by the of developmental progress provides and EI providers data about the of their development and can their In systematic of developmental progress has the to provide educational agencies, and early programs with information that can system and by and within their with hearing are at of and of hearing and/or This has been in a of studies over the in all and of hearing who are as hearing may and of hearing in the hearing with of hearing may the more unpublished data, with hearing spectrum have been to have significant delays in communication, and language, and literacy development. In their developmental are to children with is about the developmental outcomes of children with hearing who due to hearing with hearing are at an of hearing in the of as with children with hearing of the of children with hearing and or such as fitting and audiologic are for these children to optimal developmental and audiologic is for all children who are D/HH, with any of hearing the audiologic and medical of the children in the audiologic in goal 7 are frequently by the EI service in with the or in the and development. is that more audiologic of these children will result in an earlier identification of such as or EI providers to establish collaboration with to these This for collaboration is the the EI providers not have knowledge about the skills and development of children with all and of hearing between families and EI programs and systems are critical to the of EHDI programs and the of optimal outcomes for and are critical developing and programs to ensure that the systems of care support a of the and the of children who are D/HH, families and not typically have support in their established deaf or hard of hearing the child as well as the and this as well as families with children who are D/HH. that there is and in support from and families who have children who are D/HH and who have is a of an between the and the that cannot be through for families to with and support or designed for with and families are a component of the of such as the for the and of the for and the by have for providing family-to-family from programs in which provide support to the of families in a by professionals who families with a family-to-family support as of the most of support for the in with of D/HH children had of their child, and who are D/HH a of individuals with a of and educational to their in EHDI systems can be professionals and the importance of providing children who are D/HH and their families the opportunity to meet with who can their goal is to have individuals who are D/HH the of EHDI systems at who are D/HH what works to meet their and needs in a that who are hearing Because the support of and of is intended to be the of EHDI it is critical to include D/HH in these few EHDI systems include D/HH in a The system should have diverse at many D/HH with appropriate should be for as EHDI EHDI and service audiologists, speech-language pathologists, EI service providers, and educators of the deaf and in these EHDI systems should partner with and that support D/HH has the of providing children who are D/HH and their families to of the D/HH who have many with who are D/HH a strong of with to their child who is When there are no D/HH in the deaf individuals as of the most of support in to therapists, and who are deaf are able to provide children who are D/HH with that who are hearing more that families have with who are D/HH, the they may their including developing goals and that are not limited by about the of who are D/HH. The goal of the system is to infants/children who are D/HH for who they at the the and programs such as D/HH in deaf individuals in as and with the child who is D/HH and his or her family. These individuals may or information about D/HH, educational and hearing or about the deaf and deaf are to the in with EI service may assist families in families who are hearing with to more about D/HH family and family support of the of intervention to assurance that the intervention to the family and child is to promote a quality of for the family and the provide for the development of or that are appropriate to the and the cognitive and age of the and provide that optimize skill development with the of the implementation of intervention requires knowledge of intervention and well-defined interventions on and of intervention on and data to that the intervention result in the of implementation includes the interventions to outcomes and of specific a data system for and a system for and making and for EI providers have not systems and programs that document the of the intervention to families and A quality EI program should have a for it is to establish a of and the of intervention services. This information is key to establishing an evidence base for documentation of it is difficult to interventions with successful for families and infants/children who are D/HH a complex of many child, and intervention This for developing well-defined interventions, training professionals in the intervention and the of these interventions. In progress has been of successful interventions is necessary to ensure that are in the infant of and of it is critical that the first be literature currently that links the of the implementation of intervention for children who are D/HH with successful outcomes. the literature that assurance of the of the implementation of interventions is the key to successful outcomes for children in and for medical interventions for both children and In these positive outcomes were to 3 related of implementation of the degree to which the interventions were and the of intervention implementation the teacher data on each of the for all of these is of the in each this best practice statement has for the implementation of coordinated statewide systems with the expertise to provide individualized, EI programs for children who are D/HH and their families. of child and family outcomes is an optimal outcomes for the of is a to strengthen the evidence base supporting specific EI The of practice implementation of appropriate protocols for of and to research are critical this includes a of and related to the provision of early development services for children who are D/HH and their families. These from different best practice and position statement are the for early development The of these that early development providers from diverse (eg, early educators of the D/HH, and speech-language by the are intended to be as an entire set of practices to with this of children and families. For specific knowledge and skills to with are throughout in the The were by A. M. and to the 2007 was by the Joint Committee on Infant Hearing Joint committee and their representatives who this statement include the for the and of Hearing and the of and the of and E. the of and the the on of the include the for the and of the for the of of the and of the of of and for the the of of the and the of the S. and the of and Hearing in and to the JCIH include also the of and and for their committee that this statement include the for the and of the of the of and the of the and the on of the