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A Culture of Assessment: A Bioecological Systems Approach for Early and Continuous Assessment of Deaf Infants and Children

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Title: A Culture of Assessment: A Bioecological Systems Approach for Early and Continuous Assessment of Deaf Infants and Children
Language: English
Authors: Clark, M. Diane (ORCID 0000-0001-7429-7124), Baker, Sharon, Simms, Laurene
Source: Psychology in the Schools. Mar 2020 57(3):443-458.
Availability: Wiley-Blackwell. 350 Main Street, Malden, MA 02148. Tel: 800-835-6770; Tel: 781-388-8598; Fax: 781-388-8232; e-mail: cs-journals@wiley.com; Web site: http://www.wiley.com/WileyCDA
Peer Reviewed: Y
Page Count: 16
Publication Date: 2020
Document Type: Journal Articles
Reports - Descriptive
Descriptors: Deafness, Hearing Impairments, Language Impairments, School Readiness, Language Acquisition, Child Development, Infants, Young Children, Evaluation
DOI: 10.1002/pits.22313
ISSN: 0033-3085
Abstract: Even today, with all of the hearing technology and bilingual programs available, many Deaf children arrive at school with severe language delays. With a renewed focus on having Deaf children kindergarten-ready, assessment of language milestones becomes critical as seen in the campaign Child First and the legislation referred to as Language Equality & Acquisition for Deaf Kids (LEAD-K). Here, a strategy is proposed to ensure that Deaf children are kindergarten-ready. The focus is on a re-evaluation of the epistemologies of the social and individualized medical models of health, as well as Bronfenbrenner's bioecological systems approach, to assess all components that impact a Deaf child's ecology to permit maximizing their developmental potentials.
Abstractor: As Provided
Entry Date: 2020
Accession Number: EJ1242138
Database: ERIC
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  Value: <anid>AN0141528298;pis01mar.20;2020Feb05.02:38;v2.2.500</anid> <title id="AN0141528298-1">A culture of assessment: A bioecological systems approach for early and continuous assessment of deaf infants and children </title> <p>Even today, with all of the hearing technology and bilingual programs available, many Deaf children arrive at school with severe language delays. With a renewed focus on having Deaf children kindergarten‐ready, assessment of language milestones becomes critical as seen in the campaign Child First and the legislation referred to as Language Equality & Acquisition for Deaf Kids (LEAD‐K). Here, a strategy is proposed to ensure that Deaf children are kindergarten‐ready. The focus is on a re‐evaluation of the epistemologies of the social and individualized medical models of health, as well as Bronfenbrenner's bioecological systems approach, to assess all components that impact a Deaf child's ecology to permit maximizing their developmental potentials.</p> <p>Keywords: assessment; Bronfenbrenner; Deaf; social model</p> <p>Even today, with all of the hearing technology and bilingual programs available, many Deaf[<reflink idref="bib1" id="ref1">1</reflink>] children arrive at school with severe language delays or even no language at all (Andrews, Hamilton, Dunn, & Clark, [<reflink idref="bib3" id="ref2">3</reflink>]). These issues have been the concern of many, but success in eliminating these delays has been limited and slow. Recently, there is a focus on the child as seen in the campaign called Child First (CEASD, n.d[<reflink idref="bib11" id="ref3">11</reflink>]) which includes a statement of principles. These principles include: Language deprivation is disabling, research supports the need for full access to all interactions, one size does not fit all, and a focus on the Least Restrictive Environment clause in educational law. Placing the child first requires that professionals within the field of Deaf education focus on early and continuous assessment of Deaf infants and children to create an ecology (Hutchins, [<reflink idref="bib41" id="ref4">41</reflink>]) that maximizes a Deaf child's potential.</p> <p>However, professionals within the field of newborn hearing screening, early intervention, audiology, and Deaf education frequently disagree about how to provide this effective ecology. Here, a new approach for assessment and a re‐evaluation of one's epistemology is proposed to suggest a new strategy for creating the ecology that will allow Deaf infants and children to thrive. The initial part of the strategy is to look at how a social model was created to empower those who have been labeled by society as disabled followed by a review of Bronfenbrenner's bioecological systems model. This epistemology and model will be evaluated and connected to assessment of the complex interacting systems in which Deaf children are born and grow up.</p> <hd id="AN0141528298-2">1 THE EPISTEMOLOGY OF THE SOCIAL MODEL VERSUS THE INDIVIDUALIZED MEDICAL MODEL OF HEALTH</hd> <p>How one defines health creates a sociopolitical, as well as a historical context, regarding any deviation from "normal". Therefore, those who are "sick" are seen as deviant (Barnes, [<reflink idref="bib4" id="ref5">4</reflink>]) and needing to be "fixed". This definition focuses on the individual and locates any abnormality, illness, or disability in a medical model (Parson, [<reflink idref="bib60" id="ref6">60</reflink>]). Then the role of the medical profession is to return "sick" people back to healthy or "normal" people. This model has been applied to those who are seen as disabled, including Deaf and hard of hearing individuals who have been labeled as "hearing impaired" or as having a "hearing loss." This individualized or medical perspective creates a need for Deaf people to "pass for hearing" (Harmon, [<reflink idref="bib35" id="ref7">35</reflink>]).</p> <p>In contrast, a social model locates the problem in society (Barnes, Mercer, & Shakespeare, [<reflink idref="bib5" id="ref8">5</reflink>]). Goffman (1968; as cited in Barnes, [<reflink idref="bib4" id="ref9">4</reflink>]) and Foucault (1977; as cited in Barnes, [<reflink idref="bib4" id="ref10">4</reflink>]) analyzed the social constructs of an individualistic society and how this epistemology medicalizes those who are seen as "abnormal". Barnes ([<reflink idref="bib4" id="ref11">4</reflink>]) notes that this model does not deny the importance of medical interventions, but focuses on how society causes additional problems by creating barriers. Goodley ([<reflink idref="bib31" id="ref12">31</reflink>]), when applying the social model to learning disabilities, shows how the individualized or medical model makes these differences a personal tragedy. He then concludes that one needs to investigate one's epistemology, suggesting that a change to a social model can permit those seen as disabled to be empowered and become integrated into society.</p> <hd id="AN0141528298-3">2 BRONFENBRENNER'S BIOECOLOGICAL SYSTEM APPROACH</hd> <p>Here, we integrate the epistemology of the social model into a psychological perspective for assessment based on Bronfenbrenner's ([<reflink idref="bib10" id="ref13">10</reflink>]) bioecological systems approach to development. This connection moves assessment from solely focusing on the Deaf individual to an assessment of the ecology into which this Deaf person is born and grows up. Hutchins ([<reflink idref="bib41" id="ref14">41</reflink>]) calls attention to this issue in his discussion of a cognitive ecology in which an individual is embedded, highlighting the need to match the individual to their ecology to permit effective cognitive development. The question proposed here is, what bioecology is most effective for a Deaf person to maximize their own cognitive, linguistic, and social–emotional potential and how do we assess that ecology?</p> <p>Bronfenbrenner ([<reflink idref="bib10" id="ref15">10</reflink>]) defines a bioecology system as the environment of a human that includes their own biology, their immediate environment, their larger social context, and the interactions among these contexts. This environment is seen as a set of nested contexts that includes the microsystem, the mesosystem, the exosystem, and the macrosystem. More recently a fifth system has been included, called the chronosystem (Santrock, [<reflink idref="bib66" id="ref16">66</reflink>]). Next, we expand on these nested systems and related them to a Deaf individual.</p> <p>The microsystem is how the individual interacts directly with others in their environment. This system includes families, peers, healthcare providers, the school, and any religious institutions in which the individual participates. An infant who has recently been identified as Deaf is now in an ecology that may match their hearing status, that is, their family may be Deaf as well, or an ecology that does not match their hearing status, that is, a family that has typical hearing. Depending on this ecology, an assessment will be required or may not be required or accepted when offered. Hearing families' own ecology and epistemology may cause them to feel that this news is a personal tragedy and lead them to engage with healthcare providers in an attempt to "fix" their infants' hearing. On the contrary, regardless of whether the parents are Deaf or hearing, they may be familiar with sign language as well as the Deaf community and not see this issue as even a problem. How we help these diverse families assess the situation has a strong impact on their decision‐making process and the potential match of their Deaf infant's cognitive ecology to their sensory abilities. Assessment of the results of how we share information with these families and the outcomes for their infants need to be monitored to allow us to effectively create an ecology to maximize development. Later, we will discuss assessments that need to occur in the early months to monitor language acquisition across this system and others.</p> <p>The second system is the mesosystem that includes the interconnections of all of the microsystems affecting the individual. For a Deaf infant, this system includes how healthcare providers interact with the family as well as how these families view their infant's hearing status. For example, what are families told about having a Deaf child? Is this situation portrayed as a problem within the infant that the family needs to fix or is the infant discussed as different with the potential to grow up to be anything that they want to be? Here, assessments should help families explore all opportunities for their Deaf newborn, including early intervention, hearing technologies, and language opportunities. These assessments should provide information about cutting‐edge research that shows best practices in terms of providing accessible language input during the early months that establishes the brain's language‐processing areas. It is critical that all information is easily understandable and that it is presented in a manner that puts the Deaf infant at the center of the dialogue. People who share this information with families need to understand their own beliefs and attitudes about a Deaf infant in order not to unduly influence families' decision‐making until they are aware of all opportunities.</p> <p>The third system is the exosystem, which includes social structures that do not directly contain the individual but influence them in their daily lives. These systems include the media, the neighborhood, the government, and informal social networks. Assessment, here, needs to evaluate how social structures impact families' decision‐making as well as the more long‐term outcomes of these decisions on their Deaf child. As can be seen, by a search on the internet, the most frequent websites found when searching for information about a Deaf infant focus on an individualized medical model of hearing loss and what to do to get your child to "pass as hearing." Websites that appear first when typing in, "My baby failed their newborn hearing screener. What do I do?" include Hearing First, Infant Hearing, Healthy Hearing, and Hearing Health Matters. Even when typing in, "My baby is Deaf, what do I do?" these same websites were at the top of the resulting list.</p> <p>Other websites do provide information about sign language, but are much less accessible and tend to require different keywords such as bilingual, National Association of the Deaf (NAD), or World Federation of the Deaf (WFD), which are much less familiar to families with a newly identified Deaf infant. Therefore, for hearing families who have never met a Deaf person before, they most likely will not find information related to a social model of being Deaf when they search for information.</p> <p>The fourth system, the macrosystem, is the overarching cultural patterns of a society. These values and attitudes are expressed concretely within the other three systems, already discussed. Here, information is explicitly and implicitly conveyed to members of the society. How the macrosystem views being Deaf is critical in determining how families and their Deaf child function within their culture. If the society holds an individualized medical view, then the macrosystem will tend to support passing for hearing, encouraging the use of hearing technologies to "fix" the hearing loss and the development of spoken language. Within our culture, the social model of being Deaf is not the most common belief system. This cultural view is held by individuals who value Deaf culture but the majority of hearing people have never met a Deaf person (Benedict, [<reflink idref="bib8" id="ref17">8</reflink>]) and are more influenced by the broader individualized medical viewpoint.</p> <p>Assessment, here, looks at the beliefs and attitudes individuals hold regarding having a Deaf child, as in Clark, Baker, Choi, and Allen's ([<reflink idref="bib14" id="ref18">14</reflink>]) paper on Beliefs and Attitudes about Deaf Education. Understanding this cultural milieu and assessing the impact of these implicit and explicit beliefs will allow a more nuanced perspective to be provided to hearing families who give birth to a Deaf infant.</p> <p>The final system is the chronosystem, which include life events and transitions throughout the individual's life course history. These sociohistorical circumstances include broad events that impact society as well as individuals. This system is more difficult to assess but can be understood through the methods of historical research that uses primary and secondary sources, as well as oral testimonies and personal accounts. Here, assessment may focus on how Deaf individuals view their own life course; examples can be found in research regarding life scripts and life stories (e.g., Clark & Daggett, [<reflink idref="bib15" id="ref19">15</reflink>]; Wolsey, Clark, van der Mark, & Suggs, [<reflink idref="bib75" id="ref20">75</reflink>]). For this paper, this system will not be discussed in terms of the culture of assessment. However, the impact of the chronosystem can be seen within Deaf education in the changes from the Americans with Disabilities Act as well as the educational laws that stressed least restrictive environment that embedded many Deaf students in school placements that were not language‐rich environments. Assessments in this area go into the area of policy, which is not the focus of this paper.</p> <p>Given a bioecological system together with the social model, one can see that assessment needs to occur at multiple levels. Here, the person and the environment influence one another in a bidirectional manner (Gottlieb, [<reflink idref="bib32" id="ref21">32</reflink>]). To focus only on the assessment of the individual Deaf child does not provide enough information to help us create the most effective cognitive ecology (Hutchins, [<reflink idref="bib41" id="ref22">41</reflink>]) to maximize the cognitive, linguistic, and social–emotional development of a Deaf individual. It is important to assess early language acquisition in both spoken and sign languages if the child is using one or both of these modalities. These assessments need to be early and frequent as well as reliable and valid. These measures inform us about the fit of the child, the family, and school at the microsystem level. Then, it is necessary to evaluate the fit between these interacting systems of the home and the school to be sure that development is proceeding effectively. At the macrosystem level, it is necessary to evaluate the school system and healthcare systems to be sure that their own beliefs and attitudes do not negatively impact parental choice and decision‐making regarding opportunities for their Deaf child. Finally, service providers need to understand their own epistemology to be able to provide balanced and complete information to families with newly identified Deaf infants. The next discussion starts at the macrosystem level of the bioecological systems model and moves down into the more individual levels. Understanding these systems will help us understand how the social model versus the individualized medical model impact Deaf people through the information that is conveyed by society, as well as the individuals who interact with this Deaf child and their family.</p> <p>Before we begin, we need to explain our own positionality, with our descriptions given in the order of each author on the paper. As a hearing individual, I have been involved at an academic level with the Deaf community for around 40 years. My own epistemology is Deaf centric, given my personal experiences. In the 1980s, it was easy to read all of the published research about Deaf people and at the time it was perplexing to me that many of the researchers went beyond their data and labeled Deaf people as concrete learners. Only Hans Furth's research (see Furth, [[<reflink idref="bib28" id="ref23">28</reflink>]], as well as Furth & Youniss, [<reflink idref="bib30" id="ref24">30</reflink>] as examples) suggested that the issue was a language one and not a cognitive one. However, even Furth did not discuss the fact that researchers were using an outsider or an etic perspective rather than an insider or emic perspective. My own early experiences were with members of the Deaf community, who were either Deaf themselves or Children of Deaf Adults (CODAs). I had the luxury of a year‐long educational experience at Gallaudet College where I was immersed in Deaf culture at the time when Deaf Pride was the focus of Deaf resistance. Later I returned to Gallaudet University for 13 years and had the opportunities to learn from my Deaf peers. Therefore, I take full responsibility for my views related below.</p> <p>The next author is a hearing mother of a Deaf child who is now an adult with his own family, life, and career. Her view is as follows: I learned about being Deaf in order to support my son. Now, he is a proud husband and father of two hearing children and two Deaf children. He works at a residential school for the Deaf, is a member of the Deaf Community, and has a strong Deaf‐dominant bicultural orientation. Looking back over the past 40+ years, the experiences of being a hearing parent of a Deaf child has been both frustrating and rewarding. For years, when my Deaf son was young, we did not share a communication system, and I felt powerless as I observed his lack of progress in educational systems that restricted his need for visual language access. Fortunately, the repercussions of lack of early access to language, while hindering his overall language development, did not thwart his desire to read. It is perhaps through reading that his brain found a way to organize and see patterns of communication—something we will probably never understand because he learned to read before he learned a formal sign language. Fortunately, throughout the early years, I was not alone. While my immediate family felt helpless, I met other parents of Deaf children, both hearing and Deaf, who helped me understand the road ahead and how to navigate through systems and advocate for my Deaf child's needs. Since then I have advocated for the right for all Deaf children to reach their intellectual and cognitive potential through early access to visual language. My early career was as a teacher of the Deaf; however, for the past 23 years, I have worked as a professor of Deaf Education at a university in the Midwest and collaborated with hearing as well as Deaf researchers and faculty members on projects of significance. I have a strong Deaf mother cultural orientation and I view ASL as a vital component for early communication and cognitive development for all children who are experiencing hearing loss.</p> <p>The final author is an African American Deaf mother of three children, two who are Deaf, and one who is a CODA. Her views are as follows: I learned about being Deaf early. Currently, I have five young grandchildren, two of whom are Deaf. I grew up oral, and I was one of the numerous Deaf children who shared the experiences of being "oral failures." In the past, I experienced an enormous impact from that, having my hands and mouth slapped. It was a classic experience that many others encountered as well. As I looked back on it, I recalled how ASL had such a profound impact on my life. Hence, during my early teaching years, I had hands‐on experience in the implementation of a bilingual and multicultural educational environment for diverse young Deaf and hard of hearing children. Currently, I am a Professor in the Education Department at Gallaudet University, and an ASL and English Bilingual education, and social justice consultant. My research interests are in language acquisition and the development of diverse young children.</p> <hd id="AN0141528298-4">3 CULTURE OF ASSESSMENT</hd> <p>Here, we connect the models and approaches discussed above, to specific needs in terms of assessment. This type of theory building is proposed to shift the focus from "broken individuals" to "families who require a different bioecological niche" to be successful. To achieve this perspective, it is critical to look at not only the individual but the systems that create this bioecological niche. Here, we start at the higher levels of Bronfenbrenner's approach and move down into the more specific levels in terms of how to access the ecology of a Deaf person.</p> <hd id="AN0141528298-5">3.1 Macrosystem</hd> <p>The macrosystem holds the social and cultural values that govern a society. Historically within the United States, there has been great tension between the individualized medical view of a "hearing loss" and the cultural view (like the social model but more limited to the Deaf community and their allies) of being Deaf. The individualized medical view has more money and power; moreover, it is the epistemology that most hearing families' first encounter when their infant is found to be Deaf. Many Deaf adults, with well‐intentioned hearing families, were subjected to hearing technologies and years of speech therapy with limited to little success in effectively acquiring spoken language, leading to academic problems and language deprivation (Hall, Levin, & Anderson, [<reflink idref="bib33" id="ref25">33</reflink>]). Even many "oral successes" reject spoken language as adults related to their negative experiences of bullying while growing up (Wolsey et al., [<reflink idref="bib75" id="ref26">75</reflink>]). Therefore, these "Deaf Wars" need to be assessed and, if possible, solutions found to create the most effective ecology for the Deaf infant and their family.</p> <p>Several new collaborations have occurred within the past 5 years that suggest that educational policy is attempting to bridge this historical philosophical divide in Deaf education in regard to the language of instruction. These coalitions center on the Deaf child as they build a dialogue among educators, legislators, and medical service providers. One of the earliest coalitions was called Common Ground, which was established through dialogues with the Conference of Educational Administrators of Schools and Programs for the Deaf (CEASD: historically made up of Deaf School administrators) and the OPTIONS Schools (those that use Listening and Spoken Language [LSL]; <ulink href="http://www.ceasd.org/child‐first/common‐ground‐project">www.ceasd.org/child‐first/common‐ground‐project</ulink>). Typically framed as "adversaries," they have recently created critical conversations to understand disagreements, as well as common beliefs, with the focus on the child first to frame the discussion. Next, at the macrosystem level, is a group of researchers and teachers who have created a Facebook group called the Radical Middle, represented by a Venn diagram that reminds these professionals that they have much in common. Their goal is to reframe the dialogue to create a safe space to work through professional disagreements.</p> <p>The third collaboration at this level is the Texas Deaf Children's Policy Conversation that was created after the LEAD‐K proposal was defeated by the Texas legislature in the 2017 legislative session. Emotions ran high in this debate and things were said in public meetings that were damaging to civil dialogue. Everyone was bruised and drained. Therefore, the University of Texas School of Law in their <emph>Children's Rights Clinic</emph> under the direction of clinical professors Hugh Brady and Lucy Wood called all parties to the table to work toward creating bills that would place the Deaf child at the center of the dialogue. Currently, they have four bills that have been introduced in the 86th Texas Legislative Session to benefit Deaf children: these include a Data Bill to advocate that money be invested in early Deaf education; a Terminology Bill to remove offensive words from Texas laws; a Distribution of Information Bill to provide parents resources; and an Information Sharing Bill to more effectively identify Deaf and hard of hearing children in Texas.</p> <p>The most recent collaboration occurred on October 26, 2018 when LEAD‐K and A. G. Bell met to discuss shared goals in relation to language acquisition and literacy for Deaf children. These two groups have historically held opposing views regarding language acquisition, with LEAD‐K supporting ASL and A. G. Bell supporting LSL. Leaders from both groups saw the meeting as transformational as they found their own common goals of desiring Deaf and hard of hearing children to be on par with their hearing peers in regard to language acquisition (Rems‐Smario, [<reflink idref="bib64" id="ref27">64</reflink>]).</p> <p>Clearly, these are early dialogues and many on both sides of the "Deaf Wars" are against these collaborations as can be seen by posts in newspapers and on Facebook (Simms, [<reflink idref="bib70" id="ref28">70</reflink>]). However, more and more individuals are able to take a step back and focus on the Deaf child first, trying to alter the macrosystem to be more effective in providing policies and recommendations for Deaf children. These new dialogues need to be assessed to determine if overall reading levels within the Deaf population increase, to evaluate how society frames the value of a Deaf person, and if children arrive at kindergarten, ready to learn with a fully developed system of language. Next is the exosystem.</p> <hd id="AN0141528298-6">3.2 Exosystem</hd> <p>Remember that the exosystem is the indirect environment that does not include the child, but affects people and places that indirectly impact the child. Here, the majority view of being Deaf focuses on the individualized medical model. Within the United States, Universal Newborn Hearing Screening and Intervention (UNHSI) and Early Hearing Detection and Intervention programs are overseen by the American Academy of Pediatrics and the Center for Disease Control (as well as a few other agencies). Screenings tend to be conducted in the hospital before the family and infant leave and, therefore, are overseen by those who most frequently hold a pathological view of being Deaf. They are then referred to an audiologist for additional screening and diagnosis. These meetings rarely include a Deaf adult who can help to reassure families that Deaf people can do anything but hear, as stated by the first Deaf president of Gallaudet College ("Deaf people can do anything exc...," n.d[<reflink idref="bib21" id="ref29">21</reflink>]), now Gallaudet University. This exposure to Deaf adults is important as most people have never met a Deaf person (Benedict, [<reflink idref="bib8" id="ref30">8</reflink>]) and this experience can help to reassure families that there are effective means to achieve the dreams that they have for their Deaf infant.</p> <p>In terms of assessment, we need to evaluate both the professionals who provide this service as well as the families who receive this information. Collecting attitudes and beliefs will be an important step in helping these service providers understanding the impact of their own messages on families with newly identified Deaf infants. Given their own epistemology, many professionals encourage LSL through the use of hearing technologies. The messages for families related to LSL is seen on the website of the Oberkotter Foundation, where there are statements about reaching one's full potential. This website includes a link to the Hearing First website, where it is stated that hearing is the tool for listening, talking, becoming a reader, and doing well in school (Oberkotter Foundation, n.d[<reflink idref="bib59" id="ref31">59</reflink>]). Next you find the A. G. Bell website (Bell, n.d[<reflink idref="bib7" id="ref32">7</reflink>]) that opens with the line, "A life without limits for children with hearing loss." Additionally, A. G. Bell has a section on Communication Options, which includes a description of ASL, defined as "a manual communication language ... (that) uses hand symbols and gestures combined with facial expression to communicate language" ("Children with Hearing Loss can Hear and Speak," n.d.). You are also told that ASL is used by the Deaf community, which views itself as a separate culture from mainstream hearing society.</p> <p>The views expressed on these websites suggest that today "hearing impaired" children will learn to speak with the current hearing technologies and go to mainstream schools with their hearing peers (Brody, [<reflink idref="bib9" id="ref33">9</reflink>]). Brody, a personal health columnist for the <emph>New York Times</emph> wrote in the above‐referenced newspaper article that according to Madell, a speech‐language pathologist, "parents need to know that listening and spoken language is a possibility for their children." Given what these families have been able to find on the web with the words used by those in the medical profession, naturally these families want the best for their child and it seems that the professionals are recommending hearing technologies to develop listening and spoken language skills.</p> <p>The language used by Madell in this article and on the A. G. Bell website uses positive language about LSL and the child's future. However, the implicit message is that being Deaf is "disabling," expensive to society, and preventable. The World Health Organization (Deafness, [<reflink idref="bib22" id="ref34">22</reflink>]) uses the phrase "disabling hearing loss" and encourages the prevention of this condition through public health actions.</p> <p>The danger of accessing only information related to LSL and naively accepting all of their claims is: What if a child does not develop spoken language? This philosophy often claims that if LSL does not work, then later you can provide the child sign language, which is easier to learn at older ages. For example, Madell ([<reflink idref="bib49" id="ref35">49</reflink>]) states, "Children who do not develop auditory cognitive pathways and learn to listen within the first few years of life, do not get the opportunity to do so later due to a reduction in neural plasticity" (see Sharma & Campbell, [<reflink idref="bib67" id="ref36">67</reflink>]). This idea is a mistaken one, as all languages have this issue with neural plasticity and sign languages experience the same limited perceptual window (Kuhl & Rivera‐Gaxiola, [<reflink idref="bib43" id="ref37">43</reflink>]). Therefore, for a child who has not established the neurological language areas prior to about 10 or 11 months, their language functioning shows differences in both structural (Pénicaud et al., [<reflink idref="bib62" id="ref38">62</reflink>]) and functional brain activation (Mayberry, Chen, Witcher, & Klein, [<reflink idref="bib53" id="ref39">53</reflink>]).</p> <p>Allowing these service providers to assess their own beliefs is an important step in creating more inclusive messages that can be provided to families. Providing information about all opportunities and how they can interact allows a more fail‐safe plan for families to follow in case one or another opportunity is not effective for their child.</p> <p>In terms of families, assessment needs to evaluate their satisfaction with the information and services provided to them. These assessments should be conducted at critical developmental points in their child's life to understand how the exosystem impacts the development of Deaf individuals. They should be provided with balanced and complete information about all of the opportunities including translations of the above‐mentioned research that explains the benefit of having early sign language before the implantation and activation of cochlear implants. Websites like NAD, WFD, as well as the Visual Language and Visual Learning (VL2) and the Clerc Center websites located on Gallaudet University's website, should be made available in infographics that help families quickly find additional information about all opportunities. In addition, meeting Deaf adults and obtaining an understanding of how Deaf mentors help families needs to be evaluated in terms of how families then view their Deaf infant and their future possibilities and opportunities. The next nested system is that of the mesosystem.</p> <hd id="AN0141528298-7">3.3 Mesosystem</hd> <p>The mesosystem includes connections and linkages between the child and others within their ecology including the family, early interventionists, schools, peers, and medical professionals. Given a broad view of the research about Deaf education, this system appears to have failed many students as seen in the often‐cited statistic that Deaf people read at the fourth‐grade level (Allen, [<reflink idref="bib1" id="ref40">1</reflink>]; Marschark & Harris, [<reflink idref="bib50" id="ref41">50</reflink>]). It is here that the impact of the beliefs and attitudes found within the exosystem and the macrosystem are seen in the outcomes of a large number of Deaf individuals who were raised in bioecological systems that were not good fits. One sees a system of low expectations (Simms & Thumann, [<reflink idref="bib69" id="ref42">69</reflink>]) in Deaf education that leads to passive students who have poorly developed metacognitive abilities and skills (Strassman, [<reflink idref="bib72" id="ref43">72</reflink>]). Next, we will discuss the impact of these interactions.</p> <p>Here, rather than reflect on issues within the education system, the individualized medical view tends to blame the problem on the child. However, in an earlier attempt to improve Deaf education, Johnson, Liddell, and Erting ([<reflink idref="bib42" id="ref44">42</reflink>]) released a white paper titled <emph>Unlocking the Curriculum: Principles for Achieving Access in Deaf Education</emph> that called for a move to bilingual education and a bicultural perspective that included Deaf adults; in effect, moving to a social–cultural model within Deaf education. This reflection on the state of Deaf education began the dialogue that is currently referred to as language deprivation. Too many Deaf children arrive at kindergarten with either language delays or almost no language (Mellon et al., [<reflink idref="bib56" id="ref45">56</reflink>]). These children's parents often focused on LSL programs and their child, for whatever reason, was unable to progress using spoken language. After 3–5 years of failure, families move to a sign language approach, noting that the educational system and their child's needs are not matching.</p> <p>Here, bilingual Deaf education helped society to move from using a deficit model to understand a Deaf child and to seeing that Deaf child as different and needing both ASL and English for a successful life (Humphries, [<reflink idref="bib40" id="ref46">40</reflink>]). This initial proposal focused on written English; however, with improvements in hearing technologies, this philosophy has changed to a bimodal bilingual approach (Chamberlain & Mayberry, [<reflink idref="bib12" id="ref47">12</reflink>]) that utilizes a framework of four language abilities; ASL, fingerspelling, English literacy, and spoken English. Individual language plans are created for a child based on his/her language potential in each of the four areas, thereby ensuring language access. This builds upon current research that shows that bilinguals have better academic success (Freel et al., [<reflink idref="bib26" id="ref48">26</reflink>]; Hrastinski & Wilbur, [<reflink idref="bib39" id="ref49">39</reflink>]). Importantly, current research shows that Deaf children with cochlear implants who were exposed to sign language earlier have better spoken language outcomes (Davidson, Lillo‐Martin, & Chen Pichler, [<reflink idref="bib20" id="ref50">20</reflink>]; Hassanzadeh, [<reflink idref="bib37" id="ref51">37</reflink>]). A recent finding investigating the impact of the Deaf mentor program found that after exposure to ASL, Deaf children who had no language before entering the program began to speak (Hamilton, [<reflink idref="bib34" id="ref52">34</reflink>]). The benefits of being an ASL/English bilingual, therefore, demonstrate that this strategy is effective, regardless of the modality that a Deaf child and their family finally decide on after the child masters the concept of language.</p> <p>These findings point to the benefit of having a fully accessible language during the babbling period when children are seeking statistical patterns from language input (Kuhl, [<reflink idref="bib45" id="ref53">45</reflink>]). This period, from 6 months to between 10 and 11 months, is called the perceptual window and Petitto et al. ([<reflink idref="bib61" id="ref54">61</reflink>]) suggest that being bilingual keeps the window open for a longer period. Therefore, it is important that collaborations are being established to allow us to immerse the Deaf infant in a culture of assessment at identification to monitor and to intervene as needed to support language acquisition that will allow them to arrive at kindergarten, language‐ready.</p> <p>Assessment, here at this mesosystem level, should focus on the interaction of each system and its success with Deaf children. It would be beneficial to begin to develop regression models that would help families better predict who would be a successful candidate for LSL education in contrast to a bilingual or bimodal bilingual educational approach. This type of assessment will need to be conducted in relation with those discussed below that focus on the microsystem of the family, school, and Deaf child.</p> <hd id="AN0141528298-8">3.4 Microsystem</hd> <p>Again, the microsystem is the child's immediate ecology, including home, extended family, early intervention, and the community and the interactions among these individuals. We need to monitor early linguistic milestones to be sure that hearing families are developing effective strategies to engage their Deaf infant's eye gaze and learning how to use more visual strategies in place of auditory attention‐getting strategies. We need to assess how early interventionists measure language milestones and what information they present to families. Finally, we need to develop assessments that can help evaluate how medical professionals support and facilitate a positive ecology for Deaf infants and children while they support a family's abilities to maintain this ecology.</p> <hd id="AN0141528298-9">3.5 Weaving together the nested systems</hd> <p>When evaluating a Deaf infant's ecology, it is important to include their biology. Some Deaf infants have other disabilities in addition to being Deaf. Therefore, one must look at the individual's biology and how that interacts with their ecology (Gottlieb, [<reflink idref="bib32" id="ref55">32</reflink>]; Hutchins, [<reflink idref="bib41" id="ref56">41</reflink>]) of the nested systems of the microsystem, the mesosystem, and the exosystem. An important focus of this social model is that a Deaf individual is different but not "broken" and that society needs to eliminate roadblocks to maximize their ecology. Here, it is proposed that a social model at the societal level provides a more effective ecology for Deaf individuals.</p> <p>Another important change is new legislation that comes from the exosystem and can impact the ecology of the other nested systems. LEAD‐K has passed in eight states. This legislation stresses the importance of frequent and effective assessment of language acquisition at least every 6 months, with a preference for assessment every 3 months at earlier ages to work towards making all Deaf children kindergarten‐ready in terms of their language acquisition. Interestingly, LEAD‐K includes not only assessment for Deaf children at the microsystem level but includes exosystem reporting requirements to begin to track outcomes that will impact the macrosystem potentially in terms of attitudes and beliefs about how to raise a healthy Deaf child. Next, the assessments that are currently available are discussed.</p> <hd id="AN0141528298-10">4 CURRENT MICROSYSTEM ASSESSMENTS FOCUSING ON THE DEAF CHILD</hd> <p></p> <hd id="AN0141528298-11">4.1 Spoken language</hd> <p>Given that most Deaf children are born to hearing families (Mitchell & Karchmer, [<reflink idref="bib57" id="ref57">57</reflink>]) and the prevalence of the individualized medical view, many Deaf infants are initially exposed to LSL. For spoken language, there are instruments that are reliable and frequently used. The resources below were elicited from colleagues who are speech‐language pathologists. It is important to understand that these assessments were developed for hearing children and that they are not normed on Deaf children who are acquiring spoken language. Some of these assessments target infants at risk for language delay, but again they focus on hearing infants. However, given that Deaf children do acquire language milestones in the same way as do hearing infants, if the language is accessible they should follow hearing norms. Therefore, it is critical to evaluate all typical language milestones and share with families honest evaluations of their child's mastering of Basic Interpersonal Communication Skills (BICS; Cummins, [<reflink idref="bib19" id="ref58">19</reflink>]). If a child arrives at kindergarten without BICS they will be unable to begin to develop Cognitive Academic Language Proficiency (CALP). Below, are reliable and valid assessments for evaluating spoken language (Table).</p> <p>1 Spoken language assessments</p> <p> <ephtml> <table><thead valign="bottom"><tr valign="bottom"><th>Instrument</th><th>How it is used</th></tr></thead><tbody valign="top"><tr><td>Ages and Stages 3 (Squires & Bricker, <xref ref-type="bibr" rid="bibr71">71</xref>)</td><td>Screens and assesses the developmental performance of children in the areas of communication, gross motor skills, fine motor skills, problem‐solving, and personal‐social skills. It is used to identify children that would benefit from an in‐depth evaluation of developmental delays.</td></tr><tr><td>Communication and Symbolic Behavior Scales–Developmental Profile (CSBS‐DP: Wetherby & Prizant, <xref ref-type="bibr" rid="bibr73">73</xref>)</td><td>This is a norm‐referenced screening tool for identifying infants at risk for developmental delay or disability. It includes the assessment of symbolic play, nonverbal communication, and expressive and receptive language. It contains a checklist, caregiver questionnaire, and a behavior sample</td></tr><tr><td>Early Screening Profile (Harrison, <xref ref-type="bibr" rid="bibr36">36</xref>)</td><td>Screens development in cognitive language, motor, self‐help/social, articulation, health, development, and home environments. Helps identify children at risk for learning problems.</td></tr><tr><td>MacArthur‐Bates Communicative Development Inventories (Fenson, <xref ref-type="bibr" rid="bibr25">25</xref>)</td><td>The parent‐report instrument with scales for assessing expressive and receptive vocabulary sizes and early grammatical production; reports good validity when compared with direct observation measures.</td></tr><tr><td>Rossetti Infant and Toddler Language Scale (Rossetti, <xref ref-type="bibr" rid="bibr65">65</xref>)</td><td>Used to assess preverbal and verbal communication skills and interaction in children from birth to 3‐years‐old; criterion‐referenced measure looks at language comprehension, language expression, interaction, attachment, gestures, pragmatics, and play</td></tr><tr><td>Expressive One‐Word Picture Vocabulary Test (EOWPVT) (Martin & Brownell, 2010a)Receptive One‐Word Picture Vocabulary Test (ROWPVT)(Martin & Brownell, <xref ref-type="bibr" rid="bibr52">52</xref>)</td><td>Comparisons of a child's receptive and expressive vocabulary skills.For 2‐years‐old and older, norms are available with scores presented in percentages.</td></tr><tr><td>Peabody Picture Vocabulary Test (PPVT‐4)</td><td>Measures a child's understanding of individual words (receptive vocabulary). For children 2 years, 6 months to 18 years of age. Raw test scores are converted into standard scores, percentile ranks and age equivalents. The PPVT‐4 is also available in Spanish.</td></tr></tbody></table> </ephtml> </p> <p>In addition, the American Speech‐Language‐Hearing Association (ASHA) has resources to help monitor language acquisition, starting at birth that are written in a parent‐friendly language ("Communicating with baby: Tips and milestone from birth to age 5," n.d[<reflink idref="bib18" id="ref59">18</reflink>]).</p> <p>There are a limited number of assessments that have been created for children developing LSL. One frequently used assessment is the Cottage Acquisition Scales for Listening Language and Speech (CASLLS) developed by Sunshine Cottage School for Deaf Children (Wiles, [<reflink idref="bib74" id="ref60">74</reflink>]). This curriculum provides a formal way to analyze spoken language samples and establishes language goals. It could inform families regarding whether their young child is developing typical linguistic milestones. Unfortunately, this assessment does not have norms.</p> <p>The SKI‐HI Language Development Scale (Clark & Watkins, [<reflink idref="bib17" id="ref61">17</reflink>]) was created as a comprehensive approach to identification and home intervention for Deaf children and their families. The scale is developmentally ordered and contains a list of communication and language skills by ages. Each age interval is indicated through observable receptive and expressive language use. Currently, SKI‐HI is the approach used in the Deaf mentor program (Hamilton, [<reflink idref="bib34" id="ref62">34</reflink>]) to evaluate both sign and spoken language development.</p> <p>The Central Institute for the Deaf's Early Speech Perception Test (ESP) was developed to test speech perception in children as young as 3 years of age. The ESP may be used to establish objectives and to measure the effects of a hearing aid or cochlear implant in terms of their impact on the child's speech perception ability. Therefore, it is imperative that evaluators and families are sure that these early foundational behaviors are established within the first year of life in order to build a strong language foundation. All too often Deaf children who are only provided with spoken language do not develop this foundation. A culture of assessment that includes informal assessments as well as formal assessments (de Villiers & de Villiers, [<reflink idref="bib23" id="ref63">23</reflink>]) will track these milestones and arrange for additional interventions in this first year to remediate language delays. An important piece that also needs to be evaluated is the sensitivity and specificity of these measures (Lalkhen & McCluskey, [<reflink idref="bib46" id="ref64">46</reflink>]). Sensitivity is the ability of a test to correctly identify those who are positive for an outcome (here developing typical language milestones), whereas specificity is the ability of a test to correctly identify those who are not positive (here, not developing typical language milestones). These measures typically are not included in these assessments and one must be careful that they are accurately indicating the true language outcomes of those assessed.</p> <p>If system‐wide assessments identify that a child is not achieving typical language milestones, the family may be encouraged to switch to sign language for language acquisition. This first year of life is critical in establishing the perceptual learning of phonosyntactic linguistic characteristics (Kuhl, Williams, Lacerda, Stevens, & Lindblom, [<reflink idref="bib44" id="ref65">44</reflink>]). Next, the assessments for sign language are presented. Notice that there are fewer valid and reliable measures for this assessment, reflecting a critical need in the profession (Table).</p> <p>2 Sign language assessments</p> <p> <ephtml> <table><thead valign="bottom"><tr valign="bottom"><th>Instrument</th><th>How it is used</th></tr></thead><tbody valign="top"><tr><td>Visual Communication and Sign Language (VCSL) Checklist (Simms, Baker, & Clark, <xref ref-type="bibr" rid="bibr68">68</xref>)</td><td>Monitors children's sign language acquisition to determine if children whether a child's language is typical, advanced, or delayed compared to norms, which were created during the standardization process. For children from birth to 5 years of age.</td></tr><tr><td>American Sign Language Receptive Test (ASLRT; Enns et al., <xref ref-type="bibr" rid="bibr24">24</xref>; Northern Signs Research)</td><td>Tests receptive knowledge of ASL in eight grammatical categories: number/distribution, negation, noun/verb distinction, spatial verbs (location and movement), size/shape specifiers, handling classifiers, role shift, and conditionals. The ASLRT includes a vocabulary check of 20 words. For children of ages 3–13.</td></tr><tr><td>The MacArthur Communicative Development Inventory: American Sign Language (Anderson & Reilly, <xref ref-type="bibr" rid="bibr2">2</xref>)</td><td>A tool to measure early vocabulary development of Deaf children acquiring ASL. On the basis of the English CDI, the ASL‐CDI exists only in one format, that is, for productive vocabulary for children 8–36 months of age using a parent‐report format (also used with spoken language but normed here for Deaf children).</td></tr><tr><td>Kendall Conversational Proficiency Scale (French, <xref ref-type="bibr" rid="bibr27">27</xref>)</td><td>A classroom assessment of communication competency for Deaf children. A holistic, qualitative assessment of pragmatic skills that also investigates semantic and syntactic abilities.</td></tr><tr><td>Test of Visual Phonological Awareness (McQuarrie et al., <xref ref-type="bibr" rid="bibr55">55</xref>)</td><td>A computer‐delivered test designed to measure a young Deaf child's awareness of the phonological building blocks of ASL (handshape, movement, and location). It is designed for use with children ages 4–8. Test item reliability and validity are currently under development.</td></tr><tr><td>The American Sign Language Assessment Instrument (ASLAI; Hoffmeister, et al., <xref ref-type="bibr" rid="bibr38">38</xref>;<ext-link href="http://www.asleducation.org/pages/aslai.html" /></td><td>Tracks ASL and English print literacy over time for students at ages 4–18. Test administration typically takes place over the course of 1 week, by trained evaluators.</td></tr><tr><td>Carolina Picture Vocabulary Test(Layton & Holmes, <xref ref-type="bibr" rid="bibr48">48</xref>)</td><td>Used for children of ages 4–11.5 who are Deaf and hard of hearing. This test is used to measure receptive sign vocabulary. Test consists of 130 questions with suggested basal and ceiling levels. On the basis of the PPVT. Normed on Deaf & hard of hearing children.</td></tr><tr><td>The ASL Perspective‐Taking Comprehension Test (ASL PT‐CT; Quinto‐Pozos & Hou, <xref ref-type="bibr" rid="bibr63">63</xref>)</td><td>Assesses visual‐spatial cognition and perspective‐taking skills with respect to the comprehension of classifiers within topographical space requiring shifts in perspective. Twenty phrases are delivered on a computer. Appropriate for students 7–20‐years old. Test developers are in the process of establishing norms.</td></tr></tbody></table> </ephtml> </p> <p>As can be noted in the above table, many assessments have not been normed for Deaf children. One reason for this lack of reliability is the low incidence of Deaf children in the population. Additionally, these measures were developed by researchers and not by for‐profit companies that have the resources to develop norms for a low incidence population. However, it is vital that we continue with a focus on creating additional assessments that begin at the earliest months of life to be sure that the critical foundations of language are occurring during the first year after UNHSI screening.</p> <hd id="AN0141528298-12">5 THE SOCIAL MODEL ALIGNED WITH ASSESSMENTS FROM THE BIOECOLOGICAL MODEL</hd> <p>On the basis of these theoretical perspectives, how can society best‐frame providing information to families that their newborn had been referred for additional screening? Assessments would have been collected across the exosystem, the macrosystem, the mesosystem, and the microsystem. A social model of being Deaf would underpin the philosophy related to identifying and establishing early intervention for Deaf newborns. The information would be available that was family‐friendly to explain the opportunities available for this newborn Deaf infant. This information would include both Deaf (Mitchiner, [<reflink idref="bib58" id="ref66">58</reflink>]) and hearing (Bat‐Chava, Martin, & Kosciw, [<reflink idref="bib6" id="ref67">6</reflink>]) families reasons for implanting their infants as well as providing them with early sign, prior to the cochlear implant becoming active. It would also include information about why families decided to use sign language. Below is a potential scenario of what this might look like.</p> <p>You have just been told that your newborn has been referred for follow‐up after their initial Newborn Hearing Screening. Prior to leaving with your newborn, the hospital set up an appointment for you to have a follow‐up for diagnostic testing with a team of audiologists as well as a Deaf mentor at a local clinic. The hospital also provided you with information about a website that includes information to help you understand how to maximize your newborns cognitive, linguistic, and social–emotional development. You login to the website that evening and you begin to learn of the multiple opportunities that are possible. The website starts by explain that the screening may have been a false positive and how frequently this event can happen and why it may happen. However, the website also provides you with all the opportunities that are available if the team finds that you baby's hearing level is out of the typical range. Here, you are provided with a culture of assessment that starts at identification and helps you track developmental language milestones beginning with attention, attachment, and showing pleasure and displeasure. Notice that these milestones are prelinguistic but are vital in establishing the foundation for babbling and first words. This website presents research that has been translated for families who have never met a Deaf person and are afraid that their infant's life will be limited and limiting (Benedict, [<reflink idref="bib8" id="ref68">8</reflink>]).</p> <p>At this website, families are assured by Deaf individuals who are professionals in all walks of life, many with terminal degrees in medicine, law, and higher education, that the opportunities for their infant are unlimited. Information is presented in language that a layperson can understand and includes what historically was believed to be diametrically opposed views; historically these views were the oral—manual debate or the "Deaf Wars." You are provided with some simple visual attention‐getting strategies (Clark et al., [<reflink idref="bib16" id="ref69">16</reflink>]) that help you and your infant to develop eye gaze synchrony, which is vital for later joint attention. These simple techniques may seem awkward in the beginning, as they tend to violate hearing cultural norms by using touch, flashing lights, vibrating the floor or table, and large gestures with the hands and arms. However, they work, and you and your infant know how to communicate on this prelinguistic level and you are rewarded with smiles, laughs, and giggles. Moreover, the site discusses linguistic opportunities for both sign and spoken languages as well as information on best practices in Deaf education. You are beginning to relax and see the journey you will take with your newborn, regardless if she is Deaf or hearing. This website provides contacts, information, and easy ways for you to monitor and assess her development.</p> <p>You can access this website with many keywords, including Deaf, cochlear implant, sign language, spoken language, ASL, Listening and Spoken Language, bilingual, and bimodal bilingual. This website includes information about how babies find patterns in language (a webinar on "Language learning through the eye and ear," n.d[<reflink idref="bib47" id="ref70">47</reflink>]) explaining that sign language and spoken language are equivalent. This website has information about hearing technologies, including hearing aids and cochlear implants. The site explains the importance of language exposure that is accessible within the first year of life (Mayberry & Lock, [<reflink idref="bib54" id="ref71">54</reflink>]; Mayberry et al., [<reflink idref="bib53" id="ref72">53</reflink>]) so that your baby's brain sets up typical language structures. There is an emphasis on accessible language and you are presented with reasons for beginning to sign to your infant immediately with a recommendation for bimodal bilingualism. But most importantly, all of the information is in one place presented in an inclusive manner which encourages you to provide your infant all available opportunities. You relax as you, your family, and your newborn gain confidence that she can and will become highly successful and achieve her highest goals.</p> <hd id="AN0141528298-13">5.1 Conclusion</hd> <p>The above discussion begins at a philosophical/epistemological level and challenges thinking about Deaf individuals. It highlights the potential problems that can occur when focusing on an individualized medical model and suggests moving away from locating the problem at the individual level, which are medical in nature and needing to be fixed. Rather, it proposes the use of the social model developed within the disability literature in conjunction with Bronfenbrenner's bioecological system model that will allow an assessment to create a holistic view of an effective ecology that will support the biology of a Deaf individual's visual learning. The discussion then moves to a more applied perspective and suggests how this model could be assessed. Next, current assessments are presented and issues with both sign and spoken language assessments are noted. Finally, the article proposes a hypothetical solution that could be presented to families when their newborn infant is found to be Deaf. This idealized solution is designed to allow the creation of an ecology that takes into account the newborn's biology and how society can establish an ecology that would maximize developmental outcomes. The question becomes: Can we place the Deaf child first and overcome our own epistemological biases?</p> <hd id="AN0141528298-14">ACKNOWLEDGMENT</hd> <p>We would like to thank Ashley Greene‐Woods for her help with this manuscript, as well as Jean Andrews for her feedback on earlier drafts.</p> <ref id="AN0141528298-15"> <title> Footnotes </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> In this paper, we will use Deaf to signify all individuals whose hearing status is identified as non‐hearing, including those labeled as hard of hearing.</bibtext> </blist> </ref> <ref id="AN0141528298-16"> <title> REFERENCES </title> <blist> <bibtext> Allen, T. E. (1986). Patterns of academic achievement among hearing impaired students: 1974 and 1983. In Arthur Schildroth, & M. Karchmer (Eds.), Deaf Children in America (pp. 161 – 206). 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  Data: A Culture of Assessment: A Bioecological Systems Approach for Early and Continuous Assessment of Deaf Infants and Children
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  Data: <searchLink fieldCode="AR" term="%22Clark%2C+M%2E+Diane%22">Clark, M. Diane</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0001-7429-7124">0000-0001-7429-7124</externalLink>)<br /><searchLink fieldCode="AR" term="%22Baker%2C+Sharon%22">Baker, Sharon</searchLink><br /><searchLink fieldCode="AR" term="%22Simms%2C+Laurene%22">Simms, Laurene</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22Psychology+in+the+Schools%22"><i>Psychology in the Schools</i></searchLink>. Mar 2020 57(3):443-458.
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  Data: Wiley-Blackwell. 350 Main Street, Malden, MA 02148. Tel: 800-835-6770; Tel: 781-388-8598; Fax: 781-388-8232; e-mail: cs-journals@wiley.com; Web site: http://www.wiley.com/WileyCDA
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– Name: Pages
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  Data: 16
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  Data: 2020
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  Data: Journal Articles<br />Reports - Descriptive
– Name: Subject
  Label: Descriptors
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  Data: <searchLink fieldCode="DE" term="%22Deafness%22">Deafness</searchLink><br /><searchLink fieldCode="DE" term="%22Hearing+Impairments%22">Hearing Impairments</searchLink><br /><searchLink fieldCode="DE" term="%22Language+Impairments%22">Language Impairments</searchLink><br /><searchLink fieldCode="DE" term="%22School+Readiness%22">School Readiness</searchLink><br /><searchLink fieldCode="DE" term="%22Language+Acquisition%22">Language Acquisition</searchLink><br /><searchLink fieldCode="DE" term="%22Child+Development%22">Child Development</searchLink><br /><searchLink fieldCode="DE" term="%22Infants%22">Infants</searchLink><br /><searchLink fieldCode="DE" term="%22Young+Children%22">Young Children</searchLink><br /><searchLink fieldCode="DE" term="%22Evaluation%22">Evaluation</searchLink>
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  Data: 10.1002/pits.22313
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  Group: ISSN
  Data: 0033-3085
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Even today, with all of the hearing technology and bilingual programs available, many Deaf children arrive at school with severe language delays. With a renewed focus on having Deaf children kindergarten-ready, assessment of language milestones becomes critical as seen in the campaign Child First and the legislation referred to as Language Equality & Acquisition for Deaf Kids (LEAD-K). Here, a strategy is proposed to ensure that Deaf children are kindergarten-ready. The focus is on a re-evaluation of the epistemologies of the social and individualized medical models of health, as well as Bronfenbrenner's bioecological systems approach, to assess all components that impact a Deaf child's ecology to permit maximizing their developmental potentials.
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  Data: 2020
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        Value: 10.1002/pits.22313
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 16
        StartPage: 443
    Subjects:
      – SubjectFull: Deafness
        Type: general
      – SubjectFull: Hearing Impairments
        Type: general
      – SubjectFull: Language Impairments
        Type: general
      – SubjectFull: School Readiness
        Type: general
      – SubjectFull: Language Acquisition
        Type: general
      – SubjectFull: Child Development
        Type: general
      – SubjectFull: Infants
        Type: general
      – SubjectFull: Young Children
        Type: general
      – SubjectFull: Evaluation
        Type: general
    Titles:
      – TitleFull: A Culture of Assessment: A Bioecological Systems Approach for Early and Continuous Assessment of Deaf Infants and Children
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            NameFull: Clark, M. Diane
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            NameFull: Baker, Sharon
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            NameFull: Simms, Laurene
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            – D: 01
              M: 03
              Type: published
              Y: 2020
          Identifiers:
            – Type: issn-print
              Value: 0033-3085
          Numbering:
            – Type: volume
              Value: 57
            – Type: issue
              Value: 3
          Titles:
            – TitleFull: Psychology in the Schools
              Type: main
ResultId 1