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FRC and ESIT Service Provider

1.

Supporting Children Who are Deaf or Hard of Hearing
and Their Families
FRC and ESIT Service Provider:
Understanding Specialized Providers and
Services
1 hour to
complete

Introduction
Welcome to Understanding Specialized Providers and Services.
The Early Support for Infants and Toddlers (ESIT) program is the
Washington State program for IDEA Part C services. ESIT services are
available to eligible children with a developmental disability or
developmental delay and their families. ESIT services include but are
not limited to occupational therapy, service coordination, speech
therapy, special instruction, and social work. ESIT service providers
include but are not limited to teachers of the deaf, speech therapists,
physical therapists, and special educators.
This course will give ESIT service providers and Family Resources
Coordinators (FRCs), including you, valuable knowledge about
providers who specialize in working as a team to support families of
children who are deaf or hard of hearing (DHH).

3.

Introduction
Parents and caregivers need information to make important decisions and
understand what they can do to support their child’s development. When parents
learn that their child is DHH, they may feel unsure about the next steps. Most parents
welcome assistance and guidance from someone who can connect them to
specialized services to support their child’s communication.

4.

Introduction
Working with children who are deaf or hard of hearing and their families can be
complex. This course recognizes the intricacies of effectively supporting children
identified as DHH and their families. Increasing your understanding of specialized
providers and services and the best way to connect families to them will help you
learn how to collaborate with families and other professionals. You’ll learn strategies
to guide families toward accessing the specialized services they need around
Washington. Families and caregivers can use this information to make important
decisions and understand what they can do to support their child’s development.

5.

Goal
To increase FRC and ESIT service provider knowledge of the people
who work as a team with families of children who are DHH.
Specialists in DHH services must be involved in the early stages of
the process, and FRCs and ESIT service providers need to know how
to connect and collaborate with them.

6.

Objectives
Identify the unique needs of children who are DHH.
Identify the roles of specialized providers, programs,
and supports available in Washington.
Understand and convey the opportunities if a
specialized provider is not available locally.
Evaluate special considerations for families who
decline services or have children who are DHH with
additional or concurrent disabilities (DeafDisabled).

7.

Specialized Providers and
Services

8.

The Unique Needs of Children Who Are DHH
Children who are deaf or hard of hearing have specific needs for
early support services. The period from birth to three years of
age is critical for brain development. A child who is DHH without
other challenges or disabilities often has typical brain
development. But when children’s brains don’t have access to
language, they are at risk of social-emotional, language,
cognition and communication, and literacy delays. Lack of
access to communication and language supports may result in a
child who is DHH having developmental delays.

9.

The Unique Needs of Children Who Are DHH | Experiences
Lack of access to communication and language affects the whole
child. It affects social, emotional, language and literacy skill
development. A child who is deaf or hard of hearing and does not
have access to language that stimulates the language center part
of the brain will experience:
• Delayed or limited language and speech development.
• Challenges learning in school.
• Trouble being social with other children.

10.

Multiple Disability Risks
Children who are DHH can be 30-40% more at risk for developmental
delays, even if the hearing difference is not associated with
developmental concerns (Gallaudet Research Institute, 2005).
Common disabilities that co-occur or happen alongside being DHH
are:
Cognitive disability
Cerebral palsy
Autism spectrum disorder
Low vision or blind
Down’s syndrome or Usher syndrome
Connecting a family to a specialist early helps ensure that any other
co-occurring disabilities are discovered and supported.

11.

Why It’s Important To Be Involved Early To Help Support
Providers with specialized training in working with families of
children who are deaf or hard of hearing need to be involved early
in planning services.
Infants and toddlers who are DHH, and their parents, benefit from
ESIT services and can achieve better developmental outcomes.
Early and appropriate support assists infants and toddlers in
developing social/emotional and language/literacy skills.

12.

Specialized Providers
FRCs and ESIT service providers must be familiar with the roles of specialized providers, different programs and supports for children who are
DHH, and how to connect families with these resources, including:
Click the buttons below to learn more about each specialized provider
Audiologists
Teacher of the deaf
DHH-Trained Speech Language Pathologists
Sign Language Instructors or Specialists
DHH Mentors and Role Models
Other families with children who are DHH

13.

Specialized Providers | Audiologists
FRCs and ESIT service providers must be familiar with the roles of specialized providers, different programs and supports for children who are
DHH, and how to connect families with these resources, including:
Click the buttons below to learn more about each specialized provider
Audiologists
Teacher of the deaf
DHH-Trained Speech Language Pathologists
Sign Language Instructors or Specialists
DHH Mentors and Role Models
Other families with children who are DHH
• Should be pediatric audiologists with specialized education, training, and
equipment to test and
evaluate hearing in infants and young children.
• Recommends and fits assistive technology (hearing
aids, FM systems, cochlear implants), if appropriate.
• Work with the family and their early support team
to assess how well a child responds to sounds and,
if appropriate, adjust and maintain the child’s hearing amplification.

14.

Specialized Providers | Teacher of the Deaf
FRCs and ESIT service providers must be familiar with the roles of specialized providers, different programs and supports for children who are
DHH, and how to connect families with these resources, including:
Click the buttons below to learn more about each specialized provider
Audiologists
Teacher of the deaf
DHH-Trained Speech Language Pathologists
Sign Language Instructors or Specialists
DHH Mentors and Role Models
Other families with children who are DHH
• Has special certification to teach children who are DHH.
• Works with the family and their early support team to understand the
child’s hearing and the potential impact their hearing level can have on
language, social, and cognitive development.
• Helps families learn to observe and monitor their child’s responses to
communication (through vision, listening, signing, vocalizations, and
gestures).
• Provide information about a child’s assistive technology and possible
future options for sound amplification.

15.

Specialized Providers | DHH-Trained Speech Language Pathologists
FRCs and ESIT service providers must be familiar with the roles of specialized providers, different programs and supports for children who are
DHH, and how to connect families with these resources, including:
Click the buttons below to learn more about each specialized provider
Audiologists
Teacher of the deaf
DHH-Trained Speech Language Pathologists
Sign Language Instructors or Specialists
DHH Mentors and Role Models
Other families with children who are DHH
• Should have expertise in both early childhood education and deaf
education.
• Provides speech and language therapy to help make sure the child’s
speech is more understandable.
• Evaluates the child’s speech and language skills.

16.

Specialized Providers | Sign Language Instructors or Specialists
FRCs and ESIT service providers must be familiar with the roles of specialized providers, different programs and supports for children who are
DHH, and how to connect families with these resources, including:
Click the buttons below to learn more about each specialized provider
Audiologists
Teacher of the deaf
DHH-Trained Speech Language Pathologists
Sign Language Instructors or Specialists
DHH Mentors and Role Models
Other families with children who are DHH
• Should have expertise in both early childhood education and in deaf
education.
• Helps the family learn ASL and recommends specific services to support
language acquisition.
• Has credentials in ASL instruction, assessment, and advocacy.

17.

Specialized Providers | DHH Mentors and Role Models
FRCs and ESIT service providers must be familiar with the roles of specialized providers, different programs and supports for children who are
DHH, and how to connect families with these resources, including:
Click the buttons below to learn more about each specialized provider
Audiologists
Teacher of the deaf
DHH-Trained Speech Language Pathologists
Sign Language Instructors or Specialists
DHH Mentors and Role Models
Other families with children who are DHH
• Share information about the Deaf community and personal experiences
about being deaf or hard of hearing.
• Act as positive language model and a role model for the child and family.
• Work with the early support team to support, teach, and model ways
families can more effectively communicate with their child.

18.

Specialized Providers | Other Families with Children Who Are DHH
FRCs and ESIT service providers must be familiar with the roles of specialized providers, different programs and supports for children who are
DHH, and how to connect families with these resources, including:
Click the buttons below to learn more about each specialized provider
Audiologists
Teacher of the deaf
DHH-Trained Speech Language Pathologists
Sign Language Instructors or Specialists
DHH Mentors and Role Models
Other families with children who are DHH
• Share their experiences and tell families about helpful resources they have
found.
• Offer a listening and supportive ear for families.
• Foster a shared community.
• The Hands and Voices Guide by Your Side™ program has trained parent
guides that provide unbiased support to families with children who are
DHH.

19.

What Are the Unique Needs of Children Who Are DHH? | Conclusion
The Department of Health’s Early
Hearing Detection, Diagnosis, and
Intervention (EHDDI) program
coordinates a statewide system for
newborn hearing screening,
diagnostic testing, and referral to
ESIT services when infants and
toddlers are identified as DHH.
You can visit this page here.

20.

Roles of Family Resource Coordinators (FRCs), ESIT Service
Providers, and Specialized DHH Providers

21.

The Role of the FRC or Early Support Provider as Team Member in
Assisting Families
Local FRCs and ESIT service providers are members
of a team that assists families in accessing developmental screening
or evaluation to verify the need for ESIT services. Infants and toddlers
who are DHH qualify for ESIT services based on a hearing difference
identified during a diagnostic hearing evaluation with a pediatric
audiologist.
FRCs and ESIT service providers explain ESIT services available to
families of infants and toddlers who are DHH. They help develop an
Individualized Family Service Plan (IFSP) for these services. FRC and
ESIT service providers also assist families in accessing other
community resources such as infant or toddler groups, hearing
identification services, and specialty services their ESIT provider
agency may not provide.

22.

Why is it important to be involved early to help support children who are
deaf or hard of hearing?
Why is it important to be involved early to help support children
who are deaf or hard of hearing?
• Hearing differences can affect social, emotional, language,
and literacy skill development and a child’s safety if
specialized services are not received.
• To help identify appropriate communication, hearing,
assessments, and possible medical supports.

23.

How To Connect Families with Appropriate Resources
In some Washington counties, ESIT Provider Agencies have a plan with
identified specialized DHH early support providers.
For example, the county may have specific DHH specialized programs
that FRCs and ESIT service providers should contact if they are working
with
a child who is deaf or hard of hearing. Connecting families with all
available DHH-specialized providers in your community is important. This
can help families better understand their options and not experience
delays in receiving specialized DHH services for their child.

24.

How To Connect Families with Appropriate Resources
In counties without any locally available specialized DHH early support providers, FRCs and ESIT service providers
should contact the Center for Deaf and Hard of Hearing Youth (CDHY) when they begin working with a child who is
DHH.
A CDHY outreach specialist has expertise in working with children who are DHH and early childhood professionals. They can help you find familycentered services that are locally available. They can also provide language and early communication development expertise if a DHH program is not
available in your community.
Not sure your county has a plan with identified specialized DHH early
support providers?
You can contact the CDHY or the ESIT referral contact for your county,
which can be found in the ESIT Statewide Directory.
CDHY website screenshot

25.

How To Connect Families with Appropriate Resources | Directory
In the ESIT Statewide Directory, FRC and ESIT service providers can be found for each county:
• Referral contacts
• ESIT Provider Agencies
• County Lead Agencies
• Statewide Provider
Agencies

26.

How To Connect Families with Appropriate Resources | Providers
FRC and ESIT service providers can assist families
in decision-making by supporting:
• Learning about all opportunities
• Families who wish to change their decisions based on their
goals
• Unique family characteristics, such as culture, values, and
perspective about their child’s hearing.
• Ensuring the IFSP team makes decisions based on the
family's priorities and child's unique language access needs.

27.

How To Connect Families with Appropriate Resources | Template
In this section, you will find resources (ESIT Statewide Directory) to complete a
contact sheet of local DHH resources.
Download the template from the Resources section.
Type your answer here
Type your answer here

28.

How To Connect Families with Appropriate Resources | Conclusion
It can be challenging for families to decide on a communication opportunity (modality).
To help connect families to appropriate resources, FRCs and ESIT service providers can
give families the “Decision Guide to Communication Choices” guide. FRCs and ESIT
providers can help families work through this booklet to help them
in the decision-making process and plan next steps. Connect with specialized DHH early
support providers early on, so they can help answer questions and connect families to
DHH resources.
It may take more than one appointment with the audiologist to find out how a child
hears. The family may be asked to return for more testing right away or to wait a little
while before rechecking the child’s hearing. The child’s audiologist may also
recommend seeing other specialists, such as an ear, nose, and throat (ENT) doctor.

29.

Discussing Communication Opportunities
If a family finds out their child is deaf or hard of hearing, they will be offered services from experts to teach the family how to support their child in
language learning. Children who are DHH can learn to communicate in several ways. It is important to understand a family’s various
communication opportunities. Be aware not to favor or show bias toward any one opportunity.
Click the images below to learn more about each opportunity

30.

31.

Discussing Communication Opportunities | ASL
If a family finds out their child is deaf or hard of hearing, they will be offered services from experts to teach the family how to support their child in
language learning. Children who are DHH can learn to communicate in several ways. It is important to understand a family’s various
communication opportunities. Be aware not to favor or show bias toward any one opportunity.
Bilingual American Sign Language (ASL) and English
ASL is a complete, visual language with its own unique rules. Children learn
ASL as their first language. Then they learn to read and write English or their
family’s primary language. Families may also choose to teach their child
spoken language. Using ASL is part of the Deaf community but is not limited
to the Deaf community.

32.

Discussing Communication Opportunities | Cued Speech
If a family finds out their child is deaf or hard of hearing, they will be offered services from experts to teach the family how to support their child in
language learning. Children who are DHH can learn to communicate in several ways. It is important to understand a family’s various
communication opportunities. Be aware not to favor or show bias toward any one opportunity.
Cued Speech
Cued speech helps children hear and see speech sounds.
It uses special hand shapes as “cues” around the face when speaking. This
can help children distinguish between words that can sound or look the
same.

33.

Discussing Communication Opportunities | LSL
If a family finds out their child is deaf or hard of hearing, they will be offered services from experts to teach the family how to support their child in
language learning. Children who are DHH can learn to communicate in several ways. It is important to understand a family’s various
communication opportunities. Be aware not to favor or show bias toward any one opportunity.
Listening and Spoken Language (LSL)
Listening and Spoken Language is a listening first approach. It teaches
families evidence-based strategies that help their children understand and
speak the language of their family and community. With early and
consistent use of hearing technology such as hearing aids, bone conduction
sound processors, and cochlear implants, LSL professionals help families
make the best use of these devices.

34.

Discussing Communication Opportunities | Signing Exact English (S.E.E.)
If a family finds out their child is deaf or hard of hearing, they will be offered services from experts to teach the family how to support their child in
language learning. Children who are DHH can learn to communicate in several ways. It is important to understand a family’s various
communication opportunities. Be aware not to favor or show bias toward any one opportunity.
Signing Exact English (S.E.E.)
S.E.E. is a sign system that follows English vocabulary and grammar.
Children are encouraged to communicate with their eyes, ears, hands, and
voices.

35.

Discussing Communication Opportunities | Total Communication
If a family finds out their child is deaf or hard of hearing, they will be offered services from experts to teach the family how to support their child in
language learning. Children who are DHH can learn to communicate in several ways. It is important to understand a family’s various
communication opportunities. Be aware not to favor or show bias toward any one opportunity.
Total Communication
Total Communication is a combination of auditory and visual
communication that is presented simultaneously, including talking, signing,
facial expressions, and gestures. The family’s home language is spoken at
the same time signing is used.

36.

Technological Devices
Some families choose to use hearing technology to help a child who is DHH have access to sound. Your child’s audiologist can answer more
questions about hearing technology. Hearing technology for children includes:
Cochlear implants
Flashing and vibrating
alarms
FM and DM systems
Audio loops
systems
Bone conduction sound
processors
Infra-red listening
devices
Telephone
amplifiers
Captioning
Portable sound
amplifiers

37.

Working as a Team with Families and Specialist Providers
FRCs and ESIT service providers are crucial for families accessing
specialized DHH early support services. They are the first local point of
contact that families are referred to for entry into this system.
The FRC or ESIT service provider’s role in early hearing detection and
support is as follows:
• To function as a support team member with the family and
specialist providers.
• To be aware of services available for infants who are DHH and Deaf
culture.
• To ensure access to specialized services for unique needs occurs
early.
• To direct families to DHH specialist programs.
It is up to the specialized programs to further explain the details of
language and communication support and opportunities to the
families.

38.

Case Study | Lily
Hi, I’m Lily, and I’ve been a family resources coordinator for six years. Typically, we receive
referrals from audiologists. I will have a phone call with the family to complete the intake
and collaborate with a teacher of the deaf (TOD) to arrange a visit with the family in their
home. I will usually come along with the TOD for the first visit, but sometimes the TOD will
go alone. They will do a full assessment to make sure that the child is meeting all their
developmental milestones.
It’s important that I connect the family with specialized providers as early as possible.
These providers should have expertise in both early childhood education and in deaf
education. Sometimes, I need to inform the parent of the benefits of working with a DHH
specialist, rather than a provider who does similar work but doesn’t have an
understanding of children who are DHH.
In the first meeting with the teacher of the deaf, our priority is to determine the family's
priorities and concerns about their child's development. We work closely with the family
to see what stage of the early support process they’re in. That depends on the child’s age,
the family’s understanding and feelings related to the child’s hearing identification, what
services they may already be receiving, if they’re using amplification —that kind of thing.
Those factors vary at different points while we are working with the family.
When we visit the family, we bring a questionnaire called The Family Directed Assessment,
which is part of the IFSP intake process. This lets us make detailed notes and gather as
much information as we can to identify the family’s concerns, priorities, resources, and

39.

Case Study: Lily | Activity
Why do you think Lily emphasized the importance of
contacting specialized support services early who are
familiar with children who are DHH?
Expert’s response

40.

Case Study: Lily | Activity
Why do you think Lily emphasized the importance of
contacting specialized support services early who are
familiar with children who are DHH?
Expert’s response:
With the support of specifically trained DHH early support
specialists, including professionals who are DHH and trained parent
guides, families can adapt quickly and begin learning how to
communicate effectively with their infants and toddlers.
These professionals are trained in a way compatible with the child’s
strengths, needs, and the family’s concerns and priorities.

41.

Opportunities for Families Who Do Not Have a Local
Access Provider

42.

Opportunities for Families Who Do Not Have a Local Access Provider
FRC and ESIT service providers must be aware
of opportunities to seek DHH specialized providers, programs, and
supports when unavailable within their agency. It is important to
connect with specialty providers as early as possible.
Center for Deaf and Hard of Hearing Youth (CDHY) can provide DHH
services statewide and help you find services that are not locally
available. Some specialized DHH early support programs offer
virtual services if those services aren’t available in an area. Your
ESIT provider agency may be able to contract with these early
support programs to provide
virtual specialized services for a family. You can find specialists for
families who do not have local access to providers in the resources
section.

43.

Considering Special Cases
and Circumstances

44.

Families Who Decline To Enroll in Services
• Ensure the family makes an informed decision
by providing unbiased and thorough information.
• Respect the family’s decision.
• Inform the family that they can contact ESIT any time until the child
turns three, even if they decline now.
• Reach out to the family a few weeks later (if they check the option
that this is okay on their family documentation).
• Share resource information with families.

45.

Case Study | Candie Sanchez
Sometimes, families decline services. It can be helpful to see how an FRC
responds to these decisions. Listen to Candie Sanchez, the lead family
resources coordinator for an ESIT program in Washington state.
“Some parents decline services for many reasons. There are times when
families are really overwhelmed when they learn their young child is deaf
or hard of hearing. They may be busy with work or other responsibilities,
and they don’t respond right away. I make sure to mark my calendar to
check in with them after a couple of weeks. I call and ask, “How are
things going? What do you think? Should we begin by having a teacher
come in and assess how your little guy is doing?” We shouldn’t do
everything all at once, but it’s important to let them know we’ll be there
to support them and start the process.”

46.

Case Study |Candie Sanchez - Activity
What is the most appropriate response when
a family declines services? Please choose the best response.
Candie’s response

47.

Case Study |Candie Sanchez - Activity
What is the most appropriate response when
a family declines services? Please choose the best response.
"When this happens, I let them know this is something that if we get
to it sooner, it would be more beneficial for their child at this critical
age. We can connect them to other resources and agencies
depending on their family’s needs.
If they still decline, I follow up with the referral source to let them
know. I’ll give them a program brochure and my card and tell them
they can call me back anytime without a medical referral. I make
myself very accessible and available to them. The final step is to
make sure I’ve followed all the necessary policies and procedures
when a family declines services.”
Candie’s response:

48.

Conclusion

49.

Did We Meet the Objectives?
Identify the unique needs of children who are DHH.
Identify the roles of specialized providers, programs,
and supports available in Washington.
Understand and convey the opportunities if a
specialized provider is not available locally.
Evaluate special considerations for families who
decline services or have children who are DHH with
additional or concurrent disabilities (DeafDisabled).

50.

Acquired Skills
• Understand how DHH affects language and literacy skill
development.
• Know multiple disability risks.
• Understand the FRC and ESIT service provider’s role.
• Identify the types of specialized providers
who should be part of the early support team
and how to connect families with them.
• Understand the differences between DHH language support
services and other services
a child will receive and how to connect families with them.
• Provide additional opportunities to families seeking the DHH
specialized providers, programs, and supports when they are
unavailable locally.
• Provide opportunities to families who decline
to enroll in services.
• Provide resources to families with additional needs or conditions
(DHH).

51.

Thank you for completing
this module!

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